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Warriors in Peace Operations

Preparation and Deployment of the Initial Medical Force
[67th Combat Surgical Hospital]
in support of Operation Joint Endeavor

Jumping away from World War II for a change-of-pace, I've been reading some of the online publications of the Strategic Studies Institute, US Army War College at Carlisle Barracks PA.

I was looking for references to Trieste, which was a frequent case study just a decade ago in the field of 'MOOTW', Military Operations Other Than War. Not even a whisper now!

While searching, I came across a monograph on the preparation, establishment, and operation of the 67th Combat Surgical Hospital in support of operations in Bosnia, December 1995 to March 1996. I hope you will find, just as I did, this to be an absorbing and perceptive account of deployment by an outstanding unit.

This monograph is pages 213-233 of the larger work, WARRIORS IN PEACE OPERATIONS, Edited by Douglas V. Johnson II, January 25, 1999.

Colonel William T. Bester

Operation JOINT ENDEAVOR began in December 1995 in an attempt to enforce a peaceful resolution to the ongoing ethnic conflict in the Balkans. Over 20,000 American soldiers deployed into the Bosnian Theater in support of this effort. A critical part of this deployment was the medical support for soldiers deploying into or through the Intermediate Staging Base (ISB) in Taszar, Hungary; along the Main Supply Routes (MSR) in Croatia; and in key locations in the American sector in Bosnia. This monograph will look at one portion of that medical support, that provided by the 67th Combat Support Hospital (CSH), home-based in Wuerzburg, Germany.

The 67th CSH is a 236-bed, Deployable Medical Systems (DEPMEDS) hospital. In 1995, it was the only hospital in the U.S. Army that served a dual role as both a full-up TO&E hospital and a full-time TDA facility supporting the Wuerzburg, Germany, catchment area. This meant that all the professional and personnel resources designated to deploy with the 67th CSH also served day to day in the Wuerzburg Medical Activity (MEDDAC) hospital caring for those soldiers and their family members needing peacetime health care.

Upon my arrival at the unit in June of 1994, I quickly realized that the 67th CSH had, for some time, been preparing for a possible deployment into the Balkans to support some form of peace enforcement by the U.S. military. As early as 1993, some single-parent military members were being encouraged to leave their children in the continental United States and go to Germany alone because of the high probability of a deployment shortly after their arrival. Although there was frequent talk of a possible deployment, the cry "Wolf!" had been sounded so often, and for so long, that upon my arrival any mention of a deployment was taken lightly and without concern or belief that it would actually occur.

Approximately 15 months later, however, the atmosphere changed. By autumn 1995, there were more high-level command meetings and briefings regarding the possible support of a Balkan peace enforcement operation than I had seen since my arrival in Europe. In September 1995, we were tasked to support a multi-national exercise in Grafenwoehr, Germany. During October frequent inquiries into unit status and readiness came down to us from higher command.

As peace talks progressed, the reality of a possible deployment began to strike home. In November the talk was not "whether" we would deploy, but rather "when." However, many remained skeptical. Then, in early November we were ordered to deploy the CSH to Grafenwoehr for a validation exercise. All units designated as units to deploy in support of any peace enforcement measures in the Balkans were required to "validate" that they were trained, prepared, and equipped to immediately respond to such a deployment.

The validation exercise was of grave concern to those of us in the CSH‹purely from an equipment readiness perspective. The weather was extremely rainy during this period, and had been so for some time. Our major concern was the time needed to recover and clean the hospital tents, facilities, and equipment upon return from the validation exercise. We felt that our recent primary medical support of a major multi-national exercise "validated" that we were prepared to deploy immediately and support any plan or scenario tasked down to us. We requested an exemption from the validation exercise, but were told that all units deploying would validate, regardless of any recent training or exercise experiences. We therefore moved the unit to Grafenwoehr for the validation exercise, still concerned that a deployment notice soon after our return could prevent us from recovering fully.

