A COMPARATIVE ANALYSIS OF THE MEDICAL SUPPORT

IN THE COMBAT OPERATIONS IN

THE FALKLANDS CAMPAIGN AND THE GRENADA EXPEDITION

A thesis presented to the Faculty of the U.S. Army

Command and General Staff College in partial
fulfillment of the requirements for the
degree
MASTER OF MILITARY ART AND SCIENCE

by

THOMAS E. BROYLBS, MAJ, USA

B.A., Stetson University, 1973
M.H.A., Baylor University, 1982

Fort, Leavenworth, Kansas

1987

Approved for public release; distribution is unlimited.

87-3585
 ABSTRACT

h COMPARATIVE r\NALYSLS OF THE YEDICAL SUPPORT IN 'THE COMBAT

OPERATIONS IN 'THE FALKLANDS CAHPAIGN AND THE GRENADA
EXPEDITION, by Major Thomas E. Broyles, USA, 156 pages.

This study examines the medical support of combat

operations by the British in the Falklands Campaign of 1982
and by the Americans in the Grenada Expedition of 1983.
Recent history portends the increased use of ground combat
forces in short duration employments far from logistical
bases. These two examples of rapidly deployed land forces
are investigated to illustrate the principles and operational
concepts of medical support shared in common by both the
American and British Armies and needed to support rapidly
deployed forces. Medical support by the British in the
Falklands and by the Americans in Grenada is analyzed by
comparing the two medical support operations with each other
and against established principles and operational concepts.
The medical support principles used for this comparative
analysis are conformity, proximity, flexibility,,mobility,
continuity, and control. The medical support operational
concepts used include triage, echelons of medical support,
elements of combat medicine, patient evacuation, and command
and con1,rol.
The medical support operations in the Falklands, like
those in Grenada, are examined both in planning and execution
as well as with respect to the role of medical command and
control. Lessons learned by the respective medical
departments are discussed in the light of the specific combat
operation and in their particular relevance to general rapid
deployment force medical support requirements.
The Falklands Campaign points out the highly successful
joint. medical support provided by the British and the
precisi.on with which they planned their medical support
operation. It, also points out British problems with
aeromedical evacuation. The Grenada Expedition illustrates
the hazards of precluding medical participation in planning
a combat operation and the severe impact on field medical
support when a joint operation is poorly coordinated. Both
operations reveal the vital ro1.e that medical commanders have
to play in the timely provision of medical support.
The medical support principles and operational concepts
identified are shown to be excellent tools for comparing the
two medical support operations studied as well as for
p1.anning and executing future medical support. operati,ons of
rapidly deployed Land forces. The lessons derived from eat,ti
operation, especially when compared with the lessons of t.hr
other, also provide vital answers t.o questions about. how
medical commanders can ensure their units are ready to
medically support. combat. operations of rapidly deployed
forces.

iii
 ACKNOWLEDGENENTS

From its inception this thesis enjoyed the support of a

number of people without whose assistance its completion

would not have been possible. First and foremost have been

the members of the thesis committee. The chairman, LTC

Scottie Hooker, has consistently provided encouragement and

motivation plus a discerning critical eye which has been

invaluable. LTC Nick Johnson has given me many important

insights into the Army Medical Department’s operational

concepts, especially in the area of aeromedevac. Cot. Max

Manwaring contributed most significantly in assisting me in

defining my topic in the formative stages of this project and

that has made the thesis writing achievable and enjoyable in

the limited time available.
My research about the Falklands would have been

impossible without the help of COL R.J.B. Heard, British

Liaison Officer at the USACGSC, and COL Ian Creamer, Hritish

Liaison Officer, Office of the Surgeon General, U . S . Army.

Their assistance in helping me to understand British combat

service support and medical support and providing material on
those subjects was vital. Their patience and graciousness

are deeply appreciated.

1nformat.ion on Grenada was gathered from a number o f
participants who freely shared their experiences wi t.h mo.

.41.I of t.he interviewees provided crucial i.nformation but I

iv
 TABLE OF CONTENTS

Page
ABSTRACT ............................................... iii

ACKNOWLEDGEMENTS ....................................... iv

TABLE OF CONTENTS ...................................... vi

LIST OF MAPS ........................................... viii

Chapter
I . INTRODUCTION .................................. 1

Background: Rapid Projection of Land Forces

Medical Support of Combat Operations of
.. 2
Rapidly Deployed Land Forces .............. -5
Statement of the Thesis Subject ............. -
Objectives .................................. ,
Assumptions ................................. 8
Definitions ................................. 9
Limitations ................................. 11
Delimitations ............................... 11
Significance of Study ....................... 12
Outline of Subsequent Chapters .............. 13
Endnotes .................................... 15

It . REVIEW OF LITERATURE .......................... 17

Purpose ..................................... 17
Current Doctrine Publications ............... 18
Sources and Source Documents on the Falklands
Campaign and the Grenada Expedition ....... 23
Methodology ................................. 26
Endnotes ..................................... 28

TI1 . MEDICAL SUPPORT PRINCIPLES AND CONCEPTS ....... 29

Combat Service Support Principles . . . . . . . . . . . 30

Medical Support Principles . . . . . . . . . . . . . . . . . . 32
Medical Operational Concepts . . . . . . . . . . . . . . . . 34
Triage .................................... 34
Echelons of Medical Support ............... 36
Elements of Combat Medicine ............... 38
Patient Evacuation ........................ 40
Command and Control ....................... 42
Siimmary ..................................... -13
Endnohs .................................... 1.1
 IV . MEDICAL SUPPORT IN THE FALKLANDS CAMPAIGN . . . . . 47
The Falklands Campaign: Background . . . . . . . . . . 1.7
A Brief Review of the Combat Service Support
of the Falklands Campaign ................. 50
Hedical Support in the Falklands ............ 55
The Planning of the Medical Support ....... 55
The Execution of the Medical Support ...... 60
Command and Control of the Medical Support . 68
Summary and Lessons Learned
Endnotes
...............
.................................... 70
73

V . MEDICAL SUPPORT IN THE GRENADA EXPEDITION ..... 81

The Grenada Expedition: Background ..........

A Brief Review of the Combat Service Support
81
of the Grenada Expedition................. 84
Medical Support in the Grenada Expedition ... 90
The Planning of the Medical Support ....... 90
The Execution of the Medical Support ...... 95
Command and Control of the Medical Support . 102
Summary and Lessons Learned ...............
....................................
Endnotes
105
109

VI . COMPARATIVE ANALYSIS .......................... 116

Adherence to Principles ..................... 116

Use of Operational Concepts ................. 121
Lessons Learned ............................. 125
Endnotes .................................... 130

1’11. CONCLUSIONS AND RECOMMENDATIONS ............... 131

Conclusions ................................. 131

Recommendations ............................. 132
Recommendations for Further Study ........... 135
Endnotes .................................... 139

SELECTED BIBLIOGRAPHY .................................. 1-10

INITIAL DISTRIBUTION LIST .............................. 155

vi i
 LIST OF YAPS

Page

FIGURE 1 . Distance from U.K. to Falkland Is............ 53

FIGURE 2. The Falklands Campaign Map .................. 54

FIGURE 3. Distance from U.S. to Grenada ............... 88

FIGURE 4. The Grenada Expedition Map .................. 89

viii
 CHAPTER I

INTRODUCTION

The United States Army has a proud tradition of

providing the American soldier with the finest medical

support possible. The Army Medical Department, the Army's

organization tasked to provide medical support, has steadily

improved the medical support of soldiers in every war America
has fought. This fact is evident when the statistics since

the Civil War are studied.

During the Civil War 17 percent of the soldiers who were
wounded and reached a medical treatment facility died, while

in World War I , this figure dropped to 8 . 1 percent ond in

World War I1 it was down to 4 . 5 percent.1 In the Korean

conflict only 2.5 percent of U.S. personnel who were wounded

and reached a medical treatment facility died.2 In Vietnam

less than 1 percent of the battle-injured soldiers died after

reaching an Army hospital.'

It is important to note that these percentages represent.
only the wounded personnel who died after reaching medical

treatment facilities. In the Vietnamese conflict a far

greater percent.age of wounded personnel reached medical

facilities alive than during any prior conflict. This wan

due primarily to the use of helicopter ambulances which were

1
able to rapidly evacuate severely wounded casualties who

would have died in prior wars b e f o r e the evacuee could have

reached a medical t.reat.ment facility. 4

Unquestionably the medical service in Vietnam was the

most complete and timely medical support the American soldier

has ever had. The medical support rendered there has clearly

created expectations by which all future medical support, will

be judged. This certainly appears appropriate, but if the

expectations are to be met, the Army Medical Department must

c1.osely analyze lessons learned from recent combat

operat.ions--operations which portend the increased use of

ground combat forces in short duration employments far from

logistical bases.

Background: Rapid Projection of Land Forces

The United States has maintained forces capable of rapid

deployment to potential contingencies throughout much of its

history. But only recently, as the forces of the Soviet

Union have expanded and the advances of technology have

created a truly interdependent world community, have U . S .

forces had to be prepared to deploy within hours to protect

our vital int.erests and the vital interests of our allies.

The need to rapidly pro.ject. land forces was forcefully

brought to the American public’s attention in 1 9 7 9 . This

2
came about through three events which began a dramatic

reinflation o f U . S . military aspirations and reversed the

trend of the post-Vietnam era.5 First, debate on the SALT I 1

Treaty revealed the significant deterioration of U . S .
military forces vis a vis Soviet forces.6 Second, the

overthrow of the Shah of Iran and the "seizure of U.S.

diplomatic personnel as hostages in Tehran ... underscored

.herioan's vulnerability and helplessness."' Third, the

Soviet Union invaded Afghanistan in December 1979.

In his .January 2 0 , 1 9 8 0 , State of the Union address,

President Carter proclaimed the Carter Doctrine. In i t he

declared that any attempt by any outside force to gain

control of the Persinn Gulf region would be regarded as an

assault on the vital interests of the United States. Such an

assault, he said, would be repelled by any means necessary,

including military force.8

F o r the first time, U.S. military forces were formally

committed to defend Southwest Asia, a logistically remote

region where the United States does not possess secure

military access ashore in peacetime.9 The Carter Doctrine

thus "imposed new and exceedingly difficult obligations on

L1.S. conventional forces already severely overtaxed by

traditional commitments in Europe and the Far East."*o

The gap between the military aspirations espoused by

President Carter and the forces available prompted action

that has resulted in military force modernization initiatives

during the past seven years. Included in these initiatives

3
have been enhancements of the U . S . Army's special operations

forces--Rangers, Special Forces, special operations aviation

units--as well as conventional forces." Although force

modernization has not been completed, the progress that has

been made has increased the Army's capability to handle

missions requiring the rapid deployment of ground combat

forces .
Additionally, the use of military power has become more

accepted as a means to deal with situations abroad especially

when the safety of .American citizens is involved. This is

true not only because this is the view of the current Reagan

Administration, but also because of the national will o f the

American people which grew out of the protracted American

hostage crisis in Iran from 1979 to 1981.

Yet, as Colonel Harry G. Summers of the Strategic

St.udj.es Institute has observed, there have been no dramatic

improvements in recent years in the ability of a nation to

project power and fight a war far from home. Even with all

of the hi.8h-technology weapons that are now available, the

well-trained and capably led foot soldier is still the key to

victory.12 And, as the need for a rapidly deployable land

force has been recognized and forces have been enhanced for

rapid deployment missions, the possible uses of that land

force have appeared to increase. The lJnit.nd Kingdom's

campiti.gn i n the Falklands is one example of the successful

use oP rapidly deployed land forces. Another is t.he United

States' Grenada Expedition.

 In view of the world situation today, rapidly deployed
land force operations will be used increasingly. Rapidly

inserting a force on the ground in a trouble spot appears to

our national leaders to be the best way to handle a number of
potentially explosive situations. Indeed, the advent of the

U.S. Army’s light infantry divisions and the expansion of

special operations units grew out of this realization. One
of the best ways to control volatile situations is to rapidly

deploy superior and flexible combat forces so that opponents

abandon their plans in reaction to U . S . maneuvers.13

Due to the increasing likelihood of more rapid

deployment force operations, all military professionals must

examine these operations. By doing so, all the lessons

available from previous operations can be gleaned and future

operations can be planned and executed with greater precision

and higher chances for success.

Medical Support of Combat Operations of Rapidly Deployed Land

Forces

Since their purpose is to gain the initiative and impose

a decisive force on the ground, the combat operations of

rapidly deployed land forces must be accomplished with

precision. Consequently, ground combat forces must plan

5
their miss ions carefully and execute them aggressively. 'The

combat service support of such an operation must also be

accomplished with precision. This is especially true with

respect to medical support because ineffectiveness and

inefficiency can cost lives.

The need for precision in medical support in rapidly

deployed land force operations can hardly be overemphasized.

As has already been shown, the expectations of medical care

for soldiers wounded in combat operations a r e high. The

tremendous record of medical support in the Vietnam conflict

underscores the expectations of t,he U.S. Army Medical

Department by the American public and today's soldier.

Supporting a rapidly deployed ground combat force can
pose unique problems in providing timely medical support.

This is because of the shortage of time to plan, the

difficulty of forecasting the locale of employment, and the
great distance at which medical support may have to be
provided away from large medical support complexes. Eor

these reasons, the medical support of combat, operations like

the Falklands Campaign and the Grenada Expedition must be

studied to determine if established medical support

principles were followed and what the actual execution of the

medical support can teach us to improve future uperat.ions.

6
Statement. of the Thesis Subject

To compare American and British medical support of

combat operations of rapidly deployed land forces. The
researcher will conduct a comparative analysis of the medical
support of the British Army in the Falklands Campaign and the
U.S. Army in the Grenada Expedition.

Objectives

The objectives of this study ore: (11 to determine what

the medical support principles are for U.S. Army and British
Army combat operations; ( 2 ) to determine if the principles

were followed in the Falklands and Grenada respectively: and

( 3 ) to draw conclusions from a comparative analysis of both

operations.
The medical support principles will be examined in the
context of the respective army combat service support
principles. The medical support principles of both armies
will also be compared to each other.
Nedical support principles will be determined by a
review of the published doctrinal manuals for each army.
Medical support principles and actual medical support
operations will be examined at corps level o r lower.
The principles established by the U . S . Army Hedical
Department and the Royal Army Medical Corps will then be
compared and contrasted with each other to determine if they

provide nn ndequate framework for planning and executing

medical support of combat operations.

Assumptions

This study assumes that the requirement for medical

support of combat operations is valid and that the

expectntions of medical support of combat operations, at

least for the U . S . Army, are the expectations based on the
Vietnam experience. Research and analysis will start from

these points.

That medical support is one aspect of combat service

support is a fact and medical support must, therefore, be

examined in the context of the overall combat service support
plan of any operation. Medical support, both in planning and

execution, is unique, however, and must be reviewed in the

context of special medical principles and concepts.

Planners and executors of rapidly deployed land force

operations should be concerned with appropriate medical

support of those Operations. Like all military operations,

rapid deployment force operations require adequate combat

service support both to nchieve initial success and to

sustain that success for the duration of the operation.

Therefore, the medical support which sustains the soldiers in

the operation is important and is a key element in the

8
1i

force's a h i 1 i t . y to complet,? it.5 mission. Medical support is

as essential as any part of the combat service support

equn tion.

Actual combat operations studied are the Falklands

I
Campaign and the Grenada Expedition. Medical support
principles and operational concepts are those described in

current U . S . Army and British Army field operations manuals.

Primarily referenced will be U.S. Army Field Manuals 8-10

"Health Service Support in a Theater of Operations" and 8 - 5 5

"Planning for Health Service Support" and the British Army's

".Administration in War" and "Medical Interoperability

Handbook I "

This study will use operational terms peculiar to U.S.

-- Army medical support as well as terms peculiar to British

Army medical support. All terms will be defined in

accordance with respective army doctrinal publications and

British Army terms will be carefully related to the most

similar U . S . Army term.

For the purpose of this study, a rapidly deployed Land

force will be defined as a tailored military package rapidly
assembled and deployed to meet an urgent situation. Such a

force is composed of essentially standard military units but.

is assembled for R unique mission.

To s e r v e as a framework for conducting the comparative

analysis which is the focus of this thesis, certain

principles, doct.rines, and operational concepts will be

identified a n d discussed'. In the context of this research,

the words principle, doctrine, and operational concept are

defined in the following manner:

( 1 ) principle - a fundamental truth used to guide the

planning and execution of a military operation which is

sanct. oned in official military publications;

2 ) doctrine - a body of fundamental truths or

princ ples sanctioned in official military publications;

3 ) operational concept - an idea about the conduct of

military operations formed by generalization from historical
military experiences and sanctioned in official military
publications.
In this study, field medical support consists of unit

level, division level, and corps level medical support.

Although there may be higher levels of medical support

deployed with the force, such medical support will be

discussed only as it relates to the echelons of medical
support at corps or below.
Unit level or first echelon medical support is primarily

concerned with the provision of emergency medical treatment.

and evacuation of the wounded from battle areas as necessary.

First echelon medical support is provided by unit aidmen or

by hattalion a i d post personnel.
Division ].eve1 o r second echelon inedical support. is
provided by medical companies of division medical bat.talions

10
Or forward batt,alions. A medical company, normally

placed i n support. of a brigade-size force, provides

definitive treatment. for relatively minor in.juries o r

resuscitates and stabilizes casualties with more complex

injuries for evacuation to a corps level hospital for initial

surgery.

Limitations

This study will not address non-medical aspects o f

combat service support of the two actual operations i n

detail. Research will focus on the planning, execution,

command and control of the medical support operations.

Additionally, this study will concentrate on medical

support of combat operations and not concern itself with

medical support once combat operations in Grenada and the

Falklands had ceased.

Delimitations

This study will not examine the political considerations

in the employment of forces in Grenada, in the Falklands, o r

elsewhere. The focus of the study is R comparative analysis

of the medical support. of the combat operations i n Grenada

and i n the Falklands and how the medical support in each

11
operati.on compares with common inedicaL support principles.

Historical research wilL be limited to combat. operations

since t.tic end of t h e Second Uorld War. Although thi's study

focuses on medical support of combat operations in a lox and

mid-intensity environment, it will include medical support
considerations across the whole spectrum of battlefield
intensity.
Since land forces may have to be rapidly deployed
vorldwide, this st.iidy will not be limited geographically.

'Phc medi,cal. support. principles examined will be appIicabLe to

any area i r i the world where combat operations ma!: take p l a c e .

Consequently, different types of climatic areas in the world
will not be specifically addressed.

Sisnificance of the Study

As mentioned earlier in this introductory chapter, the

lessons of medical support of recent combat operations m u s t

be closely reviewed. This is necessary t o ensure that

medical support of future rapid deployment force operations

is conducted with the benefit of an analysis of t.hose

lessons. The present recognition of the significance of

rapidly applied milithry force in the international arena

clearLy points out. that rapid deployment force oper;rt.ions
wiLl see more extensive use in the future. To t.he U . S . Army
Medical Department and the soldiers it serves, the

12
effect.iveness and efficiency of combat medical support arc

crucial.

Outline of Subseauent Chapters

Chapter Two reviews the available literature which bears

on a comparative analysis of the medical support of the

combat. operations in Grenada and the Falklands. Doctrinal.

publications by the U.S. Army and the British Army are

reviewed to assess their adequacy for the planning and

execution of medical support of rapidly deployed land forces.

From this review principles will be established in the

subsequent chapter to evaluate the actual conduct of the
medical support. operations. Publications on the actual

combat operations are also reviewed with emphasis on the

publications about the medical support of each operation.

Chapter Three specifies the relevant principles for

medical support as well as for overall combat service
support. Principles are identified and discussed for both
the U . S . Army and the British Army. The principles and

operational concepts of each army are also compared to point

out similarities and differences.

Chapter Four examines the medical support provided
during t.he Falklands Campaign and assesses whether

established medical support principles and concepts were or

were not followed.

13
 Chapter Five analyzes the medical support provided t o

American forces in the Grenada Expedition. I t also assesses

r;het.her e s b ~ b l i s h e dm e d i c a l support principles a n d concepts

were o r were not. followed.

Chapter Six compares the medical support in the Grenada

Expedition with the medical support in the Falklands

Campaign in the context of the commonly shared medical

support principles and concepts.

Chapter Seven provides conclusions and recommendat ons.

Recornmendat.ions are made as to the principles and opera i o n a l

conceptx needed to insure fur,ure siiccessfii l medical support

of combat. operations by rapid (deployment forces. Suggest. ions

are a l s o given to guide future researchers.

 ENDNOTES

CIIAP'I'EI~ 1

1. LTG Joseph M. Heiser, Jr., Vietnam Studies: Logistics

Suuuort (Washington, D.C.: Department of the Army, 1974),

p. 212.

2. XG Spurqeon Neel, Vietnam Studies: Nedical Supper-- ot:

C.S. Army in Vietnam 1965-1970 (Washington, D . C . : Depart.ment.

of the Army, 1973), p . 51.

3. "Copter Ambulances Improve Survival Rate," The Journal of

-
the -
Armed Forces 103 (December 1 1 , 1965): 12.

4. Heiser, Logistics Suuuort, p. 213.

3. St.rateaic Studies: National Security Policy C o n s i d t t r : i -

(Fort Leavenworth, Kansas: L.S. r\rmy Command and

General Staff College, 1986), p. 159.

6. Ibid.

7. Tbid.

8. President Jimmy Carter, r\ Reuort on the State of the

1 .5
--
Union 96th Congress House Document No. 96-257 (Washington,
D.C.: U . S . Government Printing OfPice, January 22, 1980),

p. 4 .

9. Strategic Studies, p . 160.

10. Ibid.

1 1 . COL James B. Motley, "Washington's Big Tug of War O v e r

Special Operations Forces," r\rmy 36 (October 1986): 18.

12. COL Harry C. Summers, "Yomping to Port Stanley," ?.lilitnrv

Review 6 4 (March 1981): 3.

13. Congressman Richard 8 . Cheney and MAJ Thomas N. Harvey,

"Strategic Underpinnings of a Future Force," Military Reviek.

66 (October 1986): 10.

16
 CHAPTER I1

REVIEW OF LITERATURE AND METHODOLOGY

Purpose

This chapter provides a review of the literature on

medical support of combat operations relevant to this thesis
It serves as a point of departure for the research presented
in the subsequent chapters and shows the foundation upon
which the research analysis is based. The chapter is

organized into three main sections.

The first section deals with publications on current

medical doctrine, but not the doctrine itself. The actual

doctrine of both armies is discussed in detail in Chapter

Three. This section presents information on the doctrinal

publications o f both the American Army nnd the British r\rmy.
Combat service support doctrine and medical support doctrine
are addressed by these publications and they are the source
of the doctrine upon wnich the actual conduct of medical

s u p p o r t . opcrat.ions is bused. A brief assessment. O F the

adeqiiacv uL' the doci.rine pr:ovidnd by these manuals is made.

Also a brief comparison of the doctrinal publications o f the

U.S. and British Armies is conducted. Chapter Three presents

a more detailed comparison.

The second section of this chapter discusses the sources

available on the actual conduct of both of the operations

under study. Source documents on the Grenada Expedit.ion and

the Falklands Campaign are revie:wed and information on t h e

techniques o r searchina f o r research material is presenr.ed.

A review of the availability and use of unclassified

publications on the medical support of Grenada and the

Falklands i s addressed. Additionally, the availability o f

classified sources is discussed.

The third section, entitled Methodology, delineates the

method for conducting the comparative analysis of the medical

support doctrines. It also specifies how the comparative

analysis of the actual medical support operations in the

Grenada Expedition and t,he Falklands Campaign is conducted.

Current Doctrine Publications

The current. doctrinal informntion on medical support of

combat operations is extensive in the U . S . Army and is found

18
in Army field manuals ( F ? l s ) and field circulars ( F C s ) .

General concepts of medical support are addressed in Army

publicat,ions on comhat service support ICSS) operations.

Detailed doctrinal information on medical support is

contained in the 8 - series of Army field manuals and

circulars. CSS doctrine publications are reviewed first

because this researcher believes that medical support must be

examined in the context of combat service support operations.

F Y 100-10 "Combat Service Support" is the U.S. Army's

keystone manual on the principles of combat. service s u p p o r t .

of forces commit,ted to battle. It is the lead volume of t.he

.\rmy's series of "how-to-support." field manuals and presents

general concepts developed in greater detail in the how-to-

support FMs.1 The other field manuals in the series are:

FM 63-1 "CSS Operations - Separate Brigade"

FM 63-2 "CSS Operations - Division"

FM 63-35 "CSS Operations - Corps"

FM 63-4 "CSS Operations - Theatre Army Area Command"

FM 63-5 " C S S Operations - Theatre Army"

These manuals provide detailed doctrinal information on t.hr

conduct of CSS operations at tho echelons designated above.

