Airfield Seizure Combat Health Support
by Captain Brian J. Bender

Airborne operations and airfield seizures are inherently dangerous. The danger arises from the fact that, during airfield seizures, paratroopers typically conduct a parachute assault deep into enemy territory in the midst of a pitched battle and are at great risk of incurring multiple injuries and wounds. Consequently, medics are always needed on the drop zone (DZ). Throughout the Army’s history of airborne operations, combat health support (CHS) has proven to be a significant combat multiplier to conserve fighting strength. In World War II, medics jumped with their units and established medical clearing stations on the DZs of France and The Netherlands. In fact, many of these medical clearing stations landed in gliders on austere landing zones.
 
Since World War II, medical personnel have jumped in all airborne operations. During Operation Just Cause in December 1989, medics from battalion aid stations and medical personnel from the 307th Medical Battalion participated in airborne operations during the seizure of Panama’s Torrijos-Tocumen Airport. Medical personnel were with the 82d Airborne Division en route to Haiti in September 1994 during Operation Uphold Democracy when the division was turned back from the jump. Most recently, medics were among the “Sky Soldiers” of the 173d Airborne Brigade who parachuted into northern Iraq to seize key objectives during Operation Iraqi Freedom.

Airfield Seizure

The 82d Airborne Division’s mission is to “deploy worldwide within 18 hours of notification, execute a parachute assault, conduct combat operations, and win.” Seizing an airfield is critical to the success of their combat operations. Airfield seizures are executed to secure key terrain that can be used to create a lodgment that will enable the continuous flow of combat power and supplies into an area of operations.
The key tasks associated with an airfield seizure are—

• Conducting pre-assault fires to suppress enemy air defenses.
• Seizing assault objectives and key facilities to eliminate a direct-fire threat.
• Blocking high-speed avenues of approach.
• Repairing the field landing site to receive airland forces.
• Seizing key terrain in and around the airhead so the enemy cannot observe the airfield. [An airhead is a designated area in a hostile or threatened territory that, when seized and defended, ensures the continuous airlanding of troops and equipment.]
 

Organization

Airborne operations have changed little since World War II. Medical personnel still accompany the infantrymen, artillerymen, and engineers, known as alpha echelon, who execute a parachute assault to conduct and support airfield seizure. Medical personnel are cross-loaded onto multiple aircraft to ensure that the loss of one aircraft does not keep the mission from being completed. Some of the medical personnel who parachute onto the objective are members of the infantry battalion’s medical platoon. Generally, 16 to 20 medical personnel, including line medics with the rifle companies, physician assistants, and physicians from the medical treatment squads of the medical platoon’s battalion aid station (BAS), jump with the initial assault forces onto the airfield.
 
Twenty-five medical personnel from the division’s forward support medical company (FSMC) also jump during an airfield seizure. The FSMC personnel typically include two seven-man treatment squads that have one physician’s assistant each, five ambulance platoon personnel, the dental officer (who serves as triage officer), a patient administration specialist, a laboratory technician, the treatment and ambulance platoon leaders, a communication specialist, and the company commander. These numbers can be tailored to support the mission.
 
The division’s organic forward surgical team (FST) is normally attached to the FSMC during an airfield seizure. Since only limited numbers of support personnel accompany the infantrymen in the initial assault, the FST usually is split into two sections—one that parachutes into combat and one that arrives later aboard an Air Force cargo aircraft. The parachute assault section usually includes two surgeons, four operating room nurses, one nurse anesthetist, two practical nurses, and three operating room technicians.
 
The bravo echelon is made up of personnel who do not jump but arrive on fixed-wing aircraft. If the airfield has only minimal damage, the bravo echelon should begin arriving at P+6 (6 hours after the first jumper leaves the first aircraft). The rest of the infantry battalion BASs arrive among these elements. Similarly, the remainder of the FSMC, consisting mostly of the area support treatment squad, the area support squad, and the company headquarters, also arrives by airland. The FSMC also is normally augmented with combat stress control and preventive medicine assets from the division’s main medical support company.
 