The validation exercise turned out worse than we even expected. We were given a site for the establishment of the hospital in a field that immediately turned to aboveankle- deep mud early in the construction phase. By the time the hospital was fully established, there was mud and standing water throughout the entire facility. All of our equipment, medical and nonmedical, along with the interior of the hospital was covered with mud. The rains continued throughout the exercise, and by the time we disassembled the hospital and packed up to return home, it was virtually impossible to clean our equipment properly due to the site we were established on and the lack of available cleaning resources.

Immediately upon return to garrison, we identified teams to clean, re-inventory, and restock the hospital. These teams worked two 12-hour shifts to allow us to recover the hospital and return as quickly as possible to our pre-exercise state of readiness. In less than 1 week, the hospital, with its entire complement of equipment and vehicles, was positioned back in the motor pool and ready for immediate deployment if called upon to do so.

Once we returned from the validation exercise and had the equipment cleaned and positioned, a marked increase in anxiety began to develop regarding our inevitable deployment and the period when it would take place. Would we leave before Thanksgiving? Would we leave before Christmas? Who would go? How long would we be gone? These were just a few of the questions frequently being asked throughout the organization. We were receiving very little information regarding these questions from our higher command, because the National Command Authorities (NCA) were not making any final decisions until the results of the Dayton Peace Accords could be evaluated and subsequently acted upon.

However, there soon developed a feeling throughout the command that information was being withheld, and this led to a growing level of frustration. We, the command group, soon realized that we needed to schedule frequent information updates to provide all information that we knew to be true at that point, squelch the many rumors that were circulating throughout the command, and answer the multitude of questions that our soldiers and their family members had. We determined to present daily briefings at 1600 in the hospital chapel. We decided on a policy to pass along all information we received that day with the rare exception of any classified or sensitive material, and opened up the briefings to all soldiers and their family members.

This decision to hold daily briefings was probably one of the most effective measures we initiated prior to deployment. In a matter of a couple of days, we were able to pass along enough relevant information to put virtually an end to the numerous rumors running rampant throughout the organization. And, because our soldiers and their families were being supplied with the most current information the command possessed, their ability to prepare for the inevitable deployment was enhanced.

However, as the days of November, and then early December, passed by, no date for deployment was announced. At the end of the first week of December, the Commander called me into the office and said that if we deployed in increments, he wanted me to go as the Advance Party Commander and that he would follow in the final wave. However, we still had no information regarding a deployment date, or how we would flow our troops into the theater.

Then, on the evening of December 10, I received a call at home from our Deputy Commander for Administration stating that he just received word that a train was positioned at Kitzingen, Germany (some 10 miles from our motor pool), for us to begin loading up the hospital for possible deployment sometime during the upcoming week. The next morning, I arrived at work and immediately got involved with the ongoing rail load plans that we had initiated the evening before. The plan called for 24-hour around the clock loading until all the equipment and vehicles were loaded. Meanwhile, rumors began to surface regarding when the unit would deploy. The rumors included leaving immediately or by the end of the week (December 17). Still, no word regarding a firm departure date arrived from higher headquarters.

At the 1600 briefing to the soldiers and their family members on December 11, we stated that no deployment date or time had been forwarded to us at this point, but that we expected to be notified very soon. We announced that if one's name was on the 32-bed Hospital Unit Base (HUB), he/she should be prepared to leave as early as tomorrow. After answering a few questions, we returned to our offices to see if the Medical Brigade had any information regarding our departure date.

At approximately 1800, we received notification from brigade regarding our departure. We were told we would deploy 100 personnel, with equipment and vehicles, in two 50-member increments. The first group would leave at 1200 on December 12; the second group would leave at 1800. The remainder of the unit (some 200 individuals) would follow at some later date. This date would be established once the Advanced Party got into Theater and established an initial medical treatment facility. We immediately got on the telephone to contact all those individuals scheduled to depart on December 12. By 2100, all of the personnel had been notified.