For this thesis, FMs 63-2, 63-35, and 100-10 are the most
relevant. These are adequat,e publications which are concise

and clearly written.

An nddit.iona1 doctrinal publication which has proved

valuahle in rescarching CSS principles has been the U.S. ;\rmy

Command and General Staff College's summarization of the

principies contained in F M 1 0 0 - 1 0 and the P I 63-series. 'This

summarization is found in Introduction Combat Sorvicn

S i . i ~ ~ p ~ used
i.t in t h e coll.ege's curriculum. Introduction to
Combat Service Support synthesizes eight broad principles of

C S S highly relevant to this research.*

Like FM 100-10, "Administration in War" (British Army

Code Number 71342) is the British Army's keystone combat
service support manual. The term administration is defined

by this British Army manual as "the management. and erecut.ion

of all military matters not included in tactics and stratesy;

primarily in t.he fields of logistics and personnel
manaqement."s "Administration in War" is similar t o FN 1 0 0 -
10, but it is a much more detailed manual. It not o n l y
presents basic principles like 100-10 but also provides
details about different echelons much as the U . S . Army's 63-
series of how-to-support manuals. This British Army manual
and several others were obtained from the U . S . Army Command
and General Staff College's British Liaison Officer, COL
R.J.B. Heard.
The British Army supplements their primary doctrinal
manuals such as "Administration in War" with precis, or brief
summaries covering new developments or elaborations of
information on a particular subject. For example, one of the
precis used in this thesis was "Logistics 2 " which outlines
administration and logistics in the division in w3r and is
used in the British Army Staff College.4

As mentioned in the beginning of this section, U . S . Army

20
8-series field manuals and circulars deal with medical

support. of combat operat,ions. These manuals and circulars

are essential I ? " h o ~ ~ - t o - m R d i c a l l ~ - s u p p o r tp

"riblicat ions.

Although they are not as consistent in dealing with

progressive echelons of support like the 63-series they do

provide detailed information in a highly readable and useful

format. FM 8-10 "Health Service Support in a Theater of

Operations" clearly specifies essential medical support
principles while FM 8 - 5 5 "Planning for Health Service

Support" comprehensively addresses all aspects of planning

medical support o f combat operations. .Also signifi,cant is 1;?1

8-8 which deals with "Yedical Support in Joint Operations."

Currently under revision, it provides guidance about Army,

Navy, and Air Force medical support in an area of operations

as well as ,joint medical planning factors and procedures.

Recently the Army has published several highly relevant

and excellent medical support field circulars. These are FC

8-15-1 "Health Service Support Operations-Light Infantry

Division," FC 8 - 1 5 - 2 "Hea1,th Service Support Operations-
Airborne and Air Assault Divisions," and FC 8 - 4 5 "Medical
Evacuation in the Combat Zone." All three address support of

combat operations and represent the most current conceptual

publications of the Army Medical Department related to this

study. Also highly relevant is TRADOC Pamphlet 5 2 5 - 5 0
"Health Service Support. AirLand Battle."
Essentially the same medical support concepts outlined
in the U . S . Army doctrinal publications are contained in the

21
Brit,ish Army's "Aclininistration in War." The specifi.c

similarities and differences between U . S . and British Army

doctrines Kill bc discussed i n the next. chapt>er.

"Administration in War" clearly presents the role and

organization of British Army medical support systems.
Medical support is further addressed in the "Medical

Interoperability Handbook" (British Army Code Number 71376)

and in a medical precis entitled "Medical Support in the

Field"--both provided by Colonel Ian Creamer, Royal Army

?!cdical Corps liaison.

Few pub1icat.ions i n either military or medical j n u r r i a i s

deal with changing current military medical doctrine. :\

search o f both American and British journals reveals a

scarcity of supplemental publications either debating the

validity of current doctrine or setting f0rt.h recommendations
f o r change. This researcher believes this is due in part

because few journals attract articles on medical doctrine and

because there are relatively few proponents for change

wil.ling to prepare such articles. The primary reason that

few supplemental publications on medical doctrine are found

is because current. doctrine has developed from time-tested

principles and concepts. These principles and concepts hax-e

been derived through the experience of both American and

Brit.ish medics in the wars each country has experienced in

t h e 19th and 20th Centuries. Tho doct,riric is sound. Ariv

dcbate grows out o f how c1osel.y the doctrine is f'o1lor;ed i n

support o f actual combat operations. Generally speaking,

22
both U.S. und British Army medical support doct,rines are

clearly written and conform to the tact.ica1 doctrines they

s'apport,.

Sources and Source Documents on the Falklands Campaign and

-
the Grenada ExDedition

Since t,he focus of this thesis is a comparative analysis

of the medical support. of two operations by rapidly deployed

land forces, the literature review next concentrated on t h e

availability of material on the Falklands and Grunudu.

Several computer searches were conducted via both military

and medical channels to obtain source material. This

material was examined on three levels: ( 1 ) general
information on each operation; ( 2 ) information on the combat
service support of each operation; and ( 3 ) specific

information on the actual medical support of the combat

operations in the Falklands and Grenada.

Information on the first level was extensive for the

Falklands Campaign both through official British Army sources

:and unofficial sources. Many books have been written about
t.he Falklands Campaign. This researcher confined himself to

the general references which concentrated on ground combat

operntions. A number are cit.ed in the bibliography but the

best are Hastings and Jenkins' T h e Battle for the Falklands

and Frost's 2 PARA Falklands: The Battalion at War. The

23
former is the most readable and historically accurate of the

books dealing wit.h the campaign as a whole while the account

of the 2nd Parachute MttaLion, by the Arnhenl veteran John

Frost, captures the ferocity o r the Falklands battles.

With respect to Grenada, the only extensive sources
available are official U.S. Army after action reports and
assessments. These include: ( 1 ) Bishop and O’Brien’s

FORSCOM/ARLANT Participation Operation Urgent Fury --

Grenadn, 1983; ( 2 ) the Grenada Work Group’s Operation Urgent
Frlry Assessment; ( 3 ) t.he Deportment of the Army’s Lessons

Learned Grenada: L.S..Arniy Lessons Learned F r o m 1983 Operation

Urgent Fury; and ( 4 1 Pirnie’s Operation Urrlent Fury: The
United States Army in Joint Operations. Books on the tirenada

intervention are scarce and much of the Army’s material is

classified. However, enough material in a number of
unofficial sources is available to clearly reconstruct the

essential events in the Grenada Expedition for this thesis.

With respect to sources on combat service support, the
material on the Falklands also significantly exceeds that
available on Grenada. CSS for the Falklands Campaign is
fully addressed in a number of official after action reports

as well as unofficial articles noted in the bibliography.

A superb distillation of these nrticles and others was

recently made by an officer in the U . S . Army Command and

General Staff Col.le,be’sSchool of Advanced Elilit.ary Studies.

Na.ior Kenneth L. Privrat.sky has written British Combat
Service Support on East Fulkland: Considerations for
Sustainina Tactical Operations & Remote ;\reus which was

published. in November 1 9 8 5 . This work has served as an

extreme1 .v useful guide to overrrl I. (‘SS operations l’or t.hr

British campaign.

Although unofficial sources on Grenada combat service

support were extremely limited, the four official after

action documents previously mentioned did cover CSS in

sufficient detail to effectively conduct this research.

Finally, with respect t.o the specific information on the

actual medical support of the combat operat.ions i n Grenmla

and the FaIlclands, the same trend continued. Fst.?nsi ~ $ 2

official and unofficial sources are available on the

Falklands Campaign. The USACGSC’s British Liaison Officer,

COL R.J.B. Heard, ppt this researcher in contact with the

Royal Army Hedical Corps’ Liaison Officer who provided a

wealth of official source material. In addition, more than a

dozen articles in British military and medical journals were

obtained which were written on the Falklands medical

esperiences. ‘These articles covered the full range of

medical support activities.

Information on medical support in Grenada was limited t.o

two types of sources. These were the official aPt.r:r action

reports and interviews wit,h medical officers who participated

in the Grenada Expedition medical support. The combination

of the information derived from both sources gave the

researcher a det.ailed picture of the medical support,

provided.

25
 Compared to Grenada, little material on the Falklands is

c1assi.fied. A1 t.hough the principal sources about. the Grenada

Expedition a r e clussified there is abundant. unclassified

material contained within the reports which has been used in

this thesis. There was no need to use classified material t,o

research the Falklands Campaign and the obstacle of

classified documents on Grenada was overcame because of the

availability of unclassified sections within the classified

repnrts,

Finally, 3 number of sources (both books and

periodicals) on combat service support, and medical. support.

were consulted for historical perspective. The best o f these

was Major General Spurgeon Keel's Medical Suuoort of the L . S .
Army in Vietnam 1965-1970, a thorough recounting of the Army

Medical Department's support in the Vietnamese conflict. The

other prominent historical analysis was Rapid Deployment

Louistics: Lebanon 1958 by Lieutenant Colonel Gary H. bade.

As Major General Dave L. Palmer states in the foreward to

that. work, "a good number of t,he logistical problems
encountered in Lebanon in 1958 recurred in the 1J.S.
intervention in Grenada twenty-five years later."s

?Int.h odo1o 9 y

'Phis investigation is founded upon a t.horough

understanding and a concise explanation of the principles o r

26
medical suppor't of combat operat,ions. These principles are
discussed in Chapt.er Three and have been examined from t.he
viewpoints of b0t.h the Amcric-an and Urit.ish ;\rinies. T h e y
have also been placed in the context of the principles f o r

overall combat service support of each army. This has been

essential to clearly delineate the role of medical support

in relation to other components of combat operations service

support.
Planning and execution of the actual CSS operations and
medical. support operntions are reviewed as well as the aspert

o f cuminand and control. As in all military operations,

planning will be shown to be vital to effective esecution of

combat service support in the Falklands and Grenada. The

planning processes of both armies have been examined per
their doctrine and in the actual situations in the two
operations. Execution of support operations has been
analyzed to determine how closely the actual support followed
plans and how effective the actual support was judged to be
by participants and expert observers.
To reiterate, the focus of this thesis is a comparative
analysis of the medical support of the combat operations in

the Grenada Expedition and the Falklands Campaign. Doctrine

of both armies is compared. Evidence collected is analyzed
with respect to the established medical support principles as

derived from 1 l . S . Army and British Army field mrlnuais. I'rom

this analysis conclusions are derived and presented.

 ENDKO'I'ES

CHAPTER I 1

1. U.S. Department of the Army Field Manual 100-10 "Combat

Service Support." : ii.

2. LTC John R . Raffle, Combat Service Support: Introduction

-
to Combat Service Support S480/6. U . S . Army Command and Staff

College, Fort Leavenworth, Kansas, 1 3 May 1985: 19-21.

3. "Administration in War." Uritish Army Manual on

Administration and Logistics. Army Code Number 71342.

Yinistry of Defence, 1984: 1-1

4. "Logistics 2 . " Precis from the United Kingdom Army Staff

College in files of British Liaison Officer, U . S . Army
Command and Staff College.

5. LTC Gary H. Wade, Ropid Deployment Logistics: Lebanon

1y58. Combat Studies Institute, U.S. , \ m y Command and S t . a f f

College, Fort Leavenwort.h, Kansas, October 1984: foreword.

28
 CHAPTER 111

MEDICAL SUPPORT PRINCIPLES AND CONCEPTS

To understand and analyze the medical support of combat.

operations of the American and British Armies, one must firs!:

examine the essential principles and operational concepts

upon which that medical support is based. These concepts and

principles are stated clearly in the medical support

doctrinal publications of both the U.S. Army Medical
Department (USAMEDD) and the Royal Army Medical Corps IRAMCI.
They grew out. of and are grounded in the principles and
concepts of combat service support o f both armies and special

medical considerations. Consequently, a brief review of

combat service support tenets f o r both armies is presented

first. Then medical support principles and concepts will be

examined in dept-h.

29
(:imhat, Service Siippor t. Pr iric i p t a s

';'he Aniericun A r m y defines combut service siipporl. ; C S S 1

as "the assistance provided to sustain combat forces,

primarily in the fields of administration and logistics."l

Administration refers to personnel service support (including

medical support) and civil affairs administration. Logistics

includes maintenance, transportation, facilities, and s u p p l y

(escliidinc!medical s u p p l y r .

The Uritish Arm:- iises t,ha word "ir,imiriistl.:it.iuii" i rt.:t,::ui

of (-ombat service support and oandi.dly points out in

"Administration i.n W a r " that the terms "administ.ration" arid

"logistics" are frequently used loosely. 2 Escept for this

point,, definitions of "combat service support" in the
American Army and "administration" in the Bri tish Army a r e

essential1.y identical. In fact, since both nations are

members of the North Atlantic Treaty Organization (NATO),

both derine "1opist.ics" as planning and carrying out the

movement. and maintenance oC f o r c e s - the standard hATO

definition. 3

The R r i t . i . s h Army i.rientifies five principles of

administration: foresight, economy, floxibili ty, s i . m p l i ci t g ,

and cooperation. These principles are augmented by t.he

principle t,hat, "Torwarti planning x i I i be essential t o the

s ~ i c c e s sof iiri oper.ot,ion since resupply iiiaj be coinptws :m,i1,iic

iliasinrum use must be made ot' local resuurces in c o o p u r a t . i u r 1
with a host nation o r nlly."5 The British also emphasize,

in a more general sense, t.hat "no plan can be formulated

wi t,tiout. an :icciirate appreciat. Lori ol' the logistic intel1igrni:e

avaj.1.ablearid of all other relevant. factors."G

Similarly the American Army incorporates "the principles

of responsiveness, flexibility, and initiative'. in their

combat service support doctrine.' These are expanded to form

the following eight principles which are identified as the

basis of U . S . Army CSS doctrine:

Support. Forward

Continuous Planning

Practice Economy

Haximum Cse o f Standing Operating Procedures

Tailored Support

Centralized Control/Decentralized Operations

Maximum Use of Throughput Distribution

Maximum Use of Local Resources 8

From this brief discussion one can clearly see that. bot,h
armies base their service support of combat operations on

highly similar principles. Differences are minor and are

ones of language rather than substance. The eight principles

listed above not only form the basis of American Army CSS

doctrine but can also he used t.o examine British Army

administ.rntion in war. They form a common context wit.hirl

which medical support principles are established and can he

31
esumined for comparing American and British medical support

operations.

Medical Support Principles

Unlike the combat service support principles which were

briefly reviewed, the following medical support principles

anli cor1cegt.s of the American and Brit,ish Armies will be more

ful.Ip examined and discussed. Cert.ainly medical support*

principles and operational concepts are central to the

comparative analysis which is the focus of this thesis.

To provide effective and efficient medical support of

combat operations, the USAMEDD and the RAMC have established
a number of general principles. The American Army specifies

these in FM 8-10 and enumerates six principles.9 These are:

( 1 ) Conformity

( 2 ) Proximity

( 3 ) Flexibility

( 1 ) Mobility

( 5 ) Continuity

( 6 ) Control

Conformity points out that medical support musL conl^orni

to the tactical plan of operation so that medical support is

provided at. the right place and time. Proximity stresses

t h a t medical siippnrt. must. be provided as close to combat

operations a s possible to minimize mnrhidi t.y rind m o r 1 , a l i t y .

Flexibili tg emphasizes t.hnt, units providing medical s u p p n r t

must be prepared to shift medical support resources to meet

changes in tactical operations.

Mobility is an essential principle becauae medical

support units must maintain close contact with maneuvering

tactical units. Continuity provides for moving the patient

khrough a propressive and phased medical support. syst.em in an

iininterrupt~d manner that decreases morbidity and morta1.it:;.

Finally cont.rol stresses the need f o r centralized management

of medical resources to maximize the treatment medical

s u p p o r t . units can offer to soldiers in combat operations.

Similarly, the British Army identifies basic principles

for the collection, evacuation and treatment of their wounded

soldiers in "Administration in War."'o The British emphasize

tactical congruency, close support, adaptability, and the

collection of casualties as quickly as possible (conformity,

proximity, flexibility, and mobility). They also stress the

importance of continuity of care and control of medical

resources. As in the CSS principles, minor differences in

language exist between British and American medical support

principles. Nevertheless, the general principles for medical

support are shared in cnmmon.

33
Medical Operational Conceuts

Medical operational concepts of the USAHEDD and the R A W

are also highly similar. A comparison of operational

concepts, however, points out the first significant

differences between American and British medical support.

The medical operational concepts of the USAMEDD and RAMC

encompass the followi,ng: ( 1 ) triage; ( 2 ) echelons of medical

support; ( 3 ) elements of combat. medicine; ( 4 ) patient.
evacuation; and ( 5 ) command and control.

Triage

Both the British and American Armies use the concept of

triage ( o r patient sorting). Triage, which in French means
"the division into three," began as a concept to separate
patients into three groups. One group needed immediate
attention, one group could wait, and one group had wounds

so severe that life could not be saved due to insufficient

time, medical personnel or resources.

Triage is an essential concept for handling large

numbers of casualties (called mass casualty situations). This
concept. applies to all medical support of combat operations
because of the ever-present likelihood of mass casualty
situations arising.

34
 Both t,he American and British Armies use the N,\TO

definition of a mass casualty situation and t,he four (not

three I NA'PO treatment group categories. ?It\TO defines a inass

casualty situation as one in which an overwhelming number of

seriously injured are placed upon medical facilities unable

to supply medical care f o r all. "Under these conditions,"

the definition states, "the aim must be to assure care to the

greatest benefit of the largest number."l' The USAMEDD and

t,he RAMC use the f o u r general treatment categories below:

( 1 ) Immediate - for patients requiring immediate

treatment to save life o r limb;
( 2 ) Delayed - for patients who, after emergency

treatment, can have major definitive

procedures delayed:
( 3 ) Minimal - for patients who need simple treatment

and can be returned to duty immediately;

( 4 ) Expectant - for patients with massive injuries and

little chance of survival even if all
medical resources are concentrated upon

them. 1 2

The use of NATO terminology with respect to the operational

concept of triage thus eliminates any significant difference

between the USAMEDD and the RAMC.

35
 Echelons of Medical Support

Both the American Army and the British Army recognize

the necessity for establishing CSS concurrently with the

employment of tactical units. FM 100-10 states that "some
combat service support elements should be employed into a

hostile environment as soon as the first forces land."13

This objective is achieved by both armies by echeloning

medical support.

The first echelon of medicnl support in the U.S. .\mi::

is unit level medical support. This is provided by medical

aidmen and aid stations organic to tactical units. In the

British Army, unit level medical support is called first. line

medical support and is essentially the same as for the

American Army." An important. supplement to this level is

buddy-aid. Both armies train their soldiers in basic life-

saving measures and first-aid treatment. This enables a

soldier to administer to himself or to a fellow soldier
if the unit medic cannot immediately attend to him.

The second echelon of USAMEDD support is division Level

medical support. Division level medical support. "includes

evacuation of patients from unit level aid stations and

initial resuscitati.ve treatment."l5 This support is provided

by medical companies and sections of the division medical

battalion or forward support battalions. The equivalent of

division level medical support, in the British Army is called

36
second line medical support.. The major second line unit is
the field ambulance whose tasks are: ( 1 ) collection of

cnsuolt.ies from unit. ( u s u a l l y reziment.al.)aid posts; ( 2 )

centralization of casualties at. dressing stations (like

American medical companies); ( 3 ) casualty treatment “to

enable them to survive evacuation to hospitals or return to
duty;” and ( 4 ) control of patient evacuation.16

Hospitals are first found in the third echelon of each

army and their role at this echelon is the same for both

armies. “This level of support includes the evacuation of

pat,ients from supported divisional and non-divisional unit.s,

resuscitntive surgery and emergency/resuscitation care on an

area basis. . . . I ’ ‘Phis is also the first level where surgery

is normally performed. USAMEDD field medical units in the

third echelon include 60-bed mobile army surgical hospitals

(MASHs), 200-bed combat support hospitals (CSHs), and 400-bed

evacuation hospitals (EVACs). 1 8

Third echelon RAMC units include 400-bed field hospitals

(Forward Support Complexes) and 800-bed general hospitals

(Rear Surgical Complexes).19 Both RAMC and USAMEDD hospit.als

at this echelon may detach small surgical teams down to

second echelon medical units or position the teams as lead or

advance elements of the third echelon medical support. This

practice is found in both armies for medical support in

rpmot,e ureiis with s1,ow means of patient evacuation. By

doctrine, t,hird echelon hospil:a.Ls are the highest. echelon

established by both armies in the combat zone.

37
 The? highest echelon o f iiiedI.ca1.care for both armies is
thr fourth echelon. In addition to having the capability of

pvnviiljng : i l l medical treatment available at. the other

echelons, fniirth echelon hospit.als can provide definitive

care f o r all patients.20 These hospitals are usually found

in the communications zone behind or out of the area of

combat operations. They may be permanent facilities or they

may occupy semi-mobile, tent-sheltered facilities. They

include fixed medical centers operated by both the USAMEDD

arid the RAM(:. USAMEDD hospitals at this echelon also include

field hospitals and general hospitals while the R,\XC

hospitals are 400-bed evacuation hospitals and 800-bed

general hospitals.21

Due to their size and the wide range of medical care

which they provide, third and fourth echelon hospitals are

augmented by large evacuation units (evacuation battalions o r

ambulance regiments) f o r evacuating patients from the

echelons of medical support immediately below them. In both

the American and British armies, first and second echelon

medical units have organic evacuation assets. (.A subsequent

section of this chapter discusses patient evacuation.)

Elements of Combat Medicine

'The type of treatment avai1abl.e for patient.s at the

t.hird and I'ourth echelons of military medical care i.s

essentially like that found in any civilian hospital or

medical center. The type of treatment found at. the first two

echelons of medical support in both the American arid British

Armies requires more specific explanation, however, because

the type of medical care given is directly related to the

fact that the care is given in a tactical environment.

The USAMEDD structures medical care at the unit-level

and the division-level around the elements of advanced trauma

life support (ATLS) care. These elements are:

( 1 1 assessment of patients with multiple injuries;

( 2 ) insertion of breathing tubes;

( 3 ) prevention and treatment of shock;

( 4 ) replacement. of lost body fluids;

(5) emergency treatment of trauma injuries; and

( 6 ) initial treatment of burns.

The USAMEDD’s goal is to provide soldiers ATLS care within

thirty minutes of injury and to stabilize patients requiring

third and fourth echelon care so that. surgical intervention

can be provided within four to six hours. As can be seen,
ATLS care is relatively basic medical cnre. Given the

environment of combat operations and the inherent

difficulties of providing medical support in that

environment, ATLS care is the right level of care which the

first and second echelons of medical support. should provide.

The RAMC uses basically the same framework at their

39
first two echelons of medical support. Like the USAXEDO, the
RAW fully recognizes the crit.icality of providing snl.dier-s

lifesaving care as suon as possible. 'The timeframes they

recognize for effectively providing that care are the same

as the ones used in the American Army. In specifying the

equipment which their personnel need in order to provide ATLS
care, the British specify those medical items needed to
encompass the six elements of combat medicine identified by
the IJSAMEDD. 2 2

Patient. Evacuation

X key concept of medica.1 support is patient evacuation.

The U . S . Army defines patient evacuation as the timely,

efficient movement of wounded from the battlefield which

begins where the injury occurs and continues until the
patient receives the definitive care he needs.23 The U.S.

operational concept is that t.he gaining medical unit is

responsible for patient evacuation - higher evacuates lower.
The British Army operates its patient evacuation system in
the same manner except for one significant difference.2'

The significant difference concerns aeromedical

evacuation. Although the IJSAMEDD relies heavily on ground
ambulances, the USANEDD specifies that the preferred means or
pat.iunt, e\aouat.ion is hy air. "Aeromedi.ca1 evacuation, to
the maximum extent feasible, will be used in the combat. zone
f o r evaciiatioii." 2 5 'The RAEIC u s e s aeromedical evacuation also

hilt. unlike the U S A > I E D D the R A N C has no aeromedioal evacuuLion

unit!; of it.s oun. The H,\EI(: must r e l y o n CSS helicopt.et-s t.o

perform neromedevac (withuut in-flight medical care) in

addition to their primary mission of moving equipment,

supplies, and troops in airmobile operations.

Evacuation is a major element in the medical support of

combat operations. The speed of evacuation and the

continuous enroute medical care from the batt.lefield to t.he

t.reatinent facility are just as important as the emergency

medical t.reatinent at the sit.e o f injury and the

coinprehensiveness of medical care available at hospitals. .As

Yajor General Spurgeon Neel, U . S . Military Assistance

Command Vietnam surgeon, observed about medical support in

Vietnam, "Getting the casualty and the physician together as

soon as possible is the keystone of the practice of combat

medicine. The helicopter achieved this goal as never

before."*G

The Korean and Vietnam experiences proved to the

American Army that the U S A H E D D shou1.d have i t , s own

helicopters f o r neromedevac. ..\ccording to the 1 i . S . Army,

air ambulances are as essential as ground ambu1.ances. 'They

provide a new dimension f o r patient evacuation and their

control by medical commanders rather than general ( 3 s

commanders is as appropriate as is the cont.ro1 of ground

ambu Lanccs . T o date, the Rr\?IC has not persuaded the O r i t. i sh

Army t.o ii similar point. of view.

