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3-55 | 83 | Index
Entries are by paragraph number.
plan, information collection, requirements management zone, 1-73
1-12,1-20, A-2 system, 6-20–6-22 sustainability, 3-29
tactical, 5-7–5-8
resources, characteristics, 3-24 synchronization, defined, 3-2
planning, 2-12 guidelines, 6-28
assumptions, 3-35–3-36 joint ISR, 6-8–6-11 T
considerations, 3-4–3-5 retask assets, 4-29 tactical, information collection
information collection, 2-3 assets, 5-7–5-8
risk assessment, 3-37–3-38
national ISR, 6-19
targeting working group, 2-39–
route, 1-46
planning systems, joint ISR, 6-12 2-41
running estimate, 3-59
point surveillance, 1-75 information collection support,
defined, 1-3
2-40
production, requirements of, 3–
48-3–50 S results, 2-41
tasks, information collection,
products, IPB, 3–16 scheme of support, information
1-30–1-83, 3-19
collection, 4-8–4-30
pull, reconnaissance, 1–54
reconnaissance, 1-31–1-34
screen reports, 4-16–4-17
push, reconnaissance, 1–55 technical channels, 1-10
security operations, 1-77–1-81
R technical channels, applicable
fundamentals, 1-80
laws and policies, 1-11
range, capability, 3-21–3-22 protect the force, 1-78
establish, 1-10–1-13
receipt of mission, 3-9–3-12 shaping operations, 1-77 subtasks, 1-9–1-17
tasks, 1-79
reconnaissance, 1-31–1-59 supervision of intelligence
accurate and timely shaping operations, security assets, 1-13
information, 1-41 operations, 1-77 technical characteristics,
assets, 1-39 signals intelligence, 1-82 resources, 3-24
continuous, 1-38
site exploitation, defined, 4-10 technical intelligence, 1-82
course of action, 1-33
support to, 4-10–4-11
tempo, defined, 1-56
criteria, 1-52, 1-59
special operations forces, reconnaissance, 1-56–1-58
defined, 1-31
capabilities, 5-20
deployment of, 5-14 threat activity, 3-28
conventional forces and, 5-21
develop, 1-44 threat event template, 3-17
effort, 1-40 staff
timeliness, reporting, 3-25
enemy contact, 1-43 efforts, 2–6
forceful and stealthy, 1-58 feedback, 4–18 tools, information collection plan,
forms, 1-45–1-51 functions, 3–3 3-43
freedom of maneuver, 1-42 input, 1-27–1-29 intelligence estimate, 3-11
fundamentals, 1-37–1-44 intelligence, 3-18 transition, 4-30
instructions, 1-36 responsibilities, 2–34–2–35 information collection assets,
IPB, 1-33 role, 2-20–2-26 5-15–5-17
methods, 1-32 running estimate, 2-25
objective, 1-35 support from, 2-26 U–V
tempo, 1-56–1-58 strategic, information collection understanding, commander, 2-1,
reconnaissance and assets, 5-5 2-10
surveillance, intelligence factors of, 2-2
surveillance, 1-60–1-76
and, 1-2
area, 1-74 unified action, 6-1–6-2
reconnaissance in force, 1-49 characteristics, 1-67–1-71 defined, 6-1
reports, correlate to requirements, continuous, 1-68 vulnerability, 3-30
4-13–4-15 defined, 1-60
screen, 4-16–4-17 early warning, 1-69 W
requests for collection or support, key targets, 1-70 war game, COA analysis, 3-55
network, 1-76
3-45–3-47 working group, description, 2-27
observation, 1-61
requests for information, 3-45– overlapping coverage, 1-71 fusion, 2-38
3-47 performing, 1-62 input from, 2-27–2-41
national ISR, 6-19 point, 1-75 operations and intelligence
working group, 2-30–2-37
requirements, correlate to reports, tasks, 1-62
targeting, 2-39–2-41
4-13–4-15 types, 1-72–1-76
develop, 4-28 watch, 1-65 |
3-55 | 84 | Index
Entries are by paragraph number.
Z zone, 1-47 zone surveillance, 1-72 |
3-55 | 85 | FM 3-55
3 May 2013
By order of the Secretary of the Army:
RAYMOND T. ODIERNO
General, United States Army
Chief of Staff
Official:
JOYCE E. MORROW
Administrative Assistant to the
Secretary of the Army
1311403
DISTRIBUTION:
Active Army, Army National Guard/Army National Guard of the United States, and United States
Army Reserve: To be distributed according to the initial distribution number (IDN) 116035, |
4-02 | 1 | FM 4-02
ARMY HEALTH
SYSTEM
NOVEMBER 2020
DISTRIBUTION RESTRICTION:
Approved for public release; distribution is unlimited.
This publication supersedes FM 4-02, dated 26 August 2013. |
4-02 | 2 | This publication is available at the Army Publishing Directorate site
(https://www.armypubs.army.mil), and the Central Army Registry |
4-02 | 3 | FM 4-02, C1
Change 1 Headquarters
Department of the Army
Field Manual
Washington, D.C., 14 July 2022
No. 4-02
Army Health System
1.Change 1 to FM 4-02 clarifies the roles and responsibilities of the U.S. Army Medical Command and the
Defense Health Agency in support of defense support of civil authorities tasks.
2.New or changed material is indicated by a star ( ).
★
3.Change FM 4-02, dated 17 November 2020, as follows:
Remove Old Pages Insert New Pages
page 4-11 through 4-12 page 4-11 through 4-12
4.File this transmittal sheet in front of the publication. |
4-02 | 4 | FM 4-02, C1
14 July 2022
By Order of the Secretary of the Army:
JAMES C. MCCONVILLE
General, United States Army
Chief of Staff
Official:
MARK F. AVERILL
Administrative Assistant
to the Secretary of the Army
2218706
DISTRIBUTION:
Active Army, Army National Guard, and United States Army Reserve. Distributed in
electronic media only (EMO). |
4-02 | 5 | *FM 4-02
Field Manual Headquarters
No. 4-02 Department of the Army
Washington, D.C., (17 November 2020)
Army Health System
Contents
Page
PREFACE................................................................................................................... vii
INTRODUCTION ......................................................................................................... ix
PART ONE ARMY HEALTH SYSTEM
Chapter 1 ARMY HEALTH SYSTEM OVERVIEW .................................................................... 1-2
Section I — Operational Environment ................................................................... 1-2
Threats ....................................................................................................................... 1-2
Health Threat ............................................................................................................. 1-3
Section II — Warfighting Functions ....................................................................... 1-4
System of Systems .................................................................................................... 1-4
Force Health Protection Mission ............................................................................... 1-4
Health Service Support Mission ................................................................................ 1-4
Section III — Tactical Combat Casualty Care ....................................................... 1-6
Care Under Fire ......................................................................................................... 1-6
Tactical Field Care ..................................................................................................... 1-6
Tactical Evacuation ................................................................................................... 1-6
Casualty Evacuation .................................................................................................. 1-7
Medical Evacuation ................................................................................................... 1-7
Patient Evacuation ..................................................................................................... 1-8
Section IV — Army Health System Principles ...................................................... 1-8
Conformity ................................................................................................................. 1-8
Proximity .................................................................................................................... 1-9
Flexibility .................................................................................................................... 1-9
Mobility ....................................................................................................................... 1-9
Continuity ................................................................................................................... 1-9
Control ..................................................................................................................... 1-10
Roles of Medical Care ............................................................................................. 1-10
Eligibility of Care Determination .............................................................................. 1-13
Knowledge of Health Care Capabilities ................................................................... 1-13
Dissemination of Eligibility for Care Information ...................................................... 1-13
Documentation ........................................................................................................ 1-14
Sample Eligibility for Care Matrix ............................................................................ 1-14
Health Information Technology ............................................................................... 1-15
Section V — Global Health Engagement ............................................................. 1-19
DISTRIBUTION RESTRICTION: Approved for public release distribution unlimited.
