Recently I had the pleasure of serving as an
assessor at a war game. The war game scenario included a joint
sustainment command that was part of a joint task force. In
preparing for my assessor duties, I reread Colonel Larry D.
Harman’s commentary, “Asymmetric Sustainment: The
Army’s Future,” in the July–August 2003 issue
of Army Logistician. His article offered intriguing insights
into the future of sustainment.
Both the war game I observed and Colonel Harman’s commentary addressed
the complex challenges of commodity and distribution management in an environment
of elevated customer expectations. As an Army alumnus, I found it intellectually
rewarding to again engage in the challenges confronting the Army, the sustainment
community, and logisticians.
Since leaving active duty, I have been involved in information architecture,
a field that requires a well-defined integrated data dictionary. Such a dictionary
defines meanings and classifies hierarchical relationships among words to reduce
confusion and enhance the clarity of the context of words. As the Army
continues to march into the Information Age, logisticians must define words clearly,
being careful to address their full context.
Take the word “sustainment,” for example. Joint Publication 1–02,
DOD [Department of Defense] Dictionary of Military and Associated Terms, defines
sustainment as “the provision of personnel, logistic, and other support
required to maintain and prolong operations or combat until successful accomplishment
or revision of the mission or of the national objective.” To understand
this definition fully, the reader must look for precise meanings of three words
it contains: “personnel,” “logistic,” and “other
support.” Joint Publication 1–02 defines personnel and logistics
but fails to offer a definition of “other support.” If a joint sustainment
command is to encompass the full breadth of sustainment, logisticians must address
all aspects of sustainment with equal enthusiasm and knowledge.
One important aspect of “other support” is healthcare. Military personnel
are exposed to a variety of health threats that are mitigated through prevention,
detection, and protection. In the last decade, improvements in healthcare and
in detecting and protecting against health threats have significantly reduced
disease and nonbattle injury (DNBI) rates in theater. In fact, DNBI rates are
lower in theater than at home stations. Again, healthcare is an area in which
definitions are important.
Look at the word “casualty,” for example. Joint Publication 1–02
defines casualty as “any person lost to the organization
by having been declared dead, duty whereabouts unknown, missing, ill, or injured.” Thus,
only those DNBI and battle injury (BI) personnel lost to the organization are
casualties. By definition, a person who is treated and immediately returned to
duty is not a casualty. However, a significant part of the medical workload is
devoted to personnel who are returned quickly to duty and thus are not a loss
to their unit. Therefore, it is important to consider the return-to-duty medical
workload when determining casualty capacity.
Casualty Capacity Versus Casualty Estimation
Determining the medical system’s casualty capacity is a complex calculus
of interacting variables. Some variables are the population at risk, length of
time a soldier is held in theater before he is returned to duty in his unit (evacuation
policy), post-operative length of stay before a patient is stable enough to evacuate
to the next level of care (evacuation delay), conditions necessary for a patient
to skip the next level of care without a medical intervention (skip factor),
and estimated medical workload in numbers of patients and range of DNBI and BI.
It is when determining the medical workload that estimating the medical system’s
casualty capacity intersects with casualty estimation.
Major David R. Gibson’s article, “Casualty Estimation in Modern Warfare,” in
the November–December 2003 issue of Army Logistician, addresses several
salient points on estimating casualties. An additional point to consider is that
casualties may become friendly force prisoners of war requiring medical attention.
However, these prisoners of war are not included in the friendly force casualty-estimation
process. Likewise, displaced civilians and civilian casualties usually are not
considered in casualty estimates.
force casualties may become friendly force prisoners
of war requiring medical attention. Above, an injured
insurgent is treated at the 31st Combat Support Hospital
in Baghdad, Iraq.
Although Major Gibson’s article is on friendly
force casualty estimation, his opening comments highlight the
dilemma that occurs when deploying medical capacity to manage
an estimated casualty load. His sources reported a medical
capacity of 13,000 beds positioned in 44 in-theater hospitals
at the beginning of Operation Desert Storm to manage the estimated
number of friendly casualties. Today, even if there were a
similar friendly casualty estimate, the deployed medical capacity
would be reduced because of changes in the population at risk,
evacuation policy, evacuation delay, and skip factor.
Excess or Idle?
When preparing for a conflict, it is important to focus on medical capacity rather
than on friendly force casualty estimation only. When focusing on friendly force
casualty estimation, it is easy to confuse excess with idle medical capacity.
An example of excess capacity is a family of four buying a six-passenger car
when it is highly unlikely that six passengers will ever be transported in the
car. Idle capacity is one member of the family using the car to run an errand.
Capacity is idle during the errand, but not when the whole family goes on vacation.
Casualties are rarely generated evenly and consistently throughout the military
forces each day. Pauses between casualty peaks create idle capacity, which gives
the medical units the time and resources to refit and resupply. Most war games
avoid realistic casualty play, so it is doubtful that meaningful insights can
be drawn from correlating a friendly casualty estimate with a casualty outcome.
Focusing on a force’s medical capacity is a more meaningful indicator for
an insightful dialogue with the combat commander. The joint force commander surely
would want to know when in-theater casualties exceed the medical capacity to
If a joint sustainment command is to embrace the full breadth of sustainment,
its logisticians must understand and address all aspects of sustainment. By understanding
the relationship between sustainment and casualty capacity, logisticians will
be better prepared to consider the implication of “other support” required
by the Army’s most critical resource: its soldiers.
Colonel David L. Nolan, USA (Ret.), is employed by BearingPoint, Inc., in
Virginia, and works in the Office of the Army Surgeon General’s Enterprise
Architecture Program Management Office as a consultant and project leader. He
has a B.A. degree in history from The Citadel and an M.B.A. degree from Western
New England College. He is a graduate of the Army War College.