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