May 2, 2024
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May 2, 2024 | |
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Third Infantry Division (Mechanized) After Action Report - Operation Iraqi Freedon Return to Table of Contents Chapter 20 Combat Health Support (CHS) During Operation IRAQI FREEDOM (OIF), the Third Infantry Division (Mechanized) (3ID [M]) evacuated over 200 soldiers to Level III medical care. The conduct of continuous offensive operations over extended distances forced the Marne medics to rely primarily on air MEDEVAC to move patients from point of injury and forward support battalion (FSB) medical companies to move patients to the supporting mobile army surgical hospital (MASH) and combat support hospitals (CSH) for Level III care. In addition to the doctrinal complement of corps medical assets, the supporting medical brigade also attached an area support medical company that operated non-doctrinally, executing division level missions in support of FSBs and the main support battalion (MSB). The medical brigade placed three forward surgical teams (FST) in direct support (DS). These FSTs were then pushed to each FSB. The 507th Air Ambulance Company was attached to the division for logistics and maintenance to the 4th Brigade and operated from division airfields and forward arming and refueling points (FARPS). Topic A - Class VIII Issue: Critical Class VIII shortages during the initial phases of the deployment. Discussion: Sick call items and controlled substances (R&Q) became critical for all units upon arrival. Units did not deploy with sufficient amounts of sick call items. Units were advised to bring R&Q items only for those medical equipment sets (MESs) they were bringing from Fort Stewart. This guidance was provided to 3ID(M) by United States Medical Materiel Agency (USAMMA) based on their assurance that APS MES would contain R&Q items. APS MES contained no R&Q items. Recommendation: Units must deploy full sick call MES as �to accompany soldier� (TAT). In addition, it is highly recommended they purchase and deploy at least one USARID drug set as TAT. The sick call items contained in these sets should sustain units until line item requisition is established. Regardless of USAMMA guidance, units should deploy TAT all R&Q items for organic MES. Issue: Planning for the initial requirements of Class VIII is critical from a theater perspective. Discussion: 3ID (M) tripled its population in a little over a month. The theater was not able to handle the initial Class VIII supply requirements. The Doha warehouse (CSA contractors) refused to allow receipt of Class VIII under a different Department of Defense, Defense Assessment Center (DODDAC). This created a situation that required circumvention by 3ID (M). 3ID( M) started ordering supplies using a specific emergency DODDAC issued by USAMMA. Medical logistics planners found an alternate delivery site known as the central receiving supply point (CRSP). This enabled 3ID (M) medical logistics to flow to this address under a different DODDAC. Recommendation: Theater planners need to anticipate/plan Class VIII requirements. This needs to include some mechanism for ordering all types of Class VIII (R&Qs, sick call medications, etc.). Class VIII accounts and responsibility need to be clearly defined prior to deployment of units into an area of operation. Issue: Internet connectivity in remote areas inhibits the ability to operate Telecommunication Access Method (TCAM). Discussion: Poor Internet connectivity in remote locations creates difficult transmissions of Theater Army Medical Information System (TAMMIS) and TCAM data. Units must provide command emphasis on providing their medical assets, platoon through company, dedicated access to local area network (LAN) line connectivity in order to pass requisitions. Recommendation: Medical companies and the division medical supply officer (DMSO) must be in close proximity to and have dedicated LAN line connectivity with the small extension node/large extension node (SEN/LEN) in order to pass successful Class VIII requisitions. Issue: Initially, enemy prisoners of war (EPW) combat configured loads (CCLs) were thought to be a requirement at various locations on the battlefield, specifically the EPW collection points. Discussion: EPW CCLs were not required as the division initially predicted. Class VIII needs for EPWs were filled utilizing organic MES. Resupply was facilitated through normal medical logistics channels. Recommendation: Although not needed during this operation, it is still recommended that units predict, build and push EPW Class VIII CCLs in combat environments like Iraq. EPW Class VIII requirements can quickly exhaust medical units� basic load (UBL) of Class VIII and overcome medical units assigned the task of EPW care. Issue: Combat lifesaver (CLS) bags need to be up-to-date and on hand prior to deployment. Discussion: Many units did not bring CLS bags to the theater. Additionally, many units did not have adequate numbers of CLS bags prior to deployment. This created a high initial demand for CLS bags for each wave of units that deployed into theater. Procurement times for this particular item averaged over a month before delivery to the unit. Recommendation: Commanders must ensure that CLS bags are inventoried monthly and the appropriate quantity is on hand to perform the unit�s mission. Issue: Prescription medication re-supply. Discussion: Soldiers deployed with 90 days of special medications. This was a mandate put in place by the garrison hospital. At the 70-80 day mark, soldiers started requesting refills. This created a difficult situation due to the lack of medical logistics infrastructure in country. As a quick fix, providers attempted to send soldiers to the Camp Doha Clinic (ARCENT-Kuwait). This system worked for a while until the remaining brigades and non-divisional units started arriving. The system was unable to