 Command Contro L

A firinl operational concept which is central to any

comparison of medical support of combat operations is command

and control. A basic understanding of command and control.

is key to an understanding of any military operation.

Paraphrasing FM 101-5-1, command and control in the

medical support. arena is the process of directing,

coordinat,ing and controlling medical units to accomplish t h e

medical. s u p p o r t . mission. "The process encompasses the

.
personnel, equi pmerit, communications,. .and procedures

necessary t,o gather and analyze information. I .," plan medical

support operations and supervise their execution.27 Unity of

command is recognized as essential for the USAPIEDD as it is

for the other elements of the American t\rmy. The role of the

medical commander - at each echelon of medical support - is

crucial to effective medical support of combat operations.

In the same way as in the American Army, medical command

and control. is recognized as absolutely vital in the British

Army. At each of the levels of medical support which the

R A W provides, medical officers control the provisi.on of

patient treatment, the order of evacuation, and the network

for medical communications.23 The RAMC's "Medical Support: i n

t.he Field" clearly describes command and control imperatives

for every echelon. I t carefully addresses the medica.1

commander's responsibilities f o r resource allocation, medical
planning, informat.ion gat.hcrind, and casualty evacuation

(casevac) ooordination.29

The medical suppovt of rapidly deployed larid force

operations requires the superior commarid and control.

described in the U.S. Army's keystone varfighting manual,

FM 100-5 "Operations." Essential for this is the thorough

understanding by all elements of a force of the overall

commander's intent and concept of operations.30 Both the

USAMEDD and the RAMC fully recognize the significance of this

understanding and emphasize its importance throughout the i. r

medical support. doctrinal publications.

Summary

The principles and operational concepts discussed in

this chapter provide an excellent framework for comparing

the planning and execution of medical support operations.

The following examination of the medical support in the
Falklands and in Grenada uses this framework to analyze the

planning, execution, command and control of those medical

support operations.

43
 END NO'I'E S

CHAPTER 1 1 1

1. U . S . Department of the Army Field Manual 101-5-1

"Operational Terms and Symbols. " : 1-16.

2. "Administration in War." British Army Manual on

Administration and Logistics. z\rmy Code Sumbar 7 1 3 4 2 .
Ministry of Defence, 1984: 1-1.

3. FM 101-5-1, p.1-43 and "Administration in War," p. 1-1.

4, "Administration in War, I' p. 1 - 2 .

5. Ibid., p . 1 - 7 .

6. Ibid., p . 1-8.

7. U.S. Department of the Army Field Manual 6 3 - 2 "Combat

Service Support Operations - Division." : 1-2.

8. LTC John R. Raffle, Combat Service S u m o r t : I troduc ion

Q combat Service Support S480/6. U.S. Army Command and

Staf'f College, F o r k Leavenworth, Kansas, 13 May 1985: 1 8 - 2 1 .

 9. U.S. Department. of the Army Field Manual 8 - 1 0 "Heal.th
Service Support in a Theater of Operations." : 2 - 1 2 and 2 -

13.

10. "Administration in War," pp. 2-54 and 2 - 6 0 .

11. "Medical Support in the Field." Precis from the Royal

Army Medical Corps Training Centre in files of British

Liaison Officer, U . S . Army Surgeon General's Office: 1A-1.

12. FM 8 - 1 0 , p. 6-3 and "Medical Support in the Field," p.

IA-1.

13. FM 1 0 0 - 1 0 , p. 2-24.

14. "Medical Interoperability Handbook." British Army Manual

Code Number 7 1 3 7 6 . Ministry of Defence, February 1 9 8 6 : 1 - 2 .

15. FM 8 - 1 0 , p . 2-4.

16. "Medical Interoperability Handbook," p . 1 - 3 .

17. Ibid.

1H. FM 8 - 2 0 , pp. 4 - 1 t h r u 4 - 5 .

19 * "Medical Interoperability Handbook," p. 1 - 4 .

'I5
20. U.S. Department of the Army Field Manual 1 0 0 - 1 6 "Support
Operations: Echelons Above Corps." : 8-2.

21. "Medical Interoperability Handbook," p. 1 - 4 .

22. "Medical Support in the Field," pp. 1-3 and 2C-5.

23. U.S. Department of the Army Field Manual 8 - 3 5

"Evacuation of the Sick and Wounded." : 1-1.

2.1. "Medical Interoperahi.lit,yHandbook, " p. 4 - 1 0 ,

25. U.S. Department of the Army Field Manual 6 3 - 3 5 "Combat

Service Support Operations - Corps." : 10-8.

263. MG Spurgeon Neel, Vietnam Studies: Medical SuoDort of

--
the L . S . Army in Vietnam 1 9 6 5 - 1 9 7 0 . Washington, D.C.:

Department of the Army, 1 9 7 3 : 59.

27. FM 1 0 1 - 5 - 1 , pp. 1 - 1 6 and 1 - 1 7

28. "Administration in War," p. 4-11

29. "Medical Support. in the Field," pp. 3 - 8 thru 3 - 1 1 .

30. U.S. Department of the Army Field Manual 1 0 0 - 8

"Operations." : 3-4 and 2 1 - 2 1 .

46
 CIIAP'I'ER I V

MEDICAL SUPPORT IN THE FALKLANDS CAMPAIGN

The Falklands Camaaiqn: Back.ground

On the second of April, 1982, Argentina invaded the

British-owned Falkland Islands. The Falklands, located 4 5 0

miles from Argentina and 8,000 miles from Britain, had lonq

been claimed by Argentina. Prior to the invasion, Argentina

was negotiating with Britain for sovereignty over the small

islands. To the Argentinians, the long negotiations did not

appear useful in altering British control of the islands.

Furthermore, to Britain, the negotiations reaffirmed its

control primarily because the 1,800 English-speaking

inhabitants "were opposed to being ruled by a Spanish-

speaking country whose government was an arbitrary military

d i c t.a torsh i p . " 1

' r h r e e d a y s after t,he Argentine invasion, on t . h e f i f t h 01'

ApriL, Britain dispatxhed the first, naval elements of a t.ask
force it would assemble to retake t.he Falklands, 'Chis task

f u r r e s!.oppwi briefly at. .\scensiori Island, halfway hetxeen

Britain and the Falklands, to await the outcome of further

negotiations to persirude Argentina to withdraw its troops.

When these negotiations failed, the stage for the land war in

the Falklands was set. (See Figure 1 , page 5 3 . )

On 25 A p r i l , a party of Royal Marines and Special Forces

landed on South Georgia and after a short fight received the

surrender of the .lrgentinian garrison. This sirccessfuj

at.tark gave t,he British task force an additional land base,

albeit still some 800 miles f r o m t.he Falklands.2
The eighth of ?lay %a= 3 Commando Brigade, Royal

Yarines, reinforced by two attached batt,al.ionsof the British

Army's Parachute Regiment leave Ascension with the mission of

retaking the FaLklands.3 (The British refer to the 2nd and

3rd battalions of the Parachute Reuiment as 2 Para and 3 Para

respectively.) On 12 May, the British Army's 5th Infantry
Brigade sailed from Brit.ain to join the task force in the

SouLh .\t.lantic. On 2 1 May, 3 Commando Brigade and the

attached parachute battalions landed at San Carlos on East

Kalkland. (See Figure 2 , page 5 4 . 1

Although raids were conducted on Pebble Island, located

just north of West Falkland, the focus of British attention

during t.he pampaign was on East. Falkland. There the

overwhel.minr:preponderance o f Argentinian st.rengt,h, nearly

10,000 soldiers, was Located. The British assumed that, the

decisive battles in the Falklands Campaign would be on East

Falk.Lanri and they were proven correct,

The breakout from the San Carlos beachhead started on 2;
Nay. In the north 4 5 Commando headed for Uouglas Settlement.

and 3 Para thrusted towards Teal Inlet:' 2 Para attacked

towards Darwin and Goose Green. In fierce battles at Darwin

and Goose Green on 2 8 and 2 9 May, 2 Para overcame strong

Argentinian defensive positions, killing some 2 5 0
Argentinians and capturing over 1600 prisoners. This defeat

deeply affected the morale o f the remaining Argentinians

garrisoned in the Falklands.5 At the same time, 4 5 Commando

taok Douglas and clashed with Argentinian troops in the ?It..

Kent area. Men and weapons were airlifted on to E l t . Kent

which was then captured. Mt. Kent dominated the western arid

northern appro,aches to Port Stanley, the capital of the

Falklands.6
On 30 May, advance elements of 5 Infantry Brigade

arrived at San Carlos. By 2 June, the complete brigade had

been deployed ashore in preparation for the final advance

against, Port Stanley. On 1 4 June, after a series of
engagements preliminary to a final assault on the capital,

the Argentine forces collapsed. A truce was arranged and the

Argentinian commander, General Menendez, agreed to surrender

all Argentinian forces in the Falklands Islands. The war in

t,he Falklands was over.

49
4 Brief Review of the Combat, Service Support of the FaLkIari&

Campaign.

The challenge of providing combat service support to the

British land forces in the Falklands Campaign was clearly a
formidable one. The sheer distance from the United Kingdom

made it so. There were no contingency plans for logistic

support of combat operations in the Falklands and, at the

t.ime of the task force's departure, it, was unclear what form

combat operations wou1.d take.' Noreover, the Brit,ish had

only one intermediate staying base, Ascension Island, which

is 1.ocat.d midway between Britain and the Falklands and,

therefore, lay 4 , 0 0 0 miles from the battlefields.

Combat service support, ( C S S ) operations on East Falkland

were the responsibility of the Commando Logistic Regiment,

Royal Marines, later augmented by army C S S units. These CSS

operations started with the landing of 3 Commando and

continued throughout the campaign.8 The Logistic Regiment

began its CSS planning using a basic losistic concept of
operations which had been exercised the previous year.9

Alt.hough the land force fought throughout. the campaign

on what Hastings and Jenkins aptly described as "shoestring
resources," CSS planners and tacticians adjusted and

synchronized plans t o insure successful sustainment. of combat

nperations.10~1' A11 in all, the British Secretary f o r
Dcfense correctly described C S S in tho Falkl.ands when he said

it was "a major success" of the campaign.''

 Since the f o c u s of this research is the medical support
provided in the campaign, overall CSS in the Falklands G i l l

b e exumined furthcr only hriefly and with respect. to the

eight CSS principles identified in the previous chapl.er.

First, with respect to the principle of S u p p o r t F o r w a r d ,

i t is clear that the British followed this principle despite

great difficulties in doing so. Since this was an island

campaign 8 , 0 0 0 miles from Britain, the British had to rely

significantly on seaborne support. Due to the lack of air

superiority, the time supply ships could be off-loaded was

1imit.ed to only a few hours each night: because the ships had
to make for the open sea before daybreak.12 Nevertheless,

forward support was maintained on the beaches initially and

further inland as the ground forces advanced. The lack of

sufficient numbers of helicopters was the only serious
deficiency in the forward support of the ground forces.

Continuous Planning was maintained once the British

government decided to commit a task force to retake the

islands. Planning was not perfect but adjustments were

continuously made in anticipation of the requirements of

tactical contingencies. Practice Economy was essential due

to the limited number of support vessels available and the

long transit. time. Additionally, the British made Masirnuin

U s e of Standing Operating Procedures by using the time
sailing to the Falklands to review and practice the
procedures later t.0 be used in the actual CSS operations.

There are many examples of Tailored S u p p u r t f o r the larid

forces in the Falklands Cumpuigri. For instance, it. was

recognized that; the islands' terrain was essentially either

moun tninous o r b o g g y :Ind would, therefore, necessit.ate B

reliance on footbornc o r heliborne movement.. For this

reason, the forces committed were tailored to leave useless

vehicles behind in Britain.

The British CSS planners, as well as the tacticians,

practiced C e n t r a l i z e d C o n t r o l / D e c e n t r a . l i z e d O p e r a t i o n s .

Despj.te the oversupervision which can often be found in a

campaign like this one wit.h tho availabi1i.t.vof advanced

communications technology, the chain of command in t.he

Falklands Campaign concentrated on providing resources to thr

soldiers on the ground and allowed the lenders on site to

execute tactical and combat service support operations.

The British also followed the last two of the basic CSS
principles identified in the previous chapter. They made

. Y a x i m u m U s e of T h r o u g h p u t D i s t r i b u t i o n and Maximum U s e o f

Local R e s o u r c e s . Ammunition, food, and other supplies were

flown as far forward as helicopter assets allowed while local

fuel supplies and transportation assets were used whenever

available and warranted by tactical necessities.
The British soldiers who provided the vital. combal:

service support in the Falklands Campaign did an

extraordinary jab. Despite limited time to plan and I.imited

resourct3s with which to execute s u p p o r t . operat.ions, t.hn CSS

provided to the Land force was vigorously rendered and did

not violate any of the cardinal. principles of CSS doctrine.

52
FIGURE 1

53
Nedical Support in t h e Falklands Campaign

'The remainder of this chapter concerns the actual

medical support of the British Army during the Falklands

Campnign. The planning, execution, command and control of

the medical support of the British Army units on East

Falkland is described below. The chapter ends with a review

of medical lessons learned and other conclusions about the

Falklands Campaign medical support.

-
The PlanninR of the Medical Support

The medical planning for the Falklands Campaign began

immediately following the Argentine invasion. Although the

Royal Navy had overall control of the conduct of the
campaign, the Royal Navy Medical Department quickly

established liaison with the medical services of both the

British Army and the Royal Air Force. 1 4 The medical plannina

and the organization for medical support "evolved during the

first few weeks until it became a fully 'corporate' effort

involving all three services."15

The time required to move land forces to the Falklands

allowed adequate organization of personnel, units, and

supplies. The planned medical support from the Army included

the following units and personnel:

55
 ( 1 ) Tho 16 Field ~Ambri1,nncnR.I\HC to provide second Line

inedicot s:ippor!. f o r the Land force;

i2 ) Sti?gic:il teams drawn f r o i i i 16 Field .Ambulance

(Parachute ('1eari.rigT r o o p ) and 2 Field Hospital R A K ; and

I31 Reaimental medical officers assigned to each major

unit (at later stages in the campaign a second medical

officer was assigned to some units).l6

.Additionally, the British appreciated ear1.y "the difficulties

of resupply F o r an operation of unknoun duration, iri which

L -1:
I::i~~a P i g i i r e a c o i r l d only be e s t.irnn:.ad, ... " and mad?

nrrangement,s f u r airlirt o f imedical supplies to .isconsion

Islnnd and sealift to the Falklands.17 >ledical planners oisu
iised the t.ime to refine their planning as operational plans

changed. They covered as many contingencies as possible and

yet, real zed that adjusting to changes, or "hot planning" as
they cal ed i t , r;ould inevitably be required.18
The nearly three-week voyage to the Falklands was also
p u t to good iise in medi.cal. training and physical fitness

traini.ng. Refresher training for RAMC personnel was

conducted and extensive first-aid training for infantry
soldiers was provided.19 Medical training for infantrymen

stressed immediate resuscitation, essential treatment for

s h o c k , control of hemorrhage, application of first-aid

(dressings, and t.he administration of morphine. Physical

F i t n e s s received $reat. emphasis and vigorous physical
Lraininy conLiriued aboard ship in accordance with the high
standards of the British Army as well as the rigorous

requirements established for the soldiers of t.he Parachute

Regiment . 2 0

The British also recognized that the fighting in the

Falklands would be different from that in Northern Ireland

where medical treatment of the highest order was readily

available. The British stressed buddy-aid in combat but also

emphasized that mission accomplishment - not casualty

treatment - was the first duty of an infantryman. Treatment

and evacuation resources were expected to be scarce

especially compared to the immediate treatment capability

available in Northern Ireland.

;\ccording to British medical operational concepts,

highly trained field medics were to accompany each combat,

unit. to provide treatment beyond the average soldier’s

capability.21 Regimental aid posts were to be positioned

just behind the maneuvering infantry units. Xedical planners

realized that the poor terrain and the wet weather meant that

casualty evacuation by road was impossible so they

anticipated that the modes of evacuation wou.ld be by

stretcher or by helicopter. Also, field surgical teams

(consisting of a surgeon, anaesthetist, resuscitation

officer, four operating theatre technicians, a blood

transfusion technician and a clerk) were to be placed as f a r

forward as possible, moving successively forward with the

casualty collect.ing sections from the field ambulance as t.he

combat units and the aid p o s t s advanced.

 16 Field Ambul.ance was to establish a dressing station

and casua.lty col.lect.ing soct.ioris ashore. .-\ugment.edby

Liio i i e l d s~~rqic:iIt.aains, it tias to serve as an in!.crmdiak..'

link betwern the surgical teams and thc h o s p i h l ship in t i i d

initial phase of the campaign. Due to the lack of air

superiority, operational-level planners did not want 2 Field

Hospital ashore but retained aboard ship with the plan for
casualties to be evacuated by helicopter from t,he dressing

and collecting stations to the hospital afloat ( a cruise

s h i p , the SS L'g:lnda. which had hnen converted into a hospitnt

ship). 2 2 Plans Gere inadr f o r 2 Field Hospital t.o drtplo,~

should the operational sit.uatiun permi.t, it. 2 3 Some surgicn!

e1einent.s of 2 Field llospital were deployed ashore xith 16
FieLd Ambulance to bolster t,he field ambulance's effort.^.

The British even planned a holding element to l o o k after the

anticipated large number of enemy prisoners of war.21

In addition to these preparations, the British

emphasized the importance of triage as well as the use o f

whole blood. Sort,ing casualties into priorities f o r

s p e c i a l t y care as soi>n as possible wns their gonL. Thrj

British aim was to "provide definitive forward surqery and

resuscitation within six hours.. . . " 2 5 To insure an adequat,r
supply of blood. "donations" t,nken from the soldiers during

t.he voyage t.o the Fdklands were augmented by blood supplied

by t.he ;\rmp D l o d S u p p l x Depot in Bri t.ain. ".\lt.<-,yet.her,

from

a1 I. s u i i r c e s , a total of :12(i2 uni t,s were provided. " 2 6

This discussion demonstrates that. the planni.nz o f t.1il-a

medical support of the Falklands cLear1y followed the s i s

principles of medical support, ident.i fied in Chnpt.cr Three,

From the o r i t s e t t h e British medical planners sought to ins1ir.r:

that the medical support plans conformed to the operat,ional.

and tactical plans. Similarly, they planned medical support

in the closest possible proximity to combat operations using

significant medical resources at every echelon to insure

rapid resuscitation and t.reatment. The flexibility which the

planners displayed has been shown in their ability to quickly

adjust and "hot plan" as the campaign evolved. The mobility

of the medical units was expectoil to be severely hampered due:

to the nature of the terrain, but the medical planners hoped

to mitigat.e this by situating their medical units well

forward with the maneuver units. Continuity of care was also

emphasized from the beginning of planning but the British

also recognized their complete reliance on stretchers and

helicopters f o r casualty evacuation (casevac). Finally, in

their medical support doctrine, they recognized the

importance of control of medical unit.s to insure effective,

efficient support. Their primary weakness in the area or

control in the planning of the medical support of the

campaign, however, appears t.o be their lack of centralized

control over helicopter evacuation assets. Although t,he

medical commanders realized the importance of helicopter

evacuation, the paucity of helicopters in the Dritish .Army

precluded their having dedicated helicopt,ers with trained

medical crews for casevac support. 2 7

 The Esecution of the ?llcdical Support

As the infant-ry went ashore at San Carlos on 2 1 ?lay,

organic medical personnel accompanied them. 'The RAMC

executed the medical support in the Falklands Campai.gri

essentially the way it was planned except that initial

planning to have only an evacuation facility at Ajax Bay had
to be changed.
Although the landing was unopposed by Argentinian qroimd
forces, intensive Argentinian air strikes at the beachhead
made casualty evacuation to the Ugrmda uncertain. 2 9 For t.his

reason, the medical commander vigorously insisted that

hospital elements be established ashore shortly a f t e r the
landing - a mob-e which the operational-levol planners liere

reluctant to approve at first.29 In spite of the fact that

he risked court-martial in his confrontations with the

tacticians, the medical commander's decisive action

undoubtedly helped save many lives in this phase of the
campaign and later. 3 0

As the British infantrymen advanced southward toward

Oarwin and Goose Green, Argentinian resistance mounted. With

eHch combat battalion went a Regimental Medical Officer
(RHO), six medical assist.ants. a field ambulance collecting

section with eight medical assistants, and regimental

soldiers (bandsmen, cooks, and H Q s personnel) designated as
ntrel.cher hearers. 3 1 As the ground fighting began, t h e real

difficulties of' casua1l:y care became apparent.

60
 Even with the relatively light casualties,
t>hc s y s t e m of t.renting them in the initial
stages produced difficul.ties The problems
I

of casualty evacuat.ion t.o regimental aid posts

arid beyond were immense, depending as t.hey d i d
upon helicoptr!rs o r stretvhrr par!.ies. Nost.
engaqements took place at night on remote hill-
sides in adverse weather conditions. ?lany cas-
ualties, including some who had lost limbs, lay
virtually untreated f o r up to 3 and, in some
cases, 7 hours.32

Due to the conditions under which combat in the

Falklands had to be fought, soldiers had to rely on xelt' aid

o r buddy aid immediately after sustaininq a wound. All

so.ldiers carried individual first aid kits while officers

arid noncommissioned officers (NCOsl carried two :ri I I I ~

morphirie syrettes. 3 3

RMOx had to be highly selective about essential medical

supplies and equipment because all Regimental Aid Post ( R A P )

equipment had to manpacked by the personnel manning the

RAP.3' Following the medical plan, casualties were evacuated

down from the craggy hillsides by stretcher to the RAP

for further treatment, and then subsequently evacuated by

lielicopt.er if medical care from a higher echelon r;as

required. (Lack of lightweight stetchers was R problem.)

The self aid and buddy aid rendered was important in

saving 1.i vcs p l u s the cold conditions promoted hemost.osis

even when some field dressings were poorly applied.35 Aft.er-

initial medical treatment, by a combat. soldier or medic, t.he

casualty then began t,hc evacuation p r o c i ? s s to ul t.imnt.rI?

gaL him to the level o f medical care needed to provide

definitive treatment.

61
 In addition to the difficulty of evacuating patients on

stretchers down hillsides over rocky crags, other conditions

in t.he Falklands increased casual t . i e s . Although the v i s n r o u s

physical training conducted before and en route to the

Falklands contributed to the campaign's success, no exercise

schedules could have prepared the soldiers for the three

weeks they spent in the harsh climate.38 The cold, damp

weather coupled with a lack of heat and water for personal

hygiene produced a number of cold injury casualties and

severely drained the fitness of all soldiers.3' Some o r Lhe

soldiers who participated in the campaign had also recently
been involved in esercises in Germany and had already

sustained **...minor degrees of non-freezing cold injury to

the feet, which undoubtedly ..." predisposed them to cnld

injuries.38 Additionally, "because of the cold climate with

everything frozen at night and snow falling several times,

the soldiers failed to drink adequate fluids and thus when

wounded blood volume was intensified by the dehydration."39

Furthermore, British medical officers discovered anot,her

factor impacting on the initial survivability or patients.
"Current teaching in the RAFlC is that a tourniquet should
only be used as a 1.ast. resort and the reality is t.hat this
means never."'O Khereas this is probably appropriate in a

country with skilled medical attention readily available, the

Rrit.ish medical officers believed that some casualties in t.he

Falklands simply bled to death because of the accept.ed

practice of prohibiting the use o f tourniquets.

62
 Medical a.,fficers also discovered that the est.remely (:$ild

tcmperatures in the 1:nlklands negated the benefit, offered b y

in t.ramiisPuI.ar mor.ph i ne i n . j cc 1. ions for bat.t I F f i e l d c a s i i i i 1 I.i t . 5 ,

The cold severely retarded drug absorption and t.hiis prevented

any measure of morphine pain relief. Later, however, a f L e r a

casualty had been evacuated and had received surgery (and the

patient’s body had rewarmed), the morphine induced profound

respiratory depression which often required massive doses of

Naloxone to reverse.42

Thc vast majority o f patients who had to be evacuated t.o

2 Vielii llospital or to forward field surgical teams w e r e

transporLed by helicopter.43 Available Gheeled v e h i c l ~ swere

used whenever possible also but the terrain rarely permitted

this. The Army’s Air Corps and the Naval and Royal Yarine

pilots did a fantastic job of casualty evacuation despite thc

difficult weather and inadequate night vision equipment.

