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Allanea's Brief Guide to Military Sustainment/Logistics

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Greater Themis
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Postby Greater Themis » Mon Dec 12, 2016 10:46 am

Congratulations once again on a fantastic piece of work. I certainly enjoyed reading it.

My contribution to the debate as it were is from my background in military medicine. Whilst by no means an expert, I've sufficient immersion from both my reserve service and my first BSc research to chip in my personal two pence, as it were. By no means to I wish to undermine Allanea, only to add to their excellent piece of work.

Role
Medical services in the military, like all services, do a vast number of things, from the obvious to the sublime:
- Emergency care - The standard role, one might think - save lives. Whilst the focus is on trauma, this extends to medical emergencies as well.
- Primary care - Preventative medicine in practice, as it were - preventing illness, preventing illness from causing loss of man hours, preventing illness from becoming severe, referring as necessary. This extends to dental care, which normally comes under a structure of its own.
- Mental Health - Speaks for itself. Highly neglected in many armed forces, which may come onto at a later date.
- Rehabilitation - Ensuring the injured are returned to as close to full function as possible - either for return to combat, or for return to civilian life.
- Veterinary Care - Providing care to working animals.
- Environmental Health - Preventative medicine outside of illness. This includes water purity, food cleanliness, location of latrines, insect extermination.
- Education - Educating all other branches in medical roles - for prevention of disease, and death. And for morale.
- Selection - More prevention (See a theme?), but of people already ill from getting into the service and causing issues to themselves and others.
- Media Operations - Hearts and minds and all those lovely words that get neglected in the NS conventional war paradigm, but are critical in the current model of war amongst the people. And the best way to win that is by providing healthcare; the best way to lose it by denying help.
- Care of the Dead - Another neglected area in NS; mainly because it's kept out of public sight, or not appreciated fully.

Impact
It's best to think of the impact medical services have in the three key areas use to describe military force:

> Physical
- At the end of the day, all weapons and artillery are force multipliers. That number being multiplied being number of men. If you lose men to illness, you may have lost the battle before it even started; both from ineffective fighting, and from men not being there.
- From the total/absolute war viewpoints, better medical care = better recycling of manpower = bonus.
- I mention this because Allanea mentioned it: pharmacological enhancement. This really is a double-edged sword, that needs using with far too much caution in this day and age to make it truly viable. But this is NS, eh?

> Moral
- This is the true sticking point these days: soldiers need to be encouraged to fight. And medical care is critical - if a soldier knows what medical resources are available, and that it's likely he will get world class care, and the best shot at surviving whatever's thrown at him, he'll be more willing to throw himself into the fray.
- War is an extension of politics. If people see lots of body bags and not that much medical support, you'll eventually lose the fight at home. You'll also see far more people attempting to avoid the draft, or voluntary service, if they know there's little medical care and lots of death and disfiguring injury.
- Further to that, the veteran body after a draft is likely to be a large, politically powerful movement. Again, messing with healthcare will cost political points.

> Intellectual
- Good medical systems in armed forces will often lead to benefits being passed back to civil society - both from doctors being dual-skilled in military/civilian service, and from innovations and techniques forced forward by necessity. The list is endless.
- Good medical support when factoring into military planning opens more options to a commander, who is now able to strategically risk more if he knows that risk is mitigated by good medical services.

Purpose
It is at this point I start to digress from Allanea. The core role of military healthcare has been preventative, as the biggest scourge of armies has in the past been pestilience. The development of military medical personnel into returning men to service only truly came about (in Europe at least) from the First World War; prior to that, the limits of medical and surgical knowledge meant there was very little prospect of returning those who were truly injured to service, instead acting as convalescence centres for nature to take its course. Indeed that concept of reverse triage (treat people who can be returned to service first) has rarely been practiced in western forces.
In the modern day, that idea of recycling personnel sits as a secondary objective - often, in this day and age, it is about combat effectiveness, through preventing illness and the complications of illness; and about providing moral incentive for people to join and people to fight.

