Medical Course of Action Tool Basics of using M-COAT Updated by LTC Bruce Shahbaz 12 Dec 2005

Agenda Introduction Agenda Learning Objectives Problem Statement Casualty Estimation Methods Medical Course of Action Tool Conclusion

Learning Objectives To introduce the fundamental principles of casualty estimation and their effect on CHS planning. To teach the basics of using the Medical Course of Action Tool.

Problem Statement There is no Army approved automated tool for conducting casualty estimation and CHS course of action planning for division and below operations Kuhn Study / JCS Guide 3161 - Corps level casualty estimation, can drill down to Division FM 101-10-1 vol 2 - Division and above ARI’s Commander’s Battle Staff Handbook - Battalion level casualty estimation Medical Analysis Tool (MAT) Corps and above Course of Action tool Does NOT do Casualty Estimation The Army has not had an approved method for doing Division or Brigade level estimates in “stand alone” Operations for the past 20 years. You can not just apply Corps level rates to Division level operations, Division rates tend to be higher than Corps rates of similar time periods.

Casualty Estimation for 1003V (US/Coalition Forces) Used numerous tools: Medical Analysis Tool CJSC 3161, “Casualty Planner” US AMEDD DNBI Data FM 8-55 Dupey Attrition Model -1% and 3% MCOAT (Medical Course of Action Tool) ACE (Army Casualty Estimate) 34 days (19 Mar – 20 April) “Shock and Awe” approx 1% for TBCs and 4% for DNBI This shows 3rd MEDCOM’s estimates for the “shock and awe” (20 March 2003 to 1 May 2003). Overestimated Total Battle Casualties and underestimated DNBI Why? Battle for Baghdad not as bad as originally forecasted, less resistance than anticipated. Also, a large shift from inpatient care to outpatient care for DNBI – historical models are inpatient care focused. Finally, shorter hospital length of stays for many WIA patients. Quickly evacuated from theater to Germany. Source: BG Weightman AUSA Presentation 2004

Casualty Estimation Methods FM 101-10-1 Volume 2 OPLOG Planner G1/G4 Battle Book Logistics Estimation Worksheet JCS Guide 3161 Dice Agree to what the Commander says Modified Dupuy Method Some of the historical models: Most are developed from WWI (not a typo, world war one) data. Joint Chief of Staff Guide 3161 is the Army’s approved method. Intended for mulit-day Corps operations, Division and Brigade estimates can be derived from the Corps estiamte.

Background M-COAT was originally developed in Force Structure and Analysis at Fort Sam Houston, TX in 1998 Confusion on whether it is a casualty estimation tool or medical workload tool – it is a medical workload tool Available on AKO 70B Toolkit (https://www.us.army.mil/suite/folder/540490). It is NOT AMEDD approved!!!! Not an Army or AMEDD approved solution – just a tool that can be used if you choose.

AKO Folder – 70B Toolkit https://www.us.army.mil/suite/folder/540490 Current Screen Shot from AKO Users Book is an instruction handbook with step by step instructions. MCOAT 8a is the most recent version. COFM MCOAT is another approach at examining the Coefficient of Forces or Battlefield Calculus. OOTW MCOAT is an article on using MCOAT for Operations Other Than War. Casualty Estimation and Workload Planning is a basic tutorial. https://www.us.army.mil/suite/folder/540490

A Low Cost, Low Risk, Near Term Solution M-COAT Overview Based on COL Trevor Dupuy’s casualty estimation method from Attrition (Nova Pub. 1995) Conventional casualty estimation method only Intended to serve as TACTICAL level Course of Action Tool Casualty Estimation is a critical Battle Staff Task Medical Requirements Personnel Replacements Not intended to serve as a Force Structure or Programming tool! Attrition: Forecasting Battle Casualties and Equipment Losses in Modern War* by Trevor N. Dupuy (NOVA Publications) ISBN 0-9638692-3-X, Paperback (176 pages), $19.95 MCOAT does NOT do NBC / CBRNE, Biological, or displaced civilians Allows planners to analyze various courses of action. A Low Cost, Low Risk, Near Term Solution

M-COAT Five Modules ExcelÒ Spreadsheet Based Casualty Estimation Patient Flow- RTD and Evac Losses Workload Evacuation Requirement and Capability Operating Room Req. and Cap. Hospital Bed Req. and Cap. Medical Supply Basis of Allocation Rules ExcelÒ Spreadsheet Based The casualty estimation module is just the front end of MCOAT, the value lies in the other medical areas. Patient Flow is based on the Total Army Analysis process and assumes a 7-15 evacuation policy. Much of workload is based on FM 8-55 Medical Supply estimation is based on subject matter experts opinion and provides a macro level estimate

