Urban WarfareCPT James R. Rice

Emergency Medicine

Interservice Physician Assistant Program

References

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 8-03-1/2/3 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

General Concepts

Military Operations on Urban Terrain– (MOUT)

Decentralized and isolated environment– Individual first aid/buddy aid is critical– Cross load medical supplies– Get city maps if possible

General Concepts

Complicated mission within the mission– You can’t pre-plan enough– You can’t rehearse enough

Mass casualty planning

– Commo Develop both an external and internal plan

The Combat Medic The medic needs to be able to operate independent

of the PA/MD– Medically– Tactically

They may be a shooter first

Don’t get shot!– 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

Providing cover for the casualty– Utilize a rope with a D-ring

Good for dragging

– Utilize vehicles as a barrier– Smoke grenades

Treating Casualties– Utilize TC3 approach– Be prepared for a lot of wounded-Triage!!!

The Combat Medic Evacuating Patients

– 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 intensive

– Improvised litter material– Litter bearer training

Battalion Aid Station Site selection

– 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

– Things might go bad– Things might be going great

Not a good site

Battalion Aid Station

Site Selection– 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

Acquiring patients– Pre-plan CCPs– Push your FLAs as far forward as possible

Remember, litter carry evac is tough

Treating Patients– 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

Treating Patients– May see more closed space blast injuries

TM ruptures Burns

– May see more crush injuries Plan for extrication equipment

Battalion Aid Station

Evacuating Patients– Utilize air evac if possible

Roof tops may not be stable enough Coordinate hoist equipment

– Good for evac and for bringing in supplies

– Ground evac Pre-plan non-standard evac Plan primary, secondary and tertiary routes

– 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– Get involved!!!

Develop back-up plans and then back-up plans to your back-up plans

Questions??

The End