Military medicine is certainly different from civilian medicine - every practitioner is forced to be a generalist out of necessity for starters. This comes from the focus on disease prevention and treating small niggles, the opposite extreme of dismemberment, and lack of a western modern hospital on the frontline. This is compounded by a demographic of healthy, fit, young men and women. Malingering is somewhat a minor thing of note, and played up far too much to the cost of ignoring or belittling true problems (often with mental health); civilian A+E departments and primary carers see their fair share of malingerers across the land, and often dismiss them rather than tackling the issue of mental illness (often untreated in these individuals) straight on. My experience may in part be down to the voluntary nature of service in the UK; though I suspect cases in other countries with conscription are likely overplayed as good conversation pieces or propaganda against anti-draft activists.

Roles
The statement you make on the individual being responsible for healthcare hits the spot perfectly. I follow with a descriptor of the UK system.

At the pre-medical services level, you are correct in noting the medical support available within a combat/combat support unit's own personnel. In the UK, the 'team medic' concept of certain soldiers trained to a level where they can administer support to injured in their section/fireteam, and assist a more qualified medic, is prolific. The individual soldier is trained to medically assist themselves or their buddies with their individual aid kits, and issued a handy flowchart as an aide-memoire for medical assistance. This comes within a relatively new concept of the 'Platinum 10 minutes' - that most trauma deaths that aren't immediate can be prevented by treatment received in the first ten minutes after injury.

This links in nicely with the battalion's level of aid - each individual combat unit will have its own unit aid post, incorporating its organic medical support (Doctors, Nurse, Combat Medical Technicians) which then provides preventative care to the unit, and in combat the first line of medical aid.

Outside structures get involved in a tiered system, based on a NATO standard:
> Role 1 - Field GP/A+E provided by a squadron level formation. Supports battalion formations and higher, often leapfrogging with a tactical move (ie one role 1 facility will move forward whilst the other stays fixed, ensuring support keeps up with the frontline). Also provide the casualty transport/evacuation facility, and a basic field service for mental health, physiotherapy, etc. Can move within an hour.
> Role 2 - Field Hospital - A larger version of the above, but with the capability of having casualties bedded down: pneumonia patients for example, who may only need three days rest away from their unit before being returned on light duties. Most versions are ''Enhanced'' with an attached surgical team, and will have attached specialists in environmental health and such-like. Operated by a medical regiment (battalion level formation). Can move within a day, shorter if a light role.
> Role 3 - Large Field Hospital - Supposedly a general hospital in the field, providing general services including X-Ray/CT, multiple operating theatres, and numerous specialists. In theory mobile, in practice not. Operated by multiple medical units - in theory a field hospital, in practice multiple in order to gain the spread of professionals.
> Role 4 - Specialist/Convalescent - Facilities operated back in the home country, often civilian, focused on rehabilitation, or specialist care not available overseas. In recent years in the UK, this has involved those stabilised at Bastion Field Hospital and undergoing further definitive treatment, and those who contracted Ebola whilst serving in Sierra Leone.

The larger the role number, the larger the formation. The navy use a similar linear scale, and refer to it as 'Echelon' rather than 'Role'. Of course there's numerous in betweens, jump arounds, and the like. But it's a nice framework to start with.

General Comments

I will note the rest of the points made in Allanea's above post are all relevant, and all true considerations. Health is physical, mental and spiritual. Healthcare when tasked with prevention spreads its tendrils into every aspect of the military. The more you look, the more you'll find it.

Medical care is something most NS wars that aim for realism neglect, much like logistical challenges. The impact of medical care, or lack of it, extends both to the simple nature of statistics that NS'ers like when gaming (losses to disease, to exhaustion and exposure), and to the more complex niceties of politics, domestic affairs, long term impacts on society, and the motivation of the average soldier. For character RP'ers, it's an area fraught with extremes of emotion, drama, morality, and insight into the human condition, and an area that is so often not paid justice - not in the sense of how accurate procedures are, or what facts are right or not, but in how the average soldier and medic experiences such a thing.

Generally it's an area that always warrants research - I can guarantee you'll be fascinated by what you find.

PS - TG if any questions, I'll always try my best to answer, or find someone who knows answers.

