Combat health support in the Army's first Stryker Brigade

Army Logistician, Jan-Feb, 2005 by Scot A. Doboszenski

Logistics doctrine is taught as a rigid standard--the right way to conduct support operations--during field exercises, training center rotations, and real-world missions. I concede that doctrine is a good starting point for training, but I believe that the Army must be flexible to win today's Global War on Terrorism. Further, I believe that, on the battlefield, non-doctrinal methods are often key to maintaining flexibility.

Lessons learned during Operation Iraqi Freedom (OIF) have shown that the current battlefield is non-linear, the enemy is unconventional, and the battlespace is nondoctrinal. As we modify our tactics to combat the enemy, the enemy likewise changes his approach; rendering massive conventional campaigns ineffective. The reason is simple; No force can match the U.S. military head-to-head in Conventional warfare.

Because of OIF experience, an evolution from current doctrine is occurring in Combat health support (CHS). While being mindful that some tenets of support must not Change, those of us who provide CHS often have to resort to innovative methods in order to provide quality, far-forward medical care. No unit has illustrated this concept better than the Brigade Support Medical Company (BSMC) of the 296th Brigade Support Battalion (BSB), 3d Brigade, 2d Infantry Division (3-2 BCT), or "Arrowhead Brigade," from Fort Lewis, Washington, in support of OIF from November 2003 to November 2004.

BSMC Assets

At first glance, the 296th BSB's BSMC looked much like a forward support medical company and had the same capabilities: level II medical care; emergency dental, limited x-ray, and laboratory services; evacuation and support elements; and a few medical operating systems that focus treatment far forward to soldiers in the brigade sector. The unique assets of the BSMC were the Medical Logistics, Mental Health, and Preventive Medicine (PVNTMED) Sections and two personnel not typically seen in a medical unit below corps level--a medical-surgical nurse, who was the officer in charge of the Patient Holding Section, and a physical therapist (not yet on the 3-2 BCT's modification table of organization and equipment).

Split-Based Operations

Flexibility was essential during the BSMC's OIF deployment. Unlike what is taught during training rotations to the National Training Center at Fort Irwin, California, and the Joint Readiness Training Center at Fort Polk, Louisiana, the BSMC healthcare providers (physicians and physician assistants) in Iraq augmented battalion aid stations (BASs) for extended periods of time.

Split-based operations were common throughout the BSMC, greatly facilitating the company's area support mission. For most of the deployment, the company was spread over six different forward operating bases (FOBs). While only one FOB had a complete level II capability, another FOB with area support augmentation from corps-level units, maintained a level II capability, minus laboratory and x-ray functions. By adding more lightweight field laboratory and field x-ray medical equipment, a level II care capability' was established later in a split-based scenario without increasing the number of authorized personnel. Ultimately, this meant that level II care (minus dental) could be provided in two locations with a minimal increase in the logistics footprint.

To conduct split-based operations, the BSMC's five healthcare providers were divided according to the company's area support mission, risk, number of traumas, and proximity to a combat support hospital (CSH). This departure from the traditional, centrally located level II care meant a heavy reliance on CSH support. For example, soldiers requiring nonemergency diagnostic studies for moderate trauma or potentially serious illnesses routinely were sent to a CSH for laboratory or x-ray services. Soldiers needing 24 to 72 hours of observation or intravenous antibiotics had to tolerate interrupted bed rest and frequent trips to the closest BAS.

One of the most significant decisions that had to be made was where and how to locate the level II medical facility in the mature theater. The primary mission of a BSMC is to provide immediate lifesaving care to stabilize casualties for transport. In planning the CHS battlefield layout, this mission is paramount. Also to be considered are demands for area support and augmentation, which are determined by looking at areas that have little to no coverage and on the population of each area. In other words, coverage is based on trauma first and sick call second.

Mental Health Section

The Mental Health Section, which was staffed by a behavioral science officer (a captain) and a mental health specialist (a specialist), was responsible for the well-being of over 5,000 soldiers in 13 different locations. To cover this large population, the 785th Medical Company (Combat Stress Control) provided augmentation in the form of four mental health specialists (two sergeants and two specialists) and a behavioral science officer (a captain). The support concept focused on far-forward care at various locations to expedite treatment and minimize both lost time and evacuation of soldiers to the rear of the brigade sector and out of theater. This battlefield coverage closely resembled the doctrinal allocation of one licensed behavioral healthcare provider for the first 2,500 soldiers, one additional provider for every 2,000 soldiers, and one mental health technician for every 1,000 soldiers.