*This publication supersedes FM 4-02, dated 26 August 2013 |
4-02 | 6 | Contents
Chapter 2 ARMY HEALTH SYSTEM COMMAND AND CONTROL ........................................ 2-1
Section I — Overview of Army Echelons .............................................................. 2-1
Operational Environment .......................................................................................... 2-1
Army Command and Support Relationships ............................................................. 2-3
Theater Army ............................................................................................................ 2-4
Theater Army Surgeon's Section .............................................................................. 2-5
Theater Sustainment Command ............................................................................... 2-6
Section II — Medical Command and Control Organizations .............................. 2-8
Medical Command (Deployment Support) .............................................................. 2-10
Medical Brigade (Support) ...................................................................................... 2-21
Medical Battalion (Multifunctional) .......................................................................... 2-30
Section III — Medical Commander, Command Surgeon, and Line ..........................
Commander ........................................................................................................... 2-36
Medical Commander ............................................................................................... 2-36
Command Surgeon ................................................................................................. 2-37
Commander ............................................................................................................ 2-40
Section IV — Army Health System Team of Teams ........................................... 2-42
Chapter 3 ARMY HEALTH SYSTEM THE EFFECTS OF THE LAW OF LAND WARFARE
AND MEDICAL ETHICS ........................................................................................... 3-1
Section I — The Law of Land Warfare................................................................... 3-1
Section II — Geneva Conventions ......................................................................... 3-1
Protection and Care .................................................................................................. 3-1
Enemy Wounded And Sick ....................................................................................... 3-3
Medical Repatriation ................................................................................................. 3-4
Protection and Identification of Medical Personnel ................................................... 3-4
Protection and Identification of Medical Units, Establishments, Buildings, Materiel,
and Medical Transports ............................................................................................ 3-6
Conditions not Depriving Medical Units and Establishments of Protection .............. 3-9
The 1977 Protocols to the Geneva Conventions .................................................... 3-10
Compliance with the Geneva Conventions ............................................................. 3-10
Medical Care for Detained Personnel ..................................................................... 3-11
Section III — Medical Ethics ................................................................................ 3-11
Ethical Considerations for the Medical Treatment of Detainees ............................. 3-11
Chapter 4 ARMY HEALTH SYSTEM OPERATIONS ............................................................... 4-1
Section I — Planning For Army Health System Support .................................... 4-1
Unified Land Operations ........................................................................................... 4-1
Operational Variables ............................................................................................... 4-1
Mission Variables ...................................................................................................... 4-5
Task-Organization ..................................................................................................... 4-7
Section II — Support To Decisive Action ............................................................. 4-7
Offensive Tasks ........................................................................................................ 4-8
Defensive Tasks ........................................................................................................ 4-8
Stability Tasks ........................................................................................................... 4-9
Defense Support of Civil Authorities ....................................................................... 4-10
Section III — Setting the Theater, Theater Opening, Early Entry, and
Expeditionary Medical Operations ...................................................................... 4-11
Theater Opening and Early Entry Operations ......................................................... 4-12
Expeditionary Medical Operations .......................................................................... 4-12
Section IV — Support To Detainee Operations .................................................. 4-14
Medical Personnel Organic to Maneuver Units ...................................................... 4-15 |
4-02 | 7 | Contents
Medical Personnel Organic to Military Police Units ................................................. 4-16
Army Health System Units in Support of Detainee Operations ............................... 4-16
PART TWO FORCE HEALTH PROTECTION
Chapter 5 OPERATIONAL PUBLIC HEALTH .......................................................................... 5-1
Mission ....................................................................................................................... 5-2
Protection Warfighting Function ................................................................................ 5-2
Organizations and Personnel .................................................................................... 5-2
Primary Tasks ............................................................................................................ 5-3
Chapter 6 VETERINARY SERVICES ........................................................................................ 6-1
Section I — Veterinary Responsibilities ................................................................ 6-1
Section II — Food Protection Mission ................................................................... 6-3
Section III — Animal Care Mission ........................................................................ 6-3
Veterinary Role 1 Medical Care ................................................................................ 6-4
Veterinary Role 2 Medical Care ................................................................................ 6-6
Veterinary Role 3 Medical Care ................................................................................ 6-6
Veterinary Role 4 Medical Care ................................................................................ 6-7
Section IV — Veterinary Public Health .................................................................. 6-7
Chapter 7 COMBAT AND OPERATIONAL STRESS CONTROL ............................................ 7-1
Section I — Combat and Operational Stress Control Responsibilities ............. 7-1
Section II — Program and Resources ................................................................... 7-1
Brigade Combat Teams ............................................................................................. 7-1
Medical Company (Area Support) ............................................................................. 7-2
Medical Detachment, Combat and Operational Stress Control ................................ 7-2
Primary Tasks ............................................................................................................ 7-2
Section III — Behavioral Health and Neuropsychiatric Treatment Aspects ...... 7-3
Treatment Provision .................................................................................................. 7-3
Primary Tasks ............................................................................................................ 7-3
Chapter 8 DENTAL SERVICES ................................................................................................. 8-1
Section I — Dental Services Preventive Dentistry ............................................... 8-1
Preventive Measures ................................................................................................. 8-1
Primary Tasks ............................................................................................................ 8-1
Section II — Dental Services Treatment Aspects ................................................ 8-1
Levels of Dental Support ........................................................................................... 8-2
Categories of Dental Care ......................................................................................... 8-2
Primary Tasks ............................................................................................................ 8-3
Chapter 9 LABORATORY SERVICES ...................................................................................... 9-1
Section I — Area Medical Laboratory Support ..................................................... 9-1
Field Environmental Laboratory ................................................................................ 9-1
Primary Tasks ............................................................................................................ 9-2
Section II — Clinical Laboratory Services ............................................................ 9-3
Chemical, Biological, Radiological, And Nuclear Clinical Laboratory Support .......... 9-3
Primary Tasks ............................................................................................................ 9-3
PART THREE HEALTH SERVICE SUPPORT
Chapter 10 DIRECT PATIENT CARE ........................................................................................ 10-1
Section I — Medical Treatment (Organic and Area Support) ............................ 10-1
Medical Company .................................................................................................... 10-2 |
4-02 | 8 | Contents
Primary Tasks ......................................................................................................... 10-2
Section II — Theater Hospitalization ................................................................... 10-2
Primary Tasks ......................................................................................................... 10-3
Combat Support Hospitals ...................................................................................... 10-3
Hospital Center ....................................................................................................... 10-5
Hospital Center Components and Employment ...................................................... 10-6
Augmentation Teams .............................................................................................. 10-7
Chapter 11 MEDICAL EVACUATION ....................................................................................... 11-1
Section I — Integrated Medical Evacuation System .......................................... 11-1
Theater Evacuation Policy ...................................................................................... 11-1
Organizations .......................................................................................................... 11-3
Primary Tasks ......................................................................................................... 11-4