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Postby Allanea » Mon Dec 12, 2016 12:10 pm

Well I think I have mentioned the preventative aspect a bit in my post, but this is a very good and positive comment. Would you approve if I link to it from the bibliography section?
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Greater Themis
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Postby Greater Themis » Mon Dec 12, 2016 12:15 pm

Allanea wrote:Well I think I have mentioned the preventative aspect a bit in my post, but this is a very good and positive comment. Would you approve if I link to it from the bibliography section?


Go for it.

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Postby Allanea » Mon Dec 12, 2016 12:19 pm

Many thanks are also owed to Purpelia for helping with the tags!
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Postby New Aeyariss » Tue Dec 13, 2016 4:05 am

- I mention this because Allanea mentioned it: pharmacological enhancement. This really is a double-edged sword, that needs using with far too much caution in this day and age to make it truly viable. But this is NS, eh?


I know that ZOMO (motorized reserves of citizen's militia, anti-riot thugs of Polish People's Republic) were given various medical drugs to increase aggression before they were sent against dissidents & protests.
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Postby Allanea » Tue Dec 13, 2016 4:12 am

New Aeyariss wrote:
- I mention this because Allanea mentioned it: pharmacological enhancement. This really is a double-edged sword, that needs using with far too much caution in this day and age to make it truly viable. But this is NS, eh?


I know that ZOMO (motorized reserves of citizen's militia, anti-riot thugs of Polish People's Republic) were given various medical drugs to increase aggression before they were sent against dissidents & protests.



You may want to listen to this podcast, it interviews a Polish historian who studied drug use in WW2:
https://www.youtube.com/watch?v=paSA7h0jGgI
Last edited by Allanea on Tue Dec 13, 2016 4:14 am, edited 1 time in total.
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Postby Thoricia » Tue Dec 13, 2016 7:50 am

Excellent work Allanea, I may try working this into FanT and FT settings as well, should be interesting
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Postby Allanea » Tue Dec 13, 2016 8:33 am

Thoricia wrote:Excellent work Allanea, I may try working this into FanT and FT settings as well, should be interesting


I think if the FT is not very 'hard' FT many of the broad lessons could be applied.
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Postby Kazarogkai » Tue Dec 13, 2016 10:46 am

A questions for you, do members of a units HQ count as part of the sustainment/logistics apparatus that you make mention of or are they an entirely separate beast in themselves?

If that is the case interestingly enough it seems atleast within my standard infantry division of 1940 that I follow both as you mention the german and soviet methodology. My admittedly rather bloated HQs mixed in with my use of an entire service regiment, comprised of a battalion of engineers and 4 of logistics, meant to service the division. My thoughts on the HQ is that it shouldn't just be for admin but should also have some light combat support duties ranging from recon to maybe simple field kitchens. Full dedicated service units meant for more "heavy" logistics on the otherhand should be only really necessary on higher levels(brigade, division).

Another thing I need to mention is the fact that well that 2-1 ratio of support to combat kinda was what informed me while doing things admittedly. During an RP I was involved in the country I played was atleast historically very actively involved overseas(the revolution will not be contained). As such that was a rather important experience which informed their decision making in later years. It really came to a head though around the time they fought a brief albeit rather destructive war which truly showed the limitations of their logistics which limited their force projection capabilities. As such a series of reforms would take place culminating in the creation of a military organization capable of truly projecting force in a meaningful way. The point was to allow the Legions, the most basic functional army unit capable of independent action, to be able to better sustain themselves on campaign. Using the rule 2-1 I made the organization look something like this with the important relevant parts being the Support Sub Legions:

Local Staff HQ(680)
Combat Sub Legion(1440)
I Artillery Column(288) 30 Guns
A Gatling Gun Block(72) 12 Guns
B Siege Gun(Mortar) Block(72) 06 Guns
C Field Gun Block(2x 72) 12 Guns
II Cavalry Column(288)
A Mounted Rifle Block(4x 72)
III Infantry Column(3x 288)
A Foot Rifle Block(4x 72)
Support Sub Legion(2x 1440)
I Engineer Column(288)
II Logistics Column(4x 288)


Mind you technically speaking the lower units below the Legion itself do not have a HQ of their own though in practice men from the Legions Local Staff are distributed downward for admin purposes(officers, signalers, MPs, etc) from the block level up with NCOs organic to the units handling the level below that.
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Postby Allanea » Tue Dec 13, 2016 11:05 am

This is a bit of a chicken and egg question.

