HomeAbout UsBrowse This IssueBack IssuesNews DispatchesSubscribing to Army LogisticianWriting for Army LogisticianContact UsLinks

Current Issues
Cover of Issue

Sustainment Brigade Medical Operations

The brigade surgeon section is key in planning and implementing effective healthcare for a sustainment brigade. This was demonstrated by the 43d Sustainment Brigade’s brigade surgeon section during its deployment to Afghanistan.

The 43d Sustainment Brigade had responsibility for the southern and western regions of Afghanistan, providing sustainment to support the surge of U.S. forces during Operation Enduring Freedom 09–11. The brigade surgeon and staff coordinated and synchronized medical operations in conjunction with the brigade’s operational sustainment support plan. Coordination and support for the brigade’s medical treatment facilities (MTFs) and medical support for the brigade’s logistics convoys required networking before deploying to Afghanistan.

Brigade Surgeon Section

The brigade surgeon is a special staff officer who reports directly to the brigade commander. The brigade surgeon’s duties include coordinating with the next-higher command surgeon and the medical brigade commanders for Army Health System support of sustainment brigade health service support (HSS) and force health protection (FHP).

While preparing to deploy to Afghanistan, much of the brigade surgeon section (BSS) work consisted of developing and coordinating Army Health System support by initiating network contacts with the sustainment units in Afghanistan that already had medical support. The BSS integrated medical support to synchronize with the 43d Sustainment Brigade operational support plan. The brigade’s large area of responsibility required much coordination to meet all of its needs for HSS and FHP in the southern half of Afghanistan.

Mission Preparation

Medical coordination and support from the already-in-place 575th Area Support Medical Company (ASMC), 30th Medical Command, and the later arriving 62d Medical Command began while the 43d Sustainment Brigade headquarters was still stateside. Determining the current levels of care and medical evacuation assets available was essential to the surge of U.S. forces expected in the region.

Before deploying, the brigade surgeon and staff diligently worked to synchronize and integrate proper medical support within the brigade’s operational support plan. Before the brigade’s arrival in country, initial contact was made with already-in-place units to coordinate and plan the brigade’s required HSS and FHP needs for its expansive role in southern and western Afghanistan.

During the brigade’s first 60 days in Afghanistan, the primary concern was establishing the role 1 MTF while planning and coordinating the brigade’s medical support. Doctrinal manning of sustainment brigades with medics and providers only supports the brigade headquarters element. The 43d Sustainment Brigade’s sustainment expansion into southern and western Afghanistan meant the BSS needed additional medics to support the brigade’s logistics convoys.

Upon arrival in Afghanistan, the brigade surgeon focused on patient management and treatment that required out-of-theater medical evaluations and treatments. Processing authorizations for aeromedevacs and medevacs through the patient administration sergeant efficiently moved patients for continued care. The BSS developed and coordinated an effective mass casualty (MASCAL) plan that complemented the base-wide emergency plan.

MTF Levels

Three levels of medical care are available in the southern half of Afghanistan. The levels use the North Atlantic Treaty Organization (NATO) designations referred to as “roles,” which are different from the American College of Surgeons “levels” that are used by U.S. trauma centers. The military roles designate differences in capabilities and not the quality of care.

Medical capabilities increase with each role step; each higher role has the capabilities of the role below it in addition to expanded capabilities. The most forward role MTF possible works to return troops to duty after minor treatment for minor injuries or illnesses. Troops requiring expanded medical care are prepared and evacuated with en route medical care to the next higher role MTF to receive the more extensive treatment.

Role 1 MTF. Role 1 MTFs provide initial triage, medical treatment, and evacuation as needed. Staffing at the role 1 MTFs includes medics and either a field surgeon or a physician assistant. Role 1 MTFs are the first level of care provided by a doctor or physician assistant and offer initial life-saving treatment of casualties, primary disease prevention, nonbattle-injury prevention, and routine sick call healthcare. Role 1 MTFs have no patient-holding facilities.

Role 2 MTF. The southern and western Afghanistan role 2 MTFs continue basic and emergency treatment, including basic primary care. They provide an increased medical capability with the addition of x-ray, laboratory, combat operational stress control, and dental services and have limited inpatient bed space (approximately 20 to 40 cots) for holding patients up to 72 hours. The 575th ASMC provided Kandahar Airfield with a U.S. Army role 2 MTF but without the patient holding because of its proximity to the Kandahar role 3 MTF.

Role 3 MTF. The 43d Sustainment Brigade headquarters, based on the large multinational NATO Kandahar Airfield, has an established NATO role 3 MTF. The Kandahar role 3 MTF provides the highest level of care within the theater and also has expanded inpatient capacity. It provides outpatient services or hospitalization for all types of in-theater patients, furnishing definitive medical care or stabilizing for medical evacuation out of the combat theater.

The Kandahar role 3 MTF has operating room tables for initial types of surgical services that include general, thoracic, orthopedic, neurosurgical, urologic, plus dental and oromaxillofacial (when the specialty provider is available), with post-operative care in intensive care units, intermediate care wards, and minimal care wards. A neuropsychiatric ward is also available. Additional laboratory, x-ray, blood bank, optometry, mortuary, and physical therapy services are available in the Kandahar role 3 MTF. The MTF also has an expanded behavioral health department. Incoming and outgoing patient evacuation transportation support is an additional feature, moving patients to and from the role 3 MTF.

Sustainment Brigade Medical Organization

Sustainment brigades are authorized a small medical platoon composed of a headquarters element, a treatment squad, and an ambulance squad. The headquarters element includes a field surgeon (who is also assigned as a treatment-squad provider) and a staff sergeant healthcare sergeant as the platoon sergeant. The treatment squad includes a physician assistant, two medical treatment sergeants, and five medics. The ambulance squad includes two ambulance medical sergeants and four medics.