Section II — Medical Regulating .......................................................................... 11-4
Section III — Strategic Medical Evacuation and Patient Movement ................ 11-5
Chapter 12 MEDICAL LOGISTICS ........................................................................................... 12-1
Section I — Medical Logistics Management in an Operational Environment. 12-1
Section II — Medical Logistics System............................................................... 12-1
Medical Logistics Management Center ................................................................... 12-1
Medical Logistics Company .................................................................................... 12-2
Medical Detachment (Blood Support) ..................................................................... 12-2
Medical Detachment Optometry ............................................................................. 12-2
Primary Tasks ......................................................................................................... 12-2
Section III — Strategic Medical Logistics Support ............................................ 12-2
Section IV — Medical Logistics Support for Roles 1 and 2 Medical Treatment
Facilities ................................................................................................................. 12-5
Section V — Medical Logistics Support for Role 3 Medical Treatment
Facilities ................................................................................................................. 12-5
Section VI — Medical Logistics Support to joint Health Services ................... 12-5
Appendix A ARMY HEALTH SYSTEM SUPPORT TO THE ARMY’STRATEGIC ROLES ........ A-1
Appendix B COMMAND AND SUPPORT RELATIONSHIP ........................................................ B-1
Appendix C SURGEON AND SURGEON SECTION ................................................................... C-1
Appendix D MEDICAL INTELLIGENCE ...................................................................................... D-1
Appendix E INSTITUTIONAL FORCE SUPPORT TO THE OPERATIONAL ARMY ................. E-1
Appendix F ARMY HEALTH SYSTEM SYMBOLS ..................................................................... F-1
GLOSSARY ................................................................................................ Glossary-1
REFERENCES ........................................................................................ References-1
INDEX ............................................................................................................... Index-1
Figures
Figure 1-1. System of systems ..................................................................................................... 1-5
Figure 1-2. Army Health System support operational framework ................................................. 1-5
Figure 1-3. Army Health System Principles .................................................................................. 1-8
Figure 2-1. Army Health System support logic chart .................................................................... 2-2 |
4-02 | 9 | Contents
Figure 2-2. Army Health System command and support relationships ......................................... 2-4
Figure 2-3. Medical structure in theater ........................................................................................ 2-6
Figure 2-4. Notional deployed medical command (deployment support) ................................... 2-11
Figure 2-5. Medical Command (deployment support) organizational structure .......................... 2-13
Figure 2-6. Medical command (deployment support) staff structure ........................................... 2-14
Figure 2-7. Notional deployed medical brigade (support) ........................................................... 2-21
Figure 2-8. Medical brigade (support) organizational structure .................................................. 2-22
Figure 2-9. Medical brigade (support) staff structure .................................................................. 2-24
Figure 2-10. Notional deployed medical battalion (multifunctional) ............................................ 2-31
Figure 2-11. Medical battalion (multifunctional) organizational structure ................................... 2-32
Figure 2-12. Medical battalion (multifunctional) staff structure ................................................... 2-33
Figure 2-13. Army Health System—a team of teams .................................................................. 2-42
Figure 9-1. Four levels of identification ......................................................................................... 9-2
Figure A-1. Army Health System support during operations to shape .......................................... A-2
Figure A-2. Army Health System support during operations to prevent........................................ A-3
Figure A-3. Army Health System support during large-scale ground combat operations ............. A-5
Figure A-4. Army Health System support during operations to consolidate gains ........................ A-7
Figure C-1. Surgeon link to medical and warfighting functions .................................................... C-3
Figure C-2. Ten medical functions aligned with warfighting functions ......................................... C-3
Figure C-3. Surgeon and protection/sustainment cell coordination and synchronization matrix . C-4
Figure E-1. The Soldier Recovery Unit ......................................................................................... E-4
Tables
Introductory Table-1. Rescinded Army terms ................................................................................... x
Introductory Table-2. Modified Army terms ...................................................................................... xi
Table 1-1. Health threat ................................................................................................................. 1-3
Table 1-2. Sample eligibility for medical and dental care support matrix .................................... 1-15
Table 2-1. Primary tasks and purposes of the medical command and control function ............... 2-9
Table 4-1. Medical aspects of the operational variables ............................................................... 4-2
Table 4-2. Offensive tasks, purposes, and key medical considerations ....................................... 4-8
Table 4-3. Defensive tasks, purposes, and key medical considerations ...................................... 4-9
Table 4-4. Stability tasks, purposes, and key medical considerations ........................................ 4-10
Table 4-5. Defense support of civil authorities tasks, purposes, and key medical considerations . 4-
10
Table 4-6. Example of Army Health System activities which may be conducted in theater opening
and expeditionary medical operations ...................................................................... 4-13
Table 4-7. Focus of Army Health System support to detainee operations ................................. 4-14
Table 5-1. Primary tasks and purposes of the operational public health function ........................ 5-3
Table 6-1. Primary tasks and purposes of veterinary services ..................................................... 6-2
Table 6-2. Primary tasks and purposes of veterinary services treatment ..................................... 6-4
Table 7-1. Primary tasks and purposes of the combat and operational stress control function ... 7-2 |
4-02 | 10 | Contents
Table 7-2. Primary tasks and purposes of behavioral health/neuropsychiatric treatment ............ 7-3
Table 8-1. Primary tasks and purposes of preventive dentistry ................................................... 8-1
Table 8-2. Primary tasks and purposes of the dental services function ....................................... 8-3
Table 9-1. Primary tasks and purposes of the operational medical laboratory function performed
by the area medical laboratory ................................................................................... 9-2
Table 9-2. Primary tasks and purposes of the clinical laboratory services ................................... 9-3
Table 10-1. Primary tasks and purposes of the medical treatment (organic and area support)
function ..................................................................................................................... 10-2
Table 10-2. Primary tasks and purposes of theater hospitalization function .............................. 10-4
Table 10-3. Hospital center and hospital augmentation detachment bed and surgical hour
capabilities ................................................................................................................ 10-8
Table 10-4. Example hospital center configuration (maximum 240 beds) in support of full range
military operations .................................................................................................... 10-9
Table 10-5. Example hospital center configuration (maximum 240 beds) in support of foreign
humanitarian assistance or stability operations ....................................................... 10-9
Table 11-1. Primary tasks and purposes of the medical evacuation function ............................ 11-4
Table 12-1. Primary tasks and purposes of the medical logistics function ................................. 12-3
Table B-1. Army command relationships ...................................................................................... B-3
Table B-2. Army support relationships .......................................................................................... B-5
Table C-1. Surgeon section by echelon ........................................................................................ C-5
Table C-2. Medical reports ............................................................................................................ C-6
Table C-3. Coordinations between surgeon/surgeon section and staff elements ........................ C-7
Table D-1. Checklist for assessing a foreign medical infrastructure ............................................ D-7
Table D-2. Checklist for assessing foreign medical treatment facility capabilities and services .. D-8
Table F-1. Medical main icons ...................................................................................................... F-1
Table F-2. Medical sector 1 modifier ............................................................................................ F-2
Table F-3. Medical sector 2 modifiers ........................................................................................... F-3
Table F-4. Medical main icons for activities .................................................................................. F-4
Table F-5. Medical sector 1 modifiers for activities ...................................................................... F-4
Table F-6. Medical CBRN control measures ................................................................................ F-4
Table F-7. Medical sustainment control measures ....................................................................... F-5
Table F-8. AHS unit or element symbols ...................................................................................... F-6
Table F-9. AHS vehicle symbols ................................................................................................. F-10 |
4-02 | 11 | Preface
FM 4-02 provides doctrine for the Army Health System (AHS) in support of the modular force. The AHS is
the overarching concept of support for providing timely AHS support to the tactical commander. It discusses
the current AHS force structure which was modernized under the Department of the Army-approved Medical
Reengineering Initiative and the Modular Medical Force. These modernization efforts were designed to
support the brigade combat teams and echelons above brigade units.
