Risking our Battalion Aid Station to Save our Artillerymen

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U.S. Army Spc. Nicholas Sudderth, left, and U.S. Army Spc. Jace Frudden, both Combat Medic Specialists with Bulldog Battery, Field Artillery Squadron, 2d Cavalry Regiment teach instructions on combat first care during mission downtime at 7th Army Training Command’s Grafenwoehr Training Area, Germany, July 21, 2021. (U.S. Army photo by Gertrud Zach)

Risking our Battalion Aid Station to Save our Artillerymen

By: SFC Hector M. Najera and SGT Quentin A. Mendez

These past 19 years of conflict during the Global War on Terrorism has resulted in unrealistic medical evacuation expectations for future conflicts. The Yom Kippur War of 1973 (06-25 October 1973) saw an estimated 7,500 wounded Israeli casualties, 21,000 wounded Syrians, and 30,000 wounded Egyptians in 19 days as the combined arms conflict illustrated the deadly, casualty-producing results of artillery and air defense (Los Angeles Times, 1991).

Large scale combat operations (LSCO) with near-peer or peer-topeer adversaries will place a large strain on our medical support operations. The increased casualty rates, large casualty densities, and the lack of air superiority will require Role 1 medical treatment facilities to be positioned in the most advantageous locations to provide the timely medical care needed to preserve the unit’s fighting strength. Field Artillery (FA) units face a unique challenge in caring for multiple “urgent” casualties during LSCO due to the artillery and counterfire threat that they face. Commanders must position their Battalion Aid Stations (BAS) as far forward as tactically possible if they are to effectively triage casualties, provide urgent care, or enable onward movement to a higher role of care – all while mitigating risk to the mission.

FA units training at the Joint Multinational Readiness Center (JMRC) assume little risk when considering the placement of their medical platoon and BAS. In my two years as an Observer, Controller/Trainer (OC/T) at JMRC, all but two units have co-located their BAS with the combat trains command post (CTCP). A CTCP co-location generally provides little to no benefit to the medical concept of support (MEDCOS), due to their position in the battlefield, reduced support from battalion, and relative distance from the firing batteries. This proximity to the brigade support area (BSA) provides much logistical support for the Forward Support Company (FSC), but it places the BAS too close to the Role II to provide any meaningful medical support to the forward batteries. Logistical support can be provided to these batteries with little difficulty, but the firing batteries often find themselves proximal to other, non-organic, aid stations. These FA BASs find themselves treating less than 12% of their battalion’s casualties. Positioning the BAS with the battalion (BN) tactical operations center (TOC), however, is often a more suitable location. This is geographically closer to the firing batteries, has better communications with subordinate batteries and higher echelons, and benefits from the same level of security. The BASs that co-located with the Headquarters and Headquarters Battery (HHB) treated at least 83% of their battalion’s casualties due to their improved MEDCOS.

Table 7-6 of Army Training Publication (ATP) 3-09.23, “Field Artillery Cannon Battalion,” shows an example of how a CTCP could be configured based on various factors. This example includes the BAS at the CTCP and it is this inclusion that leads many to accept it as the doctrinal option for BAS occupation. This table is merely an example and doctrine provides commanders with much needed flexibility. Artillery firing batteries win wars, but it is the BAS that conserves the FA battalion’s fighting strength. In order to do so, FA BNs must stop defaulting to the CTCP as the BAS location and BN Medical Operations Officers (MEDOs) must be leveraged as the force enablers that they are. BN MEDOs possess the doctrinal knowledge and expert medical analysis to help shape the FA BNs MEDCOS. Much in the same way that tactical fire direction can be either centralized or decentralized, so too can the medical concept of support. From a battalion perspective, a centralized MEDCOS is achieved at the TOC whereas a decentralized MEDCOS is at the CTCP. This is due to the heavy BN staff support available from the TOC and the BAS’s direct access to the tactical commander. A MEDO operating from the CTCP must adhere to the principles of conformity, proximity, continuity, and flexibility with any effective MEDCOS – an issue many rotational MEDOs have faced at JMRC. Before the first fire mission is processed, a MEDO at the CTCP may already be at a disadvantage on account of their location within the battlespace providing little benefit to the firing batteries and the reduced BN support from being geographically displaced from the TOC. Co-locating the BAS with the TOC allows the MEDO to exercise control with maximum responsiveness and speed of execution in their doctrinal responsibility to provide Army Health System (AHS) support to the FA BN.

