Brigade Combat Team Research Articles

Clinician Perception of the Impact of Deployed Physical Therapists as Physician Extenders in a Combat Environment

Physical therapists (PTs) serve as physician extenders performing direct access evaluations for musculoskeletal conditions. The previous war-time mission of PTs was limited to level III medical care. Recently PTs began providing care at levels I/II with brigade combat teams (BCTs). Determine the sentiment of battlefield providers at levels I/II regarding the operational impact of PTs. Surveys were provided to BCT medical providers. There were 107 responses (response rate of 51%). According to the responses, PTs made a significant impact on overall mission accomplishment (97%) and patient prognosis (83%) and were considered local experts in musculoskeletal pathology (92%), including the ordering of radiographs (79%). Their presence was thought to significantly decrease medical evacuations within theater (68%) and out of theater (73%). There was a positive sentiment toward PTs in the BCT, suggesting they are highly valued. Future studies need to clarify further operational, medical, and fiscal implications.

Sports Medicine on the Battlefield

War is not sport! But the concept for managing injured Soldiers in garrison or combat parallels returning elite athletes to the playing field as quickly and safely as possible. U.S. Army physical therapists (PTs) have a 44-year history of providing medical care during operational deployments ranging from war to complex humanitarian emergencies. From the jungles of Vietnam to the banks of the Tigris, U.S. Army PTs serve as autonomous orthopaedic physician extenders, evaluating and treating Soldiers with and without physician referral. PURPOSE: To determine the efficacy and effectiveness of U.S. Army PTs in managing injured Soldiers during combat operations in Iraq and Afghanistan. METHODS: A standardized process for the collection of injury data metrics was designed in 2004. Data collection from participating U.S. Army PTs began in July 2004 and continues in current operations. Completed analysis is for Combat Support Hospital (CSH) data from July 2004 through Sept 2009, and for Brigade Combat Team (BCT) data from August 2005 through Sept 2009. RESULTS: At CSH facilities U.S. Army PTs have been managing 45.1% (31,653/70,184) of the total out-patient workload and 90.4% (27,910/30,874) of the orthopaedic out-patient workload, with 44.9% (8,414/18,793) of those Soldiers seen through direct access. This has resulted in a 96.5% (18,083/18,739) return to duty rate and a cost savings of $16.5M associated with theater evacuation avoidance. U.S. Army PTs in BCTs are managing 35.8% (61,625/172,138) of the total workload, with 43.8% (10,635/24,280) of those Soldiers seen through direct access with a 97.5% (23,673/24,280) return to duty rate. CONCLUSION: Data reflects the value added benefit of U.S. Army PTs to the entire Healthcare Team to manage Soldiers in a combat environment. Unlike other providers, the versatility of U.S. Army PTs enables them to not only diagnose non-surgical neuromusculoskeletal injuries, but equally important to provide a wide range of definitive care and rehabilitation, reducing the need for costly evacuation. This working relationship within the Healthcare Team affords surgeons and physicians the opportunity to better focus on more complex surgical and medical cases.

Incidence and Epidemiology of Combat Injuries Sustained During “The Surge” Portion of Operation Iraqi Freedom by a U.S. Army Brigade Combat Team

A prospective, longitudinal analysis of injuries sustained by a large combat-deployed maneuver unit has not been previously performed. A detailed description of the combat casualty care statistics, distribution of wounds, and mechanisms of injury incurred by a U.S. Army Brigade Combat Team during "The Surge" phase of Operation Iraqi Freedom was performed using a centralized casualty database and an electronic medical record system. Among the 4,122 soldiers deployed, there were 500 combat wounds in 390 combat casualties. The combat casualty rate for the Brigade Combat Team was 75.7 per 1,000 soldier combat-years. The % killed in action (KIA) was 22.1%, and the %died of wounds was 3.2%. The distribution of these wounds was as follows: head/neck 36.2%, thorax 7.5%, abdomen 6.9%, and extremities 49.4%. The percentage of combat wounds showed a significant increase in the head/neck region (p < 0.0001) and a decrease in the extremities (p < 0.03) compared with data from World War II, Korea, and Vietnam. The percentage of thoracic wounds (p < 0.03) was significantly less than historical data from World War II and Vietnam. The %KIA was significantly greater in those soldiers injured by an explosion (26.3%) compared with those soldiers injured by a gunshot wound (4.6%; p = 0.003). Improvised explosive devices accounted for 77.7% of all combat wounds. There was a significantly higher proportion of head/neck wounds compared with previous U.S. conflicts. The 22.1% KIA was comparable with previous U.S. conflicts despite improvements in individual/vehicular body armor and is largely attributable to the lethality of improvised explosive devices. The lethality of a gunshot wound in Operation Iraqi Freedom has decreased to 4.6% with the use of individual body armor.

