Medical Course of Action Tool

Description Data

enter the troop population data 4,500 Information

casualty rates decrease as the terrain becomes more
Flat, Desert
restrictive 0.9
casualty rates decrease as the weather becomes more
Dry, Sunshine, Temperate
restrictive 1
casualty rates decrease for well prepared defenders that are
Offensive
able to hold their positions 1
casualty rates decrease as the size of the unit increases e.g.
4000-6000 (BCT)
divisions tend to have a lower rate than infantry platoons 1.8
Significant Combat Power Advantage
casualty rates decrease when the combat effectiveness of a
force increases (when compared to the enemy's effectiveness) 0.7 Calculate Combat Effectiveness
casualty rates decrease if a unit is able to avoid being
No Surprise
surprised by the enemy 1
casualty rates decrease when a unit has superior equipment
Overwhelming Advantage
(when compared to the enemy's equipment). 0.3
 Agenda
• Introduction
• Problem Statement
• Recommendation
• Overview
• Background
• M-COAT
• Assumptions
• M-COAT Details
• M-COAT Accuracy
• Early User Testing
• Conclusion
• Time Line
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 Problem Statement
• There is no Army approved technique for
conducting casualty estimation and CHS
course of action (COA) planning for
division and below operations.
– Kuhn Study for DoD J4 - Corps and above
casualty estimation
– FM 101-10-1 vol 2 - Division and above
– ARI’s Commander’s Battle Staff Handbook -
Battalion level casualty estimation
– Medical Analysis Tool (MAT) - Corps and
above COA tool
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 Recommendation
• That the AMEDD Center and School adopt
M-COAT as an approved CHS course of
action tool.
• That the Adjutant General School approve
M-COAT as a division and below level
casualty estimate technique.
• That the Casualty Estimation Steering
Committee approve M-COAT for use Army
wide.
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 Overview
• Based on COL Trevor • Division and below staffs
Dupuy’s casualty do not have an valid,
estimation method from approved method for
Attrition (Nova Pub. 1995) conducting casualty
• Intended to serve as estimation.
TACTICAL level Course • Casualty Estimation is a
of Action Tool. critical Battle Staff Task.
• Required by Division and – Medical Requirements
below Commanders and – Personnel Replacements
Staffs for casualty • Not intended to serve as a
estimation and tactical Force Structure tool!
decision making process.
A Low Cost, Low Risk, Near Term Solution
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 Background
• FM 101-10-1 volume 2 is outdated and
virtually useless for division and below
estimation.
– Based on WWI and WWII continuous front type
operations.
– Can not generalize information to conduct battalion or
brigade estimates.
• FM 8-55 is difficult to use.
– Intended for theater and Corps CHS planners
– Tables and formulas are not “user friendly”
• Emergency War Surgery Handbook does
not assist with casualty estimation or
workload analysis.
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 Background (con’t)
• MAT does not have a casualty estimation
capability & is intended for Corps and
above CHS planning.
– Requires rate patterns input
– Can not do battalion or brigade CHS planning
• Failure to perform COA is reoccurring CTC
observation.
– Identified as a critical mission task at both NTC
and JRTC
• Casualty estimation and CHS workload
analysis is a difficult task!
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 Medical-Course Of Action Tool
(M-COAT)
• Six Modules
– Casualty Estimation
– Patient Flow
– Workload
– Medical Supply
– Hospital Bed Accumulation
– Basis of Allocation Rules
• Excel Spreadsheet.
• Extremely Flexible.
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 Assumptions
• COL(ret) Dupuy’s casualty estimation
process is valid.
• TAA05 patient flow is an accurate
representation of casualty flow.
• The majority of patient arrivals occur during
the “red zone” fight.
• MESs Trauma Treatment and Sick Call can
treat 40 patients.
• The majority of patients are hospitalized for
the evacuation delay time, but a small
percentage are either RTD, DOW or
evacuated before or after that time.
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 M-COAT Casualty Estimation
• Based on COL(ret) Dupuy’s book Attrition:
Forecasting Battle Casualties and
Equipment Losses in Modern War and
AMEDD Center and School’s DNBI rates.
• Dupuy’s WIA estimation formula
historically accurate: (+/- 50%).
• Modified to account for Kuhn’s
“operational patterns”.
– Continuous
– Disrupted
– Disintegrated
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 M-COAT Casualty Estimation
(con’t)
• Nine Factors that affect WIA rates:
– Population at risk (PAR)
– Terrain (17 variables)
– Weather (12 variables)
– Posture (8 variables)*
– Strength (17 variables)