handle the special medication demand of the population of soldiers. Theater level planners assumed that each soldier would bring enough special medications for the entire deployment. Recommendation: Soldiers deploy with 180-day supply of special medication. A solution for the long-term appears to be enrollment in the online pharmacy program prior to deployment. This will provide a �sure thing� in the event that special medications are not available through normal distribution channels at the end of the 180-day supply. From a theater perspective, a plan must be implemented to fill special medication prescriptions immediately after deployment based on situational variables. For very large deployments, a pharmacist may need to be inserted into the medical logistics channel (medical logistics company/battalion) early on in order to facilitate high demand special medication re-supply. Theater planners must communicate requirements to CONUS-based medical treatment facilities (MTF) prior to unit deployment. Issue: Attached echelons above division (EAD) unit Class VIII requirements overwhelmed the DMSO during reception, staging, onward movement, and integration (RSOI) and sustainment operations in the camps. Discussion: At one point, the 3ID (M) DMSO was the only Class VIII supply support activity (SSA) operational north of Camp Doha. As 3ID (M) began gaining EAD level attachments without organic medical support, Class VIII requirements overwhelmed the DMSO. Recommendation: Medical logistics assets need to be in place early and alongside division and EAD units to provide the additional Class VIII support associated with the attachment of unresourced EAD units. Issue: Requirements for environmental threat prophylaxis (Doxycycline) were not predicted, procured, and issued by theater. Discussion: Soldiers were required to take Doxycycline as Malaria prophylaxis. Sufficient Doxycycline was not available in time for initial issue and subsequent resupply. Recommendation: Theater planners must predict known environmental threats and provide appropriate prophylaxis in the required quantities. Chapter 20 Combat Health Support Topic B � Medical Operations Issue: Need current up-to-date medical intelligence in order to get the best product out of the planning process. Discussion: Although somewhat useful, the Armed Forces Medical Intelligence Center (AFMIC) did not prove to be an up-to-date source of information for the medical planning process. Some of the information was outdated by as much as ten years. The majority of the information on military medical infrastructure was based on a �best guess� response. Recommendation: AFMIC should continue to improve its information database by working with additional information sources (special operations forces, other governmental agencies, non-profit organizations, etc.). Internal information queries by AFMIC can identify files that require updated profiles. The organization needs to offer more real-time medical intelligence emphasizing the current force infrastructure and the medical logistics support channel (i.e. fixed hospitals and supply channels supporting certain military units). Issue: Units performing RSOI must ensure appropriate coordination is made with RSOI and receiving units. Discussion: Units responsible for RSOI continually sent units (FSTs, ASMCs, MASH) to the wrong destination. Units continued to show up at units with little or no notice and usually the wrong location. This caused a sense of confusion among all parties involved and reflected poorly on the receiving unit. Updates on RSOI/arrival of units were normally given upon request, not by any pre-established update timeline. Recommendation: Theater-level RSOI units must ensure daily updates are forwarded to receiving unit points of contact (POCs) in order to achieve continuity. Understanding that arriving units do not always arrive as scheduled, daily updates would allow the flexibility for subordinate units to adjust timelines. During a high volume of unit RSOI, this will allow receiving units to continually update subordinate commands on the arrival of units. Issue: Medical personnel need to categorize patients appropriately for medical evacuation. Discussion: Medical personnel categorized patients as �litter-urgent� the majority of the time. This categorization was not necessarily the appropriate classification of the patient. It became a �blanket categorization� for medical personnel in the triage process. In our particular situation, it did not matter from an evacuation perspective because of the sole reliance on air MEDEVAC. Inaccurate categorization effects did not surface until they reached higher command channels. Anxiety concerning casualties tends to be much more prevalent among commanders when categorization is severe in nature. Recommendation: On-site medical personnel need to be able to categorize casualties based on guidelines set forth in appropriate doctrine. This will provide personnel involved in the evacuation process with the correct information. This, in turn, will enhance the ability of evacuation personnel to make the appropriate decisions on disposition of the patient. Issue: Military police (MPs) units require external medical augmentation/support in order to care for enemy prisoners of war (EPWs). Discussion: Military police (MP) units had great difficulty providing medical care to EPWs with their internal medical resources. MPs were not able to provide medical care for the wide range of EPW medical needs. EPWs had injuries ranging from gunshot/fragmentation wounds to broken bones. This particular range of injuries requires medical treatment commensurate with Level II capabilities coupled with a forward surgical team (FST). In certain situations, the MPs received EPWs from a supporting forward support medical company (FSMC)/FST after surgery and post-op were complete. Based on environmental conditions (desert, arid conditions, lack