Heavy Drops

In addition to personnel requirements for conducting airfield seizures, military equipment is required. Medics must have medical equipment to provide CHS successfully during an airborne assault. Although all medics jump with an aid bag in their packs, most of the equipment they need arrives on vehicles that are heavy-dropped before the paratroopers jump. A heavy drop is defined as any large piece of equipment that can be rigged to a G–11B heavy-cargo parachute. The heavy-drop equipment is rigged before the plane is loaded, and, immediately before any paratroopers jump, Air Force personnel push the loads from the ramp of the aircraft for deployment on the battlefield.
 
The BAS usually heavy-drops one M998 cargo high-mobility, multipurpose, wheeled vehicle (HMMWV) containing trauma and sick call medical equipment sets, tents, litters, and generators. The FSMC usually heavy-drops two M998 cargo HMMWVs and one M998 with mounted radios for command and control. The FSMC cargo vehicles contain the same types of equipment as the BAS vehicles, but twice the amount. The FSMC also has 15 units of blood strapped into the passenger seat of each M998 cargo vehicle. An FST heavy drop consists of two M998 cargo vehicles carrying a surgical medical equipment set, operating room tables, 30 units of blood, tents, and generators. Once downloaded on the objective, the heavy-drop vehicles become evacuation platforms.

Airborne Operations

An airborne operation begins at parachute-hour (P-hour), which is when the first paratrooper exits the first aircraft. Once on the ground, an airborne medic must get out of his parachute harness, ready his weapon for operation, pick up his equipment, and move to his planned assembly area. The place where the FSMC normally assembles is called an “assembly area support” and is typically located on the DZ, away from the major initial assault objectives.
 
The FSMC commander must execute several tasks within the first few hours of the operation. First, he must account for all of his personnel. The division standing operating procedure requires the commander to have 90-percent troop accountability by P+1. Second, he must establish the capability to treat and evacuate casualties. Establishing this capability involves the commander sending out a heavy-drop recovery team with security to locate, derig, and return with the FSMC’s three heavy-drop HMMWVs. Third, a helicopter landing zone for medical evacuation (MEDEVAC) must be established before P+2 for evacuating casualties to a level III or higher medical facility. [A level III medical facility is normally a corps-level medical treatment facility that has intensive care and resuscitative surgery capabilities.] An ambulance platoon two-person team with a radio must establish the pickup zone (PZ) by P+2. The treatment platoon must assemble the advanced trauma life support (ATLS) tents and equipment by P+2 to receive, treat, and prepare casualties for further evacuation.
 
Part of the establishment of the treatment area includes the FST. The FST tent is set up next to the FSMC ATLS tent. The dental officer triages casualties and sends them to either the FST tent for surgery or the ATLS tent for treatment and stabilization. Once a patient is stabilized, he is placed in the appropriate evacuation category (Urgent—evacuate within 2 hours; Priority—evacuate within 4 hours; or Routine—evacuate within 24 hours) and then taken to the MEDEVAC PZ for evacuation by helicopter to the nearest level III facility. At the FSMC treatment area, casualties are manifested and moved by HMMWV or M-Gator to the field landing site for fixed-wing evacuation from the theater. [An M-Gator is a multipurpose six-wheeled, all-terrain vehicle used primarily for casualty evacuation and supply.] Medics accompany these casualties and monitor them while they await evacuation.
 
Flexibility is key to success. All medics must be able to perform each medical task on the DZ regardless of their rank or section assignment. For example, treatment personnel also must be prepared to establish the MEDEVAC PZ if needed.
 

Airfield Seizure CHS Assembly Plan

Normally, two infantry battalions under the command and control of a brigade task force headquarters execute airfield seizures. Therefore, two BASs typically take part in an airfield seizure.
 
CHS assets initially present on the DZ usually are limited. Therefore, a thorough CHS assembly plan must be developed that includes using all available assets for evacuation and treatment of casualties. For example, during one rotation at the Joint Readiness Training Center (JRTC) at Fort Polk, Louisiana, the BASs and FSMC operated together on the DZ to provide CHS. The factors of mission, enemy, troops, time, terrain, and civilians (METT–TC) drove this collaboration, which enabled the brigade task force to combine limited treatment teams and evacuation personnel and vehicles.
 

