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Third Infantry Division (Mechanized) After motion record - Operation Iraqi Freedon

Third Infantry Division (Mechanized) After action record - Operation Iraqi Freedon

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Chapter 20 combat fitness aid (CHS)

right through Operation IRAQI FREEDOM (OIF), the Third Infantry Division (Mechanized) (3ID [M]) evacuated over 200 troopers to level III clinical care. The behavior of continuous offensive operations over extended distances pressured the Marne medics to count primarily on air MEDEVAC to circulation sufferers from element of damage and forward help battalion (FSB) clinical companies to circulation patients to the helping cellular army surgical hospital (MASH) and combat guide hospitals (CSH) for level III care.

besides the doctrinal complement of corps medical assets, the assisting clinical brigade also connected a neighborhood aid scientific business that operated non-doctrinally, executing division level missions in assist of FSBs and the main help battalion (MSB). The medical brigade positioned three forward surgical groups (FST) in direct support (DS). These FSTs had been then pushed to each FSB. The 507th Air Ambulance enterprise become attached to the division for logistics and upkeep to the 4th Brigade and operated from division airfields and ahead arming and refueling features (FARPS).

subject A - class VIII

problem: vital type VIII shortages throughout the preliminary phases of the deployment.

discussion: unwell name objects and managed elements (R&Q) grew to be essential for all gadgets upon arrival. devices didn't installation with adequate amounts of ailing name gadgets. contraptions had been suggested to bring R&Q objects handiest for those scientific gadget sets (MESs) they were bringing from citadel Stewart. This tips became provided to 3ID(M) by means of u.s. clinical Materiel agency (USAMMA) in keeping with their assurance that APS MES would contain R&Q items. APS MES contained no R&Q items.

suggestion: instruments should installation full in poor health name MES as “to accompany soldier” (TAT). additionally, it is totally recommended they purchase and installation at the least one USARID drug set as TAT. The unwell call objects contained in these units should sustain instruments except line item requisition is centered. despite USAMMA suggestions, units should install TAT all R&Q objects for organic MES.

problem: Planning for the preliminary necessities of classification VIII is essential from a theater perspective.

discussion: 3ID (M) tripled its inhabitants in a bit over a month. The theater turned into no longer able to address the initial class VIII deliver necessities. The Doha warehouse (CSA contractors) refused to allow receipt of class VIII beneath a different branch of protection, defense evaluation middle (DODDAC). This created a condition that required circumvention with the aid of 3ID (M). 3ID( M) started ordering elements using a selected emergency DODDAC issued by means of USAMMA. scientific logistics planners found an alternative beginning website conventional because the valuable receiving deliver aspect (CRSP). This enabled 3ID (M) scientific logistics to move to this tackle beneath a distinct DODDAC.

suggestion: Theater planners need to count on/plan class VIII necessities. This should consist of some mechanism for ordering all kinds of classification VIII (R&Qs, sick name medicinal drugs, and so on.). class VIII debts and accountability should be naturally defined prior to deployment of contraptions into a neighborhood of operation.

problem: information superhighway connectivity in faraway areas inhibits the means to function Telecommunication access formulation (TCAM).

dialogue: bad information superhighway connectivity in far off places creates tricky transmissions of Theater military scientific suggestions equipment (TAMMIS) and TCAM facts. instruments should provide command emphasis on providing their medical property, platoon through business, committed access to native area community (LAN) line connectivity with a purpose to circulate requisitions.

recommendation: clinical groups and the division scientific deliver officer (DMSO) must be in shut proximity to and have committed LAN line connectivity with the small extension node/giant extension node (SEN/LEN) in an effort to pass a hit type VIII requisitions.

issue: at first, enemy prisoners of conflict (EPW) combat configured masses (CCLs) had been thought to be a requirement at a number of areas on the battlefield, principally the EPW collection elements.

dialogue: EPW CCLs had been now not required as the division firstly estimated. class VIII wants for EPWs had been filled applying organic MES. Resupply turned into facilitated via average clinical logistics channels.