Predictors of alcohol use prior to deployment in National Guard Soldiers

Frequent and heavy alcohol use is associated with negative mental and physical health consequences. Previous research has suggested that alcohol misuse is associated with demographic, personality, and mental health variables. This study examined the relative contribution of these factors in predicting drinking among National Guard soldiers prior to deployment to a combat zone. Members of a National Guard Brigade Combat Team ( N = 515) completed questionnaires assessing drinking behaviors in the past year (frequency, quantity, binge, and total drinking), as well as demographic, personality, and mental health variables. As a group, demographic and personality variables significantly predicted all drinking outcomes. Negative emotionality and disconstraint were independent predictors of all drinking variables. Younger age predicted higher quantity of drinking, while being unmarried predicted greater total drinking and higher frequency of binge drinking. Once the influence of personality variables were accounted for, mental health was not associated with any drinking variable. The results of this study illustrate the role of factors associated with problematic drinking in a sample of high-risk individuals.

Traumatic Brain Injury Screening

The objective of this article is to report the proportion of soldiers in a Brigade Combat Team (BCT) with at least 1 clinician-confirmed deployment-acquired traumatic brain injury (TBI) and to describe the nature of sequelae associated with such injuries. Members of an Army unit (n = 3973) that served in Iraq were screened for history of TBI. Those reporting an injury (n = 1292) were further evaluated regarding sequelae. Of the injuries suffered, 907 were TBIs and 385 were other types of injury. The majority of TBIs sustained were mild. Postdeployment, responses to the Warrior Administered Retrospective Casualty Assessment Tool (WARCAT) facilitated clinical interviews regarding injury history and associated somatic (ie, headache, dizziness, balance) and neuropsychiatric symptoms (ie, irritability, memory). Traumatic brain injury diagnosis was based on the American Congress of Rehabilitation Medicine mild TBI criteria, which requires an injury event followed by an alteration in consciousness. A total of 22.8% of soldiers in a BCT returning from Iraq had clinician-confirmed TBI. Those with TBI were significantly more likely to recall somatic and/or neuropsychiatric symptoms immediately postinjury and endorse symptoms at follow-up than were soldiers without a history of deployment-related TBI. A total of 33.4% of soldiers with TBI reported 3 or more symptoms immediately postinjury compared with 7.5% at postdeployment. For soldiers injured without TBI, rates of 3 or more symptoms postinjury and postdeployment were 2.9% and 2.3%, respectively. In those with TBI, headache and dizziness were most frequently reported postinjury, with irritability and memory problems persisting and presenting over time. Following deployment to Iraq, a clinician-confirmed TBI history was identified in 22.8% of soldiers from a BCT. Those with TBI were significantly more likely to report postinjury and postdeployment somatic and/or neuropsychiatric symptoms than those without this injury history. Overall, symptom endorsement decreased over time.

‘Human terrain’

Between July 2005 and August 2006, the US Army put together an experimental counterinsurgency programme called‘Human Terrain System’(HTS). The programme's building blocks are five‐person teams (‘Human Terrain Teams’ or HTTs) assigned to brigade combat team headquarters in Iraq and Afghanistan, comprising regional studies experts and social scientists, some of whom are armed. This article looks at the roots of the human terrain concept, which appears to have originated in domestic counterinsurgency efforts connected with US government efforts to suppress political dissent in the 1960s. Of special concern were militant groups such as the Black Panthers. The article then explores the genesis and development of HTS, as it moved from concept to reality. As the programme was being implemented, some of those involved with its creation referred to it as a ‘CORDS for the 21st Century’, in reference to a Vietnam War‐era initiative that gave birth to the infamous Phoenix Program. The latter was a‘neutralization’campaign that led to the assassination of some 26,000 Vietnamese. The article also reviews the potential future uses of the data collected by HTTs, which has been of great interest to several research groups involved in creating‘modelling and simulation’computer programmes designed to provide insight into the motivations of terrorists and their networks. The article concludes with a discussion of the ethical dilemmas surrounding human terrain for anthropologists and other social scientists.