This isn’t to say that placing your BAS at the CTCP will equate to failure in the medical mission. On the contrary, the situation on the battlefield may indicate that the CTCP is, in fact, the ideal location for the BAS. This, however, should be a decision made based on the tactical environment, the mission, the medical common operational picture (MEDCOP), and anticipated medical support requirements. BAS placement is a decision made by the combatant commander, in conjunction with the BN MEDO, to provide the most effective medical support to the battalion’s artillerymen. This decentralized location requires a competent, knowledgeable, and trusted MEDO as it is difficult to achieve medical synchronization across the battalion, particularly when commanders are still vying for centralized control.

In order to effectively execute an efficient AHS support plan, BN MEDOs must be synchronized with the Fire Support (FS) plan – this starts with inclusion in the military decision-making process (MDMP). The MDMP is where the FA battalion integrates the battalion’s planning process with that of the brigade’s. By including the MEDO, the medical team gains the knowledge of pertinent information such as running estimates, time analysis, constrains/restrictions, and facts/ assumptions. The MEDO can provide suggested BAS locations during course of action (COA) development that enables the BAS to be placed within supporting distance (specifically to high casualty areas), in relative safety, and without obstructing the tactical mission. Different phases of the operation may require the BAS to jump locations to continue providing the most effective support.

During the COA development of the MDMP, FA battalions plan D3A (decide, detect, deliver, and assess) methods for FA tasks to include triggers while integrating these triggers with higher echelon COAs (per ATP 3-09.23). This level of detail does not go into the medical planning process at the BN level, however. If FA BN commanders are not willing to assume the risk in decentralized control of their BAS placements, FA BNs should consider the triggers that would result in moving the BAS to better facilitate the MEDCOS. For example, placing the BAS at the CTCP will provide little benefit to the BN in most situations (as it would be too far to the rear). If a firing battery is expected to take increased casualties (or has taken increased casualties), will relocating your BAS to an advantageous position be tactically feasible? If your radar deployment order places your radar teams in inadvertently austere locations, without internal medical support, is there an identified location to relocate your BAS to provide the ability to also conduct medical evacuation and treatment for these personnel? The tactical situation remains fluid and the MDMP should identify alternate locations for the BAS that can best contribute to the overall AHS support plan within the FA battalion.

Co-locating the BAS with the TOC is generally the more ideal location within a field artillery battalion. This location is mutually beneficial. On one hand, the BAS is geographically closer to the firing batteries (and often brigade), thus reducing evacuation times. Battery-level casualty evacuation (CASEVAC) is improved by this reduced time/distance, and the BAS has an increased ability to push their medical evacuation platforms forward to collect casualties (or assist, such as in the event of a mass casualty situation). By being closer to the firing batteries, the BAS is capable of directly treating more of their own casualties. This allows the MEDO to better manage, plan, and coordinate force health protection assets throughout the battalion. This is also particularly beneficial to the medical platoon as it provides the medical platoon leadership additional face time with the battery medics during casualty transfers. This is an opportunity for the medical leadership to resupply class VIII medical supplies (via speedballs or custom ordered lists), provide guidance and mentorship, and relay or gather important information (a process that is even more beneficial during times of degraded communications). On the other hand, the HHB benefits from this situation by having their medical treatment facility proximal to the BN TOC – a location that is often considered a target area for opposing forces. This places the BAS near the area of expected casualties. This location at the BN TOC also places the BAS closer to a wider range of communication assets and ability to maintain communications between the BAS, BN TOC, and the firing batteries has been the differentiator between having an effective medical asset and an unreliable medical section.