I arrived at work early the next morning and met with the Commander. After reviewing our deployment plan one final time, he told me he wanted to form the first wave of soldiers up at 1130 for a formal send-off. After some words of praise and encouragement from both the Commander and myself, the soldiers bid farewell to family and friends and loaded up on buses for the 30-minute ride to Kitzingen. We arrived at the railhead at 1245 and immediately downloaded rucks and A-bags and then in-processed with the Personnel Services Branch. The soldiers were given soup and juice while waiting for the arrival of the passenger train. The train was scheduled to depart at 1430. However, delays resulted in us leaving at 1600. Prior to departure, we had loaded an immense amount of Meals Ready to Eat (MREs) and water. We were not sure exactly how long the trip was going to take, but were told it would be a 2-3 day trip and that we would not be allowed to leave the train. It was for this reason that I decided to take as much food and water as we could safely store on the train.

Our destination was Taszar, Hungary, which had been designated as the Intermediate Staging Base (ISB) for Operation JOINT ENDEAVOR (OJE). Taszar was a town none of us had heard of prior to the deployment, and Hungary was a country only a couple of our personnel had visited. Yet, over the next few months, over 20,000 American service men and women would either be assigned in the Taszar area or deploy through it on their way into Croatia and Bosnia.

After approximately 3 hours, our train passed through Schweinfurt, Germany (a 40-minute automobile drive from Kitzingen). The problem, we were to find out later, was that our train had the lowest priority on the German rail system and therefore was placed on secondary rail routes to avoid negatively impacting on regularly scheduled German passenger and freight rail traffic.

At 0100 on Wednesday, December 13, we were awakened by Czech Republic government officials and required to show our documents authorizing our travel through the Czech Republic. We were awakened two more times throughout the night to present the same documentation to other authorities in other towns.

We traveled through the Czech Republic for most of December 13. At approximately 1700, we reached the Slovakian border where we exchanged escort officers. At each border, a military officer from that country would board the train and act as an escort until we got to the next border crossing. Unfortunately, these escort officers could not speak English, leaving us without the capability of communications with rail personnel regarding our current location and our estimated time of arrival into Taszar.

We reached the Hungarian border at about 2130 on December 13. For reasons still unknown to us, we sat at the border for more than 3 hours before the train continued on its way at approximately 0100 on December 14.

I woke up at about 0600, and the train was stopped once again. We had apparently been stopped for some time considering the amount of snow that had accumulated on our rail cars and on the track in front of us. We had absolutely no idea where in Hungary we were, or how close we might be to our final destination. I moved throughout the passenger car that I was assigned in order to determine how everyone was doing and whether we had any problems that needed to be addressed. We soon discovered that the running water on the train had stopped, thus preventing us from washing our hands or flushing the toilets. At the same time, I discovered that heat had gone out in the second passenger car, and the temperature was dropping to a critical point. I immediately contacted the engineer. Neither he nor any of his crew spoke one word of English, and none of our personnel spoke Hungarian. After "sign-languaging" our way through the issue, the engineer was finally able to communicate to me that we were only a few minutes from Taszar. We got the train rolling again shortly thereafter and pulled into the loading dock in Taszar at about 0930.

We arrived to an environment of utter chaos. I had various individuals directing me to do five different actions‹all at the same time. Once I established the fact that our soldiers could only do one thing at a time and that we needed to move through the unloading process in an orderly and organized fashion, we were able to bring some structure to our actions. We expeditiously unloaded all the rucksacks, A-bags, MREs, and water. This process took about 45 minutes. We then assigned a detail to clean the two passenger cars while the rest of the unit loaded the personal gear, MREs, and water on two buses that had been assigned to us for transporting the soldiers and our personal equipment. We also had an additional detail assisting in downloading our vehicles and hospital equipment.

The one event that I was totally unprepared for was the number of news media personnel that descended upon us like a swarm of bees shortly after our arrival. I quickly asked the ISB public affairs officer to give us a couple of minutes before we met with them. I used this time to remind our soldiers to answer their questions honestly, but to not speculate on any issue that we were not prepared to address. We were here to provide medical support to all soldiers deploying into and through the ISB, and our responses should be directed toward what our mission was and not to try to answer questions that were not in our realm of responsibility or authority. The interviews went well. Our soldiers were proud to address questions related to our mission in the ISB, but were extremely careful not to try to speculate on questions pertaining to non-medical issues.

