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Medical Operations in the Sustainment Brigade

The 15th Sustainment Brigade operating in Multi-National Division-Baghdad was one of the first sustainment brigades to deploy to Iraq. While this new unit evolved out of the former division support command (DISCOM), it has substantially fewer medical assets than a DISCOM, and its medical mission is different. This poses unique challenges for planners and medical providers.

While the DISCOM, with its main and forward support battalions, had robust level I (sick call and emergency stabilization) and level II (laboratory, x ray, pharmacy, medical hold, and medical supply) assets, the sustainment brigade’s organic medical treatment assets are comparable to those found in an infantry battalion. The sustainment brigade’s total organic medical assets are within its headquarters element: a brigade surgeon section and a medical platoon. The brigade surgeon serves as special staff to the brigade commander and oversees the two surgeon sub-sections: medical plans and operations and medical logistics and sustainment. With the mission of providing level I care to approximately 400 personnel in the headquarters section, the medical platoon is composed of a treatment squad (with one doctor, one physician’s assistant, two medical sergeants, and five medics) and an ambulance squad (with two ambulance teams and four medics).

When the sustainment brigade deployed and assumed command and control of numerous other battalions, its numbers increased to several thousand. Most of the units did not have medics, and none had medical providers (physicians or physician’s assistants) or medical equipment. Coordinating for level I and II care for these troops posed the first of many challenges for sustainment brigade medical planners.

Medical Support Command

The medical support command (MSC) is the organization responsible for providing support to units, such as the sustainment brigade, that do not have sufficient internal medical assets and for providing theater level III (combat support hospital) medical support. Within the MSC, units can deliver all facets of theater medical care and logistics. The MSC and the sustainment brigade have a synergistic relationship and, by doctrine, the potential for a command relationship. The sustainment brigade moves medical supplies for the medical command and provides area logistics support to MSC units. The MSC is designed to augment medical care in the sustainment brigade with additional personnel or by positioning area support medical companies to provide level I and II care, medical logistics battalions, preventive medicine assets, and optometry and mental health services.

Evolving from the former DISCOM, some sustainment brigades retained pieces of the equipment and personnel that are no longer true parts of the sustainment brigade modification table of organization and equipment (MTOE). The 15th Sustainment Brigade is an example of a sustainment brigade in transition. Located at Camp Taji, Iraq, the 15th Sustainment Brigade initially provided forward operating base- and area-level optometry support and mental health services using assets formerly assigned to the division. These services were not carried over in the restructured MTOE and were therefore contracted through the MSC during the transition of authority planning. The brigade medical platoon’s mission was to provide level I medical care to sustainment brigade Soldiers at Camp Taji—a population of approximately 2,500.

Challenges

Soldiers serviced by the MSC were located at many different bases within Iraq; these bases relied on several different aid stations for medical care. This made the 15th Sustainment Brigade surgeon section’s requirement to provide medical oversight and planning a unique challenge. Tracking disease and nonbattle illness trends, ensuring preventive medicine measures were in place, and keeping abreast of Soldiers placed on medical profile and evacuated to higher levels of care were made more difficult by the geographic dispersion.

Approximately half of the brigade’s over 4,000 Soldiers were collocated with the brigade headquarters element at Camp Taji. Level I care was provided by the organic medical platoon without augmentation, stretching resources allocated for a smaller population. Moreover, the medical platoon had the important and labor-intensive mission of training nonmedical Soldiers to be combat lifesavers. Since medics are not assigned to most sustainment brigade battalions, the combat lifesaver (the nonmedical Soldier with first aid training) is the first medical responder on sustainment brigade logistics convoys, which travel dangerous roads in the combat zone. A 40-hour course must be completed to receive initial combat lifesaver certification, and an 8-hour recertification course must be completed annually.

Combat brigades, similar in size to sustainment brigades, have dedicated level II facilities with additional providers and services, such as laboratory,
x ray, medical hold, and dental care. At Camp Taji, the 15th Sustainment Brigade relied on the assets of the 1st Brigade, 1st Cavalry Division, level II facility. The brigade combat team (BCT) C Company (medical) is often the unit that provides level I and II care for the collocated sustainment brigade in lieu of an area support medical company. Sustainment brigade planners should take into consideration the possibility that the BCT’s primary responsibility is to support the division and that, if the mission dictates, the BCT could move locations. When sustainment brigade units rely on BCT assets, a lack of medical coverage for the sustainment brigade can result.

If no level II facility is located in the area of operations, additional personnel from the MSC may be added to the sustainment brigade’s treatment platoon to augment organic resources to provide some level II services, such as laboratory and x-ray capabilities. This was the case with the 45th Sustainment Brigade operating in northern Iraq, which ran a level II facility at Forward Operating Base Q West with the addition of a healthcare provider, laboratory technician, and radiology technician from the MSC. However, even with these additional assets, the staffing level and capabilities were still less than those of a BCT medical company that runs analogous level II facilities in theater. This adaptive ability of the sustainment brigade to become a level II facility will diminish as the sustainment brigades mature and shed additional equipment left over from the DISCOMs.

The 15th Sustainment Brigade deployed to a theater with established levels II and III medical support. In future conflicts, close coordination between the sustainment brigade and the MSC will be crucial to ensuring area medical coverage is in place for all deployed Soldiers and determining if it makes sense for the sustainment brigade to have operational control of these units.
ALOG

Major Bonnie H. Hartstein, M.D., is the Brigade Surgeon for the 15th Sustainment Brigade at Fort Hood, Texas. She has a B.S. degree from the University of Michigan and an M.D. degree from Boston University School of Medicine.