Or rather it depends on definition.

Do 'signals troops' include in 'Sustainment' (In this document I have not included them, and US doctrine excludes them)?
What about the cooks at your HQ?
WHat about the S4 officer, is he 'sustainment'?

This sort of thing is why it's hard to define this stuff.
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Postby Hyggemata » Tue Dec 13, 2016 1:00 pm

Allanea wrote:
Containerization
(Image)
A stack of military shipping containers.
-snip-


If the containers are camouflaged, does it mean they're supposed to be invisible? :p
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Postby Kazarogkai » Tue Dec 13, 2016 1:41 pm

Allanea wrote:This is a bit of a chicken and egg question.

Or rather it depends on definition.

Do 'signals troops' include in 'Sustainment' (In this document I have not included them, and US doctrine excludes them)?
What about the cooks at your HQ?
WHat about the S4 officer, is he 'sustainment'?

This sort of thing is why it's hard to define this stuff.


Maybe, they are pretty essential to administration
Definitively, they effectively are the distributors of the logistics train so I would count them.
I don't know what that is so... if by that you mean quartermaster then I would say yes.

Just to give you an example of how things run, this is the composition of a Foot Infantry companies HQ:

Company HQ(24)
Command Team(6)
- 2 Officer
- 2 Quartermaster
- 2 Cooks
Armourer Team(4)
- NCO
- 3 Armourer
Medic Team(4)
- NCO
- Wagon Driver
- 2 Stretcher Bearer
Signal Team(4)
- NCO
- 5 Runners
Recon Team(6)
- NCO
- 5 Scout
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Postby Allanea » Tue Dec 13, 2016 1:44 pm

Why are there four armorers?
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Postby Kazarogkai » Tue Dec 13, 2016 4:08 pm

Allanea wrote:Why are there four armorers?


Originally I had none actually. I made that team by taking 2 men from my original 6 man signaler and medical teams. I'm thinking about just adding them back, tacking 2 of my recons and making it just a 2 man force of master and assistant.
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Postby Greater Themis » Wed Dec 14, 2016 1:25 am

New Aeyariss wrote:
- I mention this because Allanea mentioned it: pharmacological enhancement. This really is a double-edged sword, that needs using with far too much caution in this day and age to make it truly viable. But this is NS, eh?


I know that ZOMO (motorized reserves of citizen's militia, anti-riot thugs of Polish People's Republic) were given various medical drugs to increase aggression before they were sent against dissidents & protests.


The use of mind-altering drugs through history and today is a fascinating subject, one which I've a passion knowledge. Certainly there are the advantages as seen by the proliferation of amphetamines, something you still see today in truck drivers in Asia, and the working poor in places such as the Philippines (which is where Duterte has the wrong end of the stick, being narrow minded.)

The cost? Amphetamines have side effects in the long run. Addiction, mood disorder, anorexia are but a few. It is the mental health side of things that is the real put-off these days - suicide, harm of others, feeding an addiction back home, exacerbation of underlying mental health vulnerabilities and conditions such as PTSD. In combat, one has to consider the effects in the six month overseas deployment manifesting while operating. One also has to note the effect on decision making whilst using (more reckless decisions made).

Modafinil may be the future drug of choice. I remain sceptical whilst researching it, and will post my findings at a later date.

And then theres the known harms of addiction to opiates, so much so that it was one of the decisions to implement debtanyl as a combat analgesic over morphine over here.

In my opinion, short term gain isn't worth long term pain, especially now we know the impact. If you RP a more malicious or uncaring regime therefore , combat drugs are an ideal representation of your regimes view, and make a nice plot device.

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Postby Allanea » Wed Dec 14, 2016 2:32 am

Amphetamines are actually a broad family of drugs as you well know.