Postdeployment Health Reassessment: A Sustainable Method for Brigade Combat Teams

The Postdeployment Health Reassessment (PDHRA) was mandated in 2006 and the 3rd Infantry Division was the first unit to perform a large-scale implementation. This article outlines a reproducible model for conducting PDHRA using only existing resources. The PDHRA (DD 2900) screening and referral processes are reviewed and data on positive screens are reported. Of the 12,817 soldiers who participated in the mass screening, 1,460 (11.4%) were referred for behavioral health, 815 (6.4%) for primary care, 71 (0.01%) for specialty services, and 9 (0.001%) for emergency services. Consult requests were higher in maneuver brigades than in support units (12.1% versus 8.6% for behavioral health and 6.9% versus 4.4% for primary care referrals). All (1,460, 100%) of the behavioral health consults were completed on-site and the unit incurred no additional financial cost in conducting this process. This method for performing a large-scale implementation of the PDHRA provides a flexible, efficient, and cost-effective process that could be implemented at the brigade combat team level without difficulty and in most locations without significant impact on other medical demands.

Division Mental Health in the New Brigade Combat Team Structure: Part I. Predeployment and Deployment

Recent Army transformation has led to significant changes in roles and demands for division mental health (DMH) staff members. This article focuses on predeployment and deployment. Surveillance of Combat and Operational Stress Reactions data, review of DMH implementation plans, and observations by staff members, providers, and soldiers were reviewed. During the course of the deployment, the Task Force Baghdad DMH unit had >22,000 soldier encounters with 5,542 clinical encounters. The duration of the deployment and increased levels of threat later in the deployment resulted in increased stress problems but not a substantial or sustained increase in mental health casualties. Predeployment education and communication probably eliminated some problems during deployment, and communication among mental health and command units during deployment resolved most problems encountered.

Division Mental Health in the New Brigade Combat Team Structure: Part II. Redeployment and Postdeployment

Recent Army transformation has led to significant changes in roles and demands for division mental health staff members. This article focuses on redeployment and postdeployment. The postdeployment health assessment behavioral health screening and referral process and redeployment plan are reviewed, and data on postdeployment rates of negative events are reported. All soldiers and many of their families participated in an aggressive education program. Of the 19,500 soldiers screened, 2,170 (11.1%) were referred for behavioral health consultation; of those referred, 219 (10.1%) were found to be at moderate or high risk for mental health issues (1.1% of total screened). Of the moderate/highrisk soldiers, 146 (71.9%) accepted follow-up mental health treatment upon return to home station. Fewer cases of driving under the influence, positive drug screens, suicidal gestures/ attempts, crimes, and acts of domestic violence were seen, in comparison with rates seen after an earlier deployment of this unit to Iraq. A formalized approach with command support and coordination can have a positive impact on successful referral and treatment and reduce negative postdeployment events.

The Evolving Role of the Division Psychiatrist

With the recent restructuring of Army infantry divisions in the new brigade combat team model, division psychiatrists are facing new and unique demands. This article outlines the varying perspectives of the position and the duties and responsibilities of a division psychiatrist. It provides guidance on how to negotiate the myriad of challenges unique to the position. Discussion includes planning and supervision, providing command consultation, educational efforts, fulfilling the roles of an officer and leader, and future directions for the position.