The principal audience for FM 4-02 is all members of the profession of arms. Commanders and staffs of
Army headquarters serving as joint task force or multinational headquarters should also refer to applicable
joint or multinational doctrine concerning the range of military operations and joint or multinational forces.
Trainers and educator throughout the Army will also use this publication.
Commanders, staffs, and subordinates ensure that their decisions and actions comply with applicable United
States, international, and in some cases host-nation laws and regulations. Commanders at all levels ensure
that their Soldiers operate in accordance with the law of war and the rules of engagement. (See FM 6-
27/MCTP 11-10C). It is to be used as a guide in both obtaining and providing AHS support in an area of
operations. Information in this publication is applicable to decisive actions in support of unified land
operations. It is compatible with the Army’s sustainment and protection doctrine and is also in agreement
with Joint Publication 4-02.
This publication implements or is in consonance with the following North Atlantic Treaty Organization
(NATO) Standardization Agreements (STANAGs); American, British, Canadian, Australian, and New
Zealand (ABCANZ) Standards.
NATO ABCANZ
TITLE STANAG STANDARDS
Blood Supply in the Area of Operations 815
Identification of Medical Materiel for Field Medical Installations
2060
AMedP-1.5
Forward Aeromedical Evacuation—AAMedP-1.5 2087
ABCA Medical Professional Credentialing/Privileging 2108
Documentation Relative to Initial Medical Treatment and
2132
Evacuation— AMedP-8-1
Allied Joint Doctrine for Medical Support—AJP-4.10 2228
Road Movements and Movement Control—AMovP-1(A) 2454
Orders for the Camouflage of Protective Medical Emblems on Land
2931
in Tactical Operation—ATP 79
Minimum Requirements for Blood, Blood Donors and Associated
2939
Equipment
Aeromedical Evacuation—AAMedP-1.1 3204
FM 4-02 uses joint terms where applicable. Selected joint and Army terms and definitions appear in both
the glossary and the text. Terms for which FM 4-02 is the proponent publication (the authority) are italicized
in the text and are marked with an asterisk (*) in the glossary. Terms and definitions for which FM 4-02 is
the proponent publication are boldfaced in the text. For other definitions shown in the text, the term is
italicized and the number of the proponent publication follows the definition.
This publication applies to the Active Army, Army National Guard/Army National Guard of the United
States, United States Army Reserve, Army Civilian Corps, and Army contracted medical providers, unless
otherwise stated. |
4-02 | 12 | Preface
Due to the nature of the medical profession which is highly regulated throughout both the civilian and military
communities, Army Medicine doctrine is heavily influenced by—
* United States and international law (including respective U.S. and allied-nation health regulating
agencies).
* Policy guidance in the form of Army Regulations and Department of Defense (DOD) policy
promulgated in the form of DOD Directives (DODD) and DOD Instructions (DODI) and other
documents.
* Medical standards established by civilian organizations (such as The Joint Commission).
* Technical guidance from both military and civilian organizations charged with medical/scientific
oversight responsibilities.
Throughout this publication, as appropriate, reference is made to the major policy guidance impacting each
specific topic. These references should not be considered as the only policy guidance available. When issues
arise that require consideration of policy guidance, the issue should be thoroughly researched and, as
appropriate, coordinated with the supporting staff judge advocate or governmental/nongovernmental agency
involved.
The proponent of FM 4-02 is the United States Army Medical Center of Excellence. The preparing agency
is the Doctrine Literature Division, United States Army Medical Center of Excellence. Send comments and
recommendations on Department of Army (DA) Form 2028 (Recommended Changes to Publications and
Blank Forms) to Commander, United States Army Medical Center of Excellence, ATTN: MCCS-FD (FM
4-02), 2377 Greeley Road, Suite D, JBSA Fort Sam Houston, TX 78234-7731; by e-mail to
[email protected] or submit an electronic DA Form 2028. |
4-02 | 13 | Introduction
The content of this update remains generally consistent with the 2013 publication on key topics while
adopting updated terminology and concepts as necessary. Key topics include AHS, FHP, Health Service
Support, ten medical functions, and law of land warfare and medical ethics.
The material presented in this publication reflects enduring practices in providing timely AHS support to the
tactical commander. This publication depicts AHS operations from the point of injury or wounding through
successive roles of care within the area of operations and evacuation to the continental United States-support
base.
Summary of changes include:
* Aligning this publication with Army hierarchy publications including FM 3-0 and FM 4-0.
* Aligning this publication with Joint Publication 4-02, Joint Health Services’ FHP and HSS
definitions and descriptions.
* Reorganizing the order of the publication; FHP is now Part Two while HSS is Part Three.
* Revising the definitions of the following terms: Army Health System, force health protection,
health service support, definitive care, essential care, and triage.
* Replacing the mission command medical function with medical command and control; this is in
line with ADP 6-0.
* Replacing “field preventive medicine” with “operational public health” according to AR 40-5.
* Adding Global Health Engagement information.
* Adding hospital center information.
* Adding an appendix discussing AHS support to the Army’s strategic roles (shape operational
environments, prevent conflict, prevail in large-scale ground combat, consolidate gains).
* Adding an appendix derived from FM 3-0 discussing command and support relationships.
* Adding a surgeon and surgeon section appendix.
* Adding the approved medical symbols appendix.