It's worth noting they were used extensively in Soviet industry (methcatinone, a member of the family, was used in Soviet factory drinking water in the 1930s), as well as by truck drivers and others out to the 1970s. There's lots of people who use amphetamine-family drugs either illegally or semi-legally to this day with varied effects. From my reading I understand at least some of the effects are overstated by the media.

Several things are relevant here.

1. Purity is important. Amphetamines are used by the Air Force in a controlled setting and that's entirely different from being just randomly issued.
2. Risk-taking is not necessarily bad. If, say, you can make troops 5% less likely to flee during close combat or 5% more likely to engage in it that's different than them 'running like madmen through the minefield'. Lots of military engagements depend on soldiers being willing to do things that are short-term risky or at least seem risk in favor of long-term survival. (Say, assaulting into the fire).
3.The extent of the risk is important. If, say, your nation is facing a life-or-death struggle, or if your outpost is about to be overrun by 10,000 Bigtopian guerrillas, you might want to get hopped up on meth and throw yourself into the final battle.
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Postby Greater Themis » Wed Dec 14, 2016 4:20 am

Allanea wrote:Amphetamines are actually a broad family of drugs as you well know.

It's worth noting they were used extensively in Soviet industry (methcatinone, a member of the family, was used in Soviet factory drinking water in the 1930s), as well as by truck drivers and others out to the 1970s. There's lots of people who use amphetamine-family drugs either illegally or semi-legally to this day with varied effects. From my reading I understand at least some of the effects are overstated by the media.

Several things are relevant here.

1. Purity is important. Amphetamines are used by the Air Force in a controlled setting and that's entirely different from being just randomly issued.
2. Risk-taking is not necessarily bad. If, say, you can make troops 5% less likely to flee during close combat or 5% more likely to engage in it that's different than them 'running like madmen through the minefield'. Lots of military engagements depend on soldiers being willing to do things that are short-term risky or at least seem risk in favor of long-term survival. (Say, assaulting into the fire).
3.The extent of the risk is important. If, say, your nation is facing a life-or-death struggle, or if your outpost is about to be overrun by 10,000 Bigtopian guerrillas, you might want to get hopped up on meth and throw yourself into the final battle.


The effects of illegal narcotics, including amphetamines, are overstated by opponents and understated by users, this is true. From my side though:
> All amphetamines have severe side effects in the long run. So much so that they haven't been prescribable outside very niche conditions (ADD, Narcolepsy) in the UK for decades. This is assuming 100% purity. Impurities are certainly dangerous and much of the media hype focuses on that and the impact of certain administration routes (smoking -> mouth damage, lung damage, injection -> abcess). They don't focus on profound depression and insomnia so much. I've met patients on long term medical amphetamines who have suffered greatly from the side effects, though not as much as from narcolepsy.
> Supervision of use is certainly important- pilots are a good example as they are well supervised, and when finished with a sortie return to a relative safe haven, higher tier accommodation, and enforced rest for safety's sake. The average grunt doesn't cost millions to train and doesn't operate millions to billions of dollars worth of kit, so inevitably the supervision is not going to be as strict, both of administering and supervising performance enhancers. Morphine goes missing in service more times then I can mention.
> I certainly agree with you on situational risk. At the end of it, you have to look at the risk in the immediate/ mid term, and what happens after the war with the population . Its finding that balance - NS being different in that sense.

At the end of the day, it becomes a question of one off use versus routine use. From your arguments i would certainly agree one time use is feasible given appropriate structures of supervision and discipline; frequent use though is highly questionable. If your ideology is taking soldiers to die in suicide attacks and such like, yes drug use is in all likelihood expected, but one has to question the long term success of such a model. As I recall, the Iraqi insurgent threat of drug-addled suicide fighters was addressed with highet calibre munitions in routine use, the police in the UK addressing this by training armed officers to go for head/brainstem shots rather than centre of mass.

Interestingly enough, my brief literature review brought up similar, if weaker correlations, for Modafinil as for Amphetamines, reference long term sleep disorder, depression, and anxiety.