recommendation: however now not essential throughout this operation, it is still counseled that devices predict, construct and push EPW type VIII CCLs in fight environments like Iraq. EPW category VIII requirements can immediately exhaust clinical units’ basic load (UBL) of classification VIII and overcome clinical instruments assigned the assignment of EPW care.

difficulty: combat lifesaver (CLS) baggage should be updated and reachable ahead of deployment.

dialogue: Many units did not convey CLS bags to the theater. moreover, many units did not have enough numbers of CLS baggage just before deployment. This created a excessive preliminary demand for CLS bags for every wave of gadgets that deployed into theater. Procurement times for this selected item averaged over a month earlier than delivery to the unit.

suggestion: Commanders should make sure that CLS luggage are inventoried monthly and the appropriate quantity is available to perform the unit’s mission.

challenge: Prescription medicine re-deliver.

discussion: soldiers deployed with 90 days of particular drugs. This became a mandate put in area by means of the garrison clinic. at the 70-eighty day mark, soldiers began soliciting for refills. This created a tough situation due to the inability of scientific logistics infrastructure in nation. As a short repair, providers attempted to ship soldiers to the Camp Doha health facility (ARCENT-Kuwait). This gadget labored for a while unless the final brigades and non-divisional contraptions begun arriving. The system turned into unable to address the special remedy demand of the inhabitants of troopers. Theater level planners assumed that each and every soldier would bring enough particular medicinal drugs for the whole deployment.

recommendation: soldiers deploy with a hundred and eighty-day deliver of particular remedy. a solution for the long-term seems to be enrollment within the online pharmacy software previous to deployment. this will supply a “sure thing” in the experience that particular medications are not purchasable via standard distribution channels on the conclusion of the one hundred eighty-day provide. From a theater viewpoint, a plan ought to be carried out to fill special remedy prescriptions instantly after deployment in keeping with situational variables. for terribly huge deployments, a pharmacist may need to be inserted into the clinical logistics channel (clinical logistics business/battalion) early on to be able to facilitate excessive demand special remedy re-supply. Theater planners need to communicate necessities to CONUS-based mostly clinical remedy amenities (MTF) ahead of unit deployment.

challenge: attached echelons above division (EAD) unit category VIII requirements overwhelmed the DMSO all through reception, staging, onward circulation, and integration (RSOI) and sustainment operations within the camps.

dialogue: At one factor, the 3ID (M) DMSO changed into the only classification VIII give help endeavor (SSA) operational north of Camp Doha. As 3ID (M) begun gaining EAD level attachments with out biological scientific guide, classification VIII requirements overwhelmed the DMSO.

recommendation: clinical logistics belongings deserve to be in area early and alongside division and EAD devices to deliver the further class VIII guide associated with the attachment of unresourced EAD instruments.

concern: requirements for environmental probability prophylaxis (Doxycycline) were now not expected, procured, and issued by way of theater.

discussion: soldiers have been required to take Doxycycline as Malaria prophylaxis. sufficient Doxycycline become no longer obtainable in time for preliminary issue and subsequent resupply.

advice: Theater planners ought to predict universal environmental threats and provide appropriate prophylaxis within the required quantities. Chapter 20 combat fitness guide

topic B – clinical Operations

subject: need present updated scientific intelligence with the intention to get the most desirable product out of the planning system.

dialogue: besides the fact that children a little effective, the defense force medical Intelligence middle (AFMIC) did not prove to be an updated supply of counsel for the medical planning system. one of the vital suggestions became outdated by using as a whole lot as ten years. the vast majority of the tips on armed forces clinical infrastructure became based on a “surest bet” response.

advice: AFMIC should proceed to enrich its information database via working with additional information sources (special operations forces, different governmental groups, non-earnings agencies, etc.). inside information queries through AFMIC can identify info that require updated profiles. The organization should offer greater real-time clinical intelligence emphasizing the present force infrastructure and the clinical logistics assist channel (i.e. mounted hospitals and supply channels assisting definite defense force instruments).

challenge: gadgets performing RSOI have to make certain appropriate coordination is made with RSOI and receiving instruments.