From the Combat Medic to the Forward Surgical Team: The Madigan Model for Improving Trauma Readiness of Brigade Combat Teams Fighting the Global War on Terror

Medics assigned to combat units have a notable paucity of trauma experience. Our goal was to provide intense trauma refresher training for the conventional combat medic to better prepare them for combat casualty care in the War on Terror. Our Tactical Combat Casualty Care Course (TC3) consisted of the following five phases: (1) One and one-half-day didactic session; (2) Half-day simulation portion with interactive human surgical simulators for anatomical correlation of procedures and team building; (3) Half-day of case presentations and triage scenarios from Iraq/Afghanistan and associated skills stations; (4) Half-day live tissue lab where procedures were performed on live anesthetized animals in a controlled environment; and (5) One-day field phase where live anesthetized animals and surgical simulators were combined in a real-time, field-training event to simulate realistic combat injuries, evacuation problems, and mass casualty scenarios. Data collection consisted of surveys, pre- and posttests, and after-action comments. A total of 1317 personnel participated in TC3 from October 2003 through May 2005. Over the overlapping study period from December 2004 to April 2005, 327 soldiers participated in the formal five-phase course. Three hundred four (94%) students were combat medics who were preparing for combat operations in Iraq or Afghanistan. Of those completing the training, 97% indicated their confidence and ability to treat combat casualties were markedly improved. Moreover, of those 140 medics who took the course and deployed to Iraq for 1 year, 99% indicated that the principles taught in the TC3 course helped with battlefield management of injured casualties during their deployment. The hybrid training model is an effective method for training medical personnel to deal with modern battle injuries. This course increases the knowledge and confidence of combat medics deploying and fighting the Global War on Terrorism.

Cognitive Complexities Impacting Army Intelligence Analysis

The primary goal of this effort was to understand the problems faced by military intelligence analysis personnel as well as how, and to what degree, the identification of these problems could guide the development of computational support systems. To develop this understanding, we performed a literature review, knowledge elicitation interviews and a cognitive task analysis (CTA) in the domain of Army Intelligence Analysis at the Brigade Combat Team. This effort consisted of identifying: (1) the major functions or cognitive tasks entailed in Army Intelligence Analysis; and (2) the complexities in the domain that pose challenges to performance of these cognitive tasks. Identifying the cognitive tasks and the challenges faced in performing those tasks provided a basis for determining opportunities for more effective support of human information processing and decision-making. In this paper, we document selected results of this analysis effort.

From the combat medic to the forward surgical team (FST): The madigan model for improving combat trauma readiness of brigade combat teams fighting the global war on terror

From the combat medic to the forward surgical team (FST): The madigan model for improving combat trauma readiness of brigade combat teams fighting the global war on terror

Maneuver analysis methodology to predict vehicle impacts on training lands

Tactical mobility analysis techniques were merged with land management strategies to assess potential impacts of vehicle operations on training areas for rangeland planning and management. A vehicle mobility analysis was performed for a suite of vehicle types using the NATO Reference Mobility Model (NRMM II). Input parameters include terrain information (soil type, slope, vegetation, surface roughness, soil strength), terrain surface condition based on climate (terrain strength, freeze–thaw, moisture content, snow cover), and vehicle specifications (tire, power train, weight on each axle, ground clearance, dimensions, ride). The vehicle performance was spatially mapped over the terrain for different seasons of the year and used to calculate the maneuverable acreage, which was compared to acreage needed for training requirements. This can be related to land capability based on expected training impact (Maneuver Impact Miles, MIM) and Land Condition Curves which link training density to land condition. This methodology can be used to determine the suitability of training lands and the degree of land management or rehabilitation expected. The methodology was applied to the transformation of the Alaska training lands to support a new brigade unit called the Stryker Brigade Combat Team (SBCT3), but is equally useful for other training areas and military units. For summer use, Alaska training lands are capable of supporting four times the projected training requirements. For winter, when the ground is frozen, more than 10 times the area needed was available.

Using simulation to understand Interim Brigade Combat Team munitions logistics

Today, military leaders have limited options when reacting to the wide range of current threats existing in our world. These threats demand forces be able to deploy rapidly while possessing combat capabilities to stabilise a hostile area quickly. The Army’s answer to this requirement is the Interim Brigade Combat Team (IBCT). Logistically supporting the IBCT will require the Army to develop support organisations that exploit available technologies to automate support activities, enhance situational awareness and minimise the overall logistics footprint. We have developed an ARENA 5.0 discrete event simulation model to analyse the receipt, storage and distribution of ammunition stocks to the various units that make up the IBCT. Our model focuses on the operation of the ammunition transfer point (ATP) specified in current army guidance to provide ammunition to the IBCT. We examine a number of different operating conditions and conduct a statistical analysis to reveal significant factors influencing ATP performance.

