JMRC MASCAL Lessons Learned for LSCO

Leader Development
Nov 1 · 8 min read

Written by SFC Hector M. Najera and SFC David Edwards; Contribution from MAJ David Rodriguez

A simulated casualty is prepared for evacuation during Saber Strike in Bemowo Piskie, Poland (photo by SPC Robert Douglass)

A MASCAL is a medically heavy sustainment operation.
— COL Steven M. Dowgielewicz

Exercise Saber Strike 2018

During one of the Saber Strike rotations, we observed something profound. A medic team brought a Soldier onto a trauma table in the Role 2 with his casualty card attached. The doctor took a look at the injuries listed on the card, examined the interventions in place, and studied the line of Soldiers waiting for treatment. Satisfied, the doctor shouted, “We can’t save him, send me someone else!”

The Observer Coach/Trainers (OC/T) examined the casualty card. The card listed multiple gunshot wounds to the chest (several hours old), without personal protective equipment, uncontrolled bleeding from the chest, unconscious, and an incomplete Tactical Combat Casualty Care (TC3) card . We came to the same conclusion. The patient was placed in the expectant category. This was exceptional because, up until that point, we had never seen a doctor turn away a patient in a mass casualty (MASCAL) scenario.

US and British medics work side by side during a simulated MASCAL during Saber Strike in Swidwin, Poland (photo by SPC Aaron Good)

This unit trained to make that call, and they made the correct decision. After we observed this, the Adler Team determined every future MASCAL simulation must include a certain number of expectant category patients. Triaging those patients correctly is just as important as finding those who could be saved.

The “Golden Hour” is Dead On Arrival

Reflecting on historical battles provides insight into what Army leaders must plan for should we have to engage in LSCO. The Battle of Antietam and Operation Overlord hold distinction as some of the bloodiest days in American history. Thousands of Soldiers lay dead or dying after days of close quarters combat. At the battle of Antietam, Federal forces rallied every wheeled conveyance to evacuate the wounded to hospitals. On the beaches of Normandy, the Allies converted landing craft into makeshift hospitals and used every wheeled vehicle to move the wounded to hospital clearing companies to evacuate Soldiers back to England.

Both examples illustrate the logistical expertise required to move large numbers of wounded Soldiers off the battlefield. No single medical unit, or combination of medical units, has the capability to move hundreds of patients a day. Operations in Iraq and Afghanistan did not present similar challenges to Coalition forces. However, any future LSCO will require the medical preparation and logistical capability to accomplish medical evacuation on a scale not seen since D-Day.

Medics from the US and UK treat a simulated casualty in Bemowo Piskie, Poland (photo by SPC Hubert Delany)

Responsibilities

At the Joint Multinational Readiness Center (JMRC), we coach sustainment planners to consider the:

First Aid is rendered to a simulated casualty in Poland while MEDEVAC is requested (Photo by SPC Robert Douglas)

· Number of aircraft allocated to the Brigade Combat Team (BCT)

· Number of ambulances at all roles of care

· Number of vehicles at the battalion S4’s disposal

· Number of non-medical personnel who can perform duty as a combat lifesaver (CLS)

· Casualty Estimate

The numbers produced by these considerations provide a rough idea of who must be transported and the number of seats available to move casualties to the next echelon of care.

Brigade Medical Planner

A 2CR Soldier renders aid to a simulated casualty during Saber Strike in Bemowo Piskie, Poland (photo by SPC Hubert Delany)

Division Medical Planner

Recommendations for Training

· Overwhelm logistic and medical capability. The simplest way to flood the sustainment system is with walking wounded. The walking wounded are at exceptionally high risk to switch categories while awaiting treatment. As an example, walking wounded may go into shock while awaiting treatment or suffer from hidden trauma.

A simulated MASCAL during Saber Strike 2018 in Swidwin (Photo by SPC Kimberly Derryberry)

· Precisely define MASCAL conditions in unit Standard Operating Procedures (SOP) per ATP 4–02.2, Medical Evacuation. When every medical hand is on a patient, and every casualty evacuation vehicle is outbound while Soldiers are still dying in the sun, it’s a MASCAL. Even more precise, when the number of patients exceeds the number of medical, CLS, and aircraft/vehicle seats, it’s a MASCAL.

· Delegate the MASCAL approving authority. Doctors and surgeons are not always in the best position to declare a MASCAL. Radio operators, battle captains, and battle staff must be equipped with precise MASCAL conditions to declare a MASCAL. Waiting for the doc to call it is often too late, and the staff will be the entity to coordinate inbound resources.

· Determine what paperwork is required per ATP 4–02.5, Casualty Care. The Tactical Combat Casualty Care (TC3) card is perfectly adequate for all casualties prior to damage control or primary surgery. Lengthy trauma forms confuse non-medical personnel who may provide record keeping, and slow casualty treatment.

A patient numbering system is used by a medical company during a simulated MASCAL in Oleszno Pomorskiego, Poland (Photo by Christopher Estrada)

· Implement a numbering system. A number system ensures patient accountability and saves treatment time. The number is entered on the TC3 card, the patient’s clothing, and a roster to ensure accountability. Medical personnel record treatment and medications and gather personal information when time permits.

Summary


SFC David Edwards began his military career in 2002 as a 68W, Healthcare Specialist. He is currently a U.S. Army Training and Doctrine Command Capabilities Manager at Joint Base San Antonio.

SFC Hector Najera began his military career in 2009 as a 68W, Healthcare Specialist. He is currently an Observer, Controller, Trainer at the Joint Multinational Readiness Center at Hohenfels, Germany.

MAJ David Rogriguez was commissioned through ROTC as an active duty Medical Service Corps Officer in 2009. He is currently a student at the Command and General Staff College.

The views expressed in this article are the authors’ alone and do not reflect the official position of the Medical Service Corps, the Department of Defense, or the US Government.


To read more articles like this, visit Medical Service Corps Leader Development

Evacuation assets supporting a MASCAL exercise in Swidwin Poland (Photo by SPC Aaron Good)

The Medical Leader

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Leader Development

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The Medical Leader

International military medical forum providing thoughts on leadership and strategy.

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