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ment, and supplies are damaged or destroyed. Above
once they realize that the other side considers them-
A medical facility such as this field hospital in Desert Storm makes an ideal target— hard to defend and staffed by medical personnel with little or no experience with field conditions, tactics, security, or weapons. If medical personnel are to be able to take care of the sick and wounded, they first must be able to take care of themselves.
THE ATTACKER’S PERSPECTIVE: Don’t delude yourself, doctor. You are not immune from risk on the battlefield. Medical personnel and their facilities make very attractive targets. In the highly fluid combat theaters of conventional warfare, the physicians, support personnel, and their facilities undoubtedly will be closer to the battle than in previous combat actions. Without total control of the air, helicopter medevac becomes more dangerous, and you must set up closer to the wounded. The threat can come from any direction, and the enemy may blend with the indigenous noncombatant population. Seemingly harmless or even grateful civilians by day can become enemies by night.
The targeting of medical personnel and facilities is not a new phenomenon: In both Korea and Vietnam, surgery performed in helmets and flak jackets was routine for some medical facilities. My job is to assault your field hospital to disrupt its function and perhaps wound or kill as many of your people as possible. You offer me an easy target, with relatively low risk to my assault force—and the act of assault will accomplish nearly as much in failure as it will in success.
In analyzing the strengths and vulnerabilities of a target, I look for the greatest result with the least amount of force and with the least risk to my forces. If I were to plan an assault on a rear-echelon target, you and your hospital would be high on the target list for the following reasons:
► Information and intelligence would be readily available through several avenues. The general openness of your facility and personnel would provide a great deal of information on the location of various activities within tb* hospital compound. Small reconnaissance teams with av erage training can gather a remarkable body of data wit!1' s out coming near your front gate. Indigenous personnel vl!' iting, working, or being treated within the compound oftef can be used to confirm locations and procedures.
> Your security standards and your degree of adherent to them are often less stringent than in other military unit’
> Medical personnel seldom are well trained in war-fig!11 ing skills needed to repel an assault.
> The morale of troops in the field will suffer when thw realize that no one will be able to provide medical
if they are injured.
>■ Medical facilities often are located near headquarters01 aircraft terminals, which have a relatively high tactic3* priority. A lightly defended hospital abutting a more heav ily defended compound or base makes a very convenieI11 backdoor leading into the main target.
An assault can pursue either of two general objec| tives. The first is to inflict general damage and person^ casualties. This could be an attack by fire—with mortal or rocket-propelled grenades, or even hand grenades, sh° or thrown from outside the perimeter of the hospital coH1- pound. The second option is a full-out assault with the o'0' jective of destroying specific equipment or facilities.
In either type of attack, hospital routine is halted °( badly disrupted, as casualties mount and buildings, equip
the morale of your staff and your patients will plumfl121 virtually unarmed, passively defended outpost—a targ1 Efficiency and quality of care will suffer in turn.
As a raid commander, I can mount one vigorous assau and follow it with sporadic harassment. Each incident "'j11 achieve almost the same result as the initial attack: d>s. ruption of medical efficiency. A minimum number 0 rounds fired into the compound on a sporadic basis vvl remind you that you are vulnerable to my firepower, whs11 ever I choose.
Whether you perceive yourself as a healer employed W warriors or a warrior employed as a healer, you, your sta*' and your facility are all vulnerable and tempting targetS’ I am glad that I carry a weapon and not a stethoscope, & cause my combat duties and methods of survival are cl^'
Proceedings / October
1 or understood radio procedures or communications
THE TARGET’S PERSPECTIVE: Most of my medial colleagues practice in secure settings, with controlled eavironments, and use the most sophisticated equipment to provide health care to their patients. Take away our technology by destroying our X-ray, lab, and operating y°om, and we can provide only minimal care to the injured. Disrupt our supply system, or destroy our exist- [ng supplies, and we can provide even less. Injure or k'U members of our medical team, and we may be unable to function.
After every war, the lessons we have learned so Painfully seem to be forgotten. They are relearned at great c°st by succeeding generations. A medical facility is an 'deal target: It is hard to defend, and most of its personnel have little or no experience with field conditions,
H the line expects medical support to be there when need it, they need to provide medical personnel with r°per training and equipment. During Operation Desert 0rrn, personnel from Navy medical treatment facilities ere assigned to the Marines. Many had never been in e field. Most had never pitched a tent or built a bunker. , ery few could place their gas masks into operation or „ 1Ve a military vehicle. Virtually no one had ever used a radio,
j. Jnty. Few had ever fired a weapon; fewer still could assemble and clean one—accidental discharges were ch too common.
All were intelligent, energetic, and willing to learn. They lj a considerable incentive to do so—their survival could ,aVe depended on it. Even in this short conflict, doctors their lives.
Proper training should include everything from living under field conditions to understanding base defense and some infantry tactics. To be able to defend itself and take care of its own needs, the medical department needs to be integrated into activities in the field.
The Combat Casualty Care Course attempts to address this by taking medical personnel to the field. Most medical officers get the opportunity to take this course—a single trip, for one week, to a single field course, once in a career.
Regular exposure to the workings of the operational detachments is essential. There is no better way to understand the role of the Marine in the field or the sailor on a ship than to be with an operational detachment on assignment. There is no better way to understand the limitations of practicing medicine in the field than to be there trying to do it.
There are obvious training needs that must be met, including weapons familiarization, base security, and base defense. Other training should include understanding the problems of communication and supply in the field, familiarization with the effect of environmental factors and fatigue on troops in the field, as well as the impact of food, water, sanitation, and hygiene problems on operational units. When I poll Naval Reserve medical personnel at reserve centers, I usually find that fewer than 1 in 20 can start and drive a Humvee, and fewer than 1 in 50 know how to use a radio. This must be corrected.
Whenever Marines exercise, medical people should go with them. Before being issued personal weapons, the doctors and nurses should train with them and periodically requalify. Otherwise they will be more hazardous than helpful. When a detachment goes to the firing range, make sure the medical people come along to learn. When setting up a camp, teach the doctors, dentists, and nurses about defense perimeters, fields of fire, and booby traps. Make sure they can dig foxholes, provide field sanitation, use a radio, and drive a Humvee.
This might save their lives. It also might save yours.
Captain Baker, a vascular and thoracic surgeon in private practice, served with the First Medical Battalion in support of Marine operations during Desert Storm. He recently returned from the Persian Gulf following a tour as the (acting) force surgeon for U.S. Naval Forces Central Command. Captain Baker has authored numerous articles on trauma and wound care and serves as a consultant to the Joint Military Medical Readiness Training Team at Fort Sam Houston, Texas.
'edings / October 1993