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By Commander Steven L. Oreck, Medical Corps, U.S. Naval Reserve
Joint military operations in remote surroundings will put additional demands on Navy medical personnel. Meticulous prior planning and familiarity with other services’ and allies’ operations—here, members of U.S. Hospital Unit Six train with hospital corpsmen from New Zealand during Desert Storm—will ensure support is there when it’s needed.
For the U.S. military, Desert Storm was the first major operation of the new joint era. With the downsizing of the U.S. military and the international emphasis on multilateral action—whether through the United Nations, NATO, or other international groups—U.S. naval forces no longer will have the luxury of doing things eti' tirely “our way.” We increasingly will have to deal wit*1 doctrine and systems that are different from ours, and that may not be what we want or need. This extends to the joint planning of medical treatment.
To many people, medical support is something that “jus1 happens.” In fact, proper medical support requires detail^ planning, including many of the same operational coH' siderations (supply, communications, interoperability, an1* doctrine) as any military operation. Remote medical op' erations require even more planning, especially when seV' eral services or allies are involved.
The medical support for the multinational explosive ord' nance disposal (EOD) team that cleared the harbors, ap' proaches, and underwater pipelines of liberated Kuwa*1 had to operate in this new joint environment. While unde1 Navy auspices and staffed by Navy personnel, the EO^ team involved other U.S. services and several coaliti0'1
allies, as well a* local Kuwai11 medical and sup'
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port services. This effort—bo^ its successes art' its failures—wd1 help to highlig'1! the planning an11 procedures neces' sary for propel medical supp°r for remote jo<n operations.
EOD operatic11! in Kuwait, base at As-Shuwaik harbor in KuW^1 City, require( medical supp°fa
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'ng or displacing without notice. It took a significant effort—on almost a daily basis—to maintain contact with tfiese backup units. This was critical for many reasons, n°t the least of which was to confirm their continued op- national status.
One reason for the “disappearing-unit” problem and the aced for reconnaissance by the medical team was that no- b°dy was in charge of medical support in the Kuwait City area. Various components of a medical support system jyere in place and working together—because ot the ef- °rts of the personnel involved—but no one was in charge, to make sure it happened.
Oomnlicating the medevac problem were difficulties Mth bofi communications and transportation. No local
J ^“Ceedingf/ October 1992
One major consideration was the rearward evacuation °f casualties. Any serious illness or injury could only be stabilized at our level, and prompt evacuation to a more- CaPable facility could be a matter of life or death.
The primary backup facility for most of the deployment was the 377th Combat Surgical Support Hospital (U.S.
^rmy Reserve), which was set up at Kuwait International Airport, about 15-20 kilometers from the port. The 377th’s deployment period was extended by about a week, to preVent a gap in coverage. Other limited coverage became
bailable from a French medical facility established in the magmneu. uesen cuu.n. auuwwu mm — — —
New English School and a British surgical team estab- pect to see significant medical problems on scant notice fished at the Amahdi hospital. A medevac map was avail- frequently from an unexpected quarter.'1 The only way for able, but the medical facilities listed had a habit of clos- the medical support personnel to deal with these problems
for *1 particuf
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all countries, and the 4rug of choice
units organic to the operation.3 Organic medical support consisted of one hospital corpsman (HM) attached to Mobile Inshore Undersea Warfare 202, one HM attached to 'he U.S. Marine Corps Fleet Antiterrorist Support Team, and one Royal Australian Navy medic. In addition, one special operations/chamber qualified HM was stationed °n board the MV Scorpio del Golfo, a chartered vessel supporting dive and SAM (remote-control mine-clearing drone) operations in offshore areas.
Medical supplies were limited. Fleet Hospital Fifteen, located northwest of A1 Jubayl, Saudi Arabia, was tasked with providing additional medical support to this operation. This support consisted of a medical officer (two were Used in rotation) and supplies. The supplies and equipment brought to Kuwait City from the fleet hospital were equivalent to a partial battalion aid station.