U.S. Soldiers with Cobra Battery, Field Artillery Squadron, 2d Cavalry Regiment, take cover because of a simulated attack during the squadron’s training exercise at the 7th Army Training Command’s Grafenwoehr Training Area, Germany, July 21, 2021. (U.S. Army photo by Gertrud Zach)

Little to no adjustments need to be made to the overall security plan – either at the BN TOC or at the CTCP. The medical platoon is rarely included into the base defense plan thereby eliminating any adjustments in that area. Planning must be made, however, to provide medical support to the area not being co-located. This is considerably easier for the CTCP when the BAS is at the TOC. The CTCP is generally safer than the TOC on account of its location, has less risk of enemy attack, and will require less overall medical support. Their proximity to the BSA and the Role II also enables direct medical support from that location. The FSC also has a large vehicle fleet with a larger casualty load capacity. This makes their CASEVAC plan far easier to plan than that of the HHB. This does place your BAS at a greater risk of attack, damage, or capture. This can be mitigated by a proper base defense plan but is also a decision that the tactical commander must consider: do we place our Battalion Aid Station in increased danger to provide the most effective medical care for our artillerymen?

How do we reduce the risk aversion that is so prominent in our FA battalions as it pertains to our BAS site selection?

This starts with changing the way we visualize the next conflict America may face. Former Surgeon General of the Army and commander of Army Medical Command Lieutenant General Nadja West once stated “a Soldier with a head wound in Afghanistan could arrive from the point of injury to Bethesda Naval Medical Center where the medical specialist was standing by within 24 hours of being wounded” (Vergun, 2016). 35 This is no longer the case. In today’s day and age of advanced/ advancing enemies, artillerymen and artillerywomen are more susceptible to artillery and retaliating counterfire than ever before. As counterfire results in mass casualty (MASCAL) situations, line medics with their finite amount of Class VIII between their aid bag and the units’ combat lifesaver (CLS) bags, casualties can be expected to still be at their organic BAS 24-hours after point of injury. The expectation is to have stressed evacuation channels and no air assets available during these conflicts, increasing the necessity for far-forward medical care.

Nearly 20 years of air superiority is coming to an end. What we will face in future near-peer or peer-topeer conflicts in LSCO – particularly as it applies to FA BNs facing counterfires – is a lethal, high casualty-producing fight. Soldiers will die. Cannons and Howitzers will be lost, as will their crew. The human toll of a war with Russia, China, or any near peer will be high. Minor examples of this can be seen in the Yom Kippur War, the Korean War, and throughout World War II. Military tactics have evolved and so has the weaponry of our enemies. Combatant commanders and medical planners must position their medical assets in the most tactically feasible and medically advantageous locations. Field Artillery Battalion commanders must not shy from the risk of losing medical assets. Only by doing so, can the field artillery battalion aid station provide the most medical care to save the lives of your artillerymen.

About the Authors:

SFC Hector M. Najera is a Healthcare Specialist (68W) in the U.S. Army. Najera is currently serving as an Observer, Controller/Trainer (OC/T) at the Joint Multinational Readiness Center in Hohenfels, Germany. He has previously served as a platoon sergeant and S3 Plans/Operations NCO in 1st Medical Brigade, Fort Hood, Texas and as a battery senior medic with 2-1 Air Defense Artillery, Kunsan Air Base, Korea. He has deployed twice in support of Operation Enduring Freedom as a platoon medic with the 36th Engineer Brigade.

SGT Quentin A. Mendez is a Healthcare Specialist (68W) in the U.S. Army. He is currently assigned to the 4th Battalion, 319th Airborne Field Artillery Regiment out of Tower Barracks, Grafenwohr, Germany. Sgt Mendez has conducted rotations through JMRC with 4-319th and has assisted as a guest OC/T.

References: Burket, D. (2019). Large-Scale Combat Operations: The Division Fight. Retrieved from https://www.armyupress. army.mil/Portals/7/combat-studies-institute/csi-books/ lsco-the-division-fight.pdf Department of the Army. (2015). Army Training Publication 3-09.23: Field Artillery Cannon Battalion. https:// armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/web/atp3_09x23.pdf Los Angeles Times. (1991). Casualties of Mideast Wars. Retrieved from https://www.latimes.com/archives/laxpm-1991-03-08-mn-2592-story.html Vergun, D. (2016). Survival rates improving for Soldiers wounded in combat, says Army surgeon general. Retrieved from https://www.army.mil/article/173808/survival_rates_improving_for_soldiers_wounded_in_combat_says_army_surgeon_general