The helicopters, since they were not solely for casevac

use, usually carried ammunition in and casualties out. Of

the 783 British soldiers wounded, an estimated 400 casualties

were extracted by helicopters from forward positions.44

Helicopters were frequent targets of both small arms fire and

.Argentinian aircraft. Perhaps due to the lack of medical

markings, at least one helicopter engaged in a casualty

evacuation mission was shot down by an Argentinian close

support aircraft. Army and Royal Marine helicopter pilots

performed cnsevac f o r every engnyemcnt. and were decorat.4 f o r

their det-ermination and skill iri this role.

63
 .But, thure were definite problems Kith the aeromedev:ic

in the Falklands. Since helicopters were also performing

l.og!ist.ica! missions, they x e r e not, a l ~ n y sreadily avai1.aL)I.e

for casevac. Yhen they were available, weather and night,

vision difficulties as well as the lack of air superiority

often made them slow in arriving. John Frost, reporting on

the casevac problems of 2 Para, points out that the soldiers

had difficulty getting the patients to helicopter pick-up
points. They were a l s o short of stretchers and had t o

improvise with ponchos and othor field expedients. 4 :

R(:cause of a l l t,hese di CFicuities, t.he British % < e r e

oYt.un unable to achieve t.heir* goal o f getting their

cnsuulti.es to surgical care within six hours of wounding.

It was nol. unusual for evacuation t.o take eight h o u r s t.0

days.46 Consequently, soldiers with major injuries often

died before they could be evacuated t,o a hospital on land or

at s e a .

Once the casualties got to the hospital at Ajax Bay they

wero almost certain to be saved. Of all the wounded who

re:x.ched hospital facilities al.ive, on1.y three subsequently

died. 2 Field Hospital performed admirably despite the

following problems: ( 1 ) insufficient. light: for major surgery,

especial.1.y abdominal; ( 2 ) insufficient heat, for drying out,

damp items and properly treating hypothermia patients; ( 3 1

insufficient pokable water for routine washing. insuff icienl-

l e water f o r int.ravenous fluids or operating room

sl.ei-i

irrigation, and lack o f w a t e r for washing hospithl linens:

I4 inxdequat,e communications - no warning of new casual ties

en rout.e; first Itnok-ledge was upon arrival at the hospit.aL;

and ( 5 1 insufficient papcr and writing material to m:aintiiin

patient records.4'

Having been established ashore at San Carlos earlier

than planned, the Ajax Bay hospital was set up in a

refrigerator plant.48 Since the refrigerator plant was also

being used to store ammunition and since it had not been

iniirked with red crosses, the Argentinians bombed the plant

wit.hin 2-1 hours of the landing. Even though two unexploded

bombs k-ere found in the plant. after t.he Argentinian 3i.r r a i < - l ,

the medical unit continued to operate while the bombs were

being defused. In one 48-hour period, the hospital performed

100 operations. 4 1

The British were fortunate in being able to rely on the

experience of the hospital's senior surgeon and anesthetist

who had set up field equipment and had operated in adverse

circumstances before.30 The Ajax Bay hospital was operational

from 2 1 May to 9 June and t.rented 450 of the 7 8 3 casualties

in t,he campaign. After caaual.t.ies hnd received treatment at

the hospital, they were evacuated to the U,qanda if required.

As inentioned above, the lighting for surgery at. the A.jux B a y

hospital was very poor. Consequently, the British found that

about half of the abdominal wounds explored there had to be

reexplored aboard the hospital ship because holes i n h o u e l s

had been missed or ot.her prohl ems had b e e n iivnrlouliert . 9 I

65
 Insuring adequat.e rest. for the hospital per-
sonnel was a problem since everyone came o n
dut,y when patients arrived, rather than those
oPf-shirt continuing their rest. [1: was also
riot,ad thaL hospital personnel needed to be
t.he highest. caliber. lt. was found that. a
urit.ton, understood policy was a must. The
examination o f patients required the removal
of all clothes, otherwise small wounds of
entry into the back or into a thigh with sig-
nificant abdominal damage could be missed be-
cause the wound of entry was never noted.
The British found it very practical and appro-
priate to also designate individuals as resus-
citation officers and triage officers and to
use these same individuals in those positions
t,hroughout.5 2

%lien tho intermediate objectives of the campaign iiifr!:

seiLed IDar~iinarid Goose G w e n ) , forces shifted oas1:rinr.i

t.oward P o r t . Stanley. ?lot,on1.y was Stunlup t,he capit.a.1 to?

the Falltland IsLands, i t was a l s o where the b u l k of the

Argent.inian forces were Located. Similarly, whi Le t.he s e r : o n d
half of the campaign prepared to begin, medical resources
also displaced to keep up with the advancing inPanl;ry. Like
the British infantry, who "yomped" or foot. marched uiLh pacl\s
weighing up to 140 pounds, the RAP personnel yomped their
equipment and supplies forward. Field surgical teams also
moved forward to support t.he eastriurd engagements anc.1 to

do s o they established t.hemselves at Fitzroy and Teal Inlet.

,As other infantrymen sailed in t.he Sir Gn.lahnd t,o i3iuff

Cove to be positioned for the assault. on Stanley and the

surrounding ,\rgentinian positions, elements of 16 Field
Ambulance aocoiiipanird t,heiii. ,As the troops were di sumharkinn,
I.he weather I
: loured unrspect,edlv and the ship was at,tackr=rl

iq .\r'geni.ini;inaircraft. :Among the fifty soldiers I c i l l e ~ l

66
in the raid were three members of the 16th, including the

second in command. 5 3

'The Sir Cialahad bombing produced 1 7 9 casualties alone. 5 . 1

This incident, the only one in which the available medical.

facilities were almost overwhelmed, was the closest the
British came to a mass casualty situation. Triage had been
applied at every point in the casualty evacuation chain

throughout the campaign and the dental officers who filled

the role as triage team leaders did a fine job. Now, with

this enormous number of casualties, the experienced triage

officers faced their most difficult test. Casualties from

the bombing were taken to the field hospital if they required

surgery or to the Uganda if they were suffering from
exposure.53 Due to the large numbers of untreated casualt.ies

which arrived at the advanced dressing station, patient

transfer to the L'ganda was expedited and every medic

available worked continuously until all patients had been

treated, released or evacuated.56

The final assaults on the Argentinian positions

surrounding Stanley were fierce, small unit engagements.

Although casualties occured from gunshot wounds and artillery

fire, treatment. facilities were in place and evacuation,

though still constrained by limited helicopter assets,

proceeded relatively smoothly. Hospital personnel, having
become proficient at battle surgery, focused on the

definitive care needed to fight possible infections in the

gunshot wounds and burns of the British casualt,ics.

67
 Once patients were stabilized aboard the Uganda, they

were transferred to one o f Lhree ambulance ships. The three

ambulance ships - the H r d n , the H e r a l d , and the H.vdra -

carried the casualties to Yontevideo in Uruguay where they

were transferred to Royal Air Force aircraft for the final

leg of their return trip to the United Kingdom.

Command and Control of the Yedical Supaort

During the Falklands Campaign effective command and

control of the medical support was maintained with the

exceptions of conkrol over and communications with the

casevac helicopters. The medical officers in command showed

that the British medical support doctrine was sound and that
their medical support system could support tactical

operations thoroughly and vigorously. The medical commanders

knew their personnel, equipment, procedures, and

communications.
The British task force consisted of elements from all.
three services and the tri-service medical cooperation, like

the tactical cooperation, was excellent. Initial planning

was the responsibility of the Royal Navy, but the Royal Navy

Medical Department understood how essential it was for the

medical officers o f a L l three services to actively control

the vital parts they each must play in the Falklands
Campaign. Furthermore, each medical service realized t.he

necnssi t y o f fully understanding thc responsibil i t.i e s and

c n p a l ~ i it.ies
l of I:he ot.her two. 5 7

With respect to command and control, the British

stressed in their after action report the importance at' the

medical commander on the ground being able t,o deploy his

resources to best advantage to provide the clinical links

between forward medical support units and rear-area

hospitals.59 This was clearly demonstrated at the beginning

of the land campaign when the first soldier landed and t.he

medical commander insisted upon establishing surgical

capability ashore.

The only instance of a lack of command o r adequate

control in the medical support arena concerned helicopter

evacuation. The RAMC commanders recognize that rapid

evacuation from point of wounding to surgery "is the most

important factor in the saving of lives."l9 Yet their 1.ack

of dedicated casevac helicopters resulted in no direct

control in this area. Procedures for requesting aeromedevac

were cumbersome in that. they had to be forwarded a l l the way

to Commander Amphibious Warfare Headquarters f o r approvsl.6"

The lack o f control. o v e r casevac helicopters and the scarcit.y

of helicopters meant there were insufficient helicopters t o

evacuate all casualties and lives were lost because of the

rielay.6'

69
 Summary and Lessons Learned

T!ie :netlicn: siippnrt. o f r h t ? F ' a l k l n n d s [L'ampaign i n :nnriv

i;a:.'s s e r v e s a s a t e s t . b o o l r e x a m p l e f o r medical n i i p p o r L o f ;I

r a p i d i y deployed land f o r c e . 'The c o o p e r a t i o n bet.ueeri t h e

medical d e p a r t m e n t s o f all t h r e e B r i t i s h m i l i t a r y s e r v i c e s

a l s o s e r v e s as a f i n e e x a m p l e o f j o i n t m i l i t a r y s u p p o r t

operations. The o p e r a t i o n a l c o n c e p t s o f t r i a g e , support i n

e c h e l o n s , c o m b a t m e d i c i n e , e v a c u a t i o n , a n d command a n d

c , o i i t . r o l e s p o u s e d by t h P R o y a l Army Y e d i c a l Corps were

c f f r c ; r. i 1y p 1 anriod and. e f f i c i. en t 1>- i . m p l a ? m e r i t.ed . ijr I. !. i :< 11

m n l i i:ctl s u p p o r t was p r o v i . d e d i n a c c o r d a n c e w i t h t h e R.\?lC-

i n d o r s e d o p e r a t i o n a l c 0 n c e p t . s a n d i t r e s u l t e d i n ~ i i o r e t h a n :J!!

p e r c e n t o f t h o s e r e c e i v i n g i n j u r i e s w h i c h w e r e not-.

immediately f a t a l s u r v i v i n g t o r e t u r n home.62

The R A W a l s o c l o s e l y f o l l o w e d t h e s i x p r i n c i p l e s o f

medical s u p p o r t : ( 1) conformity; (2) proximity; ( 3 )

flexibility; (4) mobility; ( 6 ) c o n t i n u i t y ; and ( 6 ) cont.rot.

T h e s t ? p r i r i c i p l e s , i n t e g r a l t.o R r i t . i s h medical s u p p o r t .

d o c t r i n e , w e r e u s e d i n t h e p l a n n i n g a n d e x e c u t i o n o f t.hp

F a l k l a n d s Campaign m e d i c a l s u p p o r t . They w e r e a p p l i e d i n t h c

c o n t e x t - o f t.he R , W C o p e r a t i o n d c o n c e p t s a l r e a d y r o v i c r < e d .

And, +.hey were a p p l i e d e f f e c t i v e 1 . y i n a l l r e s p c ' c t s ex(.epI. f o r

r o n t r o l a n d i n o n l y o n e importzint. a s p e c t - t h e cont.ro1 of

e\aciintion assets.

T i i t ? R i - i I : is11 t'imld inodic:il suppor1: s y s t e m inc111dr.s

o r g a n i c - , o v a c : i i r \ t i o n assets at. e v e r y e c h e L o n o f m e t l i c a i supp>rt.

and in the Fal.kI:rnds i t even included n hospital ship wit.n

three supportinq ambulance s h i p s . But, by doctrine nnri in

nctiiaL practice in the Falklands, Hrit,i.sh medical commandz::rs

did not control helicopter evacuation assets. The l a r k o f

control over the evacuation helicopters was identified b y t h e

British as the main lesson for the RAMC in the Falklands.

They concluded that the medical services must have dedicated

helicopters under their control at all times to transport the

wounded. 6 3

There were n number of other important lessons Learned

about medical support .in t.he Falklands. These inc I ilrlrtl Ivht:

importance of physical fit,ness; che value of self aid, buddy

aid, tourniquets arid far forward resuscitnt i o n ; and the neetl

for greater emphasis on fluid intake by soldiers. The value

of simple surgical procedures and simple clinical polit.'

- 1 es

which are understood by all was reaffirmed.64 Additionally,

the British Army surgeons recognized the need for broader.

training for physicians which would include greater

familiarity wi t.h field medical equipment, and battlefield

casualty management.. 6 5 The problems at. the hospital at, .\,j:i.<

Bay (insufficent lighting, heating, and supply levels) were

also noted. Further, it was reaffirmed that injuries o f t,he

head and t.riink ( 2 0 percent of the casualties) are the most.

taxing surgical problems and that, to handle these and the

tot,her injuries in war, t,he military surgeon must be 3 trul>-

d e n e r a 1 surgeon. 6 6

A final point, t,o consider, and perhaps t.he I I I O S I

71
important one of 31.1, is t,he e1.ement of Lime. 'The Faililands

Uampniqn was conducted r s p i c i l y and the med i cal. s u p p o r t . , I i iio

tho rest o f khe zombnt nervici. supporl-.,hail to be quickL:- b u !

carefu1.L~assembled. k'ith no existing plan far a contirirSency

operation in the FalkLands, the British used the limited tine

they had to prepare a plan that proved much more than just

adequate to meet the medical support needs of the campaign.

They used all the time available to increase their chances

f n ~ .SUCCBSH and t o insure the actions of one service

t.hose o P the ot.het- t . 1 ~ 0 .

~?omplemerii-.ed

T h e Falk1:ands Campaign, truly R .joint operation, i i a s

eonduct.ed r;it.h aLL three medical depart.rr1ant.s working 1-1 o s e l > -

together. II: clearly illustrates the siqnificance which the

British place on cooperat.ion and the thoroughly profossi,orlaI

manner in which they p1.an and execute medical support of

combat operat.ions.

i 2
 ENDNOTES

1. John S p a n i e r , Games N a t i o n s Play ( N e w York: H o l t ,

R i n e h a r t and Winston, 1 9 8 4 ) , p. 60.

2. Interview with Colonel R . J . B . Heard, B r i t i s h L i a i s o n

O f f i c e r , L.S. A r m y Command a n d G e n e r a l S t a f f C o l . l e g e , F1.

LeavenrGorth, K a n s a s , 2-1 > l a r c h 1 9 8 7 .

3. Flax H a s t i n g s a n d Simon J e n k i n s , The B a t t l e for the

F a l k l a n d s ( N e w York: Norton, 19831, p . 176.

4. I n t e r v i e w , COL H e a r d , 2 4 M a r c h 1 9 8 7 .

5. Ibid.

6. Ibid.

7. V a l e r i e Adarns, "Logistic Support f o r the Falklands

C a m p a i g n , " .Journal o f t,he R o y a l U n i t e d S e r v i c e s I n s t i t u t e

f o r D e f e n c e S t u d i e s 129 ( S e p t e m b e r 1 9 8 4 ) : 4 4 .

8. ?ItLJ K e n n e t h P r i v r a t s k y , B r i t i s h Combat S e r v i c e S u n p o r t . !!!!

East Fallcland: Considerat.ions for S u s t a i n i n g Tactical

0parat.ions Remote :\rens. S c h o o l o f Advanced E l i l i t a r y

S t u d i e s , I:.S. A r m y Command a n d G e n e r a l S t a f f College. (Fort.

L r n v e n w o r t h , I i i i n s a s : 2.5 November 1 9 8 5 1 : 3 .

9. Adams, " L o g i s t i c S u p p o r t f o r t h e F a l k l a n d s , " p . 4;.

1 0 . H a s t i n g s and J e n k i n s , The B a t t l e for t h e F a l k l a n d s , p p .

319-320.

11. P r i v r a t s k y , B r i t i s h Combat. S e r v i c e S i i p a o r t o n E a s t

I:al.kland, p. 16.

1 2 . " T h e F a l k l a n d s C a m p a i g n : The L e s s o n s , " P r e s e n t a t i o n b y

S e c r e t . a r y o f S t a t e f o r Defence t o P a r 1 , i a m e n t ( L o n d o n : Her

N a j e s t y ' s S t a t i o n e r y O f f i c e , December L 9 8 2 ) , p . 25.

1 3 . COL H a r r y G. S u m m e r s , "Yomping t o Port, S t , a n l e y , " Y i 1 i . t n i . y

Review 6 4 (March 1 9 8 4 ) : 5 .

1 4 . Surgeon V i c e - A d m i r a l S i r John H a r r i s o n , "Naval Yedicine

i n t h e Falklands Conflict,, April-July 1982, Overall P o l i c y

a n d O p e r a t i o n s , " T r a n s c r i p t o f t h e X e d i c a l S o c i e t y o f London

8 4 (November 2 8 , 1983): 76.

1 5 . S u r z e o n Commander A . R . ? l a r s h , " A S h o r t . nut. D i s t a n t . X F L P -

the F a l k l a n d s C a m p a i g n , " J o u r n a l o f t h e R o y a l S o c i e t y .f

M e d i c i n e 7 6 ( N o v e m b e r 1983): 9 7 2 .

73
1 6 . D.S. Jackson, C.C. Batty, J.Y. R y a n , a n d h . S . P . NcGregor,
.. ~ h cF a l k l a n d s
.r
Xar: A r m y F i e l d S i r r g i c a l E x p e r i e n c e . " A n n a l s ,

-
of' -
the Royal C o l l e g e of Surqeons fi Enyland 6 5 (Sept.ember

1 9 8 3 ) : 281.

17. Marsh, " A S h o r t B u t D i s t a n t War," p . 972.

1 8 . " P a l k l a n d I s l a n d s Campaign N e d i c a l A s p e c t s , " B r i e f i n g

S c r i p t p r e p a r e d b y t h e R o y a l Army Medical C o r p s p r e s e n t e d

1:d Dr. R o b e r t . I{, M o s e b a r , M e d i c a l O f f i c e r , D i r e c t o r a t , e t'or

Combat D e v e l o p m e n t , Academy o f H e a l t h S c i e n c e s , F o r t , Sam

Houston, Texas: 3.

1 9 . E l i z a b e t h J . S h e r m a n , " I n B i t t e r L i t t l e F a l k l a n d s War,

Enemy Medics C o o p e r a t e d , " A r m y T i m e s 20 ( D e c e m b e r 2 9 , 19861:

11.

2 0 . ?lu.jor J o n a t h a n B a i l e y , R o y a l A r t i l l e r y , "Training for

har:The Falklands 1982," 6 3 M i l i t a r y Review ( S e p t e m b e r

19831: 59.

2 1 . S h e r m a n , " B i t t e r L i t t l e F a l k l a n d s War," p . 11.

22. " S a v i n g L i v e s i n t h e South A t . l a n t , i c , " N u r s i n g i R

(June 23, 1 9 8 2 ) : 1044.

75
2 3 . "Fa1.liiand Isinnds Campaign Yedical Aspact.s," 1 3 r i c f i n g

Script,, p. 5.

2 I. T b i d .

25. Surgeon Vice-Admiral Sir John Harrison, "Naval Medicine

in the Falklands," p.77.

2 8 . Xarsh, p . 977.

29. Privratsky, p. 23.

30. Robert F o x , Eyewitness Falklands (London: Yethurn, i 9 8 2 t :

126.

3 1 . "Falkland Islands Campaiqn Yedicnl . \ s p e c t s , " ariefinq

Script, p . 6.

32. Bailey, "Training f o r W a r , " p. 6 3 .

3.1. Ibid.

?.i. !lursh, p . 9 3 8 .

3 6 . Bailey, p. 6 2

3 7 . Ibid.

3 8 . "Falkland Islands Campaign Medical Aspects," Briefiny

Script.. p . 2 0 .

39. Dr. Robert H. Xosebar, "Lessons Learned i n Lebanon and

t.he Falklands," Briefing Script prepared by the author, the

Yedical Officer, Directorate of Combat. Development, Academy

of Health Sciences, Fort Sam Houston, Texas: 1 2 .

40. D.S. Jackson, M . D . Jowitt, and R.J. Knight, "First and

Second Line Treatment in the Falklands Campaign: A

Retrospective View," .Journal of the Royal A r m y Medical (lor'ps

130 (June 1 9 8 4 ) : 80.

41. Ibid., p . 8 1 .

42. Jackson, et al., " F i r s t . and Second Line Treatment,," p .

81.

43. .Jackson, Batty, Ryan, and McGregor, "Tht! Falklands G a r , "

p. 283.

L4. "Army ;\ir Corps," informat.ion sheet published by the

Royal Army dealing Kith aspects of the Fal.klands Campaign

in the files of the British Liaison Officer, C.S. Army
Command and General Staff College.

45. John Frost, 2 PARA Falklands: The Battalion at War

(London: Uuchan and Enripht, Publishers, Limited, 1983): 66.

16. I,TC John W. Harmon and C O L Craig Lewellyn, ReporL 011 the

Symposium on the Falkland Islands Campaign - Xedical Lessons

at. the Royal College of Surgeons, London, England, 17-18

February 1983.

47. Dr. Robert H. Mosebar, "Field Hospital in the Falkland

Islands," Memorandum prepared by the Medical Officer,

Directorate of Combat Development, Academy of Health
Sciences, Fort Sam Houston, Texas: 2.

48. "Lesson of Falklands: Prepare for Surprises," U.S.

Xedicine (February 1 , 1983): 3.

49. Ibid.

30. Yarsh, p . 977

78
5 1 . ?!osebar, " L e s s o n s I,Ff:irried i n L e b a n o n a n d I.hr F ; . r i k i n n d s ,

p. 13.

32. Ibid.

5 3 . Marsh, p . 9 7 7 .

.is. "Lesson of F a l k l n n d , " L A ?ledicine. p. 3.

__ .
3I " F a l k l a n d I s l a n d s C a m p a i g n ?ledicai A s p e c t s , " p. 14.

58. Ibid.

59. I b i d .

60. P r i v r z i t s k y , p. 30.

6 1 . Narsti, p . 982.

62. " F a l k Land I s l a n d s Campni qn Medical aspect.^, " p. i.

i !i
64. Nosebar, " 1 , e s s o n s Learned i n Lebanon and t h e Fa1 k l n r i d s , "

pp. 15-16.

6.5. " F a l l t l a n d Islands Campaign N e d i c a l A s p e c t s , " p , 1 6 .

66. Ibid., p . 18.

 CHAPTER V

MEDICAL SUPPORT IN THE GRENADA EXPEDITION

The Grenada Expedition: Background

' On 1 3 October 1 9 8 3 , violence erupted on the small island

nation of Grenada. The charismatic Xaurice Bishop, who had

seized control of the island four years earlier, was deposed

by hard-liners in his own government. Bishop and those who

overthrew him were Marxists who had steadily been increasing
Grenada's ties with Cuba and the Soviet Union.'
The other nations in the eastern Caribbean and the
United States had long been uneasy about the military and

political developments on the island.2 The presence of

advisers from the Soviet Union, Cuba, and other communist
regimes, and khe invit.ation of Cubans to construct a large

a i r p o r t , raised many concerns.

' Observers noted that, as well as the promise o f

81
increased t.ourism for the island, the new airport held t,he

potentia L f o r being a bast? for long-range mi.litary aircraft.

..rurthermor,?, iri view of t,iic Grenada government ' 5 : close

association with communist rcgiines, the llnited States and the

eastern Caribbean nations worried about a communist threat to

regional stability.

Additionally, the presence of six hundred American

citizens attending the St. George's University School of

Nedicine in Grenada increased concern that another American

host,ilye crisis such as i.n Iran might, occur. Consequent..ly. on

1 7 C,ct.obar, President Reagan ordered the Joint Chiefs t.o

begin noncombatant. evacuat,ion plnnni.ng.3

After Prime Minister Bishop and three of his cabinet

members were executed on October 1 9 , the resulting breakdown

of law and order, the imposed shoot-on-sight curfew, and the

unpredictable power struggle placed the safety of Americans

in Grenada in great jeopardy.' Due to the disorganization o f
the new, but highly tenuous, Grenada government, repeated
diplomatic attempts to coordinate an orderly evacuation of

U.S. citizens failed.5 Then, on October 2 1 , the Organization

of Eastern Caribbean States (OECS), p . t u s Jamaica and

Barbados, requested that. the 1 I . S . join them in intervening in
Grenada by force for the protection of the entire region.6

F o r these reasons, on October 21, President Reagan

expanded the orizinal mission and ordered h e r i c a n mi.Li,t;iry

Forces to pl.an for a complete seizure o f Grenada as part of i~

combined U.S.-Caribbean security force operation on Grenada.