Drop Zone Evacuation

As mentioned, evacuation assets are very limited on the DZ. Front line ambulances are not part of the initial airfield seizure package; instead, nonstandard M998 cargo HMMWVs are the preferred evacuation platforms. The medical team does not have enough assets to conduct all evacuations alone, so M-Gators, antitank vehicles, and mortar vehicles also must be used.
 
In the event of a true no-notice deployment of the 82d Airborne Division to a remote location, it may be impossible to have dedicated rotary-wing aircraft for support. In such a situation, the 82d Airborne Division must work with Air Force medical personnel to coordinate the strategic lift of casualties from the DZ. The Air Force’s Aeromedical Evacuation Liaison Team (AELT) is designed to help the FSMC plan, coordinate, and certify the evacuation of casualties on fixed-wing aircraft. The AELT usually works directly with the FSMC commander. Together, they work to evacuate casualties as quickly as possible. The sooner casualties are certified and manifested, the sooner they are evacuated to higher echelons of medical care. Therefore, it is critical to have all patients manifested by the AELT before the first aircraft lands.
 
A mobile aeromedical staging facility (MASF) also can play a critical role in evacuation from the DZ. A MASF is an Air Force asset designed to provide shelter, medical supplies, and medical care while casualties are awaiting evacuation. The MASF can be located near the “hammerhead” of the field landing site. [The hammerhead is the area of the runway where aircraft normally turn around.]
 

Drop Zone Sweeps

It is imperative to provide rapid treatment and evacuation of soldiers in the DZ. To accomplish this, dismounted and vehicle-mounted medical personnel must sweep the DZ for casualties. To avoid fratricide, initial assault objectives should be secure before the DZ sweep is executed. To conduct the sweep, the DZ is divided into grid sectors, and the BASs and the FSMC sweep the sector assigned to them. Established routes are used in each sector. Depending on the terrain, medics may need to dismount and walk through areas where casualties may be concealed.
 
A DZ sweep can be difficult to accomplish because of limited evacuation assets. A balance must be established between sending assets on DZ sweeps and evacuating casualties from casualty-collection points.
 

Follow-on Missions

Out-of-sector air assaults are common follow-on missions after securing the airfield and subsequent objectives. Rotary-wing aircraft from an intermediate staging base usually land on the airfield to load paratroopers for the air-assault mission. Casualties from the air assault are loaded on the last aircraft and flown back to the PZ, where they are offloaded and treated by the medical personnel. Once stabilized at the PZ, the casualties are evacuated to the FSMC or the nearest level III medical facility. This mission is accomplished by a treatment team from either the BAS or the FSMC, depending on the size and complexity of the air assault operation.
 

Ground Operations

As the infantry battalions clear their assigned areas and expand the lodgment, they move and their BASs follow. The bravo echelon arrives once the field landing site is cleared and repaired. When the planes arriving with the bravo echelon land and the vehicles and equipment are offloaded, the arrival airfield control group receives the vehicles and places them into unit chalks (convoy groups).
 
The FSMC vehicles will be directed to the brigade support area (BSA) and will arrive according to a priority vehicle listing. The first vehicle in the priority vehicle listing is usually a light medium tactical vehicle (LMTV) loaded with area support treatment equipment. Once this vehicle arrives in the BSA and links up with the FSMC quartering party, it is downloaded and the area support treatment squad establishes its area.
 
The FSMC BSA quartering party typically consists of the treatment platoon sergeant, a physician’s assistant, and two medics. The treatment platoon sergeant calls the FSMC commander and informs him that he is ready to receive casualties at the BSA. Once this information is sent to the brigade, the patient flow shifts from the DZ ATLS tent to the BSA for treatment. The MEDEVAC PZ is moved from the DZ to the BSA. Once downloaded, the LMTVs are moved to the DZ ATLS site. The LMTVs then move casualties from the DZ to the BSA or, depending on the scenario, to the field landing site for fixed-wing evacuation.
 

Assets are limited during an airfield seizure. Medics have important responsibilities, so they must move quickly at the assembly area and recover the heavy-drop vehicles that contain their equipment. Evacuation assets are limited on the DZ, so the evacuation plan must be well integrated into the overall plan. A well-planned, rehearsed, and executed combat health support plan can save many lives during an airfield seizure.

http://www.almc.army.mil/alog/issues/MarApr04/Airfield_Seizure_Combat.htm