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Postby Allanea » Wed Dec 14, 2016 4:26 am

That's strange because I've read that modafinil is almost entirely safe. But then I'm not a doctor and everything I've read includes publications in the non-specialist press.

The chief use of enhancement drugs seems to be, historically, in the context of situations where soldiers are expected to operate for unusual amounts of hours without rest, i.e. in unusually heavy fighting.

[I am exempting here the Japanese plan, effectively, for national suicide by 'let's get high on meth and fight the American landing forces' since this was never implemented]
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Postby Allanea » Wed Dec 14, 2016 4:26 am

Also, ADD is hardly niche.

https://www.theguardian.com/society/201 ... tal-health

This suggests that lots of kids are being medicated for it, but I am not sure whether 'a million prescriptions per year' is really niche.

I actually have a book in my possession that contains medical information about amphetamines...

This one.

I'll look through what it says and get back to you, if you are interested.
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Postby Rich and Corporations » Wed Dec 14, 2016 5:32 am

nothing more important than getting there the fastest with the mostest
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Postby Allanea » Wed Dec 14, 2016 5:35 am

Rich and Corporations wrote:nothing more important than getting there the fastest with the mostest


He ain't wrong.

Or, to quote (supposedly) Peter the Great: the women will birth new ones.
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Postby Greater Themis » Wed Dec 14, 2016 5:40 am

Allanea wrote:Also, ADD is hardly niche.

https://www.theguardian.com/society/201 ... tal-health

This suggests that lots of kids are being medicated for it, but I am not sure whether 'a million prescriptions per year' is really niche.


That's in the context of a billion prescriptions a year for all medicines on the NHS. I'll admit that I have relatively little exposure to childhood prescribing.

I actually have a book in my possession that contains medical information about amphetamines...

This one.

I'll look through what it says and get back to you, if you are interested.


Would be an interesting read - the cover looks a bit pop-science, but I'll see if I can get a copy to read through. Never judge a book by its cover, I suppose ;). For my part, the medical reference:
https://www.evidence.nhs.uk/formulary/b ... y-disorder

And I tend to use Rang & Dale's pharmacology textbook as a general guide for the mechanism more than anything, though that's not necessarily relevant in the cultural context of amphetamine use.

That's strange because I've read that modafinil is almost entirely safe. But then I'm not a doctor and everything I've read includes publications in the non-specialist press.


The majority of reports into Modafinil are based on anecdotal evidence, given the vast number of users are self-medicating and using as a performance enhancer. My brief pubmed and web of science searches picked up a mix of positive findings (assists in fatigue post-chemotherapy) and negative findings (addiction, mood disorder, hypersexuality) - though again there is no real controlled study into the use of Modafinil. This is further compounded by the perceived psychological impact of the drug, and difficulty in nailing down psychiatric symptoms as a measure from a study.

The chief use of enhancement drugs seems to be, historically, in the context of situations where soldiers are expected to operate for unusual amounts of hours without rest, i.e. in unusually heavy fighting.


And this seems to be one of few conditions where they may be useful. I would still wonder whether the availability of such drugs would see commanders more encouraged to engage in longer periods of fighting between periods of rest - the tendency is to use something that may work repeatedly, rather that save for a one-off. I do feel that we could debate for days on the issue - in the end it's down to the balance of risks we've discussed, both for and against using them.

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Allanea
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Postby Allanea » Wed Dec 14, 2016 5:46 am

#HyperEarthBestEarth

Sometimes, there really is money on the sidewalk.

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Morrdh
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Postby Morrdh » Wed Dec 14, 2016 6:16 am

Exercise Lionheart in 1984 was a big logistics test for the British Armed Forces and, to a degree, NATO.

Theres a video series on Yotube that covers a fair bit of the logistics.

https://www.youtube.com/watch?v=KU-qmHYXosQ
Irish/Celtic Themed Nation - Factbook

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Allanea
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Postby Allanea » Wed Dec 14, 2016 6:20 am

Thanks Morrdh!
#HyperEarthBestEarth

Sometimes, there really is money on the sidewalk.

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