By Whitney Waldsmith
While in AMEDD BOLC[i] as a newly graduated veterinarian, I learned convoy operations under the July sun at Camp Bullis, Texas. The heat was oppressive and I wondered (loudly) why we, as medical personnel, needed to know how to lead a convoy. The response was that despite our medical expertise, we were soldiers first and needed to be ready to operationalize if necessary. That attitude is unfortunately pervasive in the AMEDD and officers regularly dig in their heels when asked to work outside their scope. I was proven wrong; since my initial training at Camp Bullis, I have been assigned in positions that required me to learn a significant amount about military operations and security objectives through SOF[ii] activities and exercises. These experiences have broadened my scope of practice and taught me to understand operations. Above all, it has demonstrated to me that medical personnel can positively impact the Civil Affairs mission.
"...medical personnel can positively impact the Civil Affairs mission."
Civil Affairs (CA) should integrate medical personnel into the network analysis, civil reconnaissance, and non-lethal targeting processes. Medical expertise has historically been utilized for hospital assessments and direct MED/VETCAP[iii] engagements. These events generally focus on access and placement as well as influence operations. While useful, limiting medical personnel to these types of engagements is a missed opportunity. In some circumstances, MED/VETCAPS can even be destabilizing rather than creating capacity. Doctors, nurses, and veterinarians are highly trained in recognizing patterns, implementing management protocols, and continuous reassessment. Focusing their medical skills on these tasks directly supports mission objectives. CA personnel often view their medical personnel as a means to an end and not a resource to guide planning and assist in analysis, and this is a missed opportunity.
Physicians and veterinarians train to recognize symptoms and trace their origins with mnemonic devices like VINDICATE and DAMNIT[iv]. These acronyms represent all the systems that can cause symptomatic effects or external forces that can cause symptoms in the body. The diagnostic process in medicine is very similar to the network analysis process employed by CA personnel when deployed. Recognizing symptoms of societal instability like protest, inequality, and conflict requires subsequent consideration of root cause through platforms like the operational variables and civil considerations (PMESII-PT/ASCOPE)[v]. Considering treatment protocols is remarkably similar to the D3A targeting process[vi]. Both medical and CA personnel are trained to report findings and plan appropriate responses. Empowering medical personnel with basic analysis and systems training will yield results far beyond the required investment. This is an example of a true force multiplier.
Going forward, Civil Affairs operators should include their organization’s medical personnel in planning operations. Medical personnel, by virtue of their specialties, will see opportunities that CA personnel will not. It is critical that CA personnel teach medical personnel to understand the broader mission, objectives, and effects (and the source documents that direct them) in order to facilitate effective planning. Medical personnel should also function as adjuncts to CATs[vii] when forward to conduct Subject Matter Expert Exchanges or Global Health Engagements and assist with reporting and interagency cooperation. Additionally, because CAT deployments are limited to six months and medical personnel assignments are often 2-3 years, medical personnel can be the continuity to understand and measure long-term MOEs[viii] and be the familiar face to UAPs[ix]. Medical integration supports both tactical and strategic objectives.
Integrating medical and CA personnel is a worthy goal to strive for, but it will pose a challenge to CAT personnel who are already overwhelmed by the requirement to prepare for three different mission sets (CME, UW, and LSCO[x]). This is a crucial opportunity for the 70H (Medical Planner), already part of the MTOE[xi] at the Battalion level. The majority of doctors and veterinarians commission directly into the military; most 70Hs are prior-enlisted or ROTC graduates and have significant operational experience. While 70Hs do not have diagnostic or clinical experience, they are ideal to be a bridge between medical and CA personnel. As a “medical interpreter,” 70Hs provide a direct benefit to operational efficiency by facilitating the functions described above.
"Where CA operators see a whole-of-government approach, medical personnel see the physiology of systems that necessarily work in concert."
A largely untapped opportunity sits in the med section of every battalion. Medical providers do not generally arrive at CA with extensive operational experience, but they have the capacity to rapidly learn and employ that skill set. CA personnel must recognize their relevance and ensure medical personnel understand and are involved in mission planning and implementation. Where CA operators see a whole-of-government approach, medical personnel see the physiology of systems that necessarily work in concert. Not only will this collaboration improve the quality of their deployed activities, it will improve the image of CA in the eyes of UAPs and IC[xii] partners. Civil Affairs strength has always been in its diversity; including medical personnel in operations is a long-term strategy for continued relevance.
NOTE: The Geneva Conventions contain language requiring medical organizations to remain neutral and opposing parties to respect their sovereignty. This is the principle of medical neutrality. This principle is often cited as an argument against medical personnel working to support operational objectives. However, breaches of the Geneva Conventions require an armed conflict. Breaches generally consist of attacks launched from medical facilities or vehicles, and do not include medical personnel working in support of operations.
About the Author
Whitney Waldsmith is currently serving as the BN Veterinarian and Human Network Analysis OIC at 97th CA BN. When she’s not updating her ISOPREP or sitting in the middle seat on very long flights, she enjoys making cocktails and debating whether Bill Nye is cooler than Neil deGrasse Tyson.
[i] AMEDD BOLC: Army Medical Department Basic Officer Leadership Course [ii] Special Operations Forces [iii] MEDCAP: Medical Civic Action Program, VETCAP: Veterinary Civic Action Program; engagements focused on direct patient care [iv] Diagnostic scheme acronyms - VINDICATE: vascular, infection, neoplasm, drugs, inflammatory/idiopathic, congenital, autoimmune, trauma, endocrine/metabolic. DAMNIT: degenerative/developmental, autoimmune, metabolic/mechanical, nutritional/neoplastic, inflammatory/infectious/iatrogenic, trauma/toxin [v] PMESII-PT: political, military, economic, social, information, infrastructure, physical environment, time (operational variables); ASCOPE: areas, structures, organizations, people, events (civil considerations). [vi] D3A: decide, detect, deliver, and assess; this is the cyclic process by which targeting specialists determine if military actions have achieved their goals, and how those activities should be adjusted in the future [vii] Civil Affairs Teams [viii] MOEs: Measures of effectiveness; this is a targeting methodology used to assess whether the actions taken achieved their prescribed goals [ix] UAPs: Unified Action Partners; depending on the operational context, this may be partner nation government, military, NGOs, other US military, or other relevant actors. [x] These are currently the three primary Civil Affairs mission sets. CME: civil military engagement; UW: unconventional warfare; LSCO: large-scale combat operations [xi] MTOE: modified table of equipment, prescribes the numbers and types of personnel assigned to a given unit [xii] IC: intelligence community