. \ I t,tiough a I;.S. c o n t . i n g e n c y p l a n f o r t h e r e g i o n i.n rch ic h

G r e n a d a iias L u c n t c d d i d e x i s t . , t.here tias n o f u l l y d e v e l o p e d

- .
.; ',,ir.in.rcnc:; p i a n Poi- o c c ! i p > - i n < tiit. e n t i i f ? is1arlr.i. :

\t!vertheless, G p e r a t i o n Urgent F u r y - t h e codename f o r th+

American i n t e r v e n t i o n i n G r e n a d a - b e g a n four d a y s l a t e r i n

t h e e a r l y m o r n i n g h o u r s o f O c t o b e r 25, 1 9 8 3 .

I ' The 1st R a n g e r B a t t a l i o n , 75th Infantry, airdropped onto

t h e 1 0 , 0 0 0 - f o o t P o r t S a l i n e s a i r f i e l d a t t h e s o u t h e r n t i p of
,.
u r n n n d ; r :it. 0536 a n d secured i,t. b y 0 7 1 5 a l o n g w i t h t h v 2nd

Har,tsl ion. 9 The R a n g e r s t h e n secured t h r 'l'riie Ulile (:;impus 0 P

r l i ~St.. G e o r g e ' s U n i v e r s i t y S c h o o l o f ! l e d i c i n r a n d rescued

Zihul, 131) ; \ m e r i p a n s t u d e n t s . ' ' - ' A b o u t , t h e same t.ime a s t h c

Rangers' assault., 400 M a r i n e s a b o a r d t r o o p h e l i c o p c e r s

; ~ t . t . a c k e d t h e P e a r l s a i r p o r t on t h e i s l a n d ' s east, c : n n s t . LI:

Later, e l e m e n t s o f t h e 2nd B r i g a d e , 82nd A i r b o r n e D i v i s i o n ,

l a n d e d at. P o i n t S a l i n e s .

S h o r t l y b e f o r e n o o n o n 2 6 O c t o b e r , Army t r o o p s a d v a n c e d

n o r t h w a r d t o t h e G r a n d A n s e Campus o f t h e medical s c h o o l

r c h i l e Y a r i n e s moved s o u t h f r o m t.ho n o r t h e r n t i p of G r e n a d a .

T h e R a n g e r s a n d t h e N a r i n e s j o i n e d I.oyet.hor a n d n s s n u L t . n i j t . h r

G r a n d ,Arise Campus a n d , a t 1 6 0 0 , r e s c u e d t h e r e m a i n i n g

American s t . u d e n t s . 1 1

On t h e e v e n i n g o f 27 O c t o b e r , p a r a t r o o p e r s a s s n u . l t e r l t h e

C u b a n h e a d q u a r t e r s l o c a t e d at. C a l v i g n y Harraclts a n d s t x i i r e d

t h a t ob.ject.ive. 1 2 E x c e p t For n e u t r a l i z i n g sinal I por:lcet s 01'

rtLsist.anco 1;ite.r 9 n t h e 27t.h a n d i ? : ~ r L yo n t h e 2 H t . h , !.hi.>

combat, o p e r ; i t i o n s o n tiren;ida were o v e r . k i t h in four dnvs,

1:and forces consisting of two Army Ranger bat,tal.ions, some

Special F o r c e s , two 82nd >\irborne Division brigades, and n

Yarine ! \ i n p h i b i o u s (:nit hari s e r u r t x i all signiPicani..mili t a r p

objectives an13 successful1.y rescued all U.S. cit,izens.1 :I

A Brief Review of the Combat. Service Suwport of the Grenada

iixpedi tion

Providing combat. sorvioe support t.0 the American 1 and

f o r c e s in Grenada !+as a challenge primarily because o f Ltie

compressed timeframe in which t.he Grenada Expedition

occurred. Although the Joint Chiefs had discussed logistical

requirements for the evacuation operation as early as 20

Oct.ober, the quickly changing mission for the land forces

(evacuation of noncombat.ants VS. seizure of the entire

island) and the strict requirements for operational security

severely restricted time for CSS preparation.14

The distance of Grenada from the continental llnited

States is over 1300 miles and this posed a significant

problem also. The possession o f a secure base on Barbados,

only 160 miles away, and the ready availability of cargo

aircraft t.o support tho expedition, however, mitigated some

o f t.he dirficulties in conducting CSS operations over siich :I

distance. ( S e e Figure 3 , page 8 8 . )

Combat service support on Grenada was provided by the

R .1
division support command ( D I S C O N 1 of the R2nd Airborne

Division.15 The CSS provided began with t.he landing of

t.hu paratroogrrs on the firsL clay of t.he erpetlil.iun ancJ

cont.inued after combat. operations had ceased. 'The 82nd

DISCOM advance elements deployed in phases based on

established contingency plans for rapid deployments. 1 6

The sheer rapidity with which the expedition began and

proceeded made the provision of combat service support

difficult. CSS soldiers reacted quickly, like t.heir ?ombat

a r m s coirnt.erparts, and adjusted plans to siist.ain the (:ombat.

aperations which ended .just. 96 h o u r s aft.er they had bpgun.

Since the subject of this research is the mediral

support provided to the Army expeditionary forces, overall

combat, service support in Grenada will be discussed f u r l : h e r

only briefly. Combat service support will be exami.ned wi t.h

respect to the eight CSS principles identified in Chapt.er

Three.

The 82nd DISCOM and the organic CSS elements of the

Ranger and airborne battalions (:ortainly adhered to t.he

principle of Support F o r w a r d . The Americans established

combat service support on t.he island as the Port Salines

airfield was being secured. They took advantage of the

support which the naval forces stationed just off the island

r . o u l d provi.de and en.joyed the air superiority which the N a v y

maintained. (See Figure -1, page 8 9 . )

C o i i t i r i i i o i ~ s P l u n n i r i ~simply was not conducted with

respec t, 1.0 combat service support, however. Concerns a b o u t

85
s e c r e c y s e v e r e l y res t . r i o t e d t h e number o f p e r s o n n e l i n c l u d e i i

i n t h e p l a n n i n g p r o c e s s a n d f o r t h i s r e a s o n t h e r e were no CSY

r . r ~ p r ' e s e n t , a t , i v e : sf o r p l a n n i n g , 1 7 T!>a . \ m e r i c . n n s d i d Prar-1:I L ' ~ >

Economy ho1.h i n t h e i r !.is@of l i g h t forces a n d b e c a u s e of

t h e i r d e p e n d e n c e o n a e r i a l movement a n d a e r i a l r e s u p p l y .

I Y a x i m u m U s e of S t a n d i n g O p e r a t i n g P r o c e d u r e s w a s e s s e n t i a l

a l s o b e c a u s e u n i t s , e s p e c i a l l y CSS u n i t s , h a d l i t t l e time t o

p r e p a r e f o r t h e specific requirements f o r t h e Grenada

Expedition.

' ? h e r e a r e a number o f esamples o f 71ai.lnivd S i i p p o r t f o r

t,he Gr,!nari:i E x p e d i L i o n . S i r i c e . as menti,oried :aho\.n. t h e

m i s s i o n c a l l e d for l i g h t i n f a n t r y f o r c e s , s u p p o r - p i a n r i i n g

was t a i l o r e d t.u p r o v i d e f o r t.he CSS n e e d s o f t h o s e t'orccts.

T h e r e s t r i c t i o n o n t,he i n f o r m a t i . o n a v a i l a b l e , h o w e v e r ,

p r e v e n t e d a g r e a t deal o f s u p p o r t . t a i l o r i n g a n d f o r c e d

r e l i a n c e on s t a n d a r d , g e n e r a l s u p p o r t p a c k a g e s ,

A l t h o u g h A m e r i c a n CSS c o m m a n d e r s u s u a l l y r e l y on

Centralized Contro.l/Decentralized O p e r a t i o n s , Grenada posed a

real p r o b l e m i n t h i s a r e a . This w a s due upain t o t h e

o p e r a t i o n a l p l a n n e r s n o t i n c l u d i n g t h e CSS p l a n n e r s i.n t h o

planning process. I n a c c u r a t e i n t . e l l i g e n c e a n d l a c k of

u n d e r s t a n d i np a b o u t t h e c a p a b i l i t . i e s o f d i f f e r e n t s e r v i c e s i n

t h i s j o i n t . o p e r a t i o n d e g r a d e d t h e amount o f c o n t r o l CSS

commanders had i n e m p l o y i n g t h e i r s u p p o r t , p a c k a g e s . 'This

prcihl.em r<as n o t confined t,o C S S o p e r a t i o n s o n l y . Indeed,

t h e (command s t . r i i c t u r c ? o f t h e t i r e n a d a E x p e d i t i o n w a s j u d s ' c d

t.o h a v e h a m p e r e d e v e r y f a c e t of t h e operat,ion."J

XR
 Due to the short. duration of the cotlibat operat ions i n

Grenada, ,\ln.siinum L$e o f Throir.r'hput U . i s t r . i b u t i o n was only

I est.e?rt 1.0 a iimi t.ed :Irgr.+.c.. Evt..n thoii.'h .-\msr.icanCSS

officers could rely on Barbados and Roosevalt Roads, PuerI:o

Rico as intermediate support bases, the relative proximity by

air of Port Dragg, North Carolina (1750 miles) did facilitate

throughput distribution.19 The 82nd DISCOM and the 1st Corps

Support Command, both based at Fort Bragg, were linked by

existing contingency plans and, consequently, were vell-

s u i t.ed to provide throughput CSS to the 1J.S. forces on

Grenada. 2 I'

The ;\mei-icans made the Xasimuirt L'se of Local ii'esources 8 s

was feasib1.n. Rangers used trucks and bulldozers parkerl b y

the Cubans on the Point. Salines runway to remove enemy

barricades and local facilities were used for CSS operat.ions.

The rapidity of the combat operations severely restricted any

significant demand on local resources, however.

The American soldiers from the 8Znd DISCON and the 1st.

Support (:ominand used est,nbljshed combat service sirpport.

procedures to successfully support t.he Grenada Espedit i hii.

In view of the rapidly changing situation, the C S S soldiers

displayed great initiative. Even wit,h significant, p r o b l e m s

in the operat,ional command struct.ure, they reacted quickly

and n l l j i i s t , e d effectively. The violations of the principles

L)f Continuous P1annin.y and C e n t r n l i z e d C o n t r o l were c a u s e d b y

the siqni f icarit. dericiencias in the joint, command st,rii<>tiirt:

rather than any CSS procedurnl or organizational prohl enis.

FIGURE 3

88
 N

PO"
S".,*U

GRENADA
FIGURE 4
4ledictrl Support in the Grenada Exnedi,tio_I?

The r e s t of t h i s chapter deals with the medical s u p p o r t .

of the American Army during the Grenada Expedition. Tho

planning, execution, command and control of t,he medical

support of the American Army units in Grenada is described

below. The chapter ends with a review of medical lessons

learned and other conclusions about the Grenada Expedition

medical support.

The Planning of the Xedical Support

. I

As mentioned earlier, combat service support planninS

was essentially not conducted for the Grenada Expedition.

Indeed, "critical details of the support plan, combat. support

and combat service support were not available during the

planning phase."Zl Consequently, medical support planning

had to he conducted with lit.tle information. The
rest.rictions of operational security imposed at every rchpl on
of command prevented medical planners (both the 82nd Airborne

Division surgeon and the 307th Medical Battalion commander)

from being informed of the expedition's destination until

after combat operat,ions tiad begun. 2 2

Although t h e Commander-in-Chief Atlantic ( C I N C L A t i T ) ,

Admiral ?IcI)onald, had overal.1 command of the operation, t h e r e

was nevpr an overrill medical command or contrul element.

90
 .

established for the operation by the Navy or any other

service. Thp quick format.ion of Joint T a s k Force ( J T F ) 1'211

(commanded by Vice Admiral !letcalf) and t.he wide range $ o f

].and forces it involved (Marines, Rangers, paratroopers, and

Special Forces) is still an object of controversy. 1 J The

rapidly formed coalition of forces was not synchronized and

the medical support, like most aspects of the expedition,

lacked centralized control.

Since the Army forces committed to the Grenada

Expedition were moved by air, t.ime was scarce to speci.ficnity

organize medical personnel, units, and supplies. Standard

rapid deployment packages had to suffice.*.' The units

normally designated for supporting the Army forces were

alerted and included the following:

( 1 ) The 307th Medical Battalion, 82nd Airborne Division,

to provide division level medical support for the Army

elements; and
( 2 ) Yedical platoons organic to the Ranger and airborne

battalions.

ff,?"'...
In addition,/the Commander of the 82nd Airborne Division was

told by CINCLANT that the U.S.S. Guam and the 1 J . S . S . S a i p a n

had significant medical support, capabilities (equivalent. to R

100-bed o r larger hospital). For that reason, the division

commander believed that medical support units Prom t.he

division could be kept to a minimum.25

91
 The p r e - p l anned medical support packages wh ioh t h e

merii(:nl planners would use h'ere uull-suited to the medica 1

s i ~ p p u r tmission. They oonsisl-o<lo r t w o echelons from each

<:ompuny in the 307t.h ?ledioal Dat,talion. These two anhel n n s

were designated Alpha and Bravo echelons respectively. The

Alpha echelon was a light, air-droppable package designed to

go in with the initial assault. The Bravo echelon was a

heavy package to be airlanded with follow-on elements.26

'There was no time available for special medical. training

even i.f tho medics had been fully bripfed on what. to espt->t:t..

'The medics xere alread:: at. a high statr o f readiness,

however. 'lany of them had oompl eted emerqency med Lca 1

technician training through on-going medical proficienc>-

training programs.2' 'The physicians assigned for the

operation were fully qualified Yedical. Corps officers but

none had attended the AMEDD's Combat. Casualty Care C o u r s e ,

called C 4 . 2 9 ~ * 3 C4 is designed to prepare AMEDD officers to

function successfully at forward points in the battlefield

casua1t.y care system. 3 0

In accordance with American medical operational

coricepts, a physician, a physician assistant, and medics h:e:re

b.0 accompany each Ranger and airborne battal.ion cnmiiii t,t,od t.0

combat,. nattalion aid stations were to be established as

close us possible to where infantrymen were in contact ~ i t h

opposing f o r c t - h s .

Since infurmat.ion on what t.0 expect with regard to t h e

int.ensit.y O F t,he conflict was so sketchy, medical planners

92
once again had to rely on existing, general medical support

plans. These called f o r a number of ground and air

:zmbirlancrs to be deployed as s o o n iis aircrafl. to transport

them to Grenada were available. The ground ambulances were

organic to the airborne battalions and the medical companies

of the 307th Medical Battalion. The air ambulances were to

be provided by the 57th Medical Detachment (Air Ambulance),

a corps level medical unit.

The medical companies in the 307th Medical Battalion had

R small, organic field surgical capability in the Alpha

echelon so priority for movement was planned f o r thc men

and equipment providing that, capability. If required to

support the American combat operations, additional medical

company personnel and equipment. in the rest of the Alpha

echelon and the Bravo echelon would be flown to Grenada.
Division level medical cnre for the Rangers' initial
assault would not be immediately available from the Army.

That level of care would be provided by the Navy until

Company C of the 30ith arrived with the 82nd Airborne

Division soldiers who were to be airlanded at the P o r t

Salines airfield. Ostensibly the Navy could provide division

level care on an interim basis. However, "no Army reference
could be located that provided for planning data f o r Navy
shipboard medical facilities."31
: In preparing f o r the Grenada Expedition, medical

planners ilt.t.empted to follow the six principles of medical

support,. They were frustrated in their attempt., howevt?r,

93
because of the secrecy surrounding the operation. Unable t3

find o u t specific information about operat.iona1 and t.actica1

pL:ans, t.hey had to assume their standard medicnl. support

packages would conform to t,hc medical needs of the combat

units employed. They also had to assume that medical support

elements would be allowed to deploy with the combat elements

they supported thus permitting close proximity to the

soldiers in contact with opposing forces.

Lack o f operational information prevented flexibility i n

planning yet flexibility was intrinsic to the standard rapid

deployment pazlcages. The mobi litv of the medical sup~iort.

unit.s was insured by the configuration of the medical support

packages also. But the medical planners could only assume
they would get, t.he deployment airlift they would need at. the

time they needed it,.

Yaintaining continuity of care was covered in existinq

medical contingency support plans but the 82nd medical

planners did not know when the Rangers would go in o r how
soon afterwards the R2nd would land. Xonsequently,
continuity of care in that. instance would depend on the Navy.
Also, how great the need for medical care would be and how
the system for evacuation of casualties would work during the

combat, operations could not be forecasted by the planners.

Finally, control of the medical units to be used was

relatively clear f o r each service, but the interrctut ionships
between medical elements of each service were not. 'rhe l a c k

of a unified medical plan prevented medical purticipants in

94
the Grenada F'spedit.iori from knowing what medical e1ement.s

were Lo be involved arid what capabilities each had. [n

short., i f synchronizat.ion of medical s u p p o r t ~ o i i l do c c u r , i l

would happen only i f existing contingency plans and standina

operating procedures made it happen. Joint planning of

medical support and casualty evacuation did not occur. And

the Army medical planners did not have the time or the access

to the information to resolve this serious deficiency.

T h e Execution of the Medical Support

As mentioned earlier, the Rangers began the attack on

Grenada at 0536 on 2 5 October 1983. Due to an "umbrella of

flak" over the Port Salines airfield, the C-130 aircraft

carrying the Rangers were forced to dive Low and the Rangers

had to .jump from only 500 feet, "a height not, employed in

combat since World War II."32 (Oddly enough, despite the

strict operational security maintained with the Army, t h e

Cuban government was given two hours advanced warning of the

attack by the State Department. This was apparently done t.o

give the Cubans on Grenada time to withdraw i f t.heg wishnd,

but, instead Premier Castro exhorted his soldiers to fighl. I:,)

their deaths. 3 :' )

9 .5
 'Shortly after t.he i.ni.Lialassault on the airfield, t.he

Rangers ' organic medical persunnel parachut.ed i n and provided

i.nimt;.diatetreatment, t.0 a small number o f casualties. 'The

Ranger medics received some med.i.ca1 s u p p o r L from t.he has.!. bui.

essentially treated the casualties themselves unti: the

advanced element of Company C , 307th Medical Battalion

(consisting of one orthopedic surgeon, one enlisted practical

nurse, and four medical aidmen) arrived approximately twelve

hours later." Once the Rangers had secured the airfield,

paratroopers from t.hn 82nd airlanded.

.\s t h e first airborne battalions from the 82nd :xrri\.e:l

at the Port. Salines airfield and the di.visiori commaridl!r,

:lajar General Trobauzh, judged the Cubans to be gix-ing ~ n u c h

greater resistance than expected, "the decision was made t:n

send more combat and combat support forces to Grenada instead

o f continuing the deployment of the combat. service support,

elements."35 JThe commanding general's decision was

undoubtedly influenced by his belief that the Navy cou1.d

provide any medi.cu1 care needed.

Company C ' s advanced element arrived as early as i t d i d

because the surgeon and his medics deployed with one of the

lead airborne battalions. dDue to severe Limitations on

aircraft space availability, the surgeon had only been abLe

to bring basic life saving equipment for st.abil.ixing

patients. H e arid his five personnel had to use "shelters $of

opportunity" t.0 eslxihlish their limited f i e l d surgical

se.ct.i.nnon *.he evenins of t.he 2 3 t h . 3 6

96
 . A ; !:ioiisii < h e n i g h t . of' Lhe 2 3 t h sarr' na s i g n i f i c a n t . ? o l n t ) u L

xction, t h e R a n g e r s a n d \.he p a r a t r o o p e r s d i d r e c e i \ . e s p o r a c l i c -

sm;~ll.arms : i r e around the ai.rfield. E:xt??t for t h e evening

a t t a c k t h a t , w o u l d occur on t h e 2 7 t h , t h e Grenada E x p e d i l . i o r l ' s

c o m b a t o p e r a t i o n s x o u l d i n v o l v e no a t t a c k s a t n i g h t . Ene1n.v

s n i p i n g c o n t i n u e d e a c h n i g h t u n t i l combat o p e r a t i o n s

concluded, however.
I . ,
.".,By t h 8 m o r n i n g o f t h e 2 6 t h , i t w a s c l e a r t o t h e Army

medical p e r s o n n e l a t t h e d i v i s i o n l e v e l o f c a r e t h a t t h e

Y a v y ' s a c t , u a l i n e r i i c d c a p a b i l i t i e s d i d noL m a t c h I:he

i n f o r i i i a t , i < i n t . r a n s m i t t,ed t o t h e 8 2 n d D i v i s i o n hemlqui%rler':.

I n d e e d , n e i t h e r of t h e s h i p s i d e n t i f i e d :is being able? tn

p r o v i d e medic;il s u p p o r t . h a d a f u l l nicdical. s t a f f and t h c

I.'.S.S. Guam w a s t h e o n i y o n e o f t h e t u o s h i p s w i t h a siir'<t=on.

F o r t u n a t e l y , a n o t h e r e l e m e n t . o f Company C ' s A l p h a e c h e l o n

wns e x p e c t e d to a r r i v e s o o n .

T h e A l p h a e c h e l o n h a d b e e n b r o k e n down i n t o t h r e e parks

b e c a u s e o f t h e c h a n g e s i n c h a l k s , or l o a d s , f o r t h e C r e n a d a -

bound a i r c r a f t . The f i r s t . p a r t h a d a r r i v e d as a l r e a d y

described. T o insure t.he d e p l o y m r n t . f r o m F o r t . Brngc of tho

r e m a i n i n g t w o p a r t s of t h e A l p h a e c h e l o n w a s n o t p o s t p o n e d ,

t h e 30'it,h Nedical B a t t a l i o n c u m m a n d e r hati t o p e r s o n a l l y

intervene. 37 Unfort.unately, the second p a r t , consist,iny u f

t w o additional physicians and a nurse a n e s t h e t i s t , w a s

divert.ed f r o m Port S a l i n e s due t.o small. arms f i r e a r o u n d t.h-

a i r f i r l < . l , 'TIlosc p e r s g > i i n e l a n d t . h e i r eqiiipnierir. tiad t o 1;inrl $711

B a r b a d o s a n d wt?rI u n a t i I r t.o g e t t,o G r e n a d a u n t , i 1 t h < > e \ e : i i r i g

of t,he 2 7 t h . T h e t.hi.rri p : i r t , r<it,h a n o t h e r p h y s i c i A n :i1ii1

f o i r r t . e P n m u r e medical p e r s o n n < : : , ended u p procadin: :heis :iiic!

:it'ri \.iiil :ir,)iin(.i 1 2 0 0 con :he 2til.h ?van ?hoii$h t>hiiy h:id k n

P I rcle Ltic u i r r i e l d f o r s e v e r a l l i u u r s b < : f o r e landi.ii!:.

S h o r t l y b e f o r e that, P a r t or t h e A l p h a e c h e l o n n r r i.\.o:i (ii?

t h e 2 6 t h , t h e R a n g e r s a n d paratroopers began t h e i r n o r t h w a r d

a d v a n c e t o t h e G r a n d A n s e Campus of t h e S t . George's

U n i v e r s i t y S c h o o l of iledicina. S m a l l n u m b e r s of c a s u n l t . i e s

K*Pro r e c e i v e r 1 at. t h e Company C c l e a r i n ~s t . a t i o n t h a t

, ,I,, , . ! , I

x i ' t . r r n o o n fro!n t h a t , a c L i o n . S i r l c t ! fer; a m h u i n n c r s h d har!i

~ - l e p l o > ~; e- .~i l1 - 1 ~ , o r h a r t.nct.;r.nl .:enicies Iiail kt> i>v: ascii r . )

niovt-: c a s u n l t i o s From a i d s t . a t . i o n s t n the c l + . a r i n g s t : i i i n n .

T h e C o i a p n n y C a i n h u l n n r e s h a d n o t . y e t a r r i v e d e i t h e r , so thc.

inedicul p l a t o o n s h a d t o e v a c u a t . e t.hei r c a s u a l r . i e s t.o t h e ,

m e d i c a l coinpany i n s t e a d o f b e i n g a b l e t o r e l y o n t h e medical

conipariy t o evacuate t , h e j r pnti1.nt.s from them. 39

In a d d i t i o n t o p e r s o n n e l , t h e f i r s t p a r t o f Company L ' S

A l p h a e c h e l o n yas now a u g m e n t e d w i t h a d d i t i o n a l e q u i p m e n t . ,

s u p p l i e s , mid t e n t a g e w h i c h a r r i v e d r;it.h t h e t h i r d p a r t o f

t h e Alpha e c h c l o n . . - \ l t h o u z h t . h r first. parL ( o f Co!npntiy (''3

Alpha e c h e l o n w a s i n i t i a l l y co-1ocat.ed w i t h t h e lead e l e m e n t s

o f t.he F o r r i a r d Area S u p p o r t . T e a m I F . \ S T ) h r a d q u a r t u r s , t.h+l

t,wo e1,einenLs o f t h e medical c o m p a n y now r e l o c a t e d L o t h e

o r h e r s i d e of t,he a i r t ' i o l s i t o a l l o w for r n o m t.0 set. u p morn

eqiiipmi?nt a n d l a y oi11. 1:indiri.q i i r o a s f o r a i r a n l h u i : i n t . o s .

