Preparing the Armored Brigade Combat Support Medical Company for Deployment to the Korean Peninsula
Written by Captain Brent Stolzoff and Second Lieutenant Blake Pickel
The Armored Brigade Combat Team (ABCT) is one of the fastest and most lethal units in the United States Army. By deploying an ABCT to the Korean Area of Operations within the Republic of Korea, the United States shows commitment to security and partnership on the peninsula. Any Company in the Raider Brigade (1st ABCT, 3rd Infantry Division), must be able to rapidly move to keep up with the maneuver elements. If the Armored Brigade (BDE) Support Medical Company (BSMC) cannot keep up with the pace of the ABCT, Soldiers’ lives are put at risk. The ability to fight tonight is even more paramount on the Korean Peninsula. As such, the need for speed and readiness is imperative for the BSMC.
Preparation for the Korean Regionally Aligned Forces (RAF) Mission began for the Raider Brigade when it went to one of two National Training Center (NTC) rotations prior to the RAF Mission. There was an instance where the Died of Wounds (DOW) rate skyrocketed because the Role II was unable to set-up in time to treat a rapid influx of patients. Identifying this root cause of the spike in DOW casualties enabled our team to work towards training and improving for the next NTC rotation. With a new Command Team and new Platoon leadership, we immediately started training towards two primary goals: rapid deployment of the Role II to save life, regardless of location or time, and maintaining the flexibility to push assets forward efficiently and effectively. Through targeted training and effective management of resources, the Company was prepared, trained, and ready to succeed during another NTC rotation.
During this rotation, the Role II package focused on speed and adaptability. While the Initial Operating Capability (IOC) party used both M-577’s as Advanced Trauma Life Support (ATLS) and Lab/X-ray vehicles to treat patients, the rest of the Role II set up utilizing Expandable-Vans for emergency dental care, patient hold, and behavioral health until achieving Fully Operational Capability (FOC) status. The mobile set-up enabled the Role II to rapidly and safely move locations six times without issue, greatly reducing the BDE’s DOW rate.
To further reduce the DOW rate, the BSMC attached M113s to the Role Is to increase evacuation capability, greatly reducing the stress on the Role Is evacuation assets.
The company’s success in lowering the DOW rate stemmed from the multiple Casualty Evacuation (CASEVAC) Leader Professional Development (LPD) sessions and the exceptional work of the Role I’s in evacuating and treating their casualties at the Point of Injury (POI). To further reduce the DOW rate, the BSMC attached M113s to the Role Is to increase evacuation capability, greatly reducing the stress on the Role Is evacuation assets. This enabled the Role I’s evacuation assets to focus on evacuation from the POI to the Role I while the BSMC evacuated from the Role Is to the Role II. Testing the Mobile Role II through the crucible of the NTC Rotation 18–01 provided the Company with the confidence to deploy to the Republic of Korea, knowing we were prepared to cheat death if called upon.
Ready to Fight Tonight
The necessity for a rapid deploying, mobile, and effective Role II is incredibly important on the Korean peninsula because hostilities could begin at a moment’s notice. Special consideration during mission planning must be given to the limited road networks, mountainous terrain, and of course the enemy always gets a vote. Knowing the situation in Korea could become kinetic at any time, the Armored BSMC must remain ready to fight tonight. The roads and air-space will most likely be congested or denied in a fight on the peninsula, so the Company had to again adapt the way it planned to deploy. Taking the base concept of the mobile Role II validated at the NTC, we modified the package to account for the challenges of fighting on the Korean peninsula. This requirement created the “Role II in-a-box”.
Role II In-A-Box
The Role II in-a-box (R2B) consists of the two Tactical Combat Medical Care (TCMC), Patient Hold, Dental, X-ray/Lab, Physical Therapy (PT), and Sick Call Medical Equipment Sets (MES) all stored in a sling-load ready, 20 foot Shipping Container. The R2B enables the ABCT to rapidly increase medical capability to any location on-demand, by having the vital MES packaged and ready to deploy 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). Working with the BSB Distribution Company to train and equip organic BSMC Soldiers on the LHS enabled the BSMC to move and perform independently. This proved vital to the Distribution Company as it was one less load for them to carry forward.
In addition to the R2B, the BSMC utilizes the M577’s in the same manner on the Korean Peninsula as performed at the NTC, providing 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 already pre-staged and upon notification of an EDRE, the BSMC is immediately ready to deploy regardless of the conditions. This enduring readiness affords the BSMC time to focus on accountability, final vehicle preparation, issuing of weapons, and issuing of war medications (individual CBRN treatment medications). These practiced procedures produce a fully mustered and ready to deploy BSMC, equipped with the entire Role II, within one hour.
The only special consideration is power generation and shelter. Even with the R2B, the need for power generation and shelter remains. The container can store the necessary tentage for the Role II, but it requires the removal of the PT set to fit inside the R2B. The preferred method is to establish the R2B in a hard stand building, removing the need for power generation or tentage. An additional concept uses additional expandable containers to completely remove the necessity of tentage, which in-turn greatly increase maneuverability and readiness. Unfortunately, the expandable containers are not as widely available compared to tent systems.