Taszar was a Russian MiG Base prior to the end of the Cold War. After the Cold War ended, the base was shut down with the exception of a few buildings on the airfield that were utilized by the Hungarian forces. The MiGs were flown only rarely, and the remainder of the military base slipped into a state of disrepair. Upon our arrival, we were directed toward old barracks buildings some two miles from the airfield and railhead area. The buildings had not been used in over 5 years, and, as we were approaching them, we all pictured the worst. We soon arrived at the barracks building that had been designated as "temporary" billeting for our initial 100-person contingent. We were all pleasantly surprised. Although the building was physically in poor shape, it had heat, hot and cold running water, six male shower stalls, and three female shower stalls. We were fortunate to have not only these luxuries, but also to be afforded the opportunity to billet in a permanent structure with concrete floors. There was no complaining heard from any of our soldiers.

We spent the next hour unpacking the buses and moving all the packs, weapons, MREs, and water into the barracks. We immediately established an arms room in a caged-in area that appeared to have been an arms room during the Russian occupation. After everything was removed from the buses, I told everyone to break for lunch. A mess facility was located across the street from our barracks. Although there was no food being provided at this point, it was a great place for our soldiers to be able to sit down at tables and have hot coffee or juice with their MREs.

After lunch, we formed back up at the barracks. The First Sergeant had located a large number of metal bed frames to the rear of the building, and one of the other senior NCOs had discovered a number of old mattresses in a storage area in the building. We immediately identified teams to clean rooms, carry metal bed frames, carry mattresses, and assemble the bed frames in the rooms. The First Sergeant, the Chief Wardmaster, and I then went around the barracks, identifying how many soldiers would be billeted in each room. The space available was extremely limited, thereby requiring us to double-bunk in every room. In addition, we needed to include, and establish beds for, the nearly 60 additional members of our unit due to arrive sometime during the day.

By 1630, the entire barracks was cleaned and the beds assembled. We formed up the soldiers, congratulated them on their efforts thus far, and announced (per guidance from the Medical Brigade staff) that all protective masks would be checked in at the weapons room and that, for the time being, load-bearing equipment (LBE) would not be required. Upon completion of their protective mask turn-in, we released the soldiers to dinner.

I immediately went to USAREUR Forward Headquarters to meet with Lieutenant Colonel Moloff, V Corps Surgeon, to discuss what our initial operational mission was. After some discussion, he stated that, at the current time, we would only have a sick call mission. I then proceeded to dinner. We were provided with a hot meal for dinner that evening, the first since we left home. This proved to be a great morale booster. At dinner, I discussed our sick call mission with our senior physicians, nurses, and NCOs, and they then left to begin locating and preparing a site suitable to provide sick call capability.

Shortly after their departure, the Medical Brigade Sergeant Major came charging into the dining facility and stated that they had just had a meeting with Brigadier General Bell, the Corps Chief of Staff, who stated that he wanted the "hospital up and functioning," with operating room (OR) capability, by close of business tomorrow. I then asked for clarification on "up and functioning" and was told that we should have a functioning emergency medical treatment (EMT) facility along with "some" in-patient capability. Because of this sudden change in requirements, I immediately called a staff meeting with my key clinical and operational officers and NCOs to formulate a plan of action to meet these newly established requirements directed by Brigadier General Bell.

The Medical Brigade had arranged a site directly across from the airfield on a concrete aircraft pad. The U.S. Air Force had been given all these aircraft pads prior to our arrival, but agreed to allow us to use one-half of one pad for a "temporary" site for our initial facility until the ground could be prepared at a different site some one mile away. After our staff meeting, a handful of us proceeded to the identified aircraft pad to lay out and measure a course of action for the following day. It was now about 2000, and the site given to us was under about two feet of snow. After doing some minor snow removal by shovel to determine where the edges of the concrete pad ended, we marked off where we would erect our EMT, operating room, and central materiel supply (sterilization equipment). The next issue would be snow removal from the aircraft pad.