discussion: gadgets answerable for RSOI perpetually despatched instruments (FSTs, ASMCs, MASH) to the inaccurate destination. devices persisted to demonstrate up at units with little or no word and constantly the incorrect region. This led to a way of confusion amongst all parties concerned and reflected poorly on the receiving unit. Updates on RSOI/arrival of gadgets have been always given upon request, no longer through any pre-established replace timeline.

suggestion: Theater-stage RSOI instruments ought to be certain each day updates are forwarded to receiving unit points of contact (POCs) with a purpose to achieve continuity. figuring out that arriving gadgets do not all the time arrive as scheduled, day by day updates would enable the flexibility for subordinate contraptions to alter timelines. all through a excessive volume of unit RSOI, this will enable receiving instruments to perpetually update subordinate commands on the arrival of units.

difficulty: clinical personnel deserve to categorize sufferers accurately for scientific evacuation.

discussion: clinical personnel categorized sufferers as “litter-pressing” the vast majority of the time. This categorization was not necessarily the acceptable classification of the affected person. It became a “blanket categorization” for clinical personnel within the triage procedure. In our specific condition, it didn't be counted from an evacuation viewpoint on account of the sole reliance on air MEDEVAC. Inaccurate categorization consequences did not floor except they reached better command channels. anxiousness concerning casualties tends to be plenty greater universal amongst commanders when categorization is extreme in nature.

advice: On-site medical personnel should be capable of categorize casualties according to guidelines set forth in appropriate doctrine. this will give personnel concerned in the evacuation manner with the relevant assistance. This, in flip, will enhance the capacity of evacuation personnel to make the acceptable decisions on disposition of the patient.

concern: militia police (MPs) units require exterior medical augmentation/support with a view to care for enemy prisoners of war (EPWs).

discussion: military police (MP) gadgets had wonderful problem presenting medical care to EPWs with their inner scientific materials. MPs were not in a position to provide clinical take care of the wide selection of EPW scientific wants. EPWs had injuries ranging from gunshot/fragmentation wounds to damaged bones. This specific latitude of accidents requires scientific treatment commensurate with level II capabilities coupled with a forward surgical team (FST). In definite cases, the MPs acquired EPWs from a helping forward assist clinical company (FSMC)/FST after surgical procedure and put up-op were comprehensive. in keeping with environmental situations (desert, arid conditions, lack of shaded area), the MPs discovered it very difficult to look after EPWs after the particular submit-op period. In several circumstances, EPWs needed to be transported again to the aiding FST or greater stage of care as a way to regain stabilization.

advice: Plan to connect some category of clinical augmentation package to the MP instruments which have an EPW preserving mission. recommended kit add-ons: keeping capability, remedy skill, evacuation ability, and both instant access to an FST or the collocation of an FST.

difficulty: start of humanitarian counsel (HA) materials must be coordinated down to the lowest level.

dialogue: HA components invariably arrived with little or no be aware before birth. many times HA supplies have been delivered devoid of ground components’ abilities. This brought about an excellent deal of misunderstanding in deciding on disposition and storage necessities for HA supplies.

advice: Prior coordination of HA materials has to be communicated down to the bottom degree with prior observe so as to facilitate disposition of materials.

subject C - medical Evacuation (MEDEVAC)

situation: Synchronization of MEDEVAC in practicing versus peacetime. Many planners accept as true with that MEDEVAC aircraft “hop alongside at the back of the BSA all the way through circulate.”

dialogue: FSMCs have to make certain that devices understand the supply of MEDEVAC is limited to ambulance trade aspect (AXP) and rearward places in most cases (unless armed escort or a secure area is accessible). For planning functions, MEDEVAC plane are not in a position to launch from the FSB unless the battalion assist area (BSA) is determined.

problem: verbal exchange with MEDEVAC methods.

discussion: In working towards, range manage (Kuwait) facilitated all MEDEVAC evacuations the use of the 1042nd out of the Oregon national defend. This resulted in a undeniable complacency as MEDEVAC devices deployed into theater. After approximately one month, deploying MEDEVAC contraptions had did not comprehensive a communications synchronization activity in order to test present methods both for the requesting gadgets and the MEDEVAC unit.

advice: check MEDEVAC communications channels as soon as feasible with a view to be sure operability of both the asking for units and the receiving devices, each “within the crimson and in the green.”

