Military Partnerships in the Philippines
By Maj. Matthew J. Gomlak and Maj. Stephen Fenton
Originally published in the July-September 2012 edition of Special Warfare
In the May-June 2010 edition of Foreign Affairs, the former Secretary of Defense, Robert M. Gates, wrote an article entitled “Helping Others Defend Themselves,” wherein he emphasized that “the effectiveness and credibility of the U.S. will only be as good as the effectiveness, credibility and sustainability of its local partners.” He also wrote that, “well-integrated training and assistance efforts can achieve real results.” The recent actions of a small special-operations task force working with Marines from the Armed Forces of the Philippines on a very remote island in the Sulu Archipelago illustrate what Gates meant by real results.
On July 28, 2011, two platoons of AFP Marines infiltrated into an historical Abu Sayaaf Group encampment located on Jolo Island that held an estimated 100 ASG and Jemiah Islamiah members and affiliates. In the darkness of the early morning, the marines observed several men walking with flashlights. Both the darkness and terrain hid a series of tarps and prepared defensive positions along the high ground to the left and right flanks of the AFP Marines. At approximately 4:20 a.m. the AFP initiated contact, focusing their fire on the activity to the front. The marines immediately took heavy automatic rifle fire and 40mm grenades from both flanks. The initial exchange killed two marines and wounded several others; both AFP corpsman, the only medics in the formation, were among the fallen. One heroic platoon commander directed both platoons into a dry creek bed and then maintained a forward perimeter with four others to cover their withdrawal. After the firefight these five men were found dead and decapitated. The remaining elements of the two platoons suffered two killed in action and 21 wounded in action — most of them with gunshot wounds. By 8:30 a.m., the AFP Sulu Island Command and American advisers from Joint Special Operations Task Force – Philippines began responding to a mass-casualty situation.
In previous operations on Jolo Island, the AFP suffered heavy casualties. In August 2007, for example, they sustained 25 KIA from a roadside ambush. The events on July 28, however, stand out because of the number of wounded sustained in a short period of time and the successful treatment and evacuation of the patients through the combined efforts of the U.S. military and AFP organizations.
All U.S. forces supporting Operation Enduring Freedom-Philippines operate under the Kapit Bisig Framework, a mutually agreed U.S. and Government of the Republic of the Philippines accord by which JSOTF-P accomplishes its mission through and with its partner forces. The task force does not engage in combat operations and does not operate from independent locations — they advise and assist Philippine security forces where they are — on Philippine government bases, compounds and outposts in jungle, village and urban areas. Their efforts include intelligence sharing, support for mission preparations and rehearsal, civil-military and military-information support operations, casualty evacuations and logistics. Through this framework, JSOTF-P personnel successfully executed the mass casualty through and with partner-nation forces. The outcome was a tremendous success, resulting in the evacuation of 16 patients, the performance of two life-saving surgeries and one limb-sparing surgery.
Thirteen kilometers separated the WIAs from the nearest AFP trauma center on Camp Bautista, the main Filipino military base on Jolo Island. Units from the Philippine Air Force evacuated all 21 patients from the encounter site to the Helicopter Landing Zone on Camp Bautista in a period of four hours. Once the patients reached the HLZ, AFP and U.S. advisers facilitated transportation to the local treatment center, where Filipino doctors and five members of a U.S. Air Force Forward Surgical Team conducted triage, treatment and in some cases surgery. From the trauma center, both PAF and U.S. aviation assets moved the critically injured patients to two different medical centers in Zamboanga City, 155 kilometers north of Camp Bautista.
JSOTF-P’s efforts on July 28 provide a snapshot of what Gates meant by “real results” from well-integrated training and assistance efforts to partner-nation forces. Medical training between U.S. and AFP personnel provided the requisite individual and collective skills for casualty treatment and evacuation. Overall command and control executed by Task Force Sulu, the subordinate JSOTF-P element in charge at Camp Bautista ensured that all U.S. and AFP non-medical personnel contributed in essential supporting roles. It also facilitated a collaborative medical evacuation/casualty evacuation plan that incorporated both AFP and JSOTF-P rotary-wing and fixed-wing aircraft. Finally, the extraordinary performance of the forward surgical team provided order to patient treatment and increased the treatment capability of the AFP trauma clinic.