of shaded area), the MPs found it very difficult to care for EPWs after the designated post-op period. In several instances, EPWs had to be transported back to the supporting FST or higher level of care in order to regain stabilization. Recommendation: Plan to attach some type of medical augmentation package to the MP units that have an EPW holding mission. Recommended package components: holding capability, treatment capability, evacuation capability, and either immediate access to an FST or the collocation of an FST. Issue: Delivery of humanitarian assistance (HA) supplies needs to be coordinated down to the lowest level. Discussion: HA supplies consistently arrived with little or no notice before delivery. Many times HA supplies were delivered without ground components� knowledge. This caused a great deal of confusion in determining disposition and storage requirements for HA supplies. Recommendation: Prior coordination of HA supplies needs to be communicated down to the lowest level with prior notice in order to facilitate disposition of supplies. Topic C - Medical Evacuation (MEDEVAC) Issue: Synchronization of MEDEVAC in training versus peacetime. Many planners believe that MEDEVAC aircraft �hop along behind the BSA during movement.� Discussion: FSMCs must ensure that units understand the availability of MEDEVAC is limited to ambulance exchange point (AXP) and rearward locations in most instances (unless armed escort or a secure area is available). For planning purposes, MEDEVAC aircraft are not able to launch from the FSB until the battalion support area (BSA) is set. Issue: Communication with MEDEVAC systems. Discussion: In training, range control (Kuwait) facilitated all MEDEVAC evacuations using the 1042nd out of the Oregon National Guard. This resulted in a certain complacency as MEDEVAC units deployed into theater. After approximately one month, deploying MEDEVAC units had failed to complete a communications synchronization exercise in order to test current systems both for the requesting units and the MEDEVAC unit. Recommendation: Test MEDEVAC communications channels as soon as possible in order to ensure operability of both the requesting units and the receiving units, both �in the red and in the green.� Issue: Command and control (C 2 ) relationships concerning MEDEVAC units. Discussion: In this instance, the MEDEVAC unit was totally reliant on the 3ID (M)�s aviation brigade for maintenance and support. This was due to the fact that the brigade had the most robust UH-60 maintenance package in theater. The corps continued to attempt to place the unit in DS of the division. This created a difficult situation for the DMOC and the aviation brigade. Corps did not have the maintenance assets to support the MEDEVAC. Aviation brigade was reluctant to assist due to the C 2 relationship. DMOC continued to attempt to serve as a broker between the two organizations. Eventually, corps attached the MEDEVAC unit to division for �maintenance and logistics support.� Recommendation: Corps headquarters elements must attach corps units operating in direct support of division units. This will alleviate numerous administrative as well as logistical issues. Bearing in mind, the corps can always detach units depending on a change in mission or requirement. Issue: Synchronization of MEDEVAC with aviation brigade FARP/jump FARPS. Discussion: Aviation brigade and division support command (DISCOM) experienced problems synchronizing jump times and operational start times for FARP operations concerning MEDEVAC employment. The aviation element has a different emphasis during the fight, so the FARPS are normally located to facilitate a constant forward movement, versus a rearward evacuation movement. Throughout the fight, MEDEVAC continued to evacuate to the nearest Level III facility, normally located rearward. Recommendation: The aviation brigade FARP elements may have to delay jumping assets forward until Level III facilities have echeloned and established forward. Another option is to utilize internal MEDEVAC FARP assets to form stand-alone locations. This option requires security or additional combat power from the main/supporting effort in order for this asset to stand alone. Planners may plan to use any fixed point on the ground where the MEDEVAC assets can �piggy back� on existing combat structure (i.e. fuel points, convoy support centers, maintenance collection points). Issue: There was some confusion concerning MEDEVAC coverage during movement of DS company. Discussion: MEDEVAC coverage during DS company movement must be coordinated prior to the movement of the DS company. The DS company moved all assets forward to new location and there was confusion on who had coverage. Eventually, the DS company was contacted and it was determined that the general support (GS) company was responsible for coverage during movement. At the time the GS company�s location was approximately 1.5-hour flight time. The confusion caused about a 20-30 minute delay, which, in turn, caused a 2-2.5 hour response time. Recommendation: Evacuation battalion/medical companies must coordinate with aviation brigade elements in an effort to synchronize aviation movements with MEDEVAC coverage to alleviate lapses in coverage during movement. Ensure the coverage plan is communicated to supported units. Topic D - Medical Nuclear/Biological/Chemical (NBC) Defense Material Issue: Medical nuclear, biological, chemical, defense material (MNBCDM) storage requirements. Discussion: Storage capability is not present at the brigade and division levels for storage of the MNBCDM. Although the main support medical company can manage to store minimal amounts using resources �out-of-hide,� additional refrigeration is required for the entire division support area activity. Recommendation: Each brigade and divisional support battalion requires some type of temperature-controlled environment (reefer van) for storage