Tread-Heads or Technophiles? Army Officer Attitudes Toward Transformation

The Army has committed itself to the most dramatic change of any of the US military services. In October 1999 General Eric K. Shinseki, then the Army Chief of Staff, announced a goal of reconfiguring the Army from a force mainly composed of heavy formations into a medium-weight force capable of deploying a 5,000-soldier brigade anywhere in the world within 96 hours. The Army is replacing some heavy armored and mechanized units with a force of six Stryker Brigade Combat Teams equipped with light wheeled armored vehicles. By 2010, it will field a networked Future Force equipped with the Future Combat System. (1) This shift away from heavy armor as the main combat element of the Army portends change not only to the Army's organization and systems, but also to its hierarchy, career paths, and organizational culture. The officer corps will play a key role in determining the success or failure of Army transformation. Enthusiastic officers will work hard to make new concepts and organizations a reality. Skeptical officers, by contrast, could undermine such efforts. Unfortunately, to date leaders have had little reliable data upon which to gauge the attitudes of Army officers toward the new combat methods. On the one hand, the Army leadership asserts that the service embraces innovation. As the Army Trans formation Roadmap puts it: The Army recognizes the need to create a culture of innovation, and we are beginning to address this need through the officer professional development system. Initiatives to nurture innovation are emerging from the top down and the bottom up. These provide evidence not only of the Army's commitment to this endeavor, but also of the favorable climate within today's Army towards innovation. (2) On the other hand, in the wake of General Shinseki's initiative there were numerous reports of opposition to transformation from within the ranks of the service. (3) Nearly all such reports, however, are anecdotal, consisting of scattered quotes from unnamed sources. This article presents selected results of the first systematic effort to understand officer attitudes toward transformation in recent years. It is based upon surveys conducted in 2000 and 2002 of more than 4,500 officers--including nearly 1,900 Army officers. It reveals a dramatic shift in Army attitudes toward transformation during that period. In 2000, Army officers as a group were among the more skeptical of the need for change; in late 2002, they were among the most supportive. In 2002 they shared a belief that the spread of long-range precision-strike capabilities would require the Army to become lighter and more capable of dispersing on the battlefield. However, they were uncertain that the Army was on the right path in seeking to replace heavy armored vehicles with formations reliant upon robust information networks. Moreover, many felt that elements of the Army's organizational culture inhibited innovation. Why Study Officer Attitudes? There are four compelling reasons why it is important to understand officer attitudes toward transformation. First, the military services will be the ultimate practitioners of the new ways of war. The extent to which their members are enthusiastic about change may help determine the success or failure of new technologies, operational concepts, and organizations. Second, although very few officers will likely emerge as true innovators, the existence of a climate conducive to innovation within the officer corps may encourage individuals both to generate new ideas and to remain in the service to bring them to fruition. Third, a large percentage of career officers will rise to senior leadership positions within their services in the next 10 to 20 years. In those roles, they will establish command climates that will either support or inhibit risk-taking and innovation. Past research has demonstrated the importance to innovation of senior officers who protect and nurture the careers of young innovators under their command who are willing to take risks: Finally, officers are the recognized experts in military affairs in the United States. …

Deploying the army interim brigade combat team. A quick-look approach for strategic force closure assessments

The United States Transportation Command (USTRANSCOM) recently examined the U.S. Army's Vision for future small-scale contingency deployments with a focus on airlift transportation. The main objective was to provide feedback to the Army on initial concept feasibility. When evaluating transportation scenarios for future concepts, many of the key parameters impacting force closure are not yet well defined, such as the size, location, and time phasing of the deploying force, the level of hazardous cargo processing required, the size and composition of the dedicated airlift fleet, the location of the conflict, the available en route infrastructure, etc. To assess the essence of future transportation challenges, closure estimates and constraints were examined for a number of representative future scenarios. This paper provides details of the development and use of a strategic airlift quick-look tool to support USTRANSCOM's study effort. The tool supports rapid closure assessments and constraint identification for up to 42 different scenarios simultaneously. It is especially useful for evaluating best available future data and planning assumptions when time phased force deployment data is unavailable or of poor quality for making more detailed assessments.