As the Army’s AHS doctrine statement, this publication identifies medical functions and procedures that are
essential for operations covered in other Army Medicine proponent manuals. This publication depicts AHS
operations from the point of injury or wounding, through successive roles of care within the area of
operations, and evacuation to the continental United States (U.S.)-support base. It presents a stable body of
operational doctrine rooted in actual military experience and serves as a foundation for the development of
Army Medicine proponent manuals on how the AHS supports unified land operations.
The AHS mission falls within two warfighting functions- protection and sustainment. To clearly delineate
the two AHS missions of force health protection (FHP) and health service support (HSS), this publication is
divided into three parts- AHS overview, FHP, and HSS.
Field Manual 4-02 consists of three parts and 12 chapters:
Part One, AHS, provides a holistic view of the entire AHS and the complexities and interdependence of each
medical function in successfully accomplishing the Army Medicine’s mission to conserve the fighting
strength. This part of the manual describes and provides operational guidance on the AHS’s echelon above
brigade headquarters, as well as the medical aspects of the law of land warfare.
* Chapter 1 provides an overview of the AHS to include introduction information on tactical combat
casualty care, global health engagement, and the AHS principles.
* Chapter 2 discusses AHS command and control, overview of Army echelons, Army command and
support relationships, the AHS Team and its primary tasks, medical command and control |
4-02 | 14 | Introduction
organizations, and the roles and responsibilities of the medical commander, command surgeon,
and commander.
* Chapter 3 provides information regarding AHS and the effects of the law of land warfare and
medical ethics information.
* Chapter 4 discusses Army Health System operations; operational and mission variables; AHS
support to decisive action- offensive, defensive, stability tasks, defense support of civil authorities;
setting the theater; detainee operations; and maneuver units.
Part Two, FHP, encompasses the preventive and treatment aspects of the following medical functions:
veterinary services, combat and operational stress control, dental services, operational public health, and
laboratory services (area medical laboratory) including the testing of suspect biological and chemical warfare
agent samples.
* Chapter 5 describes operational public health’s mission, primary tasks, organizations and
personnel.
* Chapter 6 discusses veterinary services missions and primary tasks, consisting of the food
protection mission, animal care mission, and veterinary public health.
* Chapter 7 provides information on combat and operational stress control including primary tasks,
responsibilities, and programs and resources.
* Chapter 8 provides information on the preventive and treatment aspects of dental services.
* Chapter 9 discusses environmental and clinical medical laboratory services.
Part Three, HSS, encompasses medical treatment, medical evacuation (including medical regulating), and
medical logistics (including blood management). Health services support three mission sets include all of
the medical functions involved with direct patient care (medical treatment [organic and area support] and
hospitalization) to include diagnostic medical laboratories and the medical functions of medical evacuation
and medical logistics.
* Chapter 10 discusses direct patient activities including medical treatment (organic and area
support) and theater hospitalization (combat support hospital and hospital center).
* Chapter 11 provides information on medical evacuation to include integrated medical evacuation
system, medical regulating, and strategic medical evacuation and patient movement.
* Chapter 12 discusses medical logistics to include medical logistics management in an operational
environment, medical logistics command and control organizations, medical logistics support for
Roles 1 through 3 medical treatment facilities, and as theater lead agent for medical materiel and
the single integrated medical logistics manager.
The Medical Center of Excellence, Doctrine Literature Division is reorganizing the placement of terms and
definitions found in proponent publications within the Army Medicine Doctrine Publication Library. It was
determined that some of the terms are best suited in other publications within the Army Medicine Doctrine
Publication Library.
Based on current doctrinal changes, certain terms for which FM 4-02 is proponent have been added,
rescinded, or modified for purposes of this publication. The glossary contains acronyms an defined terms.
See introductory table-1, introductory table-2 on page xi for specific term changes.
Introductory Table-1. Rescinded Army terms
Term Remarks
Rescinded. Adopts common English usage. No longer
hospital formally defined.
preventive medicine Rescinded. |
4-02 | 15 | Introduction
Introductory Table-2. Modified Army terms
Term Remarks
Army Health System Modifies the definition.
casualty evacuation Modifies the definition.
combat and operational stress control Modifies the definition.
continuity of care Modifies the definition.
definitive care Modifies the definition.
essential care Modifies the definition.
first aid (self-aid/buddy aid) Modifies the definition removing gender pronoun.
Force Health Protection Modifies the definition.
Health Service Support Modifies the definition.
triage Modifies the definition. |
4-02 | 17 | PART ONE
Army Health System
The Army Health System (AHS) is a component of the Military Health System
(MHS) that is responsible for operational management of the health service
support and force health protection missions for training, predeployment,
deployment, and postdeployment operations. The Army Health System
includes all mission support services performed, provided, or arranged by the
Army Medicine to support health service support (HSS) and force health
protection (FHP) mission requirements for the Army and as directed, for joint,
intergovernmental agencies, coalition, and multinational forces. The AHS is a
complex system of systems that is interdependent and interrelated and requires
continual planning, coordination, and synchronization to effectively and efficiently clear
the battlefield of casualties and to provide the highest standard of care to our wounded
or ill Soldiers. Part One of this publication provides a holistic view of the AHS;
specifically describing its composition, along with its overarching architecture of its
design and functions without regard to the specific warfighting functions under which
it operates.
This part of the publication—
● Discusses the foundations of the Army Medicine and the fundamental
principles which have guided the provision of AHS support on the battlefield throughout
its history. It describes the roles of medical care which facilitate providing care at the
point of injury (POI) or wounding and describes the system of phased and
incrementally increasing capabilities which enables the wounded or ill Soldier to be
stabilized and evacuated to the appropriate medical treatment facility. The goal is then
to care for their specific medical condition and to restore them to health, limit long-term
disability, and either return then to duty or to their civilian life as a productive member
of that community. The term stabilized patient refers to a patient whose airway is
secured, hemorrhage is controlled, shock treated, and fractures are immobilized.
(Joint Publication [JP] 4-02)
● Provides an in-depth discussion on the provisions of the Geneva Conventions,
the law of land warfare, and medical ethics and their impact on conduct of AHS
operations. It describes the primary tasks of the AHS in support of operations
characterized by offensive, defensive, stability, and defense support of civil authorities
tasks. Further, it discusses AHS support to detainee operations and the roles and
responsibilities of the detainee operations medical director.
● Discusses the AHS medical command and control organizations, their
functions, and responsibilities. It also provides an in-depth discussion of the Army
Medicine team, the medical commander, the command surgeon, and the involvement
required of the commander.
● Provides information on the role of the institutional force and the support
provided to the operational Army. It also provides a brief description of the Warrior |
4-02 | 18 | Chapter 1
Transition Program for the continued care, convalescence, and rehabilitative treatment
of our returning wounded Warriors.
● Provides information on the importance of medical intelligence for the
identification of health hazards affecting deployed forces and the medical aspects of
intelligence preparation of the battlefield (IPB).
Chapter 1
Army Health System Overview
The AHS is a component of the Department of Defense (DOD) MHS. Although the
MHS is an interrelated system which may share medical services, capabilities, and
specialties among the United States (U.S.) Service components, it is not a joint
command and control system. Each Service component develops its medical resources
to support its Service-specific mission. This results in the development of different
types of organizations with varying levels of capability, mobility, and survivability.