of NBCDM. Issue: Issuing MNBCDM to the individual soldier. Discussion: Some units independently distributed MNBCDM without higher headquarters guidance. This created accountability, environmental control, and safety issues. Some forward support battalions (FSB)/brigade surgeons issued the MNBCDM down to the individual soldier level. This increased difficulty in accounting for the materials, which were to be reported on a weekly basis. It also created an unstable storage environment for the chemical compounds. In addition, there are safety considerations for the soldier should there be an accidental auto-injection, a situation that did occur during individual issue. Recommendation: Hold MNBCDM at the FSB level until the theater directs issuance to the soldier level. This will guarantee the chemical�s effectiveness and accountability, as well as decreasing the likelihood of an individual accidentally auto-injecting. Topic E - Army Prepositioned Stock (APS)/New Equipment Fielding Issue: New equipment fielding before deployment. Discussion: Equipment that was needed or scheduled to be fielded to units before deployment had significant training and fielding issues based on timelines for deployment. For example, the Chemical Biological Protective Shelter System (CBPSS) was scheduled to be fielded to the division in November 2002. The majority of 3ID (M) units deployed in the mid-January to mid-February 2003 time frame. The system was fielded in mid-February 2003 and training was conducted in Kuwait. Additional units (area support medical companies, forward surgical teams) continued to enter the Central Command (CENTCOM) theater without the proper training. Recommendation: With the current operations tempo (OPTEMPO), based on �The War on Terrorism,� contractors/government fielding agencies need to create a �normal� versus an �accelerated� timeline. This will create two timelines that are dependent solely on the likelihood of a unit�s deployment timeline. More importantly, these timelines need to be communicated all the way down to the user level. The units mentioned above should have been trained in CONUS between the months of December 2002 to January 2003. Issue: R&Q (controlled substance) medications need to be inventoried as a part of the APS set. Discussion: The R&Q medications were not located with the APS medical equipment sets (MES). This created significant concerns in preparation for combat operations. The R&Q medications were clearly identified as an issue, early on, and the issue was not rectified in a timely manner. Recommendation: USAMMA needs to ensure that R&Q medications associated with APS sets are inventoried on a monthly basis and that the number matches the number of MESs based on allocation. Topic F - Communications Issue: In a fast-pace operation, it is critical to execute long-range communications. Divisional medical companies are ill equipped for long-range communications (distances beyond 30 kilometers). Discussion: 3ID (M) medical planners voiced continued concerns about the long-range communication capability of both the forward support and main support medical companies. This directly impacted the ability to communicate with higher headquarters in both division and corps. They currently have the AN/GRC-213 (AM) radio as a part of their MTOE. These radios are antiquated and repair parts are difficult to obtain. Most of the medical companies (3 of 4) deployed without operational AN/GRC-213s after having parts on order for as much as three months prior to deployment. They were forced to rely on the brigade combat team (BCT) tactical operations centers (TOC). This is the only long-range communications capability in the BCT that offers a high frequency (HF) radio. The medical brigade attempted to mitigate this shortfall by issuing Iridium phones to each medical company. These phones can also be unreliable due to satellite availability. Recommendation: Reliable long-range (30-100 kilometers) communications must be embedded into the division medical companies in order to increase effectiveness. Issue: A universal HF/long-range radio is needed in corps and divisional medical units down to the FSMC level (to include DMOCs). Discussion: Division medical operation center (DMOC) has much the same issue as the medical companies. The medical brigade issued an Iridium phone to the DMOC, as it did to the medical companies in the division. Additionally, the medical brigade also issued an HF radio (GPR-117) to the DMOC a few days before the impending engagement. This created two problems. The first was a training issue and the second was a universality issue. The medical brigade did not have a plan to train units on the new radio before use. In addressing the second issue, there are many different medical units in the corps level structure. Most of these units possess several different types of communications equipment. For purposes of this operation, the division elements can only talk to the units that specifically have a GPR-117. This created problems in communicating with the various corps medical assets. Recommendation: Purchase a long-range system that is universal and is embedded at the FSMC level and above. Issue: Communications between units with different headquarters is needed at the earliest possible juncture. Discussion: 3ID (M) planners were not allowed to communicate with units that belonged to other headquarters (III Corps, V Corps) until the final moments of the operational planning. This caused a great deal of confusion when units initially arrived in the area of operation. 3ID (M) planners were unaware of the full capabilities of the arriving units as well as the requirements for initial employment. Recommendation: Headquarters need to increase flexibility in allowing units to communicate capabilities early on, as well as requirements upon arrival. Return to Table of Contents |
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