Transcript Urban Warfare - NH-TEMS

Urban Warfare
CPT James R. Rice
Emergency Medicine
Interservice Physician Assistant
Program
References
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DT 8-MOUT, Combat Health Support for Military
Operations on Urban Terrain
Mars and Hippocrates: Urban Combat and Medical
Support, LTC (Ret) Lester W. Grant, CDR Charles J. Gbur
Jr, MC USNR Army Medical department Journal PB 8-031/2/3 Jan/Feb/Mar
MAJ (Ret) Mark Stevens, 5th Special Forces Group,
Lessons Learned in Operation Enduring Freedom
CPT James R. Rice, 566th ASMC, 3ID, Lessons Learned
in Operation Iraqi Freedom
Overview
General Concepts
 Combat Medic
 BAS
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General Concepts
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Military Operations on Urban Terrain
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(MOUT)
Decentralized and isolated environment
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Individual first aid/buddy aid is critical
Cross load medical supplies
Get city maps if possible
General Concepts
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Complicated mission within the mission
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You can’t pre-plan enough
You can’t rehearse enough
 Mass
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casualty planning
Commo
 Develop
both an external and internal plan
The Combat Medic
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The medic needs to be able to operate
independent of the PA/MD
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Medically
Tactically
 They
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may be a shooter first
Don’t get shot!
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Trained on how to enter buildings
Don’t run out into the open to get a casualty
 Get
close in order to visually eval the casualty
 Drag the casualty to safety
The Combat Medic
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Providing cover for the casualty
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Utilize a rope with a D-ring
 Good
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for dragging
Utilize vehicles as a barrier
Smoke grenades
Treating Casualties
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Utilize TC3 approach
Be prepared for a lot of wounded-Triage!!!
The Combat Medic
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Evacuating Patients
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May not be able utilize MEDEVAC helicopters
May not be able to use FLAs-or won’t have
enough
The mission may not allow non-standard
vehicle evac
Utilizing litter and manual carries may be the
only choice
 Labor
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intensive
Improvised litter material
Litter bearer training
Battalion Aid Station
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Site selection
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Must be close enough to provide support, but
not too close-might interfere with the mission
and potentially endanger the element
Progress in the urban fight is often measured in
feet and yards
 You
may be able to create a more established facility
 However, be prepared to to jump
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Things might go bad
Things might be going great
Not a good site
Battalion Aid Station
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Site Selection
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Try to pick a site that is accessible by both
ground and air
Consider a site just outside the city
Fortify your site if possible
Considerations
 Treatment
space
 Defensive positions
Battalion Aid Station
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Acquiring patients
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Pre-plan CCPs
Push your FLAs as far forward as possible
 Remember,
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litter carry evac is tough
Treating Patients
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Split team operations
Casualties in the MINIMAL category need to
be returned to duty ASAP-mission comes first
Be prepared to manage casualties for extended
periods
Battalion Aid Station
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Treating Patients
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May see more closed space blast injuries
 TM
ruptures
 Burns
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May see more crush injuries
 Plan
for extrication equipment
Battalion Aid Station
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Evacuating Patients
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Utilize air evac if possible
 Roof
tops may not be stable enough
 Coordinate hoist equipment
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Good for evac and for bringing in supplies
Ground evac
 Pre-plan
non-standard evac
 Plan primary, secondary and tertiary routes
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The enemy may case-out your routes
The battle may flow interfere with a route
Summary
MOUT is the greatest challenge for both the
tactical commander and the medical
provider
 Pre-planning is absolutely critical
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Get involved!!!
Develop back-up plans and then back-up
plans to your back-up plans
Questions??
The End