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Level II Medical Support Operations

A medical company deployed to Afghanistan used split-based operations to successfully provide medical care for Soldiers spread across Regional Command North.

Over the past decade of protracted conflict, the Army has continued to employ its forces in a manner that does not always follow doctrine but instead adapts to the mission set and operating environment. The flexible and responsive application of each facet of the Army Health System is critical to sustaining those combat forces. With linear battlefields banished to distant memory and the geographic dispersion of units across regions increasing, the use of split-based medical operations within the brigade combat team has become a fixture of combat medicine and the medical concept of support.

Members of the treatment platoon treat a local Afghan boy who was involved in a motor vehicle accident.

Establishing Medical Services
C Company, 24th Brigade Support Battalion, 170th Infantry Brigade Combat Team, stationed in Baumholder, Germany, continued to subscribe to this model of support when it deployed to Regional Command North (RC North) in Afghanistan in the spring of 2011. Upon arrival, C Company established the brigade level II aid station, which was colocated with the brigade headquarters, and the battalion level I aid station and brigade medical supply office, which were colocated with the battalion. It also colocated a mild traumatic brain injury (mTBI) and transition clinic with the RC North headquarters and German role III medical facility and provided medical support for a stability transition team.

Without a medical headquarters or an area support medical company in RC North, the brigade medical assets provided primary care for all of the Soldiers in the brigade and the other units operating in its area. The vastness of the region presented a significant challenge to providing organic care. To mitigate this problem, forward treatment teams and additional healthcare specialists (combat medics) were assigned from C Company to each of the maneuver battalions. This provided increased medical coverage to every patrol and outlying combat outpost within the brigade.

mTBI Clinic
C Company manned the mTBI and transition clinic at Camp Marmal with the brigade nurse and one combat medic. With access to the neurological treatment section of the German role III facility, the mTBI clinic insulated the mTBI casualties from the stressors at their forward operating bases (FOBs) as much as possible. This provided uninterrupted recuperative time in a controlled environment to ensure that patients could return to their units once medically cleared.

As the only facility of its kind in RC North, the mTBI clinic also offered care to all in need from outside the brigade. In addition to providing post-blast restorative care, this facility served as the brigade patient hold, specialty outpatient tracking node, and as the liaison to the German role III medical facility for specialty services consults and to the U.S. forward surgical team for post-operative care and medical evacuation.

Soldiers prepare a patient for ground evacuation by mine-resistant ambush-protected ambulance to the role III hospital.

Brigade Nurse
The brigade nurse served as an extension of the command, facilitating accountability of individual Soldiers and documenting their treatment. Her team was responsible for ensuring that the specifics of the care Soldiers received at the North Atlantic Treaty Organization facility were uploaded into the Armed Forces Health Longitudinal Technology Application and for providing that information to the referring aid station. This provided immediate feedback to the referring providers, complied with the mandate for electronic medical records, and eliminated the inevitable loss of paper documentation as Soldiers returned to their FOBs via multiple flights and ground movements.

Maintaining digital patient records reduced the need to repeat medical procedures and care because of lost documentation and ensured that Soldiers received the specialty care they needed regardless of the nation providing it. The brigade nurse’s role as a nurse case manager and medical liaison enhanced medical readiness and recovery through the coordination of comprehensive treatment plans and detailed patient tracking.

Medical Battlefield Circulation
The 170th Infantry Brigade Combat Team deployed and established operations at more than 12 camps, FOBs, and combat outposts that were scattered throughout RC North. Although the reassignment of the forward treatment teams and additional combat medics and the use of coalition facilities bridged the primary care gap, the availability of ancillary services from coalition partners was limited.

To reduce the need for Soldiers to travel for chronic injury or routine specialty care, C Company developed a comprehensive medical battlefield circulation support plan to rotate each of its specialty providers and services to each remote company or larger unit on a routine basis. Services provided included physical therapy, preventive medicine, behavioral health, pharmacy, medical supply and maintenance, and dental. Pushing providers far forward not only reduced the strain on an already overtaxed transportation system but also reduced the strain on units by eliminating the requirement to lose a Soldier for over a week for him to receive 1 hour of active care.

Similar to the responsive patient care benefits, our specialty services proactively reduced and prevented the occurance of reportable events with an aggressive preventive medicine training and surveillance campaign, medication dispensing and management education, class VIII (medical materiel) management training, and routine medical maintenance within each facility. By providing specialty services and care as far forward as possible, the medical service providers maximized the combat readiness of the brigade’s most valuable weapon, the Soldier. To keep Soldiers in the fight, these providers logged hundreds of patient encounters, serviced more than 500 pieces of equipment, and conducted more than 200 inspections.

A combat medic restocks the aid station shelves after sick call.

Effects of Split-Based Medical Operations
Operating across such a large area presented many challenges, including a reduced ground evacuation capacity because the combat medics assigned to maneuver battalions came from the brigade evacuation platoon of C Company. However, it also presented many opportunities for joint and international cooperation.

Training prospects were limitless, ranging from base-wide mass casualty incident response exercises that included all medical personnel from sister services and coalition partners to medic exchange programs within the aid stations to education and training blocks of instruction with Afghan partners to opportunities for shifts within the German role III medical facility. Each of these events furthered C Company Soldiers’ medical knowledge through the exchange of clinical practices and fostered the greater goal of cooperation. The Soldiers took advantage of the chance to develop relationships across national borders in order to provide the best care possible.

The practice of split-based medical operations is not new. It has proved to be successful across multiple rotations in Operations Enduring Freedom, Iraqi Freedom, and New Dawn. The Soldiers of C Company continued to use this framework and make it their own to provide superior, comprehensive, and responsive level II medical support across RC North to the Soldiers of the 170th Infantry Brigade Combat Team and others who needed care.

Through the deliberate application of assets and resources, the dangers of distance were diminished and the intent to keep Soldiers in the fight through the provision of support as far forward as possible was met. Daily, C Company Soldiers’ efforts directly contributed to the sustainment of the medical readiness and health of the 170th Infantry Brigade Combat Team, serving a critical role in mission accomplishment.

Captain Erica L. Kane is the commander of C Company, 24th Brigade Support Battalion, from Baumholder, Germany. She was deployed to Regional Command North, Afghanistan, from February 2011 to February 2012. She holds a bachelor’s degree in psychology from the University of Notre Dame. She is a graduate of the Army Medical Department Officer Basic Course; the Plans, Operations, Intelligence, Security, and Training Course; and the Combined Logistics Captain Career Course.


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