Although joint medical resources may have similar nomenclature to describe the unit,
they are not usually interchangeable. For information on joint health services refer to
JP 4-02.
SECTION I — OPERATIONAL ENVIRONMENT
1-1. The Army accomplishes its mission by supporting the joint force in four strategic roles: shape
operational environments, prevent conflict, conduct large-scale ground combat operations, and consolidate
gains. The benchmark for Army readiness is its ability to conduct large-scale combat operations (LSCO)
fighting a near peer/peer threat with potential overmatch across multiple domains (including land, air,
maritime, space, cyberspace as well as electromagnetic spectrum and information environment).
1-2. A multi-domain approach to operations is not new. Army forces have effectively integrated
capabilities and synchronized actions in the air, land, and maritime domains for decades. Rapid and
continued advances in technology and the military application of new technologies to the space domain, the
electromagnetic spectrum, and the information environment (particularly cyberspace) require special
consideration in planning and converging effects from across all domains. Refer to FM 3-0 for more
information.
THREATS
1-3. An operational environment (OE) has a number of threats that consist of enemies, adversaries, neutrals,
and hybrid threats (force that combines traditional, irregular, disruptive, or catastrophic capabilities). These
threats are protracted confrontation among individuals, groups of individuals, paramilitary or military forces,
state actors, and nonstate actors increasingly willing to use violence to achieve their political and ideological
ends. There is a probability that in the future, United States Army forces will conduct operations in an urban
environment and in and around megacities. Urban areas are becoming safe havens and support bases for
terrorists, insurgents, or criminal organizations. For information on the OE see FM 3-0.
1-4. Commanders and staffs analyze an OE using the eight operational variables: political, military,
economic, social, information, infrastructure, physical environment, and time (See FM 6-0 for more
information on the operational variables). |
4-02 | 19 | Army Health System Overview
1-5. The Army Medicine views threats from two perspectives: the general threat and the health threat.
Although the Army Medicine’s primary concern is that of the health threat, the general threat must also be
fully considered as it influences the—
* Character, types, and severity of wounds and injuries to which our forces may be exposed.
* Enemy’s ability and willingness to disrupt AHS operations and to respect the conditions of the
Geneva Conventions in regards to the protection of AHS personnel while engaged in their
humanitarian mission.
HEALTH THREAT
1-6. The health threat faced by deployed U.S. forces is depicted in Table 1-1. The health threat is a
composite of ongoing or potential enemy actions; adverse environmental, occupational, and geographic and
meteorological conditions; endemic and emerging diseases; and employment of chemical, biological,
radiological, and nuclear (CBRN) weapons (to include weapons of mass destruction that have the potential
to affect the short- or long-term health [including psychological impact] of personnel).
Table 1-1. Health threat
Injuries Musculoskeletal injuries (primarily from physical training and
recreational activities)
Diseases Endemic, emerging, epidemic, and pandemic
Foodborne
Fomites
Waterborne
Arthropodborne
Zoonotic
Breeding grounds for vectors
Occupational and Climatic (heat, cold, humidity, and significant elevations above sea
Environmental Health (OEH) level)
hazards Toxic industrial materials
Accidental or deliberate dispersion of chemical, biological, and
radiological material
Disruption of sanitation services/facilities (such as sewage and waste
disposal)
Effects of industrial operations and industrial and operational noise
Poisonous or toxic flora and Toxic poisonous plants, bacteria, and fungus
fauna Poisonous reptiles, amphibians, arthropods, and animals
Medical effects of weapons Conventional (to include blast and mild traumatic brain
injury/concussion)
Improvised (to include improvised explosive devices)
Chemical, biological, radiological, and nuclear warfare agents
Directed energy
Weapons of mass destruction
Thermal (from nuclear blast or direct energy)
Combined injury (chemical, biological, radiological agent plus thermal,
blast, explosive, or projectiles)
Physiologic and Continuous operations
psychological stressors Combat and operational stress reactions
Wear of mission-oriented protective posture ensemble
Stability tasks
Home front issues |
4-02 | 20 | Chapter 1
SECTION II — WARFIGHTING FUNCTIONS
1-7. The Army Health System medical capabilities (ten medical functions) are grouped under two Army
warfighting functions- FHP under protection and HSS under sustainment warfighting functions. These
interrelated and interdependent medical functions are complex in nature and require medical command and
control for synchronization and integration. This ensures the interrelationships and interoperability of all
medical assets and optimizes the effective functioning of the entire system. To clearly delineate which
medical functions are grouped under which warfighting function, the Army is aligning with the joint Services
(according to JP 4-02) in grouping these ten medical functions.
SYSTEM OF SYSTEMS
1-8. The AHS is a complex system of systems (Figure 1-1). The systems which comprise the AHS are
divided into medical functions which align with medical disciplines and scientific knowledge. These systems
are interrelated and interdependent and must be meticulously and continuously synchronized to reduce
morbidity and mortality and to maximize patient outcome. The ten medical functions are:
* Medical command and control.
* Medical treatment (organic and area support).
* Hospitalization.
* Medical evacuation (to include medical regulating).
* Dental services.
* Operational public health.
* Combat and operational stress control.
* Veterinary services.
* Medical logistics (to include blood management).
* Medical laboratory services (to include both clinical laboratories and environmental laboratories).
1-9. The AHS medical functions are in consonance with joint doctrine, as described in JP 4-02. Figure 1-
2 below depicts the Army Health System operational framework. For more information on operational
framework refer to ADP 3-0 and FM 3-0.
FORCE HEALTH PROTECTION MISSION
1-10. The Army force health protection are measures that promote, improve, or conserve the behavioral and
physical well-being of Soldiers comprised of preventive and treatment aspects of medical functions that
include: combat and operational stress control, dental services, veterinary services, operational public health,
and laboratory services. Enabling a healthy and fit force, prevent injury and illness, and protect the force
from health hazards.
HEALTH SERVICE SUPPORT MISSION
1-11. The Army health service support is support and services performed, provided, and arranged by the
Army Medicine to promote, improve, conserve, or restore the behavioral and physical well-being of
personnel by providing direct patient care that include medical treatment (organic and area support) and
hospitalization, medical evacuation to include medical regulating, and medical logistics to include blood
management. Additionally, as directed, provide support in other Services, agencies, and organizations.
Health service support includes the treatment of CBRN patients. |
4-02 | 21 | Army Health System Overview
Figure 1-1. System of systems
Figure 1-2. Army Health System support operational framework |
4-02 | 22 | Chapter 1
SECTION III — TACTICAL COMBAT CASUALTY CARE
1-12. Tactical combat casualty care (TCCC) is divided into the three phases- care under fire, tactical field
care, and tactical evacuation care. Tactical combat casualty care occurs during a combat mission and is the
military counterpart to prehospital emergency medical treatment. Tactical combat casualty care in the
military is most commonly provided by enlisted personnel and includes self-aid and buddy aid (first aid),
combat lifesaver (enhanced first aid), and enlisted combat medics and critical care flight paramedics in the
Army, corpsmen in the United States Navy (USN), United States Marine Corps, and United States Coast
Guard, and both medics and pararescue men in the United States Air Force (USAF). Tactical combat casualty
care focuses on the most likely threats, injuries, and conditions encountered in combat and on a strictly limited
range of interventions directed at the most serious of these threats and conditions.
