Page 36 - JSOM Summer 2020

of its inherent limitations on resources, the Ruck model re- experts, including the senior surgeon, should be involved in
quires the highest levels of clinical skill, tactical proficiency, medical planning of mission support to ensure critical supply
and teamwork, and personnel must be highly trained in all requirements and limitations are addressed, clearly articu-
these areas for mission success. Medical planners and the lated, and solutions are developed within mission constraints.
surgeon must clearly communicate the clinical and other lim- Involve planners and the Operational Command early and
itations to mission planners and the supported Operational often in mission planning to understand command require-
Command to conduct appropriate risk mitigation. The Ruck ments, mitigate risks, and shape expectations for success. See
model fits on most transportation platforms. Although emer- Appendix A for sample packing lists for each model.
gency surgery may be performed with this model, it is generally
capable of providing temporary support for only one critical Many mission variables affect what is ultimately packed into
patient and has no capacity to hold critically ill patients for the finite cube and weight requirements for each model. See
any length of time. Blood products are extremely limited and Table 2 for some of the variables to consider when planning
the lack of power and electricity prevents use of blood storage for logistical support of ARSC missions.
and cooling, blood warming, and electronic warming devices.
As a result of these limitations, rapid patient evacuation to TABLE 2 Variables to Consider When Planning Logistical Support
the next level of care is vital and urgent resupply must occur for ARSC Missions
to continue the mission. Alternatively, the plan may include Variable Considerations
performance of en route care and return to base upon mis- • Number and type of medical personnel on the
sion completion. In addition, communications are limited to ARSC team ARSC team
personal radios, and team security must be provided by the composition • Team members’ specialties, experiences,
supported unit during clinical care. capabilities, preferences
Patient • Types of patients (e.g., friendly combatants,
variables enemy, civilian, pediatric, geriatric, MWDs)
Truck • Operational Command intent
• Security situation (i.e., expected tactical risk to
The Truck model is also very mobile, capable of set up or col- medical personnel)
lapse within minutes, and can be transported to a fixed loca- • Length of mission
tion. Although this model may have greater capability than • Number of expected casualties, number of
the Ruck model, its limitations must be carefully considered troops at risk
and communicated to planners and commanders in order not Mission • Communication capabilities of medics and next
levels of care
to fail expectations placed upon it. It includes each team mem- • Space available for equipment
ber’s ruck and as many additional supplies and equipment that • Maximum/minimum equipment weight
can fit onto the mission’s mobility platforms, depending on requirements
the mission need. This model may be able to treat and sus- • Security element for the ARSC team
• Task force composition (joint, combined) and
tain more patients but is also limited by power and electric- service, state, or national caveats
ity, blood storage, and fluid volume. Although supplies are • Team sustainment requirements
increased, the Truck model still depends on a rapid evacuation • Capability, time, distance from forward medics
and resupply chain if heavy casualties are encountered or the Evacuation • Capability of the evacuation platform
team is intended to perform a static mission. (CASEVAC vs MEDEVAC vs CCATT)
• Capability, time, distance to next level of care
• AO-specific medical concerns
House • Night versus day operations
• Cold versus hot environments
The House model is far less mobile. It refers to a fixed loca- Environmental • Indoors versus outdoors
tion where the full equipment loadout of an ARSC team can • Physical and human terrain
be established and is only feasible to be maintained at a team • Security environment
house, firebase, or other mission-support site. This model pro- • Emergent and routine time and processes for
vides the highest level of care organic to the team and has a Resupply resupply of blood products and Class VIII
greater patient capacity. Continuous operations may be sus- materiel
tainable with casualty evacuation and resupply of blood and Abbreviations: ARSC, Austere Resuscitative and Surgical Care;
CASEVAC, casualty evacuation; CCATT, Critical Care Air Transport
other Class VIII materiel. Additional requirements for full Team; MEDEVAC, medical evacuation; MWD, military working dog.
operational capability include power and electricity for blood
cooling and storage, blood warming and infusion, patient
warming, water for steam sterilization and hygiene, and other
requirements. Open communication of requirements, capabil- Resupply
ities, and limitations to planners and commanders will enable Resupply should be categorized as Mission Critical, Mission
mission success. Essential, and Mission Enhancing for planning and communi-
cating purposes. The category of medical supply or equipment
In all three models, challenges are magnified with supply and items may change depending on the mission.
resupply limitations, blood availability, and prolonged hold
time, transport time to next level of care, personnel available • Mission Critical: There is high risk of mission failure
to help, and more. It is understood that this is not the ideal without these items.
environment in which to care for surgical patients and that • Mission Essential: There may still be significant impact
certain severe injuries will not be survivable. As emphasized, but less risk of mission failure if lacking these items.
the limited capabilities of these teams have to be understood • Mission Enhancing: There is low risk of mission failure
by mission planners and operational commanders. Clinical if lacking these items.

34 | JSOM Volume 20, Edition 2 / Summer 2020