challenge: Command and control (C 2 ) relationships regarding MEDEVAC gadgets.

discussion: during this instance, the MEDEVAC unit changed into absolutely reliant on the 3ID (M)’s aviation brigade for maintenance and guide. This become because of the fact that the brigade had essentially the most amazing UH-60 upkeep package in theater. The corps endured to try and region the unit in DS of the division. This created a tough circumstance for the DMOC and the aviation brigade. Corps did not have the maintenance property to guide the MEDEVAC. Aviation brigade became reluctant to help due to the C 2 relationship. DMOC persevered to attempt to serve as a broking service between both companies. finally, corps connected the MEDEVAC unit to division for “protection and logistics aid.”

recommendation: Corps headquarters elements ought to connect corps contraptions operating in direct support of division gadgets. this will alleviate numerous administrative as well as logistical issues. allowing for, the corps can at all times detach units reckoning on a transformation in mission or requirement.

issue: Synchronization of MEDEVAC with aviation brigade FARP/start FARPS.

dialogue: Aviation brigade and division assist command (DISCOM) experienced problems synchronizing soar times and operational start times for FARP operations regarding MEDEVAC employment. The aviation aspect has a different emphasis all the way through the combat, so the FARPS are normally determined to facilitate a constant forward flow, versus a rearward evacuation circulation. all through the fight, MEDEVAC continued to evacuate to the closest level III facility, invariably determined rearward.

suggestion: The aviation brigade FARP features may should extend jumping property ahead unless level III amenities have echeloned and centered ahead. an additional alternative is to make the most of interior MEDEVAC FARP assets to kind stand-alone places. This option requires security or extra fight vigor from the leading/aiding effort to ensure that this asset to stand on my own. Planners might also plan to make use of any fixed factor on the ground the place the MEDEVAC belongings can “piggy lower back” on existing fight constitution (i.e. fuel aspects, convoy guide facilities, renovation collection aspects).

problem: There was some confusion regarding MEDEVAC insurance all over circulation of DS business.

discussion: MEDEVAC insurance all over DS enterprise movement ought to be coordinated in advance of the movement of the DS business. The DS business moved all assets ahead to new place and there become confusion on who had insurance. at last, the DS business become contacted and it turned into decided that the typical aid (GS) enterprise turned into accountable for coverage all through move. on the time the GS company’s region become about 1.5-hour flight time. The confusion caused a couple of 20-30 minute lengthen, which, in turn, caused a 2-2.5 hour response time.

advice: Evacuation battalion/scientific companies should coordinate with aviation brigade elements with a view to synchronize aviation actions with MEDEVAC insurance to alleviate lapses in coverage during stream. make sure the coverage plan is communicated to supported units.

subject matter D - clinical Nuclear/biological/Chemical (NBC) defense cloth

challenge: scientific nuclear, organic, chemical, defense cloth (MNBCDM) storage requirements.

dialogue: Storage capacity is not existing at the brigade and division stages for storage of the MNBCDM. youngsters the leading aid clinical company can be capable to keep minimal amounts the use of substances “out-of-conceal,” further refrigeration is required for the entire division support enviornment exercise.

suggestion: each brigade and divisional aid battalion requires some class of temperature-managed ambiance (reefer van) for storage of NBCDM.

challenge: Issuing MNBCDM to the particular person soldier.

discussion: Some units independently distributed MNBCDM devoid of larger headquarters information. This created accountability, environmental control, and protection considerations. Some ahead guide battalions (FSB)/brigade surgeons issued the MNBCDM all the way down to the particular person soldier level. This multiplied issue in accounting for the materials, which have been to be reported on a weekly groundwork. It also created an unstable storage environment for the chemical substances. in addition, there are protection concerns for the soldier may still there be an unintended auto-injection, a situation that did occur throughout particular person issue.

suggestion: dangle MNBCDM at the FSB degree until the theater directs issuance to the soldier level. this may certain the chemical’s effectiveness and accountability, in addition to lowering the probability of someone by accident auto-injecting.