CARE UNDER FIRE
1-13. In the care under fire phase, combat medical personnel and their units are under effective hostile fire
and are very limited in the care they can provide. In essence, only those lifesaving interventions that must
be performed immediately are undertaken during this phase.
TACTICAL FIELD CARE
1-14. During the tactical field care phase, medical personnel and their patients are no longer under effective
hostile fire and medical personnel can provide more extensive patient care. In this phase, interventions
directed at other life-threatening conditions, as well as resuscitation and other measures to increase the
comfort of the patient may be performed. Physicians and physician assistants at battalion aid stations or
during tailgate medicine support also provide TCCC. During tactical field care, personnel must be prepared
to transition back to care under fire, or to prepare the casualty for tactical evacuation, as the tactical situation
dictates. Tailgate medical support refers to an economy of force device employed primarily to retain
maximum mobility during movement halts or to avoid the time and effort required to set up a formal,
operational treatment facility (for example, during rapid advance and retrograde operations). For
more information on tactical field care see ATP 4-02.3.
TACTICAL EVACUATION
1-15. In the tactical evacuation phase, casualties are transported from the battlefield to medical treatment
facilities (MTFs). Medical treatment facility refers to any facility established for the purpose of
providing medical treatment. This includes battalion aid stations, Role 2 facilities, dispensaries, clinics,
and hospitals. Evacuation can be by either medical evacuation (MEDEVAC) (dedicated platforms [ground
or air] manned with dedicated medical providers) or casualty evacuation (CASEVAC) (ranging from
nondedicated, but tasked, platforms [ground or air] augmented with medical equipment and providers to
platforms of opportunity without medical equipment or providers).
Note. The TCCC initiative originated with the Naval Special Warfare Command and later
continued by the United States Special Operations Command. Special operations forces do not
have a dedicated, designed, and equipped MEDEVAC capability. Therefore, they use nonmedical
platforms augmented with medical personnel to perform the evacuation function. The
conventional force doctrinal categories of MEDEVAC and CASEVAC as defined in Army
doctrine on MEDEVAC are not changed, however, during this phase of TCCC both types of
evacuation occur depending upon the availability of assets and the time window available to
execute the evacuation process. Time is of the essence to remove the casualty as quickly as
possible to where further treatment can be provided. |
4-02 | 23 | Army Health System Overview
CASUALTY EVACUATION
1-16. Casualty evacuation is the movement of casualties aboard nonmedical vehicles or aircraft without
en route medical care. Also called CASEVAC. (Currently the proponent for this term is FM 4-02 but will
be moved to ATP 4-02.13 when revised). Casualty evacuation encompasses a wide spectrum of potential
capability- depending on the mix of transport platform, medical equipment, and medical providers allocated
to the mission. At the upper end of the spectrum, nondedicated platforms can be outfitted with the requisite
medical equipment and MEDEVAC assets. At the lower end of the spectrum, CASEVAC can be no more
than the transport of casualties using platforms of opportunity with no medical equipment or medical
providers (in using such assets, the risk of not moving the casualty must outweigh the risk evacuating him/her
in such a manner). Effective CASEVAC complements MEDEVAC by providing additional evacuation
capacity when number of casualties (workload) or reaction time exceeds the capabilities of MEDEVAC
assets. Casualty evacuation requires detailed assessment and planning in order to achieve an effective
integration of MEDEVAC and CASEVAC capabilities. For more information on CASEVAC, refer to ATP
4-25.13. For more information on MEDEVAC, refer to ATP 4-02.2.
WARNING
Casualties transported in CASEVAC platform may not receive
proper en route medical care or be transported to the appropriate
MTF that can best address the casualty’s medical needs. This
may have an adverse impact on the casualty’s prognosis, long-
term disability or even death may result.
MEDICAL EVACUATION
1-17. Medical evacuation is the timely and effective movement of the wounded, injured, or ill to and between
medical treatment facilities on dedicated and properly marked medical platforms with en route care provided
by medical personnel. Also called MEDEVAC (ATP 4-02.2). A patient is a sick, injured or wounded
individual who receives medical care or treatment from medically trained personnel.
1-18. The Army MEDEVAC system is comprised of dedicated, standardized MEDEVAC platforms (ground
and air ambulances). These ambulances have been designed, staffed, and equipped to provide en route
medical care to patients being evacuated and are used exclusively to support the medical mission, in
accordance with the law of land warfare and the Geneva Conventions. The focus of the MEDEVAC mission
coupled with the dedicated ambulances permit a rapid response to calls for medical support. The provision
of en route care on medically equipped vehicles or aircraft greatly enhances the patient’s potential for
recovery and may reduce long-term disability by maintaining the patient’s medical condition in a more stable
manner. En route care refers to the care required to maintain the phased treatment initiated prior to
evacuation and the sustainment of the patient’s medical condition during evacuation. (ATP 4-02.2).
1-19. The United States Army is tasked with providing intratheater aeromedical evacuation (AE) as the only
Service with dedicated air ambulances. The United States Army provides intratheater AE to all land
maneuver forces (once ashore) and also provides support to ship-to-shore and shore-to-ship patient
movement requirements.
1-20. The USAF AE system operates within the “operational or strategic” environment and provides the vital
linkage between the roles of care for regulated patients over extended distances and to continental United
States (CONUS) for final patient disposition. The USAF AE is performed by designated fixed-wing
platforms configured with standardized medical equipment and staffed with medical professionals who
provide the timely, efficient movement and en route care of the wounded, injured, or ill personnel. The
standardization of equipment and medical professionals aboard USAF AE assets ensures the continuity of
care between roles of medical care. For these reasons, USAF AE is the sole provider of patient movement
from Role 3 to Role 4 and is the preferred means of patient movement over great distances within a given
area of operations (AO). Patient movement is the act of moving a sick, injured, wounded, or other person to |
4-02 | 24 | Chapter 1
obtain medical and/or dental treatment. Functions include medical regulating, patient evacuation, and en
route medical care. (ATP 4-02.2). For more information on aeromedical evacuation, refer to DODD
5100.01, JP 4-02, and ATP 4-02.2.
PATIENT EVACUATION
1-21. In today’s OE, the reduced medical footprint forward places a high demand on en route care
capabilities. Consequently, patient evacuation capabilities are even more critical than in the past and the
United States Army in coordination with the other Service medical elements must integrate with lift
operations, as well as with the associated capabilities of multinational forces.
SECTION IV — ARMY HEALTH SYSTEM PRINCIPLES
1-22. The principles of the AHS are the foundation (enduring fundamentals) upon which the delivery of
health care in a field environment is founded. The principles guide medical planners in developing operation
plans (OPLANs) which are effective, efficient, flexible, and executable. Army Health System support plans
are designed to support the operational commander’s scheme of maneuver while still retaining a focus on the
delivery of health care.