\s t.ht. 51.' iip p r u < r r s s r d . t,hc (:ompitny I: m n i i c : s sat. r,!i:ir

LII+ d i s r r i p t , i o n of t h e , \ l p h n e c h e l o n : m d t>he ttivorsioii o f lhr

set-onrl p a r t . o f t h e e c h e l . o n t o R n r h a d o s h a d nciversr 11. . i ~ ’ < . . c - . - , i

the m e d i c a . 1 c ~ ~ ~ ~ ~ p uaibi iy1’ it.>-

s t.ti e s L a b i ish i t s e i . ? . Ccjiiipany

f ; ’ s .Alpha a n d B r a v o +c-hc?ions ::?re .-onfi<iiretd usill< +. :;;:;?.:itI;it.:!

: 3 0 7 t h ?IcdiL:al B a t t . a l j * i n c r o s b - 1 o d i n g roncept. 3 9 Cross-

l o a d i n g p r e s c r i b e d t h a t n o e n t i r e f u r i c l i o n a l area ( s u c h ;.I

w a r d , a t r e a t m e n t s e c t i o n , or t h e a d m i s s i o n s a n d d i s p o s i t i o n s

e l e m e n t ) b e loaded on a n y o n e v e h i c l e . This w a s to preclude

t h e e n t i r e l o s s o f a f u n c t i o n a l area s h o u l d a n a i r c r a f t g o

dorm. But d u e t o t h e break-up of t h e Alpha echelon d u r i n g

deplovment, t h e Company I: medics f o u n d t h a t t h r y o n i y hiit1

p a r t s a f sacn f u n c t i o n a l . a r e a (once * ) n G r e n a d a . . L,uclii I F - ,

t , i i r ~ . ~ u y ht h e r s e r t i o n o f i n i t i a l : i v u a n d t h e r e l a t i v e l y i I ‘li:

n u m b e r o f c a s u a l t i e s , Company (: w a s a b l e to continue r:ii’-’

d e s p i t.c t h e s e p r o b l e m s . 4 0

Aware of t h e i r own e q u i p m e n t s h o r t c o m i n g s a s we1 1 :is i . h e

N a v y ’ s , t h e Army medical p e r s o n n e l were s r o w i n g i n c r e a s i n g i.’

concerned a b o u t t h e i r a b i l i t y t o s u p p o r t combat o p e r a t i o n s .

T h e rest. o f t h e 2 6 t h and t h e 2 7 t h w e r e t h u s “ c o n s u m e d i n

i;rying t o deLermine what idas a c t u a l l y r o i l i t i r e d i n t h e forh:it-a-:

a r e a anal ( . o a ) r d i n a t . i n y ii p r i o r i t y f o r drployinenr. 111’ r,ti,:

e l e m e n t s p r e p a r e d for d e p l o y m e n t . ” 1 1

. \ f t e r Lhe r e s c u e (of t h e s t u d e n t s a t t h e Grand : \ n s c

Campus late i n t h e a f t e r n o o n o n t h e 2 6 t h , Army combaL

operat.ionn h a l t e d w h i l e reconnaissance elements g a t h e r e d

addit ionnl inrormation 011 enemy p o s i t i o n s . This 11111 i n t i i f ,

fight,ing <;i.;c !tic+ ;\rmy inrdic.:%l p * ~ r s n r i n e La t d i v i s i o n Le\-,.!i

a d d i tLiona1 I : i m r t o est.abj.ish thcmselves.

nn
 ,Early on t h e Z i t h , j u s t , i n t i m e t o s u p p o r t . t h e Army's

a t t a c k s p . l a n n e d t o b r i n g t h e Iireriada E x p e d i t i o n ' s combat

opor:il-.ic)ns t.o R c l o s e , .iddi t . i o n a l medical units b e q a i tc)

:irri\.e. The 5 7 t h > l o d i c a l Dst,achment ( A i v .hnbulance i La1idc.t.I

w i t h t h r e e n e l i c o p t - e r s a n d w a s o p e r a t i o n a l by 0 7 0 0 . ' 2 (Prior

t o t h i s t i m e , t a c t i c a l h e l i c o p t e r s h a d t o be u s e d t o

t r a n s p o r t c a s u a l t i e s i n t h e same way t a c t i c a l v e h i c l e s h a d

b e e n u s e d i n l i e u of a m b u l a n c e s .

As u n i t s p r e p a r e d f o r t h e f i n a l a s s a u l t . o n t h e C u b a n

h r a d r l u ; i r t t : r s at, l,he we1 l - f i ~ r t i f i ~ ~

C ai li. i.vi q n y l3arr;ickn, ; i n

ai.(:idPnt o c c u r r e d rihivh CV'LLS 1.0 result. i n the beginning (-;: ,i

mass c a s u a l t y s i t . t i a t . i o n f o r C h ; l r l , i e L'ompan?. X Aavp c ' o r s n i I,,

c a l l e d i n t.o a t t a c k t h e C u b a n p o s i t i o n , s t r a f e d n q r o u p :xf

I.'.S. p a r a t . r o o p e t - s b y m i s t a k e a n d r i o u n d a d t w e l v e o f t.hcm. 4 .;

The a i r a m b u l a n c e s , which h a d a r r i v e d e a r l y i n t h e d a y ,

b r a v e d enemy f i r e t o p i c k u p a n d r a p i d l y t r a n s p o r t these

c a s u a l t . i e s t o Company C ' s c l e a r i n g s t a t i o n a t P o r t S a l i n e s .

Then, i n w h a t w a s c e r t a i n l y p r o p i t i o u s t i m i n g , the o t h e r .
t.wo p h y s i c i a n s :and t h e n u r s e a n e s t . h e t i s L f r o m C h a r 1 i . e ' s \ L p h a

r c h e l . o n a r r i v e d i n t h e e v e n i n g o f t.hc 2 7 t h n f t . e r h n v i r i q t)et>n

d i v e r t e d a n d stranded on Barbados t h e d a y before. T h i s was

a l s o i m p o r t a n t b e c a u s e a d d i t,i o n a l r:nsual. t i ws woul,i b e

y r i n e r a t n d as t h e a s s a u l t . o n C a l i v i g n y B a r r a c k s b e g a n a r n u n d

1800."

. A 1 t h r ) i i < h enemy f o r c e s wi?re r?st,i.mnt.ed t.o he as h i qh a s

.I 0 0 a r o u n d t,ht? (:uban h e a d q u a r t . e r s , t h e a c t u o n u m b e r xias mct-11

%ma Ler. Rangers and paratroopers, t r a n s p o r ed i n 8 2 n d

A i r b o r n e D i x - i s i o n Blnclcharrk h e l i c o p t e r s , a t t a c k e d a n d s e c u r r , i

t.he ent.11'- ai'ca ti? 2100.4; In t h e a s s a u l t , horiever, t.K<>

n c * l i < . < > ! ) lP I - s ~ ~ u ~ l i c :3nd

i r d thct r . < + s u l t . i n z~ - i - i s ~ ~ ~ L i :jir cl f s ,

a d d i t i o n t o t h e c a s u u l t i e s rrnm t h e f i g h t i n g , t . h r e a t e n e d 70

o v e r w h e l m Company C ' s c a p a b i l i t i e s . 4 6

I n t h e space o f t w o h o u r s t h e A l p h a e c h e l o n r e c e i v e d

thirty casualties. U s i n g a l l t h e medical r e s o u r c e s a t h a n d ,

t o i n c l u d e some medics from t h e R a n g e r b a t t a l i o n s , the

medical c o m p a n y h a n d l e d t h e c r i s i s . In addition t.0 quickly

, .
t . r e a t i n z a n d s t a b i l i z i n g a n u m b e r o f p a t i e n t s , J'the s e n i o r

s u r g e o n c o o r d i n a t , e d w i t h t h e Air F o r c e t o f l y f o u r p a t i e n t s

t u t h e h r l s p i t a l a t , R o o s e v e l t Roads, P u r r t , o R i c o . " S i n c e tllr

Air F o r c e ' s 1st. t \ e r o m a d i c a l E v a c u a t i o n S q u a d r o n h n d n o L y e t

b e e n o r d e r e d t.o d e p l o y , h e h a d t o s e n d a p h y s i c i a n a n d nurse

with t h e p a t i e n t s , however."'

d S h o r t l y t h e r e a f t e r c o o r d i n a t . i o n w a s made t o h a \ ~ e t h e .Air

F o r c e e v a c u a t e c a s u a l t i e s t o t h e R o o s e v e l t Roads Naval

Hospital i n P u e r t o Rico. T h e r e p a t i e n t s were t e m p o r a r i l y

h o s p i t a l i z e d a n d p r e p a r e d for e v a c u a t i o n t o B r o o k e A r m y

Yedi cal C e n t e r o r Walter Reed Army Medical C e n t e r . P~tieiit,s

w i t h s e v e r e i n j u r i e s who r e q u i r e d more immediate e m e r g e n c y

c a r e were f l o w n t o t h e I:uam o r t o B a r b a d o s . 4 9

Although combat o p e r a t i o n s c o n t i n u e d t h r o u g h t h e 2 8 t h t o

n e u t r a l i z e s m a l l p o c l t e t , ~o f r e s i s t a n c e , t h e n u m b e r o f

c a s u a l t . i e n d r o p p e d s i g n i f i c a n t l y a f t . e r t h e mass c a s u a l t.y

o n t.he + v e n i n r j o f tht? 2 7 t h . D u r i n g t.he f o u r days o f t,hi--

combat., n i n e t > e e n s o l d . i e r s w r r e k i l l e d a n d 1 5 2 w e r e w o i i n d ~ d .I "

I0I
 Command Control of ,&t Yedical Supuort

Effective joint command and control of t.he medics:.

support iri the Grenada Expedition was never estahlished.

Although the American armed forces had a commonly shared

manual for the conduct of medical support in joint

operations, neither it nor the procedures prescribed in it

were used.30 The officers in the medical departments of each

service knew their own medical support doctrine well. But no

unified medical plan brought these elements together either

f o r planning o r execut.ing the medical support. missi on.

The Gpenada task force consisted of units from all thrcr

services. A s the Grenada Expedition rapidly evolved and was

executed, the soldiers, sailors and airmen cooperated well.

But. they had to overcome the lack of joint coordination which

should have been provided by the joi.nt commander and his

staff.

]'The lack of initial planning to coordinate the medical

support effort was a critical deficiency. Yedical. o f f i c ~ r s

did not. know what other services were involved in the

expedition so, consequently, they had no opportunity to

understand the capabilities of the other two medical

departments. They relied on standing operating procedures

and established medical packages to match requirements.

I , u c k i l y , the relatively low level of casualties prevent.t?d t.11,.

ineager Army medical resour(:es from being overwhelmed.

Problems in communicat.ion between elements of t,hc 82nd

DISCO?I's I'orr;ard ;\rea Support. Team (FAST1 and the support.pll

qround units ini t.ially hampered effective contro 1, ;1

S i 111 i la r l y , t,he r e k'as $1i f f i cul t y in F! s cab 1 ish ins c onimiin i *:a 7. i c) II

with the Army medical units on Grenada and the suppnrtinr!

Navy ships.52 This lack of communications exacerbated the

already deficient command and control structure of the

expedition.

Medical officers had difficulty communicating with

supported units as well as other medical units both in their

own service and in other services. They could not-.ascertain

it' there was a plan dealing with the regulation of the flax

n f patient.s and they had no idea what the situation was wit-h

respect to patient evacuation within or out.side of the combat.

zone. Furthermore, during nearly all of the time combat

operations were being conducted, the Army medical officers

had difficulty determining what was available to treat their

patients other than those supplies and medicul equipment

items which they had brought to Grenada themselves.

, Tact.ioa1 commanders also failed to appreciate the n e e d

t.0 have preventive medicine personnel accompany them o n rhr

deployment to Grenada as well as the need to follow basic

measures to prevent disease. As a result., sanitation

standards and water treatment procedures were largely

ignored and could have jeopardized a longer operation.53

"'The crucial importance ot' command and control in the

area o f medi(-al support. is <:lear. Rapidly deployed l.anil

forces like t.hose used in 1,he combat operat,ions of t.hc

tirenada Expedi,T.ion require dec i.sive action to insure medical

support is avail.able when and where needed. The medical

supp~ir~
or. thr Grenada E:qwdi tion was nearly a disaster

h e c a u s c of excessive operational security, a lack of relevant

information for planning and execution, and a failure of the

joint command structure to exert its responsibilities for

coordinating the medical support efforts.

The initiative of the medical soldiers in Grenada and at,

Fort. Bragg saved tho medical support. effort for tho Arm:..

The impact or breaking the srquence of t.hv deploymrnt o f t.he

inpdical support packages cou I d have been c a t . d s t r o p h i c had i I

:lot been For t h e resoiiri:efiilness and init.iativo of the

medics. The flexibility which they demonstrated u n d o u b t . e d l >

s a v e d the lives o f soldiers who otherwise mi,$ht have died

because of the l u c k of planning and the miscommunication at

t.he joint command level.

Decisive nct.ion by medical commanders was critical to

the overall success of Army medical support in Grenada. This

is illustrated by two examples. The first was the

intervention o f the 307th Yedical. Battalion commander in

defending the priority of the deployment of Company C ’ s Alpha

echelon. Tho second was the coordination of airlift for

pcrtient,s by the Alpha echelon senior surgeon with the Air

Force on the evening of the 27th. Both examples poi.nt out,

the importzmcc o f active command arid cont.rnl in i nsIIr i ric 1:hr.

I.imeLy pruvisi.on tot‘ effective medical s u p p o r t .

 Summar>- Lessons Learned

'The mudiral. s u p p o r l : of the Grenada Expedi tiori wiis pcnrlx-

planned and was just barely executed successfully. F o r these

reasons, the Grenada Expedition medical support serves as a

good case study for Army medical planners to review when

examining problems in medically supporting rapidly deployed

land forces.

I ,.The p o o r planning was the result. of excessive

operational securit,y. Clearly, security is essential i n iin

operation like Grenada, but there can be no excuse f o r

operational commanders excluding combat service s u p p o r t .

commanders from planning any operation. The effects o f t,ho

poor planning were exacerbated by the fact. that it occurred

at the joint level and thus disrupted established military

medical support systems which rely on interservice

cooperation. The misinformation about Navy medical

capabilities and the failure to activate a vitally needed Air

Force aeromedical evacuation squadron nearly cont.ributer1 to

t,he iit+nt.h of American soldiers wounded in Grenada.

The Army medical officers relied on established medical.

support puckages which were designed to be flexible enough t o

allow P o r the provision of minimal medical support. 'The

disruption in the division level medical company's standard

depl.oyment conf iyuration, however, almost prevented t.hat.

level of' medical support from arriving on time.

Tact.ira.1 commanders, in the turmoil of the rapid

deployment and confused batt.le situat.ion, lost. s i z h t . o f :.he

fired f , > r f a r Forward inwiicai s u p p o r t . a n t i p r e v e n t i v e medj.r: I 111.:

ineiiliiirrf:+. The:.. 3151) f o r q n t . basics L i k e i n s u r i n g t.ti3t. the: 7

soLdier.s d r a n k e n o u g h f l u i d s o r t.haI. t h e s o i d i r r s d i d noL

overload themselves. Consequently, they f i l l e d t h e i r

b a t t a l i o n a i d s t a t i o n s w i t h h e a t stress c a s u a l t i e s . 3 '

T h e medics r e l e a r n e d some o l d lessons a s w e l l . First,

t h e y relearned t h e v a l u e of s i m p l e e m e r g e n c y m e a s u r e s l i k e

tourniquets w h i c h u n d o u b t e d l y s a v e d A number o f l i v e s i n

Grr.riad;r. '7 3 S c o o n d , t.hey l e a r n e d t . h a t medics h a v e t,o ice+p

rhhai I' e q u i p i i i ~ n t ,as L i g h t as p o s s i b l e t.o lii-?rtp U I I ICi l:h

!iianeuvering i n f a n t ? ? - u n i t s . 5 6 T h i r d , t . h e p s a w l.he impor.I.:tnc~

:,€ p r i o r r o o r d i n a t . i o n w i t t i m e d i e 3 1 support. levels he.Lor; a n d

a110ve t . h e i r own. Fourt.h, Lhry d e m o n s t r a t e d t h p tremendous

v a l u e o f air a m b u l a n c e s , e s p e c i a l l y when u n d e r t h e d i r e c t .

c o n t r o l . o f AYEDD n f f i c e r s , a n d t h e r e m a r k a b l e p e r f o r m a n c e o f

t,he L H - G O h e l i c o p t e r as a n a i r a m b u l a n c e p l a t f o r m . Finally,

t h e y l e a r n e d t o f u n c t i o n a l l y load t h e i r deployment. p a c k a g e s

1.1) i n s u r e f u n c t i o n a l . i n t e g r i t y w a s m a i n t a i n e d whene\Ter

pussiblt, and t o e m p h a s i z e t o t . a c t . i c a 1 c o m s i a n d e r s t,ht,

i m p o r t a n c e o f m a i n t a i n i n g t h e s e q u e n c e o f medical support

package deployments. 5 7

T h e Army medical o f f i c e r s were n e a r l y p r e v e n k e d f r o m

r o l l o w i n g t h e s i x p r i n c i p l e s of medical s u p p o r t b y t . h e i r

? s ? l i i s i . t ) n , a l o n g w i t h t h e o t > h p r CSS p l a n n e r s , f r o m t,he

planning o f t.he G r e n a d i i E s p e d i t i o n . C o n f o r m i t.y, prusimit-,

P l e s i b i l i t . ) - , m o b i l i t.y, r:nntiriiii t.y, a n d c o n t r o l were d i C l ' i c u I t.

 to achie-:r+ in view o f t.he lack of information available to

them. Although the medics t i i d achieve the f i r s t . five t o a

limited degree, cont.ro1 was missing from a. .joint standpoint-

and severely debilitated within the cnnt.est, of the A r m y

because of faulty decisions by tactical commanders.

Grenada pointed out significant but common problems in

conducting joint operations. The Army medical support

difficulties were simply a microcosm of these probl.ems,

especially in such an informntion vacuum.

,APerhaps most, important o f all is the lesson Grenada

teaches about the need f o r completeness in a. medical ~ y : ; t . ~ ? m

to slipport soldiers in combat. Effective medical support

requires availability of care across the spectrum. Whether a.

soldier needs the simplest o r the most comprehensive c u r t . ,

all echelons of care must be in place in the combat zone or

all levels of care must. at least be accessible from the

combat zone. In Grenada medical care across the spectrum of

comprehensiveness was not provided and the means to access

c a r e outside the combat zone was not carefully planned. \'The

lack of sufficient medical treatment capability on I;renada.

I
and the initial lack of an Air Force aeromedical evacuation

squadron, f o r instance, resulted in Army medics being forced

to prematurely evacuate,patients on poorly equipped cargo

aircraft. 5 6

The Grenada Espedit,ion was an overal.1 success bict i t .

cannot serve as a model For joint. operations. Likewise, Ltie

medical support carinot serve as a model for joint meciical

support,. Hoxever, t h e lessoris G r e n a d a t.et\ches a r e i n v a 1 u : i b l e

to f u t u r e o p e r a t . i o n a 1 arid medical p l a n n e r s . F a i l u r c ? t o learn

:.hose 1esst)ns c o u l d C:ILIS~? thV2 medical s u p p o r t (.if future

r a p i d l y dep1rwc.d lctnrl forces t o e n d i n d i s a s t e r .

 B N D h OT E S

1. Ralph liinney Bennett, "Grenada: Anatomy of a 'Go'

Decision," Reader's Digest (February 1 9 8 4 ) : 7 2 .

2. Ibid

1. Grenada: Preliminary Report, Departrnent~ o f 5it.nl.e at1Q.i

the Depurtmnnt of Defense, Washington, U.C. (December !(j,

1983): 2.

5. Ibid.

6. !.ieutenant. Colonel Andrerr ?.I. Perkins. J r . , "C)perat.ion

L'rgent Fury: XII Enqinrrr's \.iew," 'I& y i l i t a r v Eiiuinoer

(>larch-April 1 9 8 4 1 : 86.

7. Strategic Studies: National Security Policy

Considerations, U.S. .\rmy Command and General Staff C d L l e g c . ,

F o r t . !,eavrrivort.h, I(:lnsas I 1986 I : 120.

19831: 2!).

1 0 . Ed Nagnuson, "D-Dog in Grenada," Tilne 1 2 2 (November 7 ,

1983): 22-23.

11. Cragg, "The IJ.S. Army in Grenada," p. 31.

12. Ihid.

13. " J C S Replies to Criticism of Grenada Operation," .

% :24

IAugllst. 1 9 8 ' 4 ) : 29.

14. Bennett, "Grenada: t\natomy of a 'Go' Decision," p. 7 3 .

1 5 . Captain Robert M . Radin and Chief Warrant Officer I W 3 )

Raymond A . Bell, "Combat Service Support of Urgent Fury,"

Loaistician 1 6 (November-December 1 9 8 4 ) : 1 7 .

16. Ibid., p . 16

17. Lessons Learned Grenada: U . S . Army Lessons Learned 1

-

1983 Operation Urgent Fury, Department of the Army,

Washington, D.C. (Yay 1985): IV-f-2.

18. Grenada Work Group, (?pt,raLi,on Urgent Fllry Assexsment,

110
C o n i t , i n t x l .\rms i : e n t e r , b.S. :\ray 'Training and Iloct.rinc?

('oiniii;ind, F o r t . Leavenworth, Iiansns I 9 J u l y 198.5 I : V - 9 .

Id. 1,inutenani; 1:oloriel ?lichaeI J . nyron, " F u r y from t h e !;+a:

?larines in Grenada," U.S. Saval lnstitute Proceedings 110

(May 1984): 1 2 0 .

20. Radin and Bell, "CSS of (Jrgent F u r y , " p p . 1 6 - 1 7 , 19.

2 1 . >la.jor . J a m e s ?I. D u b i k and %jar Terrence D. F u I . I e r t o n ,

" S o l d i e r 0 v e r l . o u r i i n g in Grenada," !li l i t a r y iEevi,ew 157 ( . J n i i ~ i n ~ . y

198;): 44.

2 2 . Telephone interview with Lieutenant Colonel Edward n.

Wilson, Health Care Operations, Office of the Surgeon

General, IJnited States A r m y , Washington, D.C., 2 3 December

1986. (Lieutenant, Colonel Wilson commanded the 307th Yedical

Battalion, 82nd Airborne Division, during the Grenada

Expadition. )

2 3 . Dorothea Cypher, "Urgent, F u r y : 'The U.S. Army in Grenada,"

Chapter Nine in Dunn, P e t . e r ?I.,

and Wat.son, Bruce h . ,

American Intervention & Grenada: The Implications af.

Operation "Urgent Fury" (Horilder, Colorado: Westview Press,

1!48.51: 10;.

111
27. Ibid.

2X. Letter i n l t t r v i e x K i t h C a p t a i n \:incent E. A s h l e y , Aciidctnij

o f H e a l t h S c i e n c e s , [!.S. .Army H e a l t h S e r v i c e s Command, F o r t

.S;m H o u s t o n , Texas, 8 Oeceinber 1986. ICapt:iin .\shic-p

coiniiianded Company i:, :>07t,h ? l e d i c a l U a l : t . a l l . o n , s u p p o r t . i n g t,h3-.

2d B r i g a d e , R2nd . \ i r b o r n e D i v i s i o n , d u r i n g t . h e ( i r e n a d u

E?:ped i t . i o n , )

23. CPT B r a d l e y , l e t t e r . i n t e r v i e w , 31 0ecernhf.r. 1 9 8 6 .

I I2
3 1 . Grenada w o r k Group, Overat ion I.irgent.F u r y Assessment,

p. Y - 5 i .

32. Ed Magnuson, "Nor; to >lake L t W o r k , " Tima 122 (November

14, 1983): 24.

3 3 . Strategic Studies: National Security Policy

Considerations, p. 1 3 0 .

34. I.nt,erview with Captain Douglas S. Phelps, Combined -\rms

Services Stuff S c h o o l , F o r t . Leavenworth, Kansas, .I ?Inri-h

1987. (Captain Phelps w a s the executive officer of Company l',

307th Xedical Battalion, the first medical company depluyed

on the Grenada Expedition.)

