by RDML Clinton E. Adams, MC, USN
Command Surgeon & CDR William J. Upham, MSC, USN Chief, Medical Concept Development & Experimentation
Deploying Joint Forces into a challenging and uncertain future poses many unanswered logistic questions for Joint Health Service Support, (JHSS), functions. These challenges are described in terms of the revolution in military affairs (RMA). The first revolution, system of systems, already working its way into doctrine but rapidly on its heals is the second RMA, information dominance. It is this second revolution that is forming the battlefield. It is determining the way we will fight the future battle space, including identifying who our enemies are, how they fight, and the asymmetric threats they pose. In fact, future joint military operations are likely to be conducted by relatively small and agile joint forces at far-forward locations in austere environments with limited base support. In-theater advanced Health Service Support in casualty care management requires a lighter medical platform that is capable, flexible, technologically advanced, and mobile. As cited by President George W. Bush, during a Citadel Speech on December 11, 2001, "Our military culture must reward new thinking, innovation, and experimentation". The President further directed the Department of Defense (DoD) to transform to meet to meet an uncertain future and the unfolding challenges of the 21st Century.2 In direct support of this directive, the DoD Joint Operations Concepts (JOpsC) was developed to describe how the Joint Force intends to operate within the next 15 to 20 years. As cited in the JOpsC document "to mitigate the risks and uncertainty of the future, DoD will transition from a threat-based, requirements-driven, force development process to a capabilities-based, concepts-driven force planning process. The JOpsC provides the conceptual framework to guide future joint operations and Service, combatant command and combat support defense agency concept development and experimentation". 3
Joint Force Health Protection will require the same capabilities-based, concepts-driven force planning process in order to sustain operations to support the war fighter on the future battlefield. Information dominance will fuel the speed of the conflict not only allowing but also requiring the more rapid medical evacuation of casualties to higher-level medical treatment for definitive care without sacrificing quality of care. At the same time enhancement of the "Golden Hour" on the battlefield requires a rapid coordinated response in support of the e medic, and use of advanced on scene casualty care management technology to stabilize and prepare an injured patient for evacuation. During Operation Iraqi Freedom, the need for rapid medevac was repeatedly demonstrated between the Battalion Aid Stations, Surgical Company, and Combat Support Hospitals because of far forward surgical stabilization not seen in previous conflict. Another example is the Urban Warrior subject to trauma of a blast injury from detonated explosives, such as victims targeted by suicide bombers or car bombs require rapid stabilization and evacuation for definitive care.
In order to reduce and or mitigate the risk of forward deployed forces, Force Health Protection should be achieved through the tailored selection and application of multi-layered active and passive measures, within the domains of air, land, sea, space, and information across the range of joint military operations. Applying the science of information dominance through the "bit stream" reduces the risk of injuries and loss of personnel.4 The employment of the bit stream through active and passive measures include employment of advanced sense and response technology and fully networked/jointly integrated information exchange capabilities to enhance medical situational awareness on the battlefield. As our ability to fight and understand the parameters of the second revolution in military affairs, there are readily available initiatives, which should be considered. asset visibility, protection, and responsiveness of the delivery of health services to support future joint military operations "out of harms way" can be achieved through Sea Basing.
Sea Basing is one enabler to assure the Joint Force's ability to effectively and decisively achieve its mission in providing direct access to the level of care needed. By definition, Sea Basing may comprise a pre-positioned mobile platform off a hostile coast in an anti-access area or denial type of environment. It may comprise a contingency of surface vessels that
are networked to augment specific joint Health Service Support capabilities, such as enhanced resuscitative surgery, to help support and sustain the war fighters mission. As applied to the JOpsC, the networked Sea Base Concept will enable the joint forces to increase operational effectiveness by allowing dispersed forces to more effectively communicate, maneuver, share an enhanced common operating picture of the battle space, and in achieving the desired end-state. Sea Basing would also further minimize the inherent risks to forward deployed personnel, physical assets, and information domains. In addition, Sea Basing would reduce resource and logistics requirements and footprint for reception, staging, onward movement, and integration, which suggests the need to consider new mobility means. As evident with our Nation's Emergency Medical System, most major cities are networked with major trauma centers to effectively respond and treat life-threatening injuries. This capability can similarly be applied to the Sea Basing concept the future Sea Base will provide resuscitative surgery capability augmented by Amphibious Ships (LHA/LHD) and Aircraft Carriers (CVN), as part of an enhanced networked Sea Basing concept. In addition, more definitive care may be provided with a modular medical package in the Marine Pre-positioned Group, e.g., Hospital Ship
(T-AHor the LPD-1- or MPF Future. Sea Basing mobility capabilities such as the "High Speed Surface Vessel" (HSV), super short take off/landing, heavy lift vertical take off/landing capabilities, all contribute to the JFT Commanders options for Joint Deployment, Employment, and Sustainment (JDES), which is part of the transition process being used by U.S. Joint Forces Command as it works to re-engineer and transform the U.S. Military into a more agile and coherently joint force. Although JDES concepts are beginning to merge, there is an identified need to create an Afloat Medical JDES system that has the ability to support a variety of widely dispersed, non-contiguous, complex joint operations, simultaneously, that leverages the Joint Sea Basing concept.
Future military operations cannot continue to rely on traditional field medical facilities ashore as they have in the past, e.g., Fleet Hospitals, Surgical Companies, and Battalion Aid Stations, the support of the joint forces ashore will require other creative solutions such as medical support at sea, along with a significant change in medical evacuation capability. Casualty evacuation from the field will require additional assets to quickly MEDEVAC patients to the Sea Base. Evacuation of casualties from the shore to the Sea Base will require either air (rotary wing aircraft such as the U.S. Marine Corps OSPREY, or shallow draft High Speed Surface Vessel) to quickly move patients out of harms way.
Sea Basing and the use of HSVs configured to provide advanced Health Service Support in the current global threat environment need further study. Fleet Forces Command in Norfolk, VA and NWDC, Naval Warfare Development Center, Newport, RI, recently conducted preliminary experiments in order to evaluate the potential capability. This new approach to centuries old problem is a potentially viable concept that needs to be studied, developed and evaluated for support of future joint military operations. Secondly, Sea Basing may alleviate the need for a land based Intermediate Staging and Support Base (ISB), which historically has required a large logistical tail and forward footprint. In addition, Sea Basing can offer tailorable capability to provide essential care to, and preparation of patients being evacuated out of a war zone for more definitive care. This advanced concept also provides a unique opportunity to integrate new/emerging technologies with Advance Health Service Support at the operational and tactical levels of war. The end result will be the provision of a highly flexible, but robust casualty care throughout all phases of joint deployment, employment and sustainment operations, especially Military Operations Other Than War (MOOTW), such as evacuation operations following a natural disaster. Enhanced networked Sea Basing utilizing HSV's provides the future Joint Forces and our coalition partners with the enabling capabilities to provide our Nation and its Regional Combatant Commanders unprecedented versatility and flexibility to exploit the force protection benefits inherit to areas outside the Littorals, relatively unconstrained by the political and diplomatic restrictions inherent by our uncertain global security environment
. In summary, as our military transforms its capabilities to prepare for asymmetric warfare and better-equipped adversaries, we must utilize robust, mobile, and precise assets/capabilities in order to sustain our combat advantage. As the future joint war fighter undergoes this transformation, we must also rely on advanced military technologies and capabilities that will advance battlefield health care. Sea Basing that is augmented by Advanced Joint Health Service Support shows significant promise as a winning combination.