Hold Capacity

The Key to Conserve Combat Power

By LTC Vern E. Campigotto, MAJ Richard K. Skinner, CPT Hannah Dalke, CPT Gabriel M. Lizama

Article published on: May 1, 2026 in the 2026 E-Edition of Pulse of Army Medicine

Read Time: < 10 mins

Medical is not important until it is important, and medical seems to always be important for exercises, missions, and deployments because of the critical role it plays in returning Soldiers to duty. Exercises allow medical units to identify gaps and vulnerabilities and develop solutions for them in real-time. The 62d Medical Brigade (MED BDE) participated in the 7th Infantry Division’s (7ID) training exercise, Bayonet Focus 25 (BF25), from 08-22 May 2025 at Yakima Training Center (YTC), Washington. The training participants were the Headquarters and Headquarters Detachment, 56th Multifunctional Medical Battalion (56th MMB), 575th Medical Company (Area Support)(MC(AS)) assigned to 56th MMB, and 28th Intermediate Care Ward (ICW) assigned to 147th Field Hospital (FH), 29th Hospital Center (HC). The lessons learned from the exercise will aid in understanding, visualizing, and describing the unconventional augmentation of patient hold capacity to a Role 2, facilitating rapid return to duty in large scale combat operations.

The Army Futures Command Concept for Medical 2028 predicts future operational environments with limited freedom of maneuver to enable evacuation of casualties and the reconstitution of those evacuees. The pamphlet emphasizes that “returning an ill, injured, or wounded Soldier to duty as far forward as possible will be essential to conserve combat power.” Warfighter exercises estimate that, on average, 10,000 of 50,000 casualties will be returned to duty. Medical capabilities available today are not the issue for returning Soldiers to duty far forward; the problem is the capacity to accommodate the high rate of casualties projected in a LSCO conflict.

A Role 2 is the most far-forward medical element with the capability to hold patients for a short period of time. It is designed to provide at least 72 hours of patient hold capability for Soldiers returning to duty, awaiting evacuation to the next higher role of care, or recovering from surgery performed by an attached Forward Surgical Resuscitation Team (FRSD). A Brigade Support Medical Company (BSMC) assigned to a Brigade Combat Team has a 20 patient hold capacity, while an area support medical company (ASMC) has a 40 patient hold capacity. In large scale combat operations, the capability gap for a Role 2 will be the limited hold capacity, which affects its ability to prioritize and rapidly return non-critical patients to the fight as far forward as possible.

A non-doctrinal solution to this critical capability gap is augmenting the Role 2 with a hospital augmentation detachment, specifically a 60-bed intermediate care ward. The detachment is designed to augment a 32-bed field hospital with three 20 bed wards, providing intermediate nursing care and additional patient administration and nutrition capabilities. When operating at full capacity, the augmentation detachment attached to an area support Role 2 increases hold capacity from 40 to 100 patients (a 150% increase) for a 72-hour period. The 575th MC(AS) and 28th ICW tested this proof of concept at Bayonet Focus 25 in an austere environment at the Yakima Training Center.

During the division exercise, 62d MED BDE and 7ID recognized a critical gap in its ability to hold and monitor Soldiers who had been evacuated, treated, and discharged from Yakima Memorial Hospital but still required up to 72 hours of observation before a likely return-to-duty decision. The 2-2 SBCT Mayor Cell could only retain patients for less than 24 hours and lacked the capability to provide continued assessment or follow-up care. As a result, patients were routinely evacuated back to Joint Base Lewis-McChord on daily shuttles, removing them from the exercise entirely. In the first week alone, the Mayor Cell transported thirteen Soldiers back to JBLM, ending their participation for the duration of the event.

To address this shortfall, the 7ID Surgeon Cell, working closely with the 2-2 SBCT Mayor Cell and the 56th MMB, integrated the 575th MCAS treatment capability and the 28th ICW’s 40-bed holding capacity into the medical concept of support. This approach added essential medical assessment, intermediate care, and monitoring functions designed to maximize rapid return-to-duty outcomes. The enhanced process closed the capability gap and enabled the Role 2 and ICW to return 19 of 23 Soldiers to duty within 72 hours, Soldiers who previously would have been evacuated back to home station. The process not only reduced the burden on the 2-2 SBCT Mayor Cell but also created a reliable pathway for timely, medically sound return-to-duty decisions, ensuring Soldiers could rejoin their units and continue contributing to the exercise.

Although the 575th MC(AS) and 28th ICW delivered important medical capabilities during BF25, their employment in a combined role for a division-level exercise fell outside doctrinal norms. The two units belong to different parent organizations within the 62d MED BDE, had never trained together, and entered the exercise with only a limited shared understanding of how their capabilities would integrate. Significant differences in their MTOE structures further complicated coordination. The 575th MC(AS) is built to be fully self-sustaining, with the organic lift required to move all personnel and equipment. In contrast, the 28th ICW faced challenges due to limited vehicle density and reliance on material-handling equipment for movement. Despite these constraints, both units successfully deployed all required equipment to support the mission. Additional shortfalls emerged in communication and power generation capabilities, highlighting areas for improvement in future joint employment.

The 28th ICW is structured to augment a 32-bed field hospital and normally operates under that hospital’s established communication and power-generation systems. During BF25, the ICW was limited to its organic radios both during convoy operations and while functioning at YTC. The team mitigated these constraints by employing CLMR radios in the lead and trail vehicles and replicating that configuration across both command posts once established, enabling reliable communication for patient movement and reception throughout the exercise.