The fact that we were the first unit of any size to arrive at the ISB resulted in the nonavailability of a number of resources. One resource we could not get was snow removal equipment. It was now 2200, and we tried to determine what our options were. If we shoveled the site out the next day, we would lose valuable daylight hours that could then result in constructing part of the hospital in the dark. This is not necessarily a critical issue, but the risk for injury would increase if we were constructing the external facility in the dark. It was at this point that I noticed a snow plow out clearing the runway some 1,000 meters from us. I instructed one of our soldiers to drive out to the runway and tell the snow plow operator that we were in urgent need of snow removal from the site we were to establish the hospital on. In a matter of a few minutes, the plow was following the CSH vehicle off the runway and over to our site. He began plowing the area for us and approximately 2 1/2 hours later had the aircraft pad and the surrounding area completely cleared.

We returned to the barracks and got to sleep at about 0200. At 0345, I was awakened to be told that the second trainload of individuals had just arrived. The primary staff got up to greet the two busloads and assist them in unloading their equipment, securing weapons and protective masks, and placing them in specific rooms. I instructed them to get to sleep, and that they would be awakened at approximately 1200 to have lunch and then proceed to the site to assist in establishing the hospital.

We then got the first trainload of individuals up and off to breakfast. We held a post-breakfast formation at 0730 and then moved everyone to the site. We broke the unit into teams and had one team erect the EMT while the other team put up the OR and CMS. We decided to run the three sections in parallel. Patients would enter the facility from the front of the EMT where we would establish a registration and triage area. The patient would then move to the middle of the EMT where he would be seen by a health care provider and rendered medical treatment. In the rear of the EMT, our plan was to place four intensive-care beds for any soldiers requiring in-patient care. To the rear of the EMT, a controlled entrance would be erected to allow passage into our CMS area. This area could provide sterile instruments to both the OR and the EMT, yet be out of the flow of normal patient and staff activity. On the backside of CMS, we would erect another passageway into the Operating Room area.

We were able to position all the pieces of equipment for this first phase without any major difficulties. The second phase of construction planned for this first day of operations was to locate our x-ray and laboratory "boxes" alongside the EMT/CMS/OR complex. However, the contracted truck driver stated he could not drive the truck into the designated locations to drop these expansible boxes because he would get stuck in the mud surrounding the aircraft pad. We therefore called for a crane to unload the expansibles. Approximately 2 hours later, one arrived at the scene. The crane operator attempted to unload the laboratory expansible for over 3 hours. However, his crane was not large enough to complete the job. So, both the x-ray expansible and the laboratory expansible placement needed to be postponed until the following day.

The next issue we needed to address was the absence of fuel for our generators that provide power for heat, lighting, and medical equipment within the hospital. We were having difficulty scheduling a fuel truck to transport fuel to our hospital site. After many attempts at arranging for a fuel truck, one finally arrived on the scene. However, he arrived with no fuel. After discovering he was empty, he left to resupply, and it was some 2 hours before he returned. Upon his return, he inserted the fuel line into the generator tank, only to find that the fuel line was frozen. He continued to attempt to pump the fuel, however, and soon burnt out the motor which pumps the fuel. Once again, he left the scene and returned some 90 minutes later with a full operational fuel tanker. We now had fuel for our generators, which allowed us to heat and light the inside of our facility and thus enable us to complete the interior establishment of the hospital.

In spite of the external resource problems described above, the unit moved methodically and expeditiously in erecting the hospital complex. By 1200, the external portions of the EMT, CMS, and OR were up and positioned. The difficulty with obtaining fuel earlier in the day somewhat delayed our ability to complete the interior construction. However, by 2000 that evening our enlisted soldiers and officers had completed a highly successful day. We had a fully functioning EMT with four intensive-care in-patient beds, a completely supplied CMS, and an operating room equipped with two surgical tables.

