During a recent light armored reconnaissance raid exercise on Okinawa, the 31st Marine Expeditionary Unit (MEU) and the amphibious dock landing ship USS Germantown (LSD 42) employed a medical evacuation tactic not commonly used since World War II.
With elements of their Shock Trauma Platoon, or STP, combined with Marine field medical training and tactics, Fleet Surgical Team (FST) 7 came up with a way to evacuate casualties from a ground conflict and provide en-route care via waterborne ambulance.
“We knew it was going to take a while to get casualties from the mountain, to the coast, and then to the ship,” said Cmdr. Hamilton Tilley, Amphibious Task Force surgeon. “And we knew, if it was going to take three or four hours and they were bleeding, we were probably going to lose them.”
Marine forces were on the ground conducting a simulated raid on enemy-held positions. As part of the exercise, casualties were imminent. According to Tilley, those casualties are typically evacuated by aircraft to the amphibious assault ship USS America (LHA 6), where they can receive resuscitative medical care until they can be sent to a Role III facility – a fully staffed hospital in friendly territory – for longer-term rehabilitation.
But residual storms from Typhoon Champi affected air evacuation (AIREVAC), so the team needed a backup plan to get injured Marines from a mountain battlefield to a casualty collection point (CCP) on the beach six miles away, then to Germantown several miles offshore, and keep them alive the whole way.
“We needed a persistent medical capability that could provide treatment and casualty holding for up to seventy-two hours until the weather situation allowed us to transfer to the FST on America,” said Lt. Derek Witkowski, a medical planner with the 31st MEU.
Tilley said this “chain of survival” depends on lifesaving care on the battlefield, starting with Tactical Combat Casualty Care, or TCCC (Marine Corps field first aid doctrine) and Valkyrie (a live, person-to-person field blood transfusion) to get patients to the CCP.
“TCCC and Valkyrie is how we’re saving people in the field,” said Tilley, “and that en-route care is how we’re sending people on the transport back to the ship.”
Given Germantown’s capabilities, Tilley’s team knew the waterborne leg of the journey could involve amphibious craft, or even an 11-meter rigid-hull inflatable boat (RIB).
“We were going to need a resuscitative team on the ground somehow,” said Tilley, who voiced concerns to Capt. Greg Baker, commodore of Amphibious Squadron (PHIBRON) 11. “The commodore said, ‘see if we can use an LCU, see if we can use a RIB.’ So that’s what we did.”
“As we train and operate with the 31st MEU, the weather often gets a vote. In this recent case, it filibustered,” said Baker. “Once again, innovation won the day as we used our organic capabilities to plan and execute a concept proven in amphibious battle space almost eighty years ago by another generation of warfighters. Our modern medical capability, coupled with what we’ve learned from those who fought before us, helped us overcome this obstacle.”
An LCU is a landing craft, utility – one of the amphibious craft employed by the America Amphibious Ready Group (ARG), which includes Germantown. LCUs are sturdy, rugged craft that can carry up to 400 troops or 140 tons of cargo from ship to shore or on the open ocean. LCUs have stood the test of time, operating with Navy and Marine amphibious forces since World War II.
Seven decades later, in the same geographic environment but with new adversaries and impediments, the blue-green team channeled this legacy amphibious tactic with renewed purpose.
“In competition and in future conflict, we need to not only return to our naval roots, we need to demonstrate the ability to move forward to a new naval future,” said Col. Michael Nakonieczny, commanding officer, 31st MEU. “As an ARG-MEU team, we must maximize all available assets to expand our current capabilities and enable us to respond to any crisis, and if need be, fight in every clime and place. This is a great example of our medical staffs identifying ARG-MEU solutions to ARG-MEU problems, despite many obstacles, to preserve the life of our warfighters on the ground.”
Tilley said his team put one section of the STP, which was assigned to Germantown, on the LCU with as much capacity and capability as they could fit aboard the craft. An emergency room provider, nurse, and en-route care corpsman were outfitted with stored blood, chest tubes, and other essential supplies to resuscitate and sustain Marines from the battlefield to the ship.
“We tried to make it as much like an emergency room as we could,” said Tilley. While he said the floating ER could notionally care for up to 10 people at a time, Tilley said it supported 17 casualties during the exercise.
Witkowski said the team looked at the survival chain, from battlefield to beach to boat, “under the lens of EABO” (expeditionary advanced base operations), “which required small, mobile, and highly capable units to avoid targeting.”
Lt. Cmdr. John Haggerty, the 31st MEU surgeon, table-topped medical EABO as opposed to a forward operating base (FOB), saying it’s smaller and more mobile in concept.
“The command-and-control element is here,” said Haggerty, indicating a spot on a tabletop. “The next day it’s here, and the next day it’s here. You can break it down and go, instead of holding ground like a FOB would.”
Witkowski pointed out that it’s crucial for future medical and casualty planners to prepare for any eventuality, as it’s impossible to know the specific conditions of a mission they may be called upon to support.
“The waterborne ambulance shows the importance that creativity and ‘outside-the-box’ thinking will have in saving the lives of the warfighter in the future,” said Witkowski. “The key ingredient was dynamic teamwork between the ARG-MEU team, and creativity when presented with a seemingly impossible challenge,” Witkowski added.
In a real-world scenario, Tilley said, this capability could be the difference between life and death.
“If any of the simulated serious casualties would’ve survived that raid, it was because of Valkyrie and a surface connector,” Tilley said.
Together, the forward-deployed ships of PHIBRON 11 and elements of the 31st MEU are operating in the U.S. 7th Fleet area of responsibility to enhance interoperability with allies and partners, and serve as a ready response force to defend peace and stability in the Indo-Pacific region.