The predeployment concept of the operation was to be able to support routine illness and some types of diving- related problems, and to provide early resuscitative care to casualties—whether due to accidents, explosive incidents, or hostile action—for approximately 60 personnel. The operational base at As-Shuwaikh was at the end of a P'er, with living quarters, messing, and work spaces in a Warehouse. The harbor master’s building, slightly bomb- damaged, was used for the headquarters and medical offices. A “battle-dressing station” with significant supplies Was established in the warehouse to preclude having to move casualties, exposing them to more fire. The opera- b°n lasted about one month.
Operational Problems
landlines were available, and the different tactical communications systems (TASS, RITA, MENTOR) were not compatible. VHF guard frequency for medevac was common, but VHF transmission in an urban area can be problematic. Access eventually was gained to the British clear HF net, which allowed more stable communications.
In addition, this provided access to the Royal Navy Sea King helicopters at St. George’s Lines. Army medevac helicopters at Kuwait International Airport were singleengine UH-ls—which had significant range limitations— and the Army aviators were reluctant to use them for any overwater flights. Another problem with evacuation from on board ship was the lack of a properly rigged Stokes litter. One salvaged at the port was crudely rigged and made available if needed. Land transport was limited; there were no ambulance-type vehicles at As-Shuwaikh. Any casualties moved by land had to be by truck or jeep.
Supplies were a potential problem. It became obvious that the kit brought from Fleet Hospital Fifteen needed to be augmented. Fortunately, medical supplies were available from the 377th. This was arranged on an ad hoc basis; supply through normal channels was nonexistent. Another problem was camp sanitation and preventive health. No test kit was available to check chlorine levels in drinking water, and there were no materials for pest control. Fly infestation was a major problem, and fly bait/poison and rodent-control services had to be obtained through the Kuwaiti ministry of health.
Discussion
A naval officer operating with Standing Naval Force, Atlantic, or a similar multinational force would never set to sea without ensuring adequate understanding of operational and technical interoperability issues. Similarly, no Marine Corps officer would go into the field with an army unit on his flank without ensuring adequate communications, a common tactical plan, and common fire support plans. The medical field should be no different.
Even in a rich environment, such as a stateside military hospital, interservice problems occur. In the austere environment of remote operations, these problems become magnified. Desert Storm showed that remote units can ex- is to be prepared for them.
The rules governing medical preparedness are not complex, and need only be stretched a bit to cover the joint environment. A key point is knowing who and where your backup is—before you need it. And they need to know who and where you are. If your backup moves or packs up without telling you, it could cause serious problems.
The same rules cover medical supply. If you run out of something, a ready source of resupply should have been identified already. Furthermore, if you encounter an unexpected problem—such as a disease outbreak—you need to be able to get your hands on the appropriate medications. Unfortunately, drug names nre not the sar le in
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ness may vary from country to country. Forehandedness is the watchword.
Knowing where your medical and supply backup is does not help if you cannot talk to them. Adequate communication, tailored to the geography and distances involved, must be established. A medical communication plan is a must.
Medevac also must be addressed in advance. If all you have are short-range helicopters, with little or no capability to operate over water, plan accordingly. Casualties can be moved in almost any vehicle, but if all you have are vehicles that do not allow access to the patient during transport, you will need to take appropriate action.
One way to ensure these problems are addressed is to have someone—anyone—in charge of and responsible for the medical support system. If someone isn’t responsible, nobody is. The Navy medical department representative and the line commander must have access to a responsible individual for predeployment planning and to assist with solving problems after deployment.
will be minor and easily dealt with on the local level but hope is not a substitute for preparedness.