In addition to the hospital construction, we had also been tasked to establish a sick call facility in a barracks building close to the one we were billeted in. We had identified an old arms room and used that for our sick call area. It allowed us to lock up our pharmaceuticals at night without concern for their security. One nurse, one physician, and one medic were assigned to this area. They established the sick call area in a matter of 2 hours and then proceeded to provide health care daily at this site.

The construction of the remainder of the facility was constrained by two primary factors. The first was space. Our instructions were to place as much of the hospital on the half of aircraft pad as we could. After measuring the dimensions required for additions to the hospital, we determined that we could only place the x-ray and laboratory expansibles in the space allowed. Lieutenant General Abrams, V Corps Commander, then sent word that the entire aircraft pad was ours. Once we received this additional space, we determined we could place an additional 12-bed Intensive- Care Unit (ICU) and a 20-bed Intermediate-Care Ward (ICW).

The other limiting factor was the availability of heavy equipment side-loaders to unload our equipment from the trucks they were transported on. Our ability to construct the hospital was directly limited by the amount of equipment the side-loaders could unload during the day.

On the third day, Lieutenant General Abrams asked me what we needed in order to construct the entire hospital on the current site. After consultation with my primary staff and extensive measurement of the area surrounding the aircraft pad, we determined that if we could have all the grassy area surrounding the pad prepped (graded) and then have rock laid down in the prepped area, we could accommodate the entire hospital set-up in that specific location. Lieutenant General Abrams reviewed our proposal, approved a $199,000 contract to do the necessary ground preparation, and directed the project proceed immediately. In a matter of 4 days, the entire area had been graded and 3 layers of rock laid to stabilize the ground and make it feasible to support the weight of the CSH. Once the ground preparation was completed, construction continued at a pace consistent with the availability of heavy equipment to down load our hospital equipment. In a matter of 3 weeks from our arrival in Taszar, we had the following hospital resources on ground, staffed, and operational:

In addition, we were given some land space adjoining our hospital area to establish our motor pool. This proved extremely beneficial due to its close proximity to the hospital area and our consequent ability to turn vehicles around quickly if needed.

The remainder of the hospital (some 150 additional personnel) arrived on December 19. With our complete complement of personnel and a rapidly maturing theater, we were prepared to meet the health care needs of the 20,000-plus soldiers scheduled to deploy through the ISB into Bosnia and for the approximately 5,000 soldiers assigned to duty in the Taszar/Kaposvar area.

Three items of special interest should be noted regarding our health care support to Operation JOINT ENDEAVOR. First, we made the decision very early on to invite the Aeromedical Evacuation Liaison Team (AELT) to physically establish themselves inside the walls of the hospital. To my knowledge, this is the first time that the AELT has been physically collocated in an Army hospital. This decision paid big dividends throughout the operation. The inclusion of the AELT on the CSH health care team greatly enhanced our ability to coordinate necessary aeromedical evacuations. Our ability to better understand the AELT's capabilities and requirements, and the AELT's ability to understand our needs, resulted in a more efficient and effective system for aeromedical evacuation.

Second, in February 1996, we received the newest model Computed Tomography (CT) Scan developed for TO&E use. We connected the CT Scan (which also was housed in an expansible) to our preexisting X-Ray Department. Constructed to the side of the CT Scan, yet attached to it, was a CT "reading room." This reading room provided the equipment and space necessary for our radiologists to interpret the results of the CT Scan. This radiographic device provided a capability heretofore not available to our physician staff. Prior to the arrival of the CT Scan, we had transferred some 75 patients to the local Kaposvar Hungarian Medical Center for CT Scans in their facility. This highly sophisticated piece of equipment allowed our physicians to make a more definitive diagnosis on our soldiers in a much quicker time frame, thus greatly increasing the quality of care we were providing.