CBRN Threat Medical Readiness
One of the most concerning issues on the Korean Peninsula is the potential for Chemical, Biological, Radiological, and Nuclear (CBRN) munitions fired against U.S. and Republic of Korea (ROK) forces. The North Korean chemical munitions capabilities are widely known, and as such, units deploying to the peninsula require focused training to counter the use of CBRN munitions against our forces.
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 one of the more difficult tasks, but when compounded with the added difficulty of CBRN casualties, the training and proficiency required increases exponentially. 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 the Mission Essential Task List (METL) and Combined Arms Training Strategy (CATS), combined with advanced schooling, the BSMC was trained and ready.
To achieve proficiency and maximum readiness to react to CBRN attacks, the BSMC must be prepared perhaps more-so than any other Company.
Once on peninsula, the BSMC quickly worked to gain proficiency with all CBRN equipment and treatment devices/supplies. This was accomplished though vigorous, train-like-you-fight training events concentrated on developing individual tasks into collective sub-tasks, and finally culminating in a collective task training exercise “Crusader Shield”. During the “Crusader Shield” collective training exercise, the BSMC reacted to a simulated EDRE caused by a CBRN strike on friendly forces. The R2B deployed via 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 IOC, the Evacuation Platoon did initial treatment with hasty patient decontamination, prior to evacuating their patients to the Role II via M113 and Field Litter Ambulances (FLA). 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 CH-47 CASEVAC. Division and BDE leadership attended “Crusader Shield” providing validation and accolades of the spectacular training exercise. This training event served as the baseline for the BSMC’s success throughout the deployment.
Prolonged Field Care
The Armored BSMC on the Korean Peninsula must have the training to perform Prolonged Field Care (PFC). All of the previously mentioned challenges to medical care on the peninsula exponentially increase the difficulty of evacuating casualties from forward locations. This problem set requires the BSMC to train on patient sustainment procedures similar to care rendered at the Role III. Specific PFC training the BSMC conducted focused on training medics to run the patient hold tailored to an ICU/step down ward (placement and maintenance of invasive devises, blood 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/procedures.
The inability to move patients caused by a significant event on the peninsula makes sustaining the fighting force even more of a concern. Unfortunately, an armed conflict is not the only potential mass casualty producing event. In addition to the threat of full-scale war, units on the Korean Peninsula must 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 have the capability to provide prolonged care to a patient for upwards of 72 hours. In the future, the BSMC would greatly benefit from the addition of a 68C on the Modified Table of Organization and Equipment (MTOE), either organically assigned or filled through the Professional Filler System (PROFIS), to assist the Brigade Nurse in running the Patient Hold. The BSMC must prepare for patient sustainment; in the same sense as the any combat medic prepares for point of injury trauma medicine.
Whole Blood Transfusions
The Emergency Blood Donor Program (Walking Blood Bank) provides causalities with necessary lifesaving blood in the event stored blood supplies are exhausted, no immediate availability for replenishment, or no acceptable timeline for patient evacuation. On the Korean Peninsula, the casualty estimates grossly outnumber the amount of available blood products. Prior to deployment, the Medics and Laboratory Technicians pre-screened donors, looking for low titer O+ donors, within the Battalion and established a list of viable donors for the Walking Blood Bank. In the event of a MASCAL or Emergency Deployment, the Role II would have the capability to draw, store (through MTOE blood refrigerators), and administer blood products.
The program trains medics to activate a buddy to buddy donation. Taught by the Special Operations Command-Korea (SOCKOR) Surgeon Cell, the BSMC gained the ability to transfer blood directly on the line. Medics who completed the training then passed the training throughout the Brigade in another class taught to all Medical Providers and senior line medics. In the event of a prolonged evacuation timeline, the trained medics collect a donor bag of fresh whole blood from one Soldier and immediately transfuse it to the casualty. Multiple studies show the sooner a casualty receives fresh whole blood, the likelihood of patient survivability greatly increases. This skill set could prove vital to an area of operations already stressed for medical supplies and services.
Conclusion
To effectively prepare, the Armored BSMC must place special emphasis on readiness and CBRN preparedness for kinetic actions and natural disasters alike. Our BSMC proved successful in both of these tasks; through rigorous training events, steadfast determination devoted to readiness at all times, and some of the finest Soldiers in the Army. In conclusion, the adaptation of the R2B, CBRN preparedness, and Prolonged Field Care training exponentially increased the BSMC’s ability to fight tonight, and win!
Author Captain Brent Stolzoff is the commander of Charlie Company, 3rd Brigade Support Battalion, 1st Armored Brigade Combat Team, 3rd Infantry Division. Co-Author Second Lieutenant Blake Pickel serves in the same company as the Treatment Platoon Leader. 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.
