U.S. Army -- The armored brigade combat team (ABCT) is one of the fastest and most lethal units in the Army. By deploying an ABCT to the Republic of Korea, the United States shows commitment to security and partnership on the peninsula.
Every company in the 1st ABCT, 3rd Infantry Division, must be able to move rapidly to keep up with the fastest ABCT in the Army. If the armored brigade support medical company (BSMC) cannot keep up with the ABCT's pace, Soldiers' lives truly could be at stake. As such, the need for speed and readiness is imperative for the BSMC.
Preparation for the Korean regionally aligned forces mission began when the 1st ABCT went to one of two National Training Center (NTC) rotations. During the first rotation, the died of wounds (DOW) rate skyrocketed at one point because the role II facility was not able to set up in time to treat a rapid influx of patients.
Identifying the root cause of the spike in DOW casualties enabled the BSMC to train and improve for the next NTC rotation. With a new command team and new platoon leaders, the team immediately started training toward one primary goal: the rapid deployment of the role II facility to save lives, regardless of location or time. The BSMC also worked on having the flexibility to push assets forward efficiently and effectively.
Through targeted training and effective management of resources, the BSMC was then prepared, trained, and ready to tackle another NTC rotation. During the second rotation, the role II package focused on speed and adaptability. The company used M577 armored command vehicles as advanced trauma life support, laboratory, and x-ray vehicles.
While the initial operational capability party treated initial patients, the rest of the role II set up expandable vans for emergency dental care, patient hold, and behavioral health services. The mobile setup enabled the role II to jump six times rapidly and safely, greatly reducing the brigade's DOW rate.
The low DOW rate also stemmed from multiple casualty evacuation leader professional development sessions and the exceptional work of the role I facilities in evacuating and treating their casualties at the point of injury (POI). To further reduce the DOW rate, the BSMC attached M113 armored personnel carriers to the role I facilities to increase evacuation capability, greatly reducing the stress on the facilities' evacuation assets. This allowed the role I to focus on POI evacuation while the BSMC's evacuation assets moved patients from role I to the role II facility. Testing the mobile role II through the crucible of the NTC rotation allowed the company to deploy to the Republic of Korea with confidence.
READY TO FIGHT TONIGHT
The necessity for a rapidly deployable, mobile, and effective role II is incredibly important on the Korean peninsula, where hostilities could begin at a moment's notice. Mission planners should especially consider the peninsula's limited road networks and mountainous terrain, and of course, the enemy always gets a vote.
Since war could break out at any time in Korea, the armored BSMC must remain ready to fight tonight. To deploy the role II at a moment's notice, knowing the roads and airspace would most likely be congested, the company had to again adapt the way it deployed. The company took the base concept of the mobile role II validated at NTC and modified the package to account for the challenges of fighting on the Korean peninsula. This package became the "role II in a box" (R2B).
ROLE II IN A BOX
The R2B consists of medical equipment sets for tactical combat medical care, patient hold, dental, x-ray and laboratory, physical therapy, and sick call, all stored in a 20-foot shipping container ready for sling load. The R2B enables the ABCT to rapidly send medical support to any location by having vital medical equipment sets packaged and ready to roll on order.
If aerial delivery via sling load is not feasible, the R2B can easily be loaded onto a flat rack and carried on an M1120 load handling system (LHS). The BSMC worked with the brigade support battalion's distribution company to train and equip its Soldiers on the LHS, which enabled the BSMC to move and perform independently. This benefited the distribution company by giving it one less load to carry forward. Again, the BSMC used its M577 vehicles as advanced trauma life support, laboratory, and x-ray vehicles. This provided an immediately ready initial higher echelon of medical support to the ABCT.
While deployed to the Republic of Korea, every unit is required to muster within four hours of notification of an emergency deployment readiness exercise (EDRE). With the R2B package, the role II is pre-staged and the BSMC is ready to go upon notification of an EDRE.
This readiness affords the BSMC time to focus on accountability, final vehicle preparation, issuing of weapons, and issuing of war medications (such as individual chemical, biological, radiological, and nuclear [CBRN] treatment medications). These practiced procedures produce a fully mustered and ready to roll BSMC, equipped with all of its role II assets within one hour.
The only special considerations are power generation and shelters. Even with the R2B, the need for power generation and shelters does not go away. The container can store the necessary tents for the role II facility, but the physical therapy set needs to be removed in order for the tents to fit.
The preferred method is to establish the R2B in a hard stand building, which removes the need for both power generation and tents. An additional concept uses expandable containers to avoid needing tents, which greatly increases maneuverability and readiness. Unfortunately, expandable containers are not as widely available as tent systems are.