In conjunction with the CT Scan, we also were provided the necessary equipment for a teleradiology system. Teleradiology enables health care providers anywhere in the Bosnian Theater who have x-ray capabilities, to electronically send the results of their radiographic studies to the CSH for evaluation by the radiologist. The CSH had the only radiologist in the Bosnian/Croatian/Hungarian AO and, accordingly, was the receiving center of radiographic exams throughout the Theater. This proved extremely useful for the 212th Mobile Army Surgical Hospital (MASH) located in Tuzla, Bosnia. They were the only other U.S. hospital in theater, but did not have the availability of a radiologist. Teleradiology allowed physicians at the 212th MASH to send their results immediately to the CSH for professional radiological review; those results were then returned to the 212th MASH expeditiously via electronic transmission. Again, the end result was an increase in the quality of health care provided to our soldiers.

Third, host nation health care support was readily available, and the quality was generally on par with U.S. health care. Their laboratory facilities were more sophisticated than the CSH's, so we periodically sent laboratory specimens to the Hungarians when their facilities exceeded the capabilities of the CSH. During the first 9 months of deployment, we utilized the local Hungarian laboratory approximately 360 times. In addition, we utilized the Hungarian medical center for surgical intervention requirements that exceeded the capabilities of our staff or our equipment. For example, a couple of soldiers needed neurosurgical procedures that we could not provide at the CSH. They were surgically treated in the Hungarian medical facility with excellent post-operative results. Other soldiers needed endoscopic procedures that we could not provide (due to equipment restrictions); thus these soldiers were cared for at the host nation facility as well. Our preference was to care for all of our soldiers in a U.S. facility, but when staffing, equipment, or urgency dictated otherwise, it was extremely helpful to have such a high-quality host nation medical facility so readily available.

The final issue I would like to address within the confines of this paper is that of additional taskings. Not unlike any exercise or real world operation, we were tasked to provide CSH resources outside the walls of the CSH. One of the first taskings we received was to provide medical support (medics plus an ambulance) at all the railheads. Next, health care clinics began to surface throughout the area. Outside the hospital, we supported clinics at Taszar Main, Kaposvar, Kaposjulak, the Life Support Area, and Taborflava Training Area. These clinics required professional and enlisted staffing that we often provided or supported from our staff assigned to the 67th CSH.

One of our larger early commitments came in a tasking to send a 20-bed ICW forward with the 212th MASH when they arrived in Theater in mid-January. Our requirement was to send the 20-bed ward, all of its equipment and supplies, all the nursing personnel required to support it, and additional physician support. The impact of this tasking was more morale-related than operational. The requirement to split off a part of any unit for an extended period of time can have an adverse effect on the morale of both those departing and those remaining.

The heaviest tasking, manpower-wise, was one we received in February to begin the JOINT ENDEAVOR Medical Screening (JEMS) Program. This program was a newly initiated Department of Defense directed program of health screening, education, and medical/psychological surveillance for soldiers and civilians returning from Operation JOINT ENDEAVOR. It was a labor-intensive program requiring enlisted, nursing, and physician resources on a daily basis. The time required varied daily, being dependent on the number of soldiers redeploying through the ISB. Most days involved 2-4 hours, with some days going as high as 8 hours. The JEMS process entailed the following:

The blood samples were obtained and then shipped to Rockville, Maryland, where they remain frozen in a vault, readily available for examination if a soldier is afflicted with some disease in the future that he feels may be linked to his deployment in Operation JOINT ENDEAVOR.

In addition, professional medical and psychiatric staff were available to review the medical and psychiatric questionnaires to determine if any soldiers needed immediate intervention or intervention once he/she returned to their home station.

Shortly after the start of the JEMS program, it was determined that all returning soldiers would have a routine dental examination in conjunction with their JEMS. This additional tasking was given to the dental facility of the 67th CSH, further impacting on our staffing situation.

The deployment of the 67th CSH to Operation JOINT ENDEAVOR was an extremely successful deployment. Fortunately, casualties and injuries were low. From December 1995 to March 1997, the CSH conducted the following medical activities:

The 67th CSH spent 485 days deployed in the Bosnian Theater. As of April 1, 1998, the 67th CSH had deployed approximately 100 soldiers back into the Bosnian Theater. The outstanding performance of this unit at every level of rank and professional standing is an example for future medical units to emulate. The AMEDD's motto "Proud to Care" was never better exemplified.

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