The medical platoon is responsible for the brigade role 1 MTF, providing emergency trauma and routine medical treatment for the almost 300 personnel in the brigade headquarters and headquarters company (HHC) plus approximately 1,700 additional troops from the other subordinate sustainment brigade units within the HHC base operating area. Once it was set up, the MTF immediately started providing medical care, creating a combined aid station (CAS) with its surgeon periodically assisting the 43d Sustainment Brigade’s field surgeon and physician assistant.

The 43d Sustainment Brigade provides all classes of supply to U.S. and NATO forces in southern and western Afghanistan. The BSS helps with acquiring additional medics and medical support for the logistics convoys because the brigade’s medical platoon has only enough medics to support one MTF. The request for more medics brought augmentation from the Air Force with medics for convoy support. The Air Force medics also replaced Army medics at one base that the 575th ASMC was supporting. Since the 575th ASMC was redeploying back to the United States, logistics convoys to one of the brigade’s major logistics bases in southern and western Afghanistan would not have had medical coverage.

When the 575th ASMC withdrew from supporting the sustainment brigade units, the 43d Sustainment Brigade’s medics began supporting the logistics convoys of one of its sustainment battalions. This reduced the number of medics available to support the brigade’s role 1 CAS MTF, causing a reduction in the MTF’s operating hours from its previous 24-hour schedule.

Setting Up Operations

Upon arrival in the 43d Sustainment Brigade area of responsibility, the brigade’s primary concerns were establishing its role 1 MTF and coordinating the medical effort for the brigade troops. As the 43d Sustainment Brigade’s Soldiers arrived at Kandahar, the brigade surgeon immediately began receiving patient care consults from brigade providers.

The BSS began coordinating and managing medical evacuation and treatment authorizations for individual troops to leave the theater by aeromedevac for more advanced tests or procedures unavailable in theater at the NATO role 3 MTF. Through the patient administration sergeant, the BSS tracked all brigade troops on aeromedevacs and on urgent but stable medevacs that left the theater until they returned to the theater or continued to the United States.

Once the brigade arrived in Afghanistan, the next step for the BSS was to develop the 43d Sustainment Brigade’s MASCAL plan and coordinate it with the multinational, joint Kandahar Airfield MASCAL plan. The brigade’s MASCAL plan implemented the identification of casualty collection areas and casualty collection points where medical supply boxes with litters are placed. The plan also identified the brigade’s subordinate units’ labor pool, communications, and security responsibilities—all of which depend on the location within the brigade’s area of responsibility on Kandahar Airfield, where a MASCAL may occur.

Medical Sustainment

The BSS monitored and tracked medical operations within the brigade with the Medical Communications for Combat Casualty Care System and provided timely information to the brigade surgeon on medical capabilities and updated medical situational awareness on the health of the command. Armed with this information, the BSS worked with the MTFs under its responsibility to continue to improve the troops’ HSS and FHP.

Within the brigade’s first 60 days in Afghanistan, the brigade medical aid stations improved the brigade’s required immunizations compliance by 23 percent; this improved the brigade’s medical readiness by more than 12 percent. This coordination and management of the class VIII (medical supplies) was made possible by working hand-in-hand with the brigade’s medical logistics officer in the commodities management center. Ordered and shipped, the class VIII went to the battalions’ role 1 CASs. From there, the providers and medics aggressively provided the needed vaccinations, tests, and profile management to keep the brigade’s medical readiness at more than 95 percent during the deployment.

Medical training occurred in the theater, with the BSS coordinating with the Kandahar Airfield medical simulation training center to support the brigade’s need for continued medic and combat lifesaver training. This helped the brigade’s Soldiers and medics to remain well-trained and confident in their medical skills and abilities. The need for sustainment training developed because of the number of brigade logistics convoys traveling on dangerous, difficult, and limited roads in southern and western Afghanistan.

As the medical providers within the brigade redeployed, the BSS coordinated with other commands, including the U.S. Navy commands, to request replacements and ensure that they arrived. In the event that the replacement provider did not arrive until over a month after the first provider redeployed, a temporary provider covered the outlying role 1 aid station’s provider shortage.

The brigade’s role 1 CAS increased its capabilities and services by coordinating primary dental services. A dentist and dental assistant with their general field dental equipment colocated in the role 1 CAS to provide basic dental care and hygiene services. Consolidated check-in and prescription dispensing streamlined both dental and medical areas for both patient types.

The BSS tracked and monitored medical operations within the brigade and effectively managed medical supplies. The results were improved brigade compliance with immunization and medical readiness. Medical training was also conducted to maintain medics’ and Soldiers’ medical skills and confidence. Coordinating the replacements for redeploying medical providers helped maintain the outlying role 1 MTFs’ medical capabilities. Additional dental care and services were also coordinated, expanding the brigade role 1 CAS capabilities. Medical analysis and flexibility within the BSS allowed the 43d Sustainment Brigade to sustain the buildup of U.S. forces in southern and western Afghanistan.

Master Sergeant Gregory C. Thorn is the senior medical operations noncommissioned officer for the 43d Sustainment Brigade. He holds an associate’s degree in applied science from Wayland Baptist University and a bachelor’s degree in healthcare services and a master’s degree in business administration specializing in healthcare management from the University of Phoenix. He is a graduate of the Army Battle Staff Course; the Senior, Advanced, and Warrior Leader Courses; and the Medical Noncommissioned Officer Course.

WWW Army Sustainment