Seat at the Table | Integrating Medical Planning in All Major Operations

By Capt. John GiganteNovember 15, 2023

(Photo Credit: Graphic by Sarah Lancia) VIEW ORIGINAL

Army medicine, health service support, medical planning, and medical logistics play crucial roles in any Army operation, especially as the Army shifts its focus from counterinsurgency operations to preparing for asymmetric large-scale combat operations (LSCO) against near peers. Now equally important in garrison, domestic training environments, and international exercises with partner nations, medical operations supporting an overall operation, whether maneuver or otherwise, are integral to sustainment plans.

In modern warfare, medical planners must sit at the table during the military decision-making process (MDMP), order production, and rehearsals. Medical considerations should not be treated as an afterthought or hand waved during the planning stages. Commanders and staff should not tolerate a generic, regurgitated one-slider for a medical concept of support. The plan must relate to the operation and be tailored to the personnel, equipment, terrain, and overall mission.

Army sustainers and combat arms professionals must actively embrace and empower medical operations officers and planners throughout the planning process. In many cases, this is not the fault of non-Army Medical Department (AMEDD) officers but possibly from inexperienced or junior medical operations officers not advocating for consideration. Many billets across the Army, especially as organizations struggle to fill positions, place junior leaders in roles that require more experience and grade. While, in most cases, this is a good opportunity for growth and development for the junior leader, it does have its downsides. Absent the expertise of a skilled and experienced senior noncommissioned officer to guide and train the officer, a junior officer working in a medical operations officer billet could easily hide in the shadows and offer little value to an organization, the rest of the staff, and the commander. While the chief medical authority of the unit is the unit surgeon, this provider may be distracted with a demanding clinic life while struggling to balance their role as a staff officer, leaving the medical operations officer to figure out staff functions and medical operations advising by trial and error.

Army medicine affects every Soldier and does not stop with the planner on staff. It provides critical support to Soldiers at all levels. Soldiers must be trained and rehearsed not only in the basics of Tactical Combat Casualty Care (TCCC) and combat lifesaver (CLS) skills but also in the fundamentals of casualty evacuation (CASEVAC), medical evacuation (MEDEVAC), and the different roles of care. The importance of Army medicine becomes even more significant in LSCO against near peers, where the intensity and scale of injuries may increase. Effective health service support ensures casualties receive timely and appropriate medical care, enhancing chances of survival and minimizing the impact on combat effectiveness.

Medical planning ensures medical capabilities are integrated into the overall operational plan. Medical planners assess the operational environment, anticipate medical requirements, and develop appropriate medical support plans. They coordinate the deployment and employment of medical units, ensure the availability of critical medical supplies and equipment, and establish MEDEVAC procedures.

Medical logistics is vital in providing the necessary resources to sustain medical operations. This includes procuring, storing, and distributing medical supplies, pharmaceuticals, blood products, and equipment. Effective medical logistics guarantee medical units are adequately equipped to provide quality care and maintain operational readiness. These positions demand a highly trained medical logistician. While numerous skilled AMEDD Soldiers are often asked to be cross-trained or dual-hatted as medical logisticians, units must prioritize employing an enlisted or officer medical logistician identified by their military occupational specialty (MOS) or area of concentration (AOC). The demands of this role are intense, necessitating decisions that affect Soldiers’ survival, and should be filled by Soldiers with appropriate MOS or AOC, not someone learning on the job.

It is relevant to refer to Field Manual (FM) 4-02, Army Health System, which serves as a comprehensive guide outlining the principles and procedures for health service support in the Army. FM 4-02 emphasizes the critical role of Army medicine in supporting Army operations. It highlights the need for medical planners to actively participate in MDMP, order production, and rehearsals, ensuring medical considerations are integrated into the overall operational plan. The manual stresses the importance of training and rehearsing Soldiers at all levels in essential medical skills, such as TCCC and CLS. It also emphasizes the significance of educating Soldiers on the basics of CASEVAC and MEDEVAC, enabling them to understand and support the roles of care in evacuating the injured.

FM 4-02 underscores the need for effective medical planning, including assessing the operational environment, anticipating medical requirements, and developing support plans. It emphasizes the coordination of medical unit deployment, ensuring the availability of necessary supplies and equipment, and establishing evacuation procedures. The manual also addresses the critical role of medical logistics in supporting health service operations. It provides guidance on the procurement, storage, and distribution of medical supplies, pharmaceuticals, blood products, and equipment, ensuring medical units are adequately equipped to deliver quality care and maintain operational readiness.

Doctrine in the Army is abundant and dense but vital. Written, published doctrine is often easy to read and understand, although sometimes lengthy. The challenge is that many leaders at varying levels do not know which doctrine to reference, as there are countless publications in the Army Publishing Directorate (APD). The takeaway is that simply taking the first step and familiarizing yourself with it, rather than hiding and ignoring it, is better than finding the perfect publication for one’s problem.

The Army may face new challenges in future conflicts, particularly when encountering chemical, biological, radiological, and nuclear (CBRN) environments. The potential for CBRN casualties poses a significant concern, especially considering the historical lack of comprehensive training on handling such situations.

Leaders at every level must prioritize and train for CBRN threats. Developing and implementing effective strategies to mitigate the impact of CBRN hazards on Soldiers and the overall mission is essential. This includes equipping Soldiers with the necessary knowledge and skills to identify, protect against, and respond to CBRN threats. Back to doctrine, numerous smart cards, derived from doctrine and available through the Army Training Network and APD, simplify these types of training that any leader can plan and execute.

Future wars will significantly increase the number of casualties per battle, potentially surpassing levels not witnessed in decades. The evolving nature of warfare and the potential use of advanced weaponry and tactics by near-peer adversaries may lead to more intense and widespread combat engagements. Given the possibility of thousands of casualties in a single battle, it becomes even more critical to prioritize medical considerations and integrate them at every level of planning. Medical operations should not be treated as an afterthought but as an integral part of operational and strategic planning.

The significance of medical readiness and preparedness cannot be overstated. All Soldiers, regardless of their MOS, must possess basic medical skills and be trained to provide initial medical care, including TCCC and CLS. This ensures immediate lifesaving measures can be administered on the battlefield, potentially saving lives and maintaining combat effectiveness. Moreover, medical planners must actively participate in planning, incorporating medical considerations from the outset. This integration includes anticipating CBRN threats, assessing medical requirements for potential CBRN casualties, and developing robust medical support plans to address these challenges effectively.

In summary, organizations, leaders, and medical planners must encourage and embrace the integration of high-quality medical planning into every operation. Leaders must recognize the potential impact of CBRN environments and casualties in future conflicts. By prioritizing training and readiness for CBRN threats, integrating medical considerations at all levels of planning, and emphasizing the importance of medical operations from basic Soldier skills to operational and strategic levels, the Army can enhance its overall readiness and increase the likelihood of successful mission outcomes while minimizing the impact of casualties.


Capt. John Gigante is a Medical Service Corps officer currently participating in an Army medical department long-term health education and training program, enabling him to complete a Master of Public Health at the University of South Florida in Tampa. He served in a Stryker brigade combat team in a brigade support medical company, has been a brigade medical operations officer in the 82nd Airborne Division, and most recently was a Company Commander in the 82nd Airborne Division in the division sustainment support battalion. Gigante has completed the medical operations course at Fort Sam Houston, Texas, the Basic Airborne Course, and is an Expert Field Medical Badge holder.


This article is published in the Fall 2023 issue of Army Sustainment.