14 – Medical support in Vertical Manoeuvre in Mountain Warfare
Maj Ágnes Györfy, PhD, NATO MILMED COE
Member of the Military Mental Health Panel
Member of NATO STO HFM RTG – 277
Areas of Work: Personnel selection, mental health screening, psychological counselling, teamwork in the integrated treatment of psychosomatic disorders, psychological preparation for riot control, SWAT activities and other special police operations, hostage negotiation, forensic psychology
Email: interop.conex@coemed.org
Introduction
In Mountain Warfare medical support could be essential for increasing the chances of survival, which is important in the case of a well-trained soldier who is capable of Mountain Warfare operation. From this aspect, the human factor, personnel are the hardest to substitute or replace, so it is a key factor to preserve their deployability for as long as possible.
Medical support in these circumstances and at this height also has its specialties, where from every aspect we could point out the crucial points that need support and solutions from the technical side. If we go through the well-known METHANE report which we use in military medical scenarios in order to gain exact information – which is crucial for treatment and timely reaction – as quickly as possible, we could see the following:
Type of incident/injury
From this aspect the usually cold weather, the particular terrain and, from a certain height above sea level, the potentially presented hypoxia could determine what injuries to expect and how differently the individual could react in those circumstances at the physiological level. In some major incidents, mass casualties could not be handled in time because of the terrain and the access to the patients. Time is crucial from a medical point of view: who wins time wins life. Therefore, there should be more emphasis on the CLS (combat lifesaver) medics’ tasks, who are part of the team, trained and prepared to handle the situation and carry out primary care and communicate the medical evacuation.
Exact location
In these scenarios, sometimes finding the exact location of the injured person(s) is the hardest task, even with activated signals and other special devices. Mountain Warfare professionals know well how to determine it exactly, but communicating it to the medical units, especially during civil-military cooperation, is a really difficult task. Sometimes the language and the concept are different between the services, and if we take the stress factor also into consideration, we can see that there could be a lot of distortion in the process. Based on practical experience in mass casualties, in civilian cases approximately the 15-18th call could give the right information, but in a well-trained military team it could be the 4-6th.
Hazards, danger
The concept of hazards and danger can be also different in these circumstances. The ice, snow, and the rapidly changing conditions of weather at altitude are enough to provide dangerous situations besides the relevant military danger.
A barely accessible terrain means that a specialist can hardly get there, and decontamination, which in some cases should be carried out before the medical evaluation and treatment to prevent the medical specialist’s possible contamination, can only be done with great difficulty or not at all. Besides this, special medical equipment may not be able to be carried on this terrain by the already fully equipped soldiers.
Accessibility
Accessibility is the key component in this process, because in this terrain the injured person(s) are usually hard to access, and special equipment and a lot of extra time is required for finding and getting close enough to them to give the right treatment and to prepare them for delivery to get more specific treatment. The specialized terrain makes it harder even when we know the exact location. Questions can be merged, such as: Where to put down the medevac, and where are the other points for delivery of the patients? Because of the protective uniforms, even the injury may hardly be accessible in most cases.
Number of casualties
The number of casualties is usually lower than on flatter land, because of the nature of the operation and the smaller groups that can move together effectively in this terrain. Sometimes just one casualty takes long hours to find and access for a whole group of medical staff. Triage is extremely difficult when there are multiple injured in barely accessible, diverse places. Their handling could be delayed for a long time, decreasing their chances of survival. Both the patients and the medical staff should be prepared for a delay in accessibility and potentially prolonged care at the scene.
Emergency
This can also – like the aforementioned points – be a critical aspect. Do we have enough time to get close and get access to the patient to save them in the event of life-threatening injuries? In these cases the normally expected ‘golden hour’ (giving treatment within one hour provides the highest chances of survival) of medical care cannot be expected because of the usually inaccessible terrain. Besides this, we must be prepared for casualty movement and prolonged field care. According to previous experience, in civilian special medical teams the average time to access and treat a patient in mountain terrain is usually 16-18 hours.
Conclusion
We can conclude that in these circumstances the training and preparation process of mountain warfare teams from the medical aspect is also essential. It would be best if every team member had CLS training (Combat Life Saver), and there should be a medic in the team with a good connection to a specialized military and/or civilian medical rescue team. They should be able to treat at least emergency cases at the scene in order to save each other’s lives. They should have basic knowledge about handling:
- Serious, life-threatening wounds
- ABC (airway, breathing, circulation)
- Haemorrhage / Control of bleeding
- Triage
- Hypothermia
- Liquid, blood sugar control
- Well-known medications
Having basic knowledge of emergency care even in this extreme terrain and circumstances, the chances of survival and preserving deployability become higher, along with the success of the operation.
References
- Allied Joint Doctrine for Medical Support AJP 4.10
- Mountain Warfare Fundamentals