35. Captain Douglas S. Phelps, "Synopsis of Division Level

Xedical Support in Grenada," undated after action summary

provided by the author.

3 6 . CPT Phelps, interview, 4 >larch 1987

37. Ibid

38. Phelps, "Synopsis of Division Level Medical Support in

Gren;ds. "

39. M A J Nolan, telephone interview, 2 2 December 198i.

113
40. UP':' Phelpn, intcr:.icr<, 4 >!arch 1 9 8 7 .

11. ?helps, " S y n o p s i s o f D i v i s i o n L c v e i >loriical S i i p p o r i i:i

Grenada, "

42. T e l e p h o n e i n t e r v i e w w i t h Major K e v i n J. S w e n i e , H e a l t h

Care O p e r a t i o n s , O f f i c e o f t h e S u r g e o n G e n e r a l , U n i t e d S t a t e s

Army, V a s h i n g t o n , D.C., 5 >larch 1 9 8 7 . (\ln.jor Swcnio WRS the

o p e r a t i o n s offi.ner. f o r t h e j i t h ?letiical. I)etnchment L \ i r

.lmbiil.:+nc~ rliir i ng t h e Grenada Espedi t i on. )

.44. C r a g g , "The U . S . Army i n Grenada," p. 31.

45. Ihid

1 6 . '1'e.Lephone i n t e r v i e r ; w i t h D r . Robert H . Yosebar, M P ~ ~ c R I

Offic.er, Dirt:ctorate o f Combat DF!V1?1.opment, .Academy o f l l ? a l r.h

Sciences, U . S . A r m y H e a l t h S e r v i c e s Command, Fort. S a m

! l o u s t o n , Tesns, 10 E l a r c h 1987.

L7. P h e l p s , " S y n o p s i s o f D i v i s i o n L e v e l Medi.ca1 S u p p o r t . i n

Grennnla . "

1 8 . CPT B r a d l e y , l e t t e r i n t - e r v i e w , 3 1 Deuembe:r 1986.

5 U . L . 5 . I)epart.inent o f I:he . \ r m y F i e l d !lanic:tl R-2. "'*iw:ii<,:i!

Support i n J o i n t Operations," I J u n e 1972.

51. L i e u t e n a n t C o l o n e l Kenneth C. S e v e r , "782nd Y a i n t e n a n c n

D a t t . a l i o n i n G r e n a d a , " O r d n a n c e 2 ( k ; i n t . e r 1 9 8 4 1 : (5.

55. Dr. M o s e b a r , t e l e p h o n e i n t e r v i e w , 10 N n r c h 1987.

5 7 . Y A J Xolari, t,elephone interview, 2 2 December 1!.)86.

I I:,
 CHAPTER V I

COMPARATIVE ANALYSIS

'The comparative analysis of the medical support nr' t h e

l.'nllrlanrls Campaign and the Grenada Expedition will first

focus on a discussion about how well the medical support,

operations followed the established principles. Then, the

medical support operations in the two expeditions will be

compared wit,h respect to the use of operational concepts.

Finally, a comparison of the lessons learned in each

oparat.ion wi 11 be presented.

Adherence PrinciDLE

The principle of conformity was strictly observed 1))- the

Royal Army Yedicnl C o r p s in t.he planning and esecution o f :.lit=

medical support. in the Falklands. T h e Brit-ish m#-dit-JaI

of'fioers were Lhoroughly briefed on t.he basic p L u n s f o r the

116
<::1mpai:n :1110 n , . ~ ~ ~ < Ld ei d #-;iangtcs 3 s t.he <c:iinpa;gn evtr L.,.t+d.

~ . ~ ~ n s r , - i u ' ~ : i , t . i .tile:>-
?, m=re nol, o n l > - a b l e t c i i.i!:i<!t. .~nc-!i n s i i r ~

v!I;,I. ~iivdi.::~; s u p ! > , l r t c o n f a r m 4 r.,) t.acL ic.1 L de1.n i o p l n t ~ i i : . ~ ,hu::

I !iej- i i e r e a b l e t.Q) b e p r o a c r . i v e a n d a n t i c i p a t . e Iicjr. ti.) t.:ii i

medic>al s u p p o r t t o f i t bat,t.lefieid developments.

Although f u l l y s u b s c r i b i n g t o t h e p r i n c i p l e of

conformity, t h e A m e r i c a n medical o f f i c e r s s u p p o r t i n g t h e

Grenada Expedition found i t d i f f i c u l t t o execute t h e

p r i n c i . p l , e b e c a u s e t h e y , a l o n g w i t h a l l combat s e r v i c e support

o f f i . < - e r s ,x e r e u s c l u d e d from t h e o p e r a t i o n a l p l a n n i n g .

G r e n a < j a i::s!iedi t i o n n e r l i c a l s u p p o r t , t . h e r e f u r e , i:onforiiie<i 5.1: I :.

to 3 l i m i t e d J e g r e a d u e t o t h e I e l i a n c e on s t a n d a r d

d r p l o y n i e n i ~ p)ac:liagyes and h a \ - i n g t u o v e r c o m e I:he d i s r u p t i o n 111

s t a n d a r d a i r f l o r ; c a u s e d by t a c t i c a l d e c i . s i o n m n k e r s .

T h e p r i n c i p l e o f p r o x i m i t y w a s m a i n t a i n e d b y t h e Hritish

i n t h e Falklands despilr the d i f f i c u l t t e r r a i n . Forward

medical s u p p o r t . e l e m e n t s m a n - p a c k e d t h e i r e q u i p m e n t t o remain

c l o s e t o t h e combat u n i t s . H o s p i t a l e l e m e n t s were

e s h b l i s h e d a s h o r e t,o p r o v i d e v i t a l l y n e e d e d , p r o x i m a l Lp-

1 ocat,w:I, m e d i c a l s u p p o r t , . T h e medical c o m m a n d e r e m p h a s i z d

t h i s point. t o t h e o p e r a t i o n a l p l a n n e r s s o t h e y would aliok.

h i m t o do t h i s i n t h e i n i t i a l stage o f t h e campaign.

Due t o t h e d i s j o i n t e d m a n n e r i n w h i c h m e d i c a l s u p p o r t

e l e m e n t s a t d i v i s i o n L e v e l were d e p l o y e d , A m e r i c a n medical

o f f i c e r s i n G r e n a d a f o u n d it, d i f f i c u l t t o p o s i t i n n themst'lvcs

n e a r iini t.s i n ~ : o r i t , : ~ c t . ' T h e i r a t t e n t i o n h a < i t o f o c ~ i so n

s imp 1 y o s t a b 1. i 5 h i n rl ;idrqwi tt: ised i (:a 1 s u p p o r t i n i t i a I I .v .

Ili
i i ' c l i i L:-, riiir t o :.he siicrt. ,-lisr2:in,-es i n v o . l v ? d in :.ti? t;r<:nacI.n

t ; u m i ) a ~ <ni)er:i?,io n s , prsxiiiiity- IC;.~:; les:; i m p n r t n n t , c h : i n i n tiit"

:: t i c i s , Stltj i t. i c)n;i i I y , I iie :i\-ai I ;ab i 1 1 ? y o F iii: !. 1 i.0 i) t e t'k ,

! ini.t-iai.13- not. mede:.:ics, ~miniinized t h e nreii for. t : i ~ s < ~ r

m i t y o f t h e d i v i s i o n L e v e l :medical s i i p p i ~ r r . .

A l t h o u g h t h e B r i t i s h medics were s o m e w h a t c o n s t r a i n e d

due t o t h e l a c k of B r i t i s h air s u p e r i o r i t y i n t h e F a l k l a n d s

Campaign, t h e f o r w a r d p o s i t i o n i n g o f medical r e s o u r c e s a t

e v e r y e c h e l o n g a v e t.hem f l . e s i b i 1 i t . y i,n s h i f t i n g m e d i c a l

r ' e ~ o i i r : : x~h~
etre most, v i , t s l l y n e e d e d . T h e t,i.me a v a i l . s h i e hi

t . i i e m :Ltti-ir;q Lhr , - l e p l o > - m e n t t n t h e F n l l c t a n d s n l s n e i i a h I ~ 3 I :!i+in

t.o i n s u r e ? l i n t t h e y h a d s m p i e medical r e s o u r c e s t o 4i;e rhf-,m

f 1-?zi b i 1i t.y i n siippii r t i nq combat, o p e r a t i.o n s .

w' I n G r e n a d a , howevt:r. t . h e s c a r c i t y of' m e d i c a l r e s o u r I - o s

a t d i v i s i o n l e v e l and t h e l a c k o f i n f o r m a t i o n about. t h e

c a p a b i l i t i e s o f t h e Havy r e s u l t e d i n t h e r e b e i n g e s s e n t i a l l y

n o f l e x i b i l i t y i n medical s u p p o r t . What, f l e x i b i l i t y t h e r e

was came a b o u t as a result. of t h e personal i n i t i a t i v e of t h e

rttedicsl o f f i c n r s i n v o l v e d a n d t.hc i i m i ted f l e s i h i l i t . ? a l r e a d y

b u i . 1 t i n t o t h e s t a n d a r d m e d i c a l d e p l o y m e n t packages.

Y o b i l i t y was o a r e f u l 1 . y c o n s i d e r e d b y t h e H i - i t . i s h for

medi<-:%l
sugporl, i n t h e F a l k l a n d s >-IS we1 l a s f o r t a c t i r - n i .

operat.ions. I:iiderst.irnding t h e i r m i s s i o n a n d th6: F:~LirJ.;unds

t e r r a i n , the D r i t i s h prepared t h e i r u n i t s t o d e a l w i t h t h e

perill i a r fc:it.ures t)f 1.iiat iir!:n of n p e r n t . i o n s . 'The? r c i l i ::ed

.<?oinq in+.() t h e c a ~ i i p a i ! ~ n
t h n t t h ,? . milsr. r e l y ei t.hri- 011

h e 1 ihorrlt? or t'ooLbi,rne t.ransport,.

118
 Due t.n the limited t.ime ot' the combat operations u i the

iGrt::nada Espedi tjon, mobility r r P the medical unit.s on,:o i.n

:;r.riiitda was nol, significant. Hiit the mobi l . i l . y , o r 1 . a c l r

t h e r e o f , in zetting to Grenada lias a s e v e r e problem.

Additionally, lack of ground ambulances, both for unit arid

division level medical units, hampered efficient medical

support. The relatively late arrival of air ambulances (two

days after combat operations began) also degraded the medical

units' ability t.o move patients, medical personnel,

eqiiipiiient, and supplies when needed.

Cont.i,nuityof care, on the whole, was maint,a.ineti b y till+

British in the Falklands hut the use of non-medical

heticopters actually resulted in an interruption in

continuity. British casevac helicopters, unlike Ameri(:sn

medevac helicopters, do not carry highly-trained medical.

aidmen and are not piloted by medically-trained evacuation

aviat.ors. For these reasons, patient care in aeromedical

evacuat,ion in the Falklands was not truly continuous.

Falklands casualties, in addition to having to Face the

hazards o f beinq transported in non-medically mariced

helicopters (remember that at least one was shot down), atso

ran the risk u € not having anyone to deal with in-flight

medical emergencies should they develop during evacuation.

Xaintaining continuity, indeed, even establishing it,

was a problem f o r ,\ineri(:an hrmy medical pcrsonnel in Grenada.

This was d u e , u f course, to the lack o f time t.0 plan, the

dis,joint.ed deployment, sequences, and the Lack of any overnl.1

119
m e d i c a l p l a n Tor t h i s . j o i n t m e d i c a l s u p p o r t o p e r a t i o n .

l ' o n t . i n u i t y o f c a r e w a s d i f f i c u l t , t.6 e s t , a h l i s h o n G r e n a d a ;.id

c u n t , i n i i i t p d u r i n g t h e e v a c : u v t i o n or' p a t . i e n t s t o F l a r b a d o s .

P i i e r t o R i c o , o r e l s e w h e r e %as i n n d e q u a t , e due t o 1 i m i . t . d

p e r s o n n e l , equipment, and s u p p l i e s .

As f a r a s c o n t r o l , t h e B r i t i s h d i d a s u p e r b j o b

achieving t h i s p r i n c i p l e with t h e h i g h l y notable exceptions

of n o t b e i n g i n c o n t r o l o f o r i n communicati.on w i t h t h e

casevac helicopters. O v e r a l l , t h e i r command o f m e d i c a l .

resources f u n c t i o n e d e f f i c i e n t . l y i n t h e j o i n t a r e n a a n d t . h e i I'

ni,or.l.linn.t.i[in w i t h m e d i c a l e l e m e n t s r;i t,hiri ench ser%vi*?e,

:is

r;elI. as b e t w e e n d i f f e r e n l s e r v i c e s , w a s c o n s i s t e n t l y

effective. Their f a i l u r e t o d i r e c t l y c o n t r o l aerial

e v a c u a t i o n a s s e t s , however, remains t h e i r p r i n c i p a l

o p e r a t i o n a l w e a k n e s s a n d t h e i r p r i m a r y p r o b l e m i n t h e medical

s u p p o r t of t h e F a l k l a n d s Campaign.

C o n t r o l o f medical s u p p o r t for t h e G r e n a d a E x p e d i t i o n

w a s e s s e n t i a l l y t a k e n o u t o f t h e h a n d s o f medical o f f i c e r s

by o p e r a t i o n a l p l a n n e r s and tactical d e c i s i o n m a k e r s . The

r e s u l t , w a s a n e a r medical d i s a s t e r . The 3 0 7 t h P l e d i c a l

B a t k a l i o n commander a n d t h e o r t h o p e d i c s u r g e o n who w a s t h e

f i r s t d i v i s i o n l e v e l medical o f f i c e r t o a r r i v e i n G r e n a d a

b o t h h a d t o p u s h h a r d to m a i n t a i n a n d e x e r t . t h e l i m i t e d

c o n t , r o l l e f t , t o them. The n e a r 1 . y d i s a s t r o u s c o n s e q u e n c e s i n

G r e n a d a p o i n t . o u t t h e s i g n i f i c a n c e o f vi.oLnt,ing t h i s

p r i n c i p l r a n d t.he n e c e s s i t . y F o r m d i c a l c o n t r o l o f s i e d i c a !

support. oper:itions.

120
 As previously stated, the operational concepts of the

USAMEDD and the RAMC encompass the following : ( 1 ) triage;

( 2 ) echelons of medical support; ( 3 ) elements of combat

medicine; ( 4 ) patient evacuation; and ( 5 ) command and

con t. 1'01 .
Both the British in the Falklands and the Aniericaris ~ r i

Grenada were each faced wit,h a mass casualty sitiiat.Lon.

.\l t.hnugh t.he situations they faced severely taxed the

available medical resources for a short period of time, the

level of casualties never overwhelmed the medical support

units, however. Consequently, while triage was used to

prioritize patients f o r treatment, the use of the expectant.

category was never required. Medical resources were

adequate, although just barely so in Grenada, to permit

treatment of patients with massive injuries and little chance

of SIJrVi.vkI1, The importance of using the concept U P triagri

was reaffirmed by both the British and the Americans in the

two operations.

The appropriateness and importance of establishing

echelons of medical support was also reaffirmed in h0t.h the

Falklands Campaign and the Grenada Expedi.tion. 'Phe H r i t i s t ?

used e v e r , v echelon o f care effectively and were very <:nl.erui

to coordinate close ties and working relationships hei.u*rn

121
medical unit.s, The :\mericnn operational pl.anners, however,

initially excluded corps or third level units from the

i;ren;id;.i EspPdit.ion. ?Ils[:omiiiunicatif~iiat. the opera.:: innnl

level iricorrectly l e d the 82nd Airborne Division commander.

to expect division and corps level medical support to be

provided by the U . S . Navy. Although the Navy did eventually

provide some medical support equivalent to these levels,

the initial lack of planning for the third level of medical
care left a serious yap in the medical support system.
The elements of combat, medicine, as stated i n Chapter-

T h r e e , provide a common framework used by both the Zritisii

and the .Americans in providing medical support. 'This

operational concept. is grounded in two Pacts: first., that,

first and second echelon medical care is u s u a l l y given in ;
I

tactical environment and must, therefore, be reiatively

austere; and second, that most soldiers who will die from

wounds will do so within four to six hours if they are not

treated.

The British knew these facts full well and planned their
medical support, with them in mind. Although the terrain i n '

the Falklands and the resulting emphasis o n night fighting

caused a number o f violations of this concept, the Brit.ish,

however, were basical1.y successful in this area except for

their failure to use tourniquets. Similarly, the Americans

knew t,hose t'nct.s and, even though they had hardly a n y t.irne I:D

p l a n , w e r e also basically successful in providing s d v n n ~ e ~ l

t.rauma l i . f e support within the acceptable timeframe.

122
 P a t i e n t $ ? v a c u a t i o n , hor,evPr, wits a Liealcness tot- h a ) tli

operations. Lr. is R i i e a k n r s s i n o n l y on,: a s p e c t f\)r rh-j

9 r i t i s h nnci I.ii,i: !;a:; k.i::h ?vsl;m~V t.o he1 i r c i p k ? r .?i'i,-ii:rt i < > ! ; ,

0nr:e rryain, t.hr l a c k o f d e d i c a t . e c l medical hei icopb.ers l e f , .

c a s e v a c s u s c e p t i b l e t o t h e s h i f t i n g p r i o r i t i e s for

h e l i c o p t e r s i n B r i t i s h combat o p e r a t i o n s . So, p a t i e n t

e v a c u a t i o n w a s d e f i c i e n t i n t h i s a s p e c t of t.he F a l k l a n d s

medi c a l s u p p o r t . .

P a t i e n t . a v a c u u t i o n w a s also a w e a k n e s s Tor t h e . i m p r i c ; a r i h

i n l i r e n a d a a n d i n s e v e r a l a s p e i ? t s e v e n t.hi,ugh the .Ameri~-:vi

A r i i i y a d v o c a t . e s medic:%! c o r i t , r o l o f a e r i a l e v a c u s L i o n am-1

s:ressr?s a e r o m e d i c : a l e v a c u a t i o n t.o t.he maximum e s t . e n r

L.'
feasible. F i r s t , , as m e n t i o n e d e a r l i e r , medical h e i i c o p t , e r s

isere r i o t a v a i l a b l e u n t . i l 1:hr c o m b a t o p e r a t i o n s i n G r e n a d a

were half over. T h i s r e s u l t e d i n non-medical helicopt.er-s

b e i n g u s e d l i k e the R r i t i x h u s e d them i n t.he F a l k l a n d s .

S e c o n d , along w i t h t h e r e s t o f t h e d i s r u p t i o n i n t h e

d e p l o y m e n t o f medical u n i t s , t h e number of g r o u n d a m b u l a n c e s

d e p l o r e d iias l e s s t h a n n e e d e d t o s u p p o r t u n i t , a n d d i v i s i o n

i e v e i medical e v a c u a t . i o n n e e d s . T h i s was t h e case sveii

t,hou%h t h e t e r r a i n i n C r e n a d u d i d a l l o w u s e of g r o u n d

ambulances. ' T h i r d , u n l i k e t h e 13rit.is.h i n t h e F a l k l a n d s xii,>

h a d ambulance s h i p s w a i t i n g f o r p a t i e n t s and a n e s t a b l i s h e d

p l a n for p a t i e n t a i r l i f t b a c k t o D r i t . a i n , the Americsns

f ' a i l d Lo ; . i c t . i v a L e :in available . \ i r F o r c e a e r o i n d i c a l

e vncun I.i o n s qiiad r o n un t i 1 < ? o mh a t. ope rii I:i o n s lie r e nea r 1y ,iv e :. .
ConsequeriLly, c a r g o ; i i r c r a P t h a d t o h e commandeered i n i t tall:;
and patient,s were flown not necessarily to the best piac,: f o r .

their treatment but t,o whrrever the planes were going.

Final;.>,,e v e n t h o u g h t.he operational concept. ( i f c?:Jinrnaiic!

and control has essont.ia1ly already been addressed i n t h e

discussion of the medical support principle o f control, i t is

important to note the significance of command and control

specifically in the medical support of a rapid deployment

force operation. The extremely limited amount. of' time

available to medical officers in preparing for medical

support. of R rapidly d ~ p l o y e r lland force argues f o r eVen

sreab.er t,h:in normal rel.innce by tactical planners o n medicai

commancl and cont,rol of medical, resources. Operationai

planners and tactical decisionmakers have to realize that

medical officers are experts in t h e medical field and should

he allowed to plan medical. support and execute medical

support operations without int.erPerence.

The British medical officers did have to overcome some

problems with operational planners and tactical

decisionmakers in the Falklands Campaign. Yet,, o n t h e whole,

command and control of medical resources was left to meilical

officers. The only aspect of control not available in the

Falklands - cont.ro1 of casevac helicopters - has already been

discussed and is an aspect of a British medical support

operational concept.. Except f o r that, medical command and

control worked well within the Brit.ish Army and bet.r;ren r.he

.Army and the other R r i tish military services.

As previously stated, the American Army medical

~:omin:mil+.r.s found t . h e m s e l v ? a ex(: l u d c d from t.he planiii.riz

proc8Ass. ?he,- w e r e : even d r r i i $ * ~ n

j ormal pavt.icipar.i,)n i n rl1<->

::lepl. ) y i ~ i a n i - .and i?secuti:jn p h a s e s because o f the ::urifu:; L ~ j l i

a b o i i t available medical support: and t.he perceived enemy

threat on the island. Although it can be argued that t,his

situation developed from the concern f o r operational security

for the Grenada Expedition, this researcher believes that

such operational considerations actually argue for grt?ater,

n o t . lcss, part.icipat.ion for medical commanders because

medical command and control is even more important than u s u a i

111 .I short,-lused, .ji,int 3aperat.ion like Grenada.

Lessons Learned

Key lessons from the medical support in the Falklands

Campaign and t h e Grenada Expedition have been discussed in

the t w o previous chapters. Yhat will be discussed her,, :ire

the lessons from those two medical support operations iitiich

are part.icularly relevant. for the planning, axecut.ion,

command and control o f future medical support. operat, ons , i f

rapidly deployed Land forces.

The! import.ance of planning i s one of 1,he most Y t, ;.I i

Lessons to be learned from these esamp.les hf medic:il siippii't

o f combat. operations of rapidly deployed land f o r c e s . 'The,

125
British example in the FallrI.arids clearly i,llustrates

effective planning in two dimensions. First. it itlustratas

tiiP i n v , o i v r m e n t o f medj~::al.pi;inners by 9)peraLional piarlnm-:+

in the operat.iona1 planning process. Second, it. points out

the effectiveness of the planning by medical commanders both

within their own service and between services. The British

medical officers, like their counterparts in other military

branches, efficiently used the limited time available to them

and developed a superb plan for the Falklands Campaign

medical support, Considering the relatively austere
t:ondit,ion of the British ?\rmy p r i o r t.n the E‘nlkl.ands,t l r i ”7.1 c h
planners at every level insured the best operat,iori possible

would be conducted.

The importarice of planning is also illustrated hi- the

Grenada Expedition. The operational problems there point out,
that operations planned in such haste must be simple o r else
run the severe risk of being s o complicated they jeopardize
success. Certainly the Americans had much less time to plan
the Grenada Expedition than the British had to plan their

campaign in the Falklands. But even in view of the severe

time restrictions, the Americans should have done a better

.joh o f involving CSS planners and in devising joint, unified

plans for tactical operations and medical support.

Another lesson important f o r planning future medical
support. of rapidly depl.oy4 land f o r c e s concerns operatiur~d

securil~y. Operat,ional security, though vital to q u i c k strike

operations, cannot be allowed to prevent effective, necessary
p.lanniiig. The oper:itiori;%i spcurity for the Grenada
Espedit.ion i i a s essentially discarded <;hen t.he C 1 l h a n s iirrt?

i.xrnr<-l tr;o hours in :idvarice o f ' the f i n r i q < ? r ' s hiitling. Lm>t,
<.

that security, which had kept units with a real need to Iinor;

out of the picture f o r days, ultimately served little purpose

except to jeopardize the operation it. was designed to

protect. This lesson is especially worthy to note because

t,he problem with operational security and medical support i s

a recurring one f o r rapidly deployed land force operatifins.

F o r esnniplc, t h e same situation as in t.he Grenada Especlit.i.>n

o c c u r r e d in t h e L.ebanon Operation o f 1958. I

The Lack of planning f o r Grenada medicai support and : . h ~

limited time for planning British medical support in the

Falklands also serve to point out. the need f o r standard

medical support packages. These packages, when designed with

a high degree of intrinsic flexibility, can greatly decrease

the time needed to plan medical support of rapid combat

deployments. The effectiveness of the 307th Medical

Rattalion's deployment packages proves this point..