1-23. The AHS principles apply across all medical functions and are synchronized through medical
command and control and close coordination and synchronization of all deployed medical assets through
medical technical channels. Figure 1-3 depicts the AHS principles.
Figure 1-3. Army Health System Principles
CONFORMITY
1-24. Conformity with the operation order (OPORD) is the most basic element for effectively providing
AHS support. In order to develop a comprehensive concept of operations, the medical commander must have
direct access to the operational commander. Army Health System planners must be involved early in the
planning process to ensure that we continue to provide AHS support in support of the Army’s strategic roles
of shape OEs, prevent conflict, prevail in large-scale ground combat, consolidate gains and once the plan is
established it must be rehearsed with the forces it supports. In operations with a preponderance of stability
tasks, it is essential that AHS support operations are in consonance with the combatant commander’s (CCDR)
area of responsibility (AOR) engagement strategy and have been thoroughly coordinated with the supporting
assistant chief of staff, civil affairs (CA) operations (G-9). |
4-02 | 25 | Army Health System Overview
PROXIMITY
1-25. Proximity is to provide AHS support to sick, injured, and wounded Soldiers at the right time and the
right place and to keep morbidity and mortality to a minimum. Army Health System support assets are placed
within supporting distance of the maneuver forces which they are supporting, but not close enough to impede
ongoing operations. To support the operational commander’s plan, it is essential that AHS assets are
positioned to rapidly locate, acquire, treat, stabilize, and evacuate combat casualties. Peak workloads for
AHS resources occur during combat operations.
FLEXIBILITY
1-26. Flexibility is being prepared to, and empowered to, shift AHS resources to meet changing
requirements. Changes in plans or operations make flexibility in AHS planning and execution essential. In
addition to building flexibility into the OPLAN to support the commander’s scheme of maneuver, the medical
commander must also ensure that he has the flexibility to rapidly support the transition from one level of
violence to another across the competition continuum (cooperation, competition below armed conflict, and
armed conflict). Medical commanders may be supporting simultaneous actions characterized by decisive
action elements- offensive, defensive, and stability. The medical commanders exercise their command
authority to effectively manage their scarce medical resources so that they benefit the greatest number of
Soldiers. For example, there are insufficient numbers of forward surgical teams (FSTs) or forward
resuscitative surgical detachments (FRSDs) to permit the habitual assignment of these organizations to each
brigade combat team (BCT). Therefore, the medical commander, in conjunction with the command surgeon,
closely monitors these valuable assets so that he can rapidly reallocate or recommend the reallocation of this
lifesaving skill to the BCTs in contact with the enemy and where the highest number of Soldiers will
potentially receive traumatic wounds and injuries. Prolonged combat, intense engagements, and LSCO
diminish unit combat effectiveness. When a medical unit is degraded to become combat ineffective and no
longer able to provide AHS support effectively, reconstitution may be required.
1-27. Reconstitution consists of those actions that commanders plan and implement to restore units to a
desired level of combat effectiveness commensurate with mission requirements and available resources (ATP
3-21.20). Reconstitution may include: removing a unit from combat, assessing it with external assets,
reestablishing a chain of command, training a unit for future operations, and reestablishing unit cohesion.
For more information on reconstitution, refer to FM 4-0 and ADP 3-90.
1-28. Maximizing the return to duty rate of injured or ill personnel in forward operating units is a major
portion of the AHS contribution to the reconstitution effort. Maximizing the return to duty rate of combat
Soldiers contributes to the pool of personnel available for reconstitution of degraded units.
MOBILITY
1-29. Mobility is the principle that ensures that AHS assets remain in supporting distance to support
maneuvering forces. The mobility, survivability (such as armor plating), and sustainability of AHS units
organic to maneuver elements must be equal to the forces being supported. Major AHS headquarters in
echelons above brigade (EAB) continually assess and forecast unit movement and redeployment. Army
Health System support must be continually responsive to shifting medical requirements in an OE. In
noncontiguous operations, the use of ground ambulances may be limited depending on the security threat in
unassigned areas and air ambulance use may be limited by environmental conditions and enemy air defense
threat. Therefore, to facilitate a continuous evacuation flow, MEDEVAC must be a synchronized effort to
ensure timely, responsive, and effective support is provided to the tactical commander. The only means
available to increase the mobility of AHS units is to evacuate all patients they are holding. Army Health
System units anticipating an influx of patients must medically evacuate patients they have on hand prior to
the start of the engagement.
CONTINUITY
1-30. Continuity in care and treatment is achieved by moving the patient through progressive, phased roles
of care, extending from the POI or wounding to the CONUS-support base. Continuity of care refers to an |
4-02 | 26 | Chapter 1
attempt to maintain the role of care during movement at least equal to the care provided at the
preceding facility. Each type of AHS unit contributes a measured, logical increment in care appropriate to
its location and capabilities. In recent operations, lower casualty rates, availability of rotary-wing air
ambulances, and other mission, enemy, terrain and weather, troops and support available, time available, and
civil considerations factors often enable a patient to be evacuated from the POI directly to the supporting
combat support hospital (CSH) or hospital center. In more traditional operations, higher casualty rates,
extended distances, and patient condition may necessitate that patients receive care at each role of care to
maintain their physiologic status and enhance their chances of survival. The medical commanders, with their
depth of medical knowledge, their ability to anticipate follow-on medical treatment requirements, and their
assessment of the availability of their specialized medical resources can adjust the patient flow to ensure each
Soldiers receive the care required to optimize patient outcome. The medical commander can recommend
changes in the theater evacuation policy to adjust patient flow within the deployed setting. A major
consideration and an emerging concern in future conflicts is providing prolonged care at the point of need
when evacuation is delayed. The Army’s future OE is likely to be complex and challenging and widely
differs from previous conflicts. Operational factors will require the provision of medical care to a wide range
of combat and noncombat casualties for prolonged periods that exceed current evacuation planning factors.
CONTROL
1-31. Control is required to ensure that scarce AHS resources are efficiently employed and support the
operational and strategic plan. It also ensures that the scope and quality of medical treatment meets
professional standards, policies, and U.S. and international law. As the Army Medicine is comprised of 10
medical functions which are interdependent and interrelated, control of AHS support operations requires
synchronization to ensure the complex interrelationships and interoperability of all medical assets remain in
balance to optimize the effective functioning of the entire system. Within the operational area, the most
qualified individuals to orchestrate this complex support are the medical commanders due to their training,
professional knowledge, education, and experience. In a joint and multinational environment it is essential
that coordination be accomplished across all Services and unified action partners to leverage all of the
specialized skills within the operational area. Due to specialization and the low density of some medical
skills within the MHS force structure, the providers may only exist in one Service (for example, the U.S.
Army has the only Veterinary Corps officers in the MHS).
ROLES OF MEDICAL CARE
1-32. A basic characteristic of organizing modern AHS support is the distribution of medical resources and
capabilities to facilities at various levels of command, diverse locations, and progressive capabilities, which
are referred to as roles of care. Definitive care refers to care or treatment which returns an ill