Army Digitization: Making it Ready for Prime Time

Today's emerging strategic environment and operational challenges demand that the Army develop a more responsive and mobile force while maintaining the lethality necessary to fight and win our nation's wars. (1) The Army is developing the Future Force as the long-term solution while the structurally-new current force, characterized by the Stryker Brigade Combat Teams, is a near- and mid-term solution for a more responsive, mobile, agile, and versatile medium-weight force. (2) Simultaneously, the current force, starting with the heavy mechanized and armored divisions, is digitizing and undergoing force structure changes to enhance its near-term ability to provide these operational capabilities. (3) Coupled with technical innovations, the structural changes--to include reduced platform density, indirect fire assets, and combat service support footprint--will purportedly allow modernized current forces to have greater capability through superiority and the ability to conduct rapid, decisive operations. (4) The Army's commitment to creating a digitized force elicits some key questions about how the Army will make the transition from an analog force in the face of rapidly changing technology while maintaining the capability to meet key strategic and operational challenges. For example, what are the force structure changes that the Army needs to make to best leverage powerful systems? What is the phasing strategy to keep units interoperable and operationally viable during the transition? How fast should the transition occur given that digitized systems continue to mature? What is the appropriate level of embedding digital systems--is brigade/battalion-level the locus or should every soldier become an node? The current state of Army digitization is immature and not uniformly delivering the promised capability to justify the current changes in the force structure. Despite great expenditures and effort, the current state of the digital system-of-systems and employment concepts makes clear the price of transformation, to accept risk in the near and mid-term, causing turbulence and unexpected change ... [while] freeing up sufficient resources for the Army to invest in new technologies that will enhance its warfighting effectiveness in the future. (5) The Army is accepting this risk, but there is uncertainty whether digitization is fully ready for prime time. This article investigates critical challenges in the Army's current digitization efforts, including force structure implications, and provides recommendations to ensure the increasingly digitized Army maintains its capability and readiness as it moves from an analog to a primarily digitally enabled force. Network-Centric Warfare and Digitization The discussion on the merits and prudence of embracing network-centric warfare continues as a great debate both within the Army and across the Department of Defense. Yet, regardless of its merits, it is safe to say that network-centric warfare, a term with a constantly evolving definition but one firmly rooted in the concept of horizontal and vertical information-sharing using advanced technology, is the chosen path for the transformation of the United States military, and the Army is incorporating its concepts. With network-centric warfare, the Army is shifting power away from an industrial-age focus on mass toward access and flow of as an essential element of combat power. (6) The business world has capitalized on leaps in effectiveness gained from digital communications, including dramatic information-sharing within established networks with real-time collaboration. The Army seeks to infuse these same qualities in its units in order to conduct rapid, decisive operations at the operational and tactical levels by using digital information technologies to acquire, exchange, and employ timely throughout the battlespace. …

5.3.2 Design of the Reconnaissance, Surveillance and Target Acquisition Squadron for the U.S. Army's Interim Brigade Combat Team

AbstractThe primary source of battlespace intelligence for the U.S. Army's proposed Interim Brigade Combat Team (BCT) is the Reconnaissance, Surveillance and Target Acquisition (RSTA) Squadron. The fundamental role of the RSTA Squadron is to provide detailed situational understanding to the BCT Commander facilitating freedom of maneuver and the concentration of combat power at the decisive time and place. Technologically advanced systems should substantially enhance RSTA Squadron operations. Among the proposed systems in the Squadron are the Future Scout and Cavalry System (FSCS), tactical unmanned aerial vehicles (TUAV), ground‐based networked sensors (acoustic, seismic, magnetic, infrared, radio frequency), radio frequency (RF) detectors, and nuclear, biological and chemical (NBC) reconnaissance systems. This paper outlines the process used to date for designing the RSTA Squadron and proposes an alternative approach: a systems engineering methodology to formulate, analyze and interpret RSTA Squadron design alternatives.