15. Medical Command and Control Application

a. Under MC4, medical information on soldiers will be stored at different levels. This will allow commanders and command surgeons at the various echelons to access medical information on their soldiers to find out specific information and to conduct analysis of disease/injury trends. These lower echelon databases also provide a means for information redundancy should destruction of an information node or communications outage occur. Each database will feed the databases above it. Personnel (medical commanders, staff surgeons) at each echelon with MC4 management functionality will be able to query the database. The CHS information required by the CSSCS will pass from the MC4 system through GCSS-A to CSSCS.

b. The brigade surgeon will maintain a database containing medical information relevant to the soldiers in the brigade. This will be the interim theater database that provides information to update sustaining base medical information systems such as the computer based patient record and health surveillance system.

c. At all echelons, MC4 will automatically provide information such as evacuation status, current fitness for combat, and hazard exposure information to the commander’s situational understanding system.

The MC4 system will provide the commander with the ability to track and record the date and location of

exposure to health hazards, which include environmental, occupational, industrial, and NBC hazards. This information is critical to the force health protection hazard analysis necessary to identify emerging DNBI problems and trends. Commanders will have real-time information on food sources safety/quality, operationally significant zoonotic disease, health surveillance/trends, and near-real-time health hazard assessment data for NBC/endemic disease threats and occupational or environmental health threats. This information will be provided to the commander from the MC4 functional digital systems through GCSS-A to CSSCS. Commanders, for the first time, will have a complete picture of the battle space, which will allow them to accurately influence current operations while synchronizing CHS with other activities.

d. The capabilities of the medical assets available to the combat brigade will be optimized with technological enablers for equipment and supplies, and with digital enablers to include FBCB2, CSSCS, MC4, TMIP, WIN, and the EIC. Figure I-7 provides an example of the MC4/TMIP database structure.

Figure I-7. Medical communications for combat casualty care/Theater Medical Information Program database structure.

J-1. Employment

In military operations on urbanized terrain (MOUT), the medical company’s/troop’s treatment units may be required to deploy forward to provide Echelon I augmentation.

J-2. Site Selection and Unit Layout

Site selection and unit layout requirements of the medical company/troop, as discussed in Chapter 3, are still valid considerations in MOUT scenarios. However, MOUT-specific issues must also be con-sidered.

a. Locations Within the City. If the area selected for the medical company to occupy is within the city, it is important that the site be—

• Adequate for the number of casualties expected.

• That avenues of approach and egress are readily available.

• That there be a smooth flow of traffic within the site.

• That the location is reasonably secure easily defended and that it affords protection from observation and the direct and indirect fires that are likely to result from that observation.

b. Existing Buildings. Combat in urban environments generally results in serious damage to existing buildings. This damage may compromise the structural integrity of these buildings and render them unsafe. If medical company operations must be established within existing battle damaged structures, they should be inspected by engineers and declared safe for occupation.

c. Basements. In many areas of the world, basements and subbasements are routine parts of construction. Although basements afford protection from small arms and automatic weapons fire, they also pose many potential hazards. Combat in urban areas may damage or destroy gas, water and sewer mains (distribution systems). As the leaking gas may be heavier than air, it will settle into the low lying spaces creating poisoning as well as fire and explosion hazards. Another hazard presented by establishing the MTF in a basement or series of basements is that the building may collapse due to artillery fire or aerial bombing, trapping medical personnel and patients under the rubble.

d. Fortifying the Building. If ground and upper level floors of a building are used, fortifica-tions to the building can lower the threat from small arms and automatic weapons fire. This can be accomplished by barricading windows and using sandbags; observation/firing ports (holes) can be left open. By covering these observation/firing ports at night, light discipline can be maintained in the MTF operational area.

J-3. Forward Surgical Team

The forward surgical team FST will collocate with the clearing station during MOUT operations. This element provides forward surgical intervention for nontransportable trauma patients. Once stabilized by the FST these patients can be evacuated further to the rear for more definitive care.

J-4. Mass Casualty Operations

Mass casualty situations are chaotic events the throw large numbers of people together under less than ideal circumstances. When anticipated and prepared for, through detailed planning, coordination, regular rehearsals and tough realistic training the chaos associated with this type of event can be minimized. These actions require proactive command level emphasis for units to be able to effectively deal with these situations

a. Planning. To ensure efficient management of MASCAL situations, the CHS planner must develop an effective plan and then rehearse it on a periodic schedule.

b. Rehearsal and Training. The response to a MASCAL situation is determined in large part by how well the unit is prepared before the event occurs. Rehearsals are an invaluable tool for assessing the strengths, weaknesses and training required to make personnel proficient in their individual and collective tasks when responding.

c. Additional Information. For additional information on MASCAL operations, see Appendix C.

J-5. Forward Deployed Medical Treatment, Preventive Medicine, and Medical Evacuation Assets a. Medical Treatment. The medical company will augment and/or reinforce aid stations as needed during MOUT operations. Combat health support planners should consider pushing additional Class VIII items forward to the aid stations in response to the increased number of casualties that are generally sustained during MOUT operations. During the initial fight, the focus of the aid station is to treat and stabilize severe trauma patients for evacuation. As a result, routine sick call services will usually be passed to the medical company. The medical company/troop must, therefore, provide this support.

b. Preventive Medicine. Throughout history, disease nonbattle injury (DNBI) resulting from medical threats (including, but not limited to, heat, cold, and disease) have accounted for more losses to fighting forces than combat-related injuries. The need for effective preventive medicine measures cannot be overemphasized, especially in MOUT operations. Combat in urbanized terrain by its nature creates some unique hazards and situations. Despite considerable advances in the technology of war, the medical threat still presents a significant danger to our forces. For detailed information concerning preventive medicine refer to FMs 8-10-7 and 21-10.

c. Medical Evacuation. Conducting medical evacuation operations in the MOUT environment challenges the CHS planner. He must ensure that the CHS plan includes special or unique materiel

requirements or improvised use of standard equipment. The plan must be sufficiently flexible to support unanticipated situations. For detailed information concerning patient evacuation in MOUT operations refer to FM 8-10-6, Chapters 5 through 10.