Special Forces detachments have been living and working with the Filipino forces on Jolo Island since 2003. Part of this relationship has been consistent training on first aid, self-care, buddy aid and patient triage. The results of this exchange were evident on July 28 when all 21 wounded Marines arrived at the Camp Bautista landing zone. All AFP wounded arrived with the majority of their wounds dressed. Several had pressure dressings and those with more severe extremity wounds had a tourniquet applied. Many of the dressings and tourniquets were makeshift out of ripped cloth and sticks, and the soldiers with severe wounds also had Quickclot within the wound itself. Despite the loss of their organic corpsman in the initial encounter, AFP Marines demonstrated proficiency in first aid and their unilateral efforts saved lives.
Additionally, technical exchanges between the TF Sulu Forward Surgical Team and the AFP military staff of the Camp Bautista trauma center set the conditions for an unusually efficient and successful MASCAL. One month prior to the start of this ongoing offensive operation against the ASG on Sulu, the FST assisted the AFP trauma center in erecting two triage tents. Additionally, they presented classes on the tenets of adequate triage. FST personnel also instructed the trauma center staff on how to properly stock their emergency rooms, operating rooms and trauma stations. This prevented the large volume of casualties from overwhelming the AFP trauma center staff and facilities.
Unilateral efforts by the partner-nation force also contributed to the overall success. On July 28, after the initial notification of Marine casualties, the AFP generated a list of potential casualties by blood type and obtained type-specific whole blood from a “walking blood bank” of AFP Marines on the base camp. Marines on Camp Bautista manned ambulances, litter teams, patient prep and ground movement teams for all wounded personnel. They also handled the remains of the five KIA and conducted mortuary affairs on site.
Another factor in the success of the MASCAL was Task Force Sulu’s orchestration of all AFP and U.S. military and medical assets during the event. Immediately after notification of friendly casualties, the task force promptly organized and assigned non-medical personnel at the arrival landing zone, within the triage tents and inside the trauma bay. Every uniformed member of the task force had a designated role prior to the arrival of the first casualty. They promptly organized combined AFP and U.S. litter teams, triage support teams, landing zone security and placed liaison elements in the trauma center, SIC headquarters and TF Sulu operations center. On-scene Special Forces and special-operations trained medics ensured the simultaneous passing of nine line MEDEVAC requests through both AFP and JSOTF-P channels. This facilitated the integration of JSOTF-P contract aircraft into the CASEVAC plan when PAF assets proved unable to handle the volume of patients and the severity of the injuries.
Finally, the extraordinary performance of the AFST in providing timely and appropriate medical care to 21 patients saved lives and strengthened the relationship between TF Sulu and their Philippine counterparts. The AFST at Camp Bautista has the mission of providing routine and emergency medical care to U.S. personnel on the base. However, they are always willing to assist with AFP casualties, at the request of the AFP trauma center commander. On the morning of the encounter, the FST emergency department physician assistant worked jointly with the trauma center commander at the arrival HLZ in order to ensure proper initial triage. The PA then returned to the hospital to continue evaluation and care for the casualties as they arrived. The orthopedic PA worked at the triage tents and trauma bay for evaluation and treatment of the casualties. The lead trauma surgeon, nurse anesthetist and operating room technician remained in the trauma bay and within the operating room once the surgical patients arrived. With support from the AFP doctors, they performed surgery on three of five surgical candidates. Furthermore, they stabilized two additional surgical candidates and facilitated their transport on the first MEDEVAC to Zamboanga City for follow-on surgical care.
Dr. Stephen Fenton, U.S. Air Force major, AFST general surgeon and co-author of this article stated that, “the MASCAL was conducted as well as those in which I have participated at Combat Surgical Hospitals in Afghanistan and stateside Level I trauma centers.” This was a joint, combined, special-operations effort with both U.S. and Filipino medical and non-medical personnel. Due to the interoperability of U.S. and AFP forces and the constant communication and coordination by the SOTF, all AFP casualties who arrived at the trauma center survived. On Jolo Island, the effects of “well-integrated training and assistance efforts” at the tactical level achieved “real results” by saving Philippine Marine lives. AFP actions at the point of injury and during CASEVAC to Camp Bautista illustrate the long-term effects of consistent medical training by U.S. SOF. The collaboration that took place at the HLZ and at the trauma center shows the synergistic results of combined efforts by U.S. and partner-nation military forces. Finally, the precise application of professional U.S. military capability in the OR and during MEDEVAC for the critically wounded illustrates how U.S. efforts can make our partners stronger.
Maj. Matthew J. Gomlak was the Task Force Sulu Commander and Maj. Stephen Fenton, U.S. Air Force, served as a general surgeon on Task Force Sulu Forward Surgical Team.