Navy Medical Department personnel must familiarize themselves with the way other services and our allies provide medical support, and learn now how to operate together. And line commanders must realize that achieving adequate levels of medical support in a joint environment! requires additional preparation and work. We in Navy i medicine are flattered by the assumption that medical sup-[1][2] port is always there—that it “just happens”—but when the chain of support involves other services or other coun- ]y tries, sometimes it just doesn’t. ^
Conclusions
d witf
Fleet Hospital Fifteen in Saudi Arabia and EOD Group 1, detachment Alt[3][4]’'
Joint operations are here to stay, and we must be prepared to operate in this environment. The days of a relatively unbroken Navy chain from the tip of the spear rearward are gone. Medical officers operating in a remote environment must make up for lack of facilities and supplies by meticulous prior planning. We all hope the medical problems encountered during these remote operations
Commander Oreck, an orthopaedic surgeon in private practice, servei in Kuwait City. He currently is a drilling reservist with a PRIMUS medical unit. He was commissioned via aviation officer candidate school l" 1970 and, after leaving active duty, served with reserve intelligence units before attending medical school and transferring to the medical corps. He has served with clinic units, Marine Corps units, and fleet hospital[5]' Commander Oreck is a prior Proceedings contributor.
ARLEIGH BURKE ESSAY CONTEST
curity number, address, and office and home phone numbers (if available) of the essayist, along with the title of the essay and motto. The identity of the essayist will not be known of the judging members of the Editorial Board until they have made their selections.
The U.S. Naval Institute is proud to announce its ninth annual Arleigh Burke Essay Contest, which replaces the former annual General Prize Essay Contest.
Three essays will be selected for prizes.
Anyone is eligible to enter and win. First prize earns $2,000, a Gold Medal, and a Life Membership in the Naval Institute. First Honorable Mention wins $1,000 and a Silver Medal. Second Honorable Mention wins $750 and a Bronze Medal.
The topic of the essay must relate to the objective of the U.S. Naval Institute: “The advancement of professional, literary, and scientific knowledge in the naval and maritime services, and the advancement of the knowledge of sea power.”
Essays will be judged by the Editorial Board of the U.S. Naval Institute.
ENTRY RULES
- Essays must be original, must not exceed 4,000 words, and must not have been previously published. An exact word count must appear on the title page.
- All entries should be directed to: Publisher, U.S. Naval Institute, 118 Maryland Avenue, Annapolis, Maryland 21402-5035.
- Esays must be received on or before 1 December 1992 at the U.S. Naval Institute.
- The name of the author shall not appear on the essay. Each author shall assign a motto in addition to a title to the essay. This motto shall appear (a) on the title page of the essay, with the title, in lieu of the author’s name and (b) by itself on the outside of an accompanying sealed envelope. This sealed envelope should contain a typed sheet giving the name, rank, branch of service, biographical sketch, social se
- The awards will be presented to the winning essayists at the 11 t-)t l Annual Meeting of the membership of the Naval Institute. Letters notifying the award winners will be mailed on or about 1 February 1993, and the unsuccessful essays will be returned to their author* during February.
- All essays must be typewritten, double-spaced, on pap[6]' approximately 8 ‘A x 11". Submit two complete copies.
- The winning and honorable mention essays will be published in u1 Proceedings. Essays not awarded a prize may be selected publication in the Proceedings. The writers of such essays will « compensated at the rate established for purchase of articles.
- An essay entered in this contest should be analytical and 1° interpretive, not merely an exposition, a personal narrative, or a report'
Deadline: 1 December 1992
K
'LCdr. A. G. Rankin, RAN, and Lt. R. G. Smith, RAN, -‘Australian Divers Cleat Mines,” U.S. Naval Institute Proceedings, July 1991 n
[2]LCdr. Dana Covey, USNR, “Offering a Helping Hand in Iraq,” U.S. Naval 1° V stitute Proceedings, Naval Review Issue, May 1992 t|
[3]Capt. Michael D. Roberts, USNR, “Navy Medicine and the Marines,” Navy Med' j icine, March/April 1992
[4]Major William Johnson, USA; Capt. Charles J. O’Hearn, USA; and Col. Josep
J. Dobner, USA, “Orthopaedic Experience in a MASH Unit in Postwar Iraq-
Orthopedics, April 1992