1. Urban Warfare CPT James R. Rice Emergency Medicine Interservice Physician Assistant Program

2. References n DT 8-MOUT, Combat Health Support for Military Operations on Urban Terrain n 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 n MAJ (Ret) Mark Stevens, 5th Special Forces Group, Lessons Learned in Operation Enduring Freedom n CPT James R. Rice, 566th ASMC, 3ID, Lessons Learned in Operation Iraqi Freedom

3. Overview n General Concepts n Combat Medic n BAS

4. General Concepts n Military Operations on Urban Terrain – (MOUT) n Decentralized and isolated environment – Individual first aid/buddy aid is critical – Cross load medical supplies – Get city maps if possible

5. General Concepts n Complicated mission within the mission – You can’t pre-plan enough – You can’t rehearse enough n Mass casualty planning – Commo n Develop both an external and internal plan

6. The Combat Medic n The medic needs to be able to operate independent of the PA/MD – Medically – Tactically n They may be a shooter first n Don’t get shot! – Trained on how to enter buildings – Don’t run out into the open to get a casualty n Get close in order to visually eval the casualty n Drag the casualty to safety

8. The Combat Medic n Providing cover for the casualty – Utilize a rope with a D-ring n Good for dragging – Utilize vehicles as a barrier – Smoke grenades n Treating Casualties – Utilize TC3 approach – Be prepared for a lot of wounded-Triage!!!

9. The Combat Medic n 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 n Labor intensive – Improvised litter material – Litter bearer training

11. Battalion Aid Station n 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 n You may be able to create a more established facility n However, be prepared to to jump – Things might go bad – Things might be going great

12. Not a good site

13. Battalion Aid Station n 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 n Treatment space n Defensive positions

15. Battalion Aid Station n Acquiring patients – Pre-plan CCPs – Push your FLAs as far forward as possible n Remember, litter carry evac is tough n 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

16. Battalion Aid Station n Treating Patients – May see more closed space blast injuries n TM ruptures n Burns – May see more crush injuries n Plan for extrication equipment

19. Battalion Aid Station n Evacuating Patients – Utilize air evac if possible n Roof tops may not be stable enough n Coordinate hoist equipment – Good for evac and for bringing in supplies – Ground evac n Pre-plan non-standard evac n Plan primary, secondary and tertiary routes – The enemy may case-out your routes – The battle may flow interfere with a route

21. Summary n MOUT is the greatest challenge for both the tactical commander and the medical provider n Pre-planning is absolutely critical – Get involved!!! n Develop back-up plans and then back-up plans to your back-up plans

22. Questions?? The End