CBRN THREAT MEDICAL READINESS
One of the most concerning issues on the Korean Peninsula is the potential for CBRN munitions being fired against U.S. and Republic of Korea forces. North Korean chemical munitions capabilities are widely known to friendly forces, and units deploying to the peninsula require focused training to counter the use of CBRN munitions.
To achieve proficiency and maximum readiness to react to CBRN attacks, the BSMC must be prepared--perhaps more so than any other company. Treating casualties on a battlefield is already difficult, and treating CBRN casualties requires even more training and proficiency.
Prior to deployment, the BSMC worked with various CBRN response agencies to build the proficiency and confidence of the company's medical providers. Through targeted training based on mission essential task lists and combined arms training strategies, combined with advanced schooling, the BSMC was trained and ready.
Once on peninsula, the BSMC quickly worked to gain proficiency on all CBRN equipment and treatment devices and supplies. The company used vigorous "train as you fight" events concentrated on first developing individual tasks and then practicing collective subtasks. The training culminated in a collective task training exercise called Crusader Shield.
During the Crusader Shield exercise, the BSMC reacted to a simulated EDRE caused by a CBRN strike on friendly forces. The R2B deployed by LHS to a clean field site while the evacuation platoon developed clean and dirty routes to the chemical patients. Once the role II was at initial operational capability, the evacuation platoon did initial treatment with hasty patient decontamination prior to evacuating patients to the role II facility using M113 vehicles and field litter ambulances.
The role II then treated the patients exhibiting symptoms from the severe chemical attack. These events caused a mass casualty scenario, which in turn forced the evacuation platoon to call for casualty evacuation by CH-47 Chinook helicopter. This training event served as the baseline for the BSMC's success throughout the deployment.
PROLONGED FIELD CARE
An armored BSMC on the Korean Peninsula must have the training to perform prolonged field care (PFC). It is very difficult to evacuate casualties from forward locations on the peninsula. It requires the BSMC to train on patient sustainment procedures similar to role III care.
Specific PFC training that the BSMC conducted focused on training medics to run the patient hold tailored to an intensive care unit or step-down ward (insertion and maintenance of invasive devices, blood administration and transfusion, pharmacology, and other management procedures for critical care patients). To bolster the medics' grasp on PFC, the medical providers and brigade nurse held weekly refresher courses on PFC, critical care, and trauma management techniques and procedures.
Unfortunately, an armed conflict is not the only event that can cause mass casualties. Units on the Korean Peninsula must also be ready to receive casualties from natural disasters. PFC is equally, if not more important, in the event of a natural disaster.
The BSMC must be able to provide prolonged care to a patient for more than 72 hours. Moving forward, the BSMC would greatly benefit from the addition of a military occupational specialist 68C (practical nursing specialist) to assist the brigade nurse in running the patient hold. The BSMC must prepare for patient sustainment in the same way that any combat medic prepares for POI trauma medicine.
WHOLE BLOOD TRANSFER
The emergency blood donor program (also called the walking blood bank) provides necessary lifesaving blood in the event that stored blood is no longer available, there is no immediate availability for replenishment, or patient evacuation is unavailable. On the Korean Peninsula, the estimated number of casualties grossly outnumbers the number of available blood products.
Prior to the BSMC's deployment, the medics and laboratory technicians, looking for O-positive donors with low titer, prescreened donors within the battalion and established a list of viable donors for the walking blood bank. In the event of a mass casualty or emergency deployment, the role II would have the ability to draw, store, and administer blood products.
The program trains medics to activate a buddy-to-buddy donation. Taught by the Special Operations Command Korea surgeon cell, the program taught BSMC Soldiers how to transfer blood directly on the line. Medics who completed the training then passed their knowledge throughout the brigade in another class taught to all medical providers and senior line medics.
In the event of a prolonged patient evacuation time line, the trained medics collect a donor bag of fresh whole blood from one Soldier and immediately transfuse it to the casualty. Multiple studies show that the sooner a casualty receives fresh whole blood, the greater the likelihood the patient will survive. This skill could prove vital to an area of operations already stressed for medical supplies and services.
The armored BSMC must place special emphasis on readiness and CBRN preparedness for kinetic actions and natural disasters alike. The BSMC proved successful in both of these tasks through rigorous training events and steadfast devotion to readiness. The adaptation of the R2B, CBRN preparedness, and prolonged field care exponentially increased the BSMC's ability to fight tonight and win.