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Using a Brigade Support Medical Company
on the Current Battlefield

A brigade support medical company deployed to Afghanistan found that flexibility was the key to providing support to a widely dispersed force.

With the current use of forward surgical teams and combat support hospitals on the battle-field, where does the medical company of a brigade combat team fall into the operation plan? The brigade support medical company (BSMC) is more robust than a role 1 facility, but it is not able to provide as many services as a role 3 facility. [Role 1 is unit-level first medical care. Role 3 is the level of care provided by a combat support hospital.] In essence, the BSMC is “the middle child,” who always seems to get “left out.” So where does the BSMC fall in the spectrum of Army medical support?

Officers are taught the correct way to conduct support operations as set in doctrine. In the current war on terrorism, however, doctrine has to be used as a starting point for what a unit does. The key is for a unit to maintain flexibility.

BSMCs have been used for different missions throughout the 9 years of Operation Enduring Free-dom. They have been used to run detainee holding facilities and provide forward operating base (FOB) security and FOB details, and they have been broken up into smaller pieces and tasked to perform as organic role 1 facilities. These are all ways to carry out the mission. But when C Company, 402d Brigade Support Battalion (BSB), deployed to Afghanistan with the 5th Stryker Brigade Combat Team, 2d Infantry Division, from Joint Base Lewis-McChord, Washington, it found that the BSMC is stronger as a whole than when it is broken into separate pieces.

Operating in Two Locations

After C Company arrived in an undeveloped theater in Afghanistan, it set up a first-aid station in a 10- by 12-foot building with one exam room. This was a temporary solution that provided medical care to over 5,000 Soldiers for 30 days.

The company was then split between two main locations. Evacuation teams from the company pushed out to the role 1 facilities to increase coverage and also to bring female medic support to each infantry battalion.

Half of the company was stationed with the BSB tactical operations center (TOC) and the brigade TOC. This aid station had between 20 and 30 Soldiers at any given time. Along with the combat medics and one medical provider, the physical therapist, the dental team, the preventive medicine team, the brigade medical support officer, the patient administrative technician, and the company supply section, the Soldiers built their new home from ground up. They supported over 800 Soldiers stationed at this location and provided care to Soldiers passing through from the front lines. This section provided care to over 3,000 Soldiers, which was more than any other aid station within the brigade’s area of operation.

Along with providing care on a daily basis, the Soldiers at this location were assigned to provide medical care on all BSB logistics convoys to outlying FOBs. The teams were made up of three medics: one senior medic as the tank commander (who sits as a passenger in the front seat and acts as the leader of the vehicle), one driver, and one dismounted medic (who can exit the vehicle to provide care at a moment’s notice). With two to three convoy missions per week, the aid station was often left with only four medics to attend to sick call patients.

To make the best use of his skills, the only physical therapist assigned to the BSMC would spend a week at a FOB, travel back to the aid station to refit and provide care, and then head to a new location. He was able to hit each location, on average, every 6 weeks. The need for physical therapy was so great at some locations that he would often be pushed out to a combat outpost (COP) where he would see up to 20 new patients within a 24-hour period. To provide continuous care, his physical therapy technician, a cross-trained Soldier in military occupational specialty 68W (healthcare specialist), would stay at the aid station to make sure that all patients received the highest level of care.

The personnel of the preventive medicine section also spent most of their deployment on the road visiting each major FOB monthly. They also traveled to each COP to make sure all Soldiers were living and working in healthy conditions. Not only did they provide care to American Soldiers; they were often used to provide SWEAT [sewer, water, electricity, academics, and trash] assessments in local villages and Afghan National Army compounds.

Because of the large amount of dental equipment, its lack of mobility, and its requirements for power, the dental team was permanently assigned to the aid station. During the last 6 months of the deployment, the team did begin to travel, with limited tools, to provide class IV exams for Soldiers and obtain a clearer picture of how many Soldiers would be redeploying as class III. [Under Department of Defense dental fitness classifications, a class IV Soldier is nondeployable if he has no dental examination recorded in the last 12 months. A class III Soldier can be deployed only if he receives treatment for conditions likely to cause a dental emergency within the next 12 months.]

Only one patient administrative technician was responsible for tracking the entire brigade’s wounded in action and killed in action personnel, so he became borrowed military manpower to the role 3 facility. He was on call 24 hours a day, 7 days a week, and he was called in to every medical evacuation (medevac) that involved a 5th Stryker Brigade Combat Team Soldier. All information that was gathered would be pushed to the brigade surgeon cell so it could be pushed to all commanders within the brigade.

Supporting Forward

The second half of the company was pushed to an outlying FOB so that the infantry elements could push their providers and medics to the outlining COPs. With x-ray, laboratory, patient holding, and combat stress treatment capabilities, this aid station provided care to more patients than all role 1 facilities combined.

Having the x-ray and laboratory capabilities closer to the fight enabled Soldiers to travel back to the FOB instead of having to travel back to the role 3 facility to receive treatment of minor injuries. This enabled Soldiers to stay in the fight.

The patient holding section made an important contribution to the forward fight. Being colocated with a combat stress team, the section was able to provide a watch for suicidal or depressed patients 24 hours a day, 7 days a week. Without this capability, these Soldiers would have been evacuated to a higher level of care, taking them off the line for at least a week for travel time alone, not to mention the time needed for treatment.

To compensate for the limited capability of the combat stress team, the organic combat stress technician was mobile and could be at any location within 24 hours of an event. He would travel throughout the area of operations to ensure that all Soldiers’ mental health needs were cared for on a daily basis in the highly stressful environment.

Being colocated with the aeromedevac capabilities increased communication between the two medical elements. Category B (urgent surgical) and category C (priority) patients could be flown straight to the role 2 facility and given care within minutes. [Role 2 is division-level care, adding dental, x-ray, laboratory, and patient-holding capabilities to role 1 care.] If the role 2 facility had not been located as far forward within the battlespace as it was, this capability would not have existed and all medevac patients would have had to be flown to a role 3 hospital, where they would have been the last to be seen because of the large number of category A (urgent) patients. In that situation, as soon as the patient was discharged, he would have had to seek out his battalion liaison officer to arrange transportation back to the unit instead of being within driving distance of his company.

Even with running two aid stations, C Company was still flexible enough to support the entire brigade. This ranged from providing specialized providers and treatment teams at the role 1 facilities for battalion-level missions to providing female medic support as far forward as possible to provide care to wounded local females as well as female search capability.

Does the current make up of a BSMC support the battlefield? No. The doctrinal composition of an evacuation, treatment, and headquarters platoon does not support current operations. But having a command that enables the company to be flexible and agile provides a stronger medical element to support all Soldiers.

Captain Carla A. Berger is the commander of C Company, 402d Brigade Support Battalion, 5th Stryker Brigade Combat Team, 2d Infantry Division, at Joint Base Lewis-McChord, Washington. She has a bachelor’s degree in psychology and recreation therapy from Pittsburg State University. She is a graduate of the Health Materiel Officer Course and the Combined Logistics Captains Career Course.


 
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