Finally, with respect to planning, the two medical

support. operat.ions examined in this thesis depict. t.he 1 i i u i t s

o f the tailored medical support. spectrum. The FaLic.Larids

medical support represents a medical support package

expressly designed for a specific land force campaign. The

Grenada Kspedi ti on medic:Al support., on t.he other hand,

represents a medical support. package that, was rssenl:inll y .in

off-the-shelf package designed f o r general contingency

missions .i<ii houi- 3 p c i P i e s a i l o r i n 4 f o r t.he

i n Grenmia.

V!: u :-+ >i a riuin b e 1. <, !' i mpq L' 1- an 1. m. . t i i. " 3 L rl B F irn 3 t' :. , r :a

Grenada and t h e F a l k l a n d s r i i t h regard t o t h e s e c i i t i o n !.,f

medical s u p p o r t o f r a p i d d e p l o y m e n t f o r c e s . The F a l k l a n d s

Campaign i l l u s t r a t e d t h e s i g n i f i c a n c e o f p h y s i c a l f i t n e s s ,

self a i d , buddy a i d , t o u r n i q u e t s , far forward r e s u s c i t a t i o n ,

simple s u r q i c a l p r o c e d u r e s , a n d s i m p l e c l i n i c a l p o l i c i e s .

'The F a lilarirls also p o i n t e d out. t h e n e e d f o r y r e a t . e r omphn:;i;

cnn f l u (1 inL:i!<e h y s o l d i e r s nnct b r o a d e r t r a i n i n q f o r m i ; i!..ir--

phys it- .ins, (irriiitrin a i s r > r e y e a Led t.hessr 1 a s t. ti..ii L~cs<)ti.; .

v G r e n a d a , i n a negat.i.:e s e n s r , r e v e a l e d t h e n e e t i C(.,r

j o i n t , inedical u n d e r s t a n d i n g a n d c o o p e r a t i o n i n t h e ? x a n u t . i o r i

o f m e d i . c a 1 support. It. r e v e a l e d t h a t i n i t i a t i v e o f nlrdihill

s o l d i e r s c a n a c c o m p l i s h much, h u t t h a t . . j o i n t e x e c u t i o n o f

medical s u p p o r t . must. riot, be l a c k i n g i f s o l d i e r s ' l i v e s a r e t.o

be saved.

, Grenada a l s o demoristrat.ed t h e n e e d for a c o m p r o h e n s l v e

iiiedicnl n y s t e i n t.o e i t . h r : r !w i n pI.ace i n t.ho comb;ir :oni' or

r e a d i l y a c r e s s i b l o from i t . Proper e s e c u t i o n o f inedi (:a1

s u p p o r t , e s p e c i a l l y i n a r a p i d deployment f o r c e operat.ion

rihan t:me is SO c r i t , i c n l . , r e q u i r e s c o m p l e t e n e s s i n t.ht!

medical s u p p o r t s y s t e m . Wit.hout. t h a t - c o m p l e t e n e s s , p a t i c n t . s

may d i e b e c a u s e t,he t.imr f n r e f t ' e o t i v r n l e d i c n l int:r+rvr.nt. iorl

hiis I w a n ; os t . .

I . a : i t , I ? - , t.hc Lessoris aboiit. ccommiind a n d r o n t . r o I s l-:ingl 0111 .

E v e n 1:Iiough a T c w i n t e r n a l p r o b l e m s were r e v e a l e d i,n t.he
 hot.h t.he3 H r i t i S I I and 1.hr Arn+ri~-:iiis, i li t.ti4-

ed, thga si<ni fir.ant p r n h I + i i ~ s~nc-~tiin~.rrt~<~i

elinii nat.?d hat-J more med t c a i command ; m i l

control been allowed. Where medical coniinanders ~ e l . 1 3a1101.ed

to control their support operations as they should, as in the

Falklands, medical support was highly effective and

efficient,. &here medical commanders were circumvented o r

excluded, as in Grenada, medical support was placed in great.

jeopardy. Further, the significant role medical c o m i n a n d e i . ~

played in making timely medical support decisions in t h e

F'a1.Iclantis Campaign and i n the Grenada Espedition demnii.;i:r.:iiV C I

the absolutx necessity f o r active medical. leadership, i:li.:ar

m.=dical command, and direct medical control.

These lessons provide answers to the questions ;itmiit. hot;

to effectively meet. the medical needs of rapidly deployed

land for<-es. Due to the increasing likelihood of more r a p i d

deployment. forre operations in the fiit.iire, these answers :.lri'

vital. They will enable operational decisionmakers ;itl<i

inrrl iriil voiiimanderrs to plan and est?(.iit.r r a p i d medical siir)liof':

operaticns i c i t.h precision s o that, another vital eleinrnt t ' . ~ ,

tliP S U ~ C R S S n f the l a n d forre can be a s s u r e d .

129
1. Evaluation of Medical S e r v i c e S u r l p o r t For t h e L e b a n o n

Oweration, O f f i c e o f t h e A s s i s t a n t S e c r e t a r y o f Defense

( H e a l t h and M e d i c a l ) , W a s h i n g t o n , D.C., 18 F e b r u a r y 1 9 6 0 :

3.
 CHAPTER V I L

CONCLUSIONS A N D RECWIMENDATIONS

Conclusions

Tho p r e c e d i n g c o m p a r a t i v e a n a l y s i s o f m e J i c a l s u p p u r t I I,

t h e F a l k l a n d s Campaign a n d t h e Grenada E s p e d i t . i o n serves ii.

i l l u s t r a t e hor; m e d i c a l s u p p o r t of' r a p i d l y d e p l o y e d L a n d

f o r c e r tias b e e n c ! o n d u c t e d . I t . also r e \ - g a l s key p o i n t s f o r

medical c o m m a n d e r s t o c o n s i d e r i n c o n d u c t i n g medir-a1 s u p p o r t

of f u t u r e r a p i d l y d e p l o y e d l a n d f o r c e s . T h e medical sup;>Li:'r

( - , p e r a t i o n s i n t h e F a l k l a n d s a n d G r e n a d a are n o t t h e o i i l y

e x a m p l e s a v i r i l a b l e o f medical s u p p o r t o f r a p i d ] . > - d e p i oyeg-i

l a r i d t'ot,::es but, i n t h e r e a e u r c h e r ' s o p i n i o n , t.hey a:',? till;

best. a n d t h e most. r e c e n t . .

l'he I ; : i l l c l a n d s a n d Grenada m e d i c a l s u p p o r t ~ p ~ r . : . i st i n s

jiaVtJ b e e n r i o m p a r e d u s i n g t h e p r i n c i p l e s or' c o n f o r m i 1.y.

proxi.mit.y, rlexib L i t . ? , m o b i l i t . y , c o n t . i n u i t y , m i t i Cont.ro~ .

'These p r i n c i p l P s , i n a d d i t i o n t.o s i g n i f i c a n t a n d (-ommonIy

s h a r p d opt?rnt.iona i:onct?pt.s, h a v e p n a h l e d ;in P x n i n i i i : * ~I ~ > I Ih:'

!lie iii+vIi < ~ 1; i 511p p o r I: o t' 1

:h c t,i<,J (I pt? r n t i ons .
'Tho, < , , r i n m o r i l y sh:.ri,Ptl p r i t i c i p l r s i i n d o p ' r : i ! i t > i i : i I t-nl,8~<~!~rs

1 :1 I
h a v e s e r v e d as e s c e l l e n ! ; too1.s for. c o m p a r i n g t h e t . ~ om wiira;

supporr nperat ions s t u d i e d . 'l'liey a r e a l s o e s c e l l e r i t , t o o Ls

l'(11, p i s i ; r i i , n g a n d eseoul.in:! Put,iirF: inedii-al s u p p o r t . o p p r a l : i nns

of rapid1 p d e p l o y e d l a n d forces. 'The l e s s o n s d e r i v e d from

t h e c o m p a r i s o n a l s o p r o v i d e a n s w e r s t o v i t a l q u e s t i o n s about

how t o m e d i c a l l y s u p p o r t f u t u r e combat o p e r a t i o n s .

Recommendations

T h e s i s p r i n c i p l e s rchicli f o r m t h e b a s i s o f b o t h :Ainrri<.;i!i

a n d B r i t i s h medical s u p p o r t . d o c t r i n e h a v e b e e n u s e f u l in

e x a m i n i n g t-he m e d i c a l s u p p o r t o f t h e c o m b a t o p e r a t . i o n s i n t.i:o

rapid depl.oyment f o r c e o p e r a t . i o n s - t h e F a l k l a n d s Campaign

a n d t h e Grenada E x p e d i t i o n . The p r i n c i p l e s ' real val.ue,

however, i s i n t h e i r u s e to p l a n a n d e x e c u t e medical s u p p o r t

of f u t u r e r a p i d d e p l o y m e n t force o p c r a t . i o n s .

?ledical s u p p o r t . p l a n n e d u s i n g t h e p r i n c i p l e s o f

r o n f o r m i t.v, p r o x i m i t y f l e s i b i l i t . y , m o b i l i t y , c o n t , nu1 t::. ;\riel

i.ontrol xi1 l provide h e founilat,ion for s u b s e q u e n t sll<:t-t?ssfll;

erecution. E s e c u t i o n f o l l o w i n g t h e p r i n c i p l ~ sw i l cna.I>i 11

s u p p o r t o f cniiihat o p e r a t . i o n s t.o be c . o m p l e t e , l

vely a n d o f f i c i r n t l y .

Y e d i c a l support, of r a p i d l y deployed land fnrcrs I S n key

issue fqir. t h e ,\MI.:DD because t h p 1 i k e l ihoorl o f <.omhiil

o l v ? r x t i o n s by s i i c h f o r r e s is in,:re:isiiig s i g i i i f i ( . n n t 1.. l'h?

I;riil.4 St,a.t,t?s. i n i t s r o l e as o n e o f the: t.wo w o r L < i

 ly b e cal Led upon for rnp1.d
sriperpt)riers, may iii<.>reasinq

mii1.tary int,ervention t20 secure areas vital to t,his nxcion

;and its ;iiLi+s. If t,he \LIEUI) is t.o meet. its oblig:*tiori of

providing timely medical support to the soldiers condur:V.in:

these quick operations, medical commanders must. enable r.heir

organizations to react rapidly and be proactive in preparins

their medical support capabilities.

Tactical and operational commanders and their staffs

must also recognize the role the ANEDI) has to play in

achieving t h e success o f their rapid dep1.oyment. opnrat i ons.

T h e y can b e confident t,hat. they can r e l y on t.heir meriic.s t o

g i v e them t,he best support. nvailable i f t.he.y rnsurr t h a t

medical planners and medical commanders are involved

throughout the planning and execution p r o c e s s o f a rapid

deployment force operation.

The medical triumphs, as well as the medical failings,

o f t.he medjral s u p p o r t in the Falklands and Grenada are

evident. when t.hese rapid deployment operations are analyzed

using the est,ablished and timn-t,est.ed medical s u p p o r t .

principles. Violiiting any of the principles opisris t.lit. t!i>,>r

to a pot,ent.ial medical disaster and jeopardizes o v e r a l 1

operational s u c c e s s .

In addition Lo the points aLready discussrd, t,his

analysis has revealed the f o l Lowing k e y recommendations:

I I ) s o l d i e r s musi. br highly physically T i t f o r r : \ p i d

. p ~ r a li oris ari~l must

* l ~ p i n y n i r r i to lhe rn<.ouragecit o I n<~r,~ast~

t . h q . i r f L u i d irit.akt>during t.hr operatinn;

 (2) s o l d i e r s must. h e t r a i n e d i n b 0 t . h s e l f a i d a n d biirld:-

a i d t o augment, u n i t mecii.cs e s p e c i a l l y i n t h e el-prrt o f a m a s s

c i ~ s i i at.y
l n i t.iintion;

(3) medical soldiers m u s t p r o v i d e r e s u s c i I : i r t i o n

c a s u a l t i e s , e s p e c i a l l y i n t h e c o n t r o l of h e m o r r h a g e , as f a r

forward a n d a s q u i c k l y as p o s s i b l e ;

( 4 ) medical s o l d i e r s , e s p e c i a l l y p h y s i c i a n s , m u s t be

f a m i l i a r with t h e special requirements of b a t t l e f i e l d

m e d i c i n e a n d knor; t h e i r m e d i c a l e q u i p m e n t a n d o r s a n i a n t i o n a

3t.r.llctLlre ;

(5) iiirdical eqiii,pmenr p a c k a g e s must, be d e s i y n r d t:, hr.

l i g h t x e i g h t a n d meet, a wide r a n g e o f medical s u p p o r t

c o n t i rig e n c i e s t h r o u g h i n t. r i n s i c f 1 e x i b i 1i 1: y a n d f u n , ? t, i o n 2 1

i nt e g r ity ;

(6) medical s u p p o r t r e l a t i o n s h i p s must, b e c l e a r l y

d e f i n e d a n d u n d e r s k o o d b y s u p p o r t e d u n i t s and b e t w e e n medic:.il

u n i t s of t h e same as % e l l as o t h e r s e r v i c e s ;

(7) t h e p a t i e n t , e v a c u a t , i o n s y s t e m must, be clearl!-

d e f i n e d a n d e s t a b l i s h e d c o n c u r r e n t l y w i t h t h e deploymen1 (of

rombat f o i - n e s t.o e x p e d i t e p a t . i n n t movement. ~ i t h i r i:I st,r\.ic:+,'s

medical i.chelons and between s e r v i c e s i n j o i n t opernt i n n s ;

(8) p a t . i e n t uv;icii:it.ioii m u s t be b y a i r r<hene\-er f c > n s i h l t +

and j n d e d i c a t e d meiii<!:il a i r c r a f ' t t.o e n s u r e ? c o n t i n i i i t y n f

care- w h i l e t;he p a t . i r n t . i s e ~ i r o i i t ~ e t,o

, t h e n e x t . e r ~ h e 1 ~ )oP
n

r <a ;
,-.,a

i9) tlic a c ( . e s s i b i I i t . t i t ' mediral r a r e outs id^ o f :i

combat. z o n t ! iiiiist. h? l n n i n t . a i r i r d t ~ ~ i na g t h o r o u g h l y ( : o o r d i n n t . n l
p a t i + n r , , z \ - a c i i a t i o n s y s t e m or t h e f u i i spect.riim O F met-licai

s i i p p o r t ( ? x p x b i l i t , i e s m i c s t . hr m a i n t a i n e d i n t,he c o i n b a t z o n e :

(lIJ! inrdit>a! u n i t s , 1 i k r a l l m i 1it.ary uniI.s, slioi.ii~ilit?

d e p l o y e d wi t h t h e i r h a b i t u a l l y a s s o c i a t e d s u p p o r t . iirii ts

w h e n e v e r p o s s i b l e t o i n s u r * e t h e f a s t e s t medical s u p p o r t of

rapid deployment f o r c e s ;

( 1 1 ) s i m p l i c i t y m u s t be s t r e s s e d t h r o u g h o u t t h e

b a t t l e f i e l d medical s u p p o r t s p e c t r u m f r o m s i m p l e f i r s t a i d

t,echniques il i k e t o u r n i q u e t s 1 t o simple s u r g i c a l procedures

and c i l i n i c a l p o l i c i e s ; and

I i 2 ) m e d i c a l t?ominanders milst e x p e c t , unforeseen p l ~ o b i r m s

t o 3 r i s e s o t h e y s h o u l d s t a y f l e s i b l e a n d dociiment, s t , r p s

t a k e n t.o overcome p r o b l e m s so i r i f o r m a t i o n w i l l b e a v a i . 1 a b l t . i

for f u t u r e t.raining and planning. 1

Reconimendat.i o n s for F u r t h e r Study

b e e n ,leinonstr;rt-.ed to h e o f s i g n i f i c a n t vaLue i n t.he p 1 . n n n i n r

a n d e s e c u t i o r i of’ r a p i d d e p l . o y m n n t forr-e m e d i o ; r l support.

Simi L a r l y , m e d i c a t support. o p e r a t , i o n a L c o n c e p t s o f tother

armies s h o u l d b e e x a m i n e d a n d a n a l y z e d i n t h e l i g h t . o f

comparisons t o a c t u a l r a p i d d e p l o y m e n t f o r c e o p e r a t i o n s .

Several o t h e r q u e s t i o n s s u r f a c e d d u r i n g t h e r e s e a r c h f o r

t h i s s t u d y w h i c h merit a d d i t i o n a l s t u d y . First, the two

o p e r a t i o n s s t u d i e d used t r a d i t i o n a l medical b a t t a l i o n - l i k e

organizations t o command a n d c o n t r o l s e c o n d e c h e l o n mc+rii<:ai.

support. I l n d e r t,he L . S . .Army’s c u r r e n t s t r i i c t u r e , m o s t

d i \ , i . i i o n s ha..-c-. f o r w a r d s u p p o r t b a t t a l i o n s ( e a c h tcikh o n e

medical c o m p a n y ) a n d n o medical b a t , t a l i o n l i k e t h e R 2 n d

.Airborne D i v i s i o n . T h i s s t u d y h a s s h o r m t h e Ire>- r o l e p l a y e d

by t.he :IOit,h ? l e d i o a l R a t t a l i o n c o m m a n d e r i n i n s u r i n q m e d i i . a I

s u p p o r t . w a s d e p l o y e d o n time t o p r e v e n t a medical d i s a s t . e r .

,A s t u d y s h o u i d h e c o n d u c t e d t2u d e t e r m i n e if forrjard support

b n t , t a l i o n c o m m a n d e r s or DISCON l e v e L medicai s t a f f o f P i t , c i - s

ran he rspect.ed t o i n t e r v e n e a t s u c h a c r i t i c a l t.inie a n d 11ni.r

136
\;or:~-i X a i ;I I :-;rid i n t - o r ~ p i r i s o i i 1.0 t . n ~C r i t . i s h e s p f ? r ~ e n ? f '

i c i r.h : . h e i r . hospit,al s h i p i n t.h(> F a l i i l r l n d s . 'l'ho i n e ( l i i : a l

: + i i p p ( > r r i ! i i l ) l i ~ - ai rI , n s 0 1 ' Irhr l.'.S.U..'-:. ' , / e v ~ ,a

vn d thr .S:\,S.

( . ' L ~ n i f , ~iire
rt i m p o r t a n t , b o t h f o r r a p i d d e p l o > - m e n t forces a n d

o t h e r operational f o r c e s . ?

F i n a l l y , a s t u d y of a n u m b e r o f medical s u p p o r t

o p e r a t i o n s of r a p i d l y d e p l o y e d l a n d forces o f s e v e r a l

d i f f e r e n t n a t i o n s w o u l d be u s e f u l i n c o n s t r u c t i n g a

innt,r.is. T h i s matris c o i i l r i b e u s w l to c o m p a r e d i f f e r e n l .

:n i 1i t n r j - i n e d i t - n l d e p a r k m e n t s and t h e i I. p e r f o r n ~ i r n c t ?rci !:I1

i ' r s p o c t . 1.0 t>he s i x m e d i c a l s u p p o r t . p r i r i c : i p l e s used in t h , -

sI.udy. T h i s rzoiild b e a n e f f e c i . i \ ? iiieans t,o compar? tht?

t u a l 1 ) e r f o r m a n c e o f m e d i . c a 1 s u p p o r t . o p e r a t . i o n s of o t h e r

n a t i o n s , e s p e c i a l l y o u r allies. Su<:h a s t u d y ~ i o u l d bc I I S ~ P I . I ~

i n a s s e s s i n g t h e f u t u r e a b i l i t y o f our a l l i e s t o m e d i c a l l ?

support .\merican s o l d i e r s i n campaigns r e q u i r i n g cnaI.iti (31:

varfare.
1. Lieutenant CoLoneL lienneth C . Sever, "782nd Xaintpnance

Battalion in Grenada," Ordnance 2 (Winter 1 9 8 4 ) : 6.

2. "hew Hospital S h i p kill Increase Readiness,'' HSI: ? I e i - c u r y

14 f Fe!hriiar- 1987) : I.
 S E L EL TED B II3 L 1OGR ,\Ptl1

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;:.S. D e p a r t m e n t o f t h e A r m y T;i.eld ! : i r c u l a r 8 - 1 5 - 2 . "tleatth
S e r v i c:e S iippo r t C)perat.i o n s - A i r h o r n e a n d 4 i r ,\ss a i l i I
Division.'' i J a n u a r y 1986.

U.S. D e p a r t m e n t of t h e Army F i e l d C i r c u l a r 8 - 4 5 . " M e d i c a l

E v a c u a t i o n i n t h e Combat Zone." 10 October 1 9 8 6 .

U.S. D e p a r t m e n t o f t h e Army F i e l d M a n u a l 8 - 8 . " M e d i c a l

Support i n J o i n t Operations." 1 June 1972.

K.S. D e p a r t m e n t o f t h e Army F i e l d Y a n u a l 8 - 1 0 . "Heal.t,h

S e r v i c e S u p p o r t i n a T h e a t e r of O p e r a t i o n s . "
2 October 1978.

C.S. D e p a r t m e n t o f t.he .Army F i e l d X a n u a l 8 - 2 0 ( T e s t ) . " H c ~ s L r . h

S e r v i c e S u p p o r t . i n a (:ombat Lone." 3 1 Play 198::.

C.S. D e p a r t m e n t o f t h e Army F i e l d Nanual. 8 - 3 5 . " E v a c i r a t ~ i o no t

t-he Sick a n d W o u n d e d . " 2 2 December 1 9 8 3 .

l!.S. D e p a r t m e n t . o f t h e .Army Fie1.d Manual 8 - 3 5 . " P l a n n i n g f o r

Health Service Support ."
I5 February 1985.

C.S. D e p a r t m e n t o f t h e Army F i e l d H a n u a l 6 3 - 2 . "Combat

S e r v i c e Support Operations-Division. " 21 November
19133.

L.S. I > o p a r t i n e n t . of t.hc! . A r m y F i e l d N a n u a 1 63-3.1. "C'oslhnt

S e r v i c e S u p p o r t O ~ i e r a t i o n s - C o r p s . " 12 :\uqiisl. 1 9 8 5 .

I!.S. D e p a r t m e n t o f t.he ,Army F i e l d Manual 6 3 - 4 . " ( l o m t n r .

S r r v i c e Support, O p e r a t i o n s - ' l ' h e a t . e r -\r,my \t.r:i
i'oinmand. " 2 4 Sept,amher 198.1 .
U.S. D e p a r t m e n t of' t.he .Army F i e l d Y a n u a l 1 0 0 - 3 . "0perat.ioiis."
5 !lay 1986.

1L.S. D e p a r t > m e n t o f t h e .\rmy F i e l d Y a n i i a l 100-10. "comhxt

Service Support. " 1 March 1983.

1:.S. Depart.ment, o f t h e ,\rmy R e R u l a t . i o n 351-3. " P r o f e s s i o n a l

,rr,~ 1' 1 r' i i n go f ,\MEDD P e r s o n n e l . " 1.5 1)eceniber 1 9 8 5 .
1;.5. r)epart.ment. 9 f l.he ,\rmy ' T r a i n i n g a n d I ) o c t r i n ~ - l'umm:tn~i
- . .
I J a i i i p h 1 c t. 5 2 5 5 0 " I . S :\ riny Ope ra 1. i onii I (. I i i i c ~e1) t t' I I'
t l e i t l t h S e r \ - i c P S u p p o r t i\irLantt 1\a1 t.1.c." 1: \l)ri 1
isnt;.
I32
\ < i i s r r n , F.,dlward B . , 1 , i e u t . e n a n t . C o l o n e l . h e a l t h \:are
D p e r a t . i o n s , O f f ice of t h e S u r g e o n G e n e r a l , L n i ted
S t a t e s Army, W a s h i n g t o n , D . C . T e l e p h o n e i n t e r v i e x ,
2 3 December 1 9 8 6 . ( L i e u t , c n a n t . C o L o n e l W i l s o n
f? o mmnridt=d t i i f? :I 0 7 t.h ?ledi r a 1. B a t . t.a 1i o n , R 2 nil ,\ i L' tio r n I
n i v i s i o n , diirLng t h e G r e n a d a E s p e d i t i o n . )

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1 , s . A r m ? i'ommand a n d C e n e r a i S t a f f \Jollege
Ft,. L e n \ - e n w o r t h , K a n s a s 6 6 0 2 7

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c' o iniiinnd e r
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C~~m~iinri~ier
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Commanrier
307t.h Xedical Bal:t.alion
82d Airborne Division
F t . Firngg, Y o r t h Carolina 283Ui-5100

(.' omma r i d e I'

326th Nedical Battalion
LOlst Airborne Division ( A i r A s s a u l t )
Ft. Campbell, Kentucky 42223-5000

Commander
1J2nd Medical Battalion
193d Infantry Brigade
4PO Niami 34004-5000