* Denotes areas that are modified from Dupuy’s original formula.

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 M-COAT Casualty Estimation
(con’t)
– Opposition (31 variables)*
– Surprise (4 variables)
– Sophistication (15 variables)*
– Operational Form (5 variables)*

• 258,019,200 combinations x PAR

* Denotes areas that are modified from Dupuy’s original formula.

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 M-COAT Casualty Estimation
(con’t)
• Three Factors that affect DNBI
– PAR
– Battlefield Location (5 variables)
– Geographic Location (36 variables)
• Based on Force Structure and Analysis’
DNBI rates.

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 M-COAT- Modules
• Patient Flow- Derived from TAA05 patient
flow (GREWMS).
• Workload - Uses FM 8-55 evacuation
planning factors.
• Class VIII consumption- Medical Resupply
Sets, FST supplies, and Blood.
• Hospital bed accumulation- Variable
evacuation delay times.
• Basis of Allocation rules (MRI and MF2K).
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 M-COAT- Accuracy
• Dupuy’s Estimates- 25 sets of data:
– 3 were within 50% of real casualties
– 6 were within 20% of real casualties
– 4 were within 10% of real casualties
– 12 were within 5% of real casualties
• M-COAT Estimates:
– Kuwait/Iraq estimate was off by -4%
– Panama estimate was off by -2%
– Mogadishu estimate was off by +2%
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 M-COAT- Accuracy (con’t)
• Dupuy Formula
– Mean Error -6.24%
– Standard Deviation of the Error 21.42%
– 95% Confidence Interval +/- 41.98%
• Modified Formula
– Mean Error -3.83%
– Standard Deviation of the Error 15.01%
– 95% Confidence Interval +/- 29.41%
• A 30% increase in accuracy
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 A Graphic Comparison

-1566% G1/G4 Battle Book +1566%

-1416% FM 101-10-1 +1416%

-42% +42% Dupuy

-30% +30% Modified Dupuy

Estimate

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 Early User Testing
• III Corps “beta” tested during Warfighter
Exercise last month.
• Additional “beta” testing at:
– NTC- Medical Company O/C
– AG School- Officer Advanced Course
– Fort Campbell- 101st Airborne DMOC
– Arkansas- 39th Inf. Bde. (National Guard)
• Feedback thus far has been very positive.

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 Conclusion
• Requires Independent Validation and
Verification
• Potential COA tool for use in CSSCS
• Need Subject Matter Experts for V&V
• Four Pronged Fielding Approach
– Institutional Training
– CTC Training
– Sperandio Conference
– Distributed Training
• OTSG Offered Matching Funds for
Distributed Learning Course Development
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 Time Line
2 December 1998- Brief ACFI
9 December 1998- Brief FORSCOM Surgeon’s Office
TBD- Brief Combat Training Centers
5 January 1999- Brief CG, AMEDD Center and School
8 January 1999- Brief Commandant, AG School and CG,
Soldier Support Institute
13-14 January 1999- Brief Casualty Estimation and Steering -
Committee
February 1999- AMEDD Pre-command Course
Conduct Validation, Verification and Accreditation
25 April 1999- Sperandio Conference
22 June 1999- Military Operations Research Society
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