Power generation was sufficient for the combined footprint; however, the 28th ICW does not possess its own Environmental Control Units to maintain appropriate temperatures for real-world patients awaiting return-to-duty. The 575th MC(AS) closed this gap by providing climate control through its Generator ECU Trailer, ensuring safe heating and cooling as needed. As this capability continues to mature, both units will need to develop a more deliberate power distribution plan with built-in redundancy to support command posts, medical equipment, and ECU requirements.

During BF25 planning, the 575th MC(AS) and 28th ICW were not originally included as part of the training audience, yet their nondoctrinal employment created a valuable opportunity for both units to collaborate and build a shared understanding of how their combined capabilities could enhance medical care in an austere environment. Rehearsals and scripted MASCAL events facilitated by HHD, 56th MMB proved essential in shaping a workable concept for integrating these units to improve return-to-duty outcomes. By identifying operational requirements early and exchanging unit SOPs, the teams were able to validate systems and processes before receiving any real-world patients. This synchronization allowed them to align nonorganic capabilities and determine which assets would provide the greatest benefit if deployed together. The result was measurable improvement in patientcare efficiency, bed capacity, inpatient treatment, and casualty preparation for onward movement. Looking ahead to large-scale combat operations, this combined capability, if deliberately employed, would significantly strengthen prolonged care for serious but non-ICU-level medical cases, reducing unnecessary evacuations and preserving combat power forward.

As the exercise progressed, both units encountered additional friction points that will require deliberate refinement for future employment. The presence of two parallel command teams without a clearly defined command-and-control relationship created ambiguity in decision-making, underscoring the need to formally establish command authority and support relationships between the 575th MC(AS) and 28th ICW. Sustainment oversight, particularly Class VIII management, also emerged as a challenge, highlighting the need to streamline ordering, resupply, and distribution processes. The ICW’s requirement for a more expansive pharmaceutical inventory than the MC(AS) can organically support further complicated sustainment planning.

Evacuation criteria for higher roles of care remained another unresolved issue. Without surgical capability, the combined element could only retain patients who were not seriously injured, requiring clear triggers for when casualties must be evacuated to the next echelon. Integrating a Forward Resuscitation Surgical Detachment with the Role 2 and the hybrid MC(AS)/ICW construct would enable surgical intervention forward, allow postoperative patients to convalesce in the ICW for extended periods, and increase the likelihood of returning Soldiers to duty, which will ultimately preserve combat power in a large-scale combat environment.

For medical mission command, the 56th MMB headquarters played a central role in planning, coordinating, and integrating the MCAS/ICW concept into the 7ID medical support plan for real-world return-to-duty operations. The battalion staff maintained oversight by synchronizing with the 2-2 SBCT Mayor Cell and the 7ID Surgeon Cell to track patient flow into the MCAS/ICW footprint, update dispositions, and enforce the Medical Rules of Engagement to ensure only those requiring 72 hours or less of post-hospital assessment were sent forward for evaluation. Responsibility for patient administrative movement remained with the mayor cell and 7ID’s organic units, as the MCAS did not have the capacity to manage those administrative transportation requirements.

The preservation of combat power depends heavily on sufficient holding capacity, and unconventional employment of medical capabilities may be essential to achieving decision advantage. In large-scale combat operations, the six core principles of the Army Health System—conformity, continuity, control, proximity, flexibility, and mobility—form the foundation of an effective and adaptable plan that enables rapid return to duty and sustains fighting strength. To meet this requirement, AHS planners must be integrated early in the planning process to develop running estimates and courses of action that deliberately support combat power at decisive points. Continuing to refine and validate the concept of ICW augmentation to a Role 2 during future iterations of Bayonet Focus will help reinforce the principle of conformity and further mature this capability for LSCO.

Continuity of care will be strained in LSCO due to inevitable delays in evacuation, requiring planners to anticipate these gaps and determine how to employ or replicate higher-level medical capabilities forward to reduce disruption. Casualties assessed as return-to-duty still require consistent monitoring and support until formally released. When paired with a Role 2, the ICW helps close this gap by providing intermediate nursing care, patient administration, and nutrition services that maintain continuity of care for RTD-eligible Soldiers. Proximity is equally important; colocating the Role 2 and ICW enables rapid evaluation and return of large numbers of casualties, directly contributing to sustained combat power. As operations shift from brigade-centric to division-centric frameworks, positioning this nondoctrinal capability within the division support area gives divisions a forward medical asset capable of preserving combat power and exploiting decision points throughout the fight.

As the Army prepares for large-scale combat operations, this concept demonstrates how existing medical capabilities can be combined in innovative ways to strengthen Army Health Service Support for the warfighter. Future conflict with near-peer adversaries will generate high casualty volumes and higher mortality risk than seen over the past two decades in the CENTCOM theater, making forward medical capacity and prolonged care more critical than ever. A deliberately designed, nondoctrinal construct, integrating the MC(AS), ICW, and FRSD, offers a modular, expeditionary package capable of delivering prolonged care, medical treatment, limited surgical intervention, and recovery time far forward, reducing the need to evacuate Soldiers out of theater. Embracing these adaptive approaches positions the Army Medical Department to provide more agile, expeditionary AHS support in LSCO and to rapidly return medically cleared Soldiers to the fight, preserving combat power when it matters most.

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