topic E - army Prepositioned inventory (APS)/New device Fielding

situation: New device fielding earlier than deployment.

dialogue: device that turned into obligatory or scheduled to be fielded to devices earlier than deployment had tremendous training and fielding concerns in response to timelines for deployment. as an instance, the Chemical biological defensive shelter system (CBPSS) became scheduled to be fielded to the division in November 2002. the vast majority of 3ID (M) contraptions deployed in the mid-January to mid-February 2003 time body. The equipment was fielded in mid-February 2003 and practising become carried out in Kuwait. further instruments (area aid medical companies, forward surgical teams) persevered to enter the central Command (CENTCOM) theater devoid of the proper training.

advice: With the current operations tempo (OPTEMPO), according to “The warfare on Terrorism,” contractors/govt fielding organizations need to create a “usual” versus an “accelerated” timeline. this will create two timelines which are based entirely on the probability of a unit’s deployment timeline. more importantly, these timelines should be communicated the entire approach right down to the consumer level. The units outlined above may still were expert in CONUS between the months of December 2002 to January 2003.

challenge: R&Q (controlled substance) medicines need to be inventoried as part of the APS set.

discussion: The R&Q drugs have been now not discovered with the APS clinical device units (MES). This created enormous concerns in coaching for combat operations. The R&Q medications had been certainly recognized as an argument, early on, and the problem changed into no longer rectified in a timely method.

suggestion: USAMMA should be sure that R&Q medicinal drugs associated with APS sets are inventoried on a monthly basis and that the quantity suits the variety of MESs in line with allocation.

topic F - Communications

problem: In a fast-tempo operation, it's vital to execute lengthy-range communications. Divisional medical businesses are unwell fitted for lengthy-latitude communications (distances beyond 30 kilometers).

discussion: 3ID (M) medical planners voiced persisted issues in regards to the long-range communique means of each the forward assist and main aid scientific corporations. This without delay impacted the capacity to communicate with larger headquarters in both division and corps. They currently have the AN/GRC-213 (AM) radio as a part of their MTOE. These radios are antiquated and fix materials are problematic to attain. many of the clinical businesses (three of 4) deployed without operational AN/GRC-213s after having constituents on order for as much as three months previous to deployment. They have been pressured to count on the brigade fight group (BCT) tactical operations facilities (TOC). this is the simplest lengthy-latitude communications skill within the BCT that presents a high frequency (HF) radio. The clinical brigade attempted to mitigate this shortfall by issuing Iridium phones to every clinical business. These phones can even be unreliable because of satellite tv for pc availability.

recommendation: official long-range (30-one hundred kilometers) communications should be embedded into the division clinical groups with a purpose to enhance effectiveness.

situation: A widespread HF/lengthy-latitude radio is needed in corps and divisional medical contraptions down to the FSMC stage (to include DMOCs).

discussion: Division scientific operation middle (DMOC) has plenty the equal subject because the medical groups. The clinical brigade issued an Iridium telephone to the DMOC, as it did to the scientific groups within the division. additionally, the scientific brigade also issued an HF radio (GPR-117) to the DMOC a couple of days earlier than the upcoming engagement. This created two problems. the first turned into a working towards challenge and the 2nd was a universality situation. The scientific brigade did not have a plan to coach units on the new radio earlier than use. In addressing the 2nd problem, there are a variety of medical devices within the corps level constitution. most of these units possess several different types of communications gadget. For functions of this operation, the division points can only talk to the contraptions that chiefly have a GPR-117. This created issues in communicating with the a considerable number of corps medical belongings.

suggestion: purchase a protracted-latitude gadget it really is common and is embedded at the FSMC degree and above.

subject: Communications between units with diverse headquarters is required on the earliest feasible juncture.

discussion: 3ID (M) planners were no longer allowed to communicate with devices that belonged to other headquarters (III Corps, V Corps) unless the last moments of the operational planning. This led to a fine deal of bewilderment when units at first arrived in the area of operation. 3ID (M) planners were ignorant of the complete capabilities of the arriving units as smartly as the necessities for initial employment.

suggestion: Headquarters should increase flexibility in enabling devices to talk capabilities early on, as well as necessities upon arrival.

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