M-COAT Casualty Estimation (con’t) Nine Factors that affect WIA rates: Population at risk (PAR) Terrain (17 variables) Weather (12 variables) Posture (8 variables)* Strength (17 variables) Opposition (31 variables)* Surprise (4 variables) Sophistication (15 variables)* Operational Form (5 variables)* Population – the smaller the population the greater the potential for larger casualty rates. A platoon in combat has a greater probability of having 50% casualties than does a battalion or brigade. As a percentage, more of the platoon is contact with the enemy. Terrain – In general, as terrain becomes more open and line of sight increases; casualty rates increase. Weather – Casualty rates increase as weather becomes less restrictive. Extremely hot or cold weather tends to decrease the casualty rate. Posture – Casualty rates are higher for offensive forces against successful defense positions. Opposition – Better equipped, trained and led enemy forces tend to increase casualty rates Surprise – the enemy’s ability to surprise friendly forces increases casualty rates. Operational Form – For the Attacker, casualty rates are higher for continuous fronts and lower for disintegrated fronts. For the defender, rates are higher for 258,019,200 combinations x PAR * Denotes areas that are modified from Dupuy’s original formula

M-COAT Casualty Estimation (con’t) Three Factors that affect DNBI Population At Risk Battlefield Location (5 variables) Geographic Location (36 variables) Based on Force Structure and Analysis’ DNBI rates The AMEDD Center and School developed this methodology for estimating DNBI. It is based on: How many people deployed Where on the battlefield are they? What is their level of infrastructure? The more austere, the higher the DNBI rate. Where in the world are they? The more endemic diseases, the higher the DNBI rate.

M-COAT Modules Patient Flow- Derived from TAA05 patient flow Workload - Uses FM 8-55 evacuation planning factors Class VIII consumption- Medical Resupply Sets, FST supplies, and Blood Basis of Allocation rules (MRI and MF2K) Most of the other planning factors come from AMEDD approved planning factors, taken from FM 8-55. The blood planning factor is based on the experience of the International Committee of the Red Cross and their blood usage at Red Cross hospitals, which have two Operating Rooms and 20 cots, limited lab and X-Ray.

A Graphic Comparison Of Various Casualty Estimation Methods +1566% -1566% G1/G4 Battle Book +1416% -1416% FM 101-10-1 +42% -42% Dupuy +30% -30% M-COAT (Modified Dupuy) Blind analysis done on 13 “modern” battles shows the accuracy of various methods. The battle included: Anzio Breakout in 1944 Mortan in 1944 Chinese Farm (Yom Kipper War) in 1973 Panama (Just Cause) in 1989 Iraq / Kuwait (Desert Storm) in 1990 Casualty Estimate (Standard Error of the Estimate) Based on 13 Battles (1940-1991)

Medical Course of Action Tool A screen shot of M-COAT shows the drop down menus used in the casualty estimation tab

Conventional vs. Operations Other Than War M-COAT Conventional OOTW Posture Offensive Recon - Screen Opposition Significant Advantage Overwhelming Advantage Surprise Minor Substantial Pattern of Operation Disrupted Front Recon An example of how M-COAT could be used for operations other than war. It is important to do daily estimates that vary based on the changing enemy and friendly situation. When doing OOTW estimates, it is important to account for smaller unit combat engagements. Examples of the different settings that COULD be used

Conventional vs. Operations Other Than War Example – Constant: 5k Soldiers, Urban, Dry Sunshine, No Sophistication Advantage Vary: Posture, Opposition, Surprise and Pattern of Operation M-COAT Conventional OOTW Total Battle Casualties 189 65 WIA 161 55 KIA 28 10 This show how changing the settings decreases the TBC by about 2/3. Examples of the different settings that COULD be used

Medical Course of Action Tool A screen shot of the workload tab, which shows level 1 combat health support. It is important to remember to use average vehicle speed, not max speed. You must take into account the time it takes to load and unload patients. Also, don’t use the max vehicle capacity as your planning factor – we don’t usually wait around for an ambulance to be full before we start evacuation. This tab will provide lots of information, but solutions to problems are not provided. It is up to the planner to figure out what is problematic and how to resolve the problems.

Airborne Operations Estimates the additional number of casualties that suffer injury from the jump Airborne casualties are in addition to conventional casualties Influences: Day vs. Night (night has higher casualty rate) Equipment weight (greater weight increases casualties) Drop Zone Conditions (harder surface increase casualties) Based on data provided by Ranger Regiment surgeon, the airborne operations method has been modified. This data came from 4 combat jumps (2 Iraq and 2 Afghanistan) and four training jumps. Several hundred jumpers total. Bottom line, the more stuff you jump with and the harder the DZ – the more casualties you are going to have.

Creditable Casualty Range The estimates are based on a number of assumptions: the operational success and the enemy resistance are the two most critical. This graph shows the WIA estimate in red and the high and low range of possible casualties. A good medical planner should have a contingency plan for the high end estimate.

Conclusion One of several tools available for use by medical planners, it is NOT the only / best / preferred way Routinely updated and improved based on user feedback, tell me how to make it more useful Do not hesitate to call or email and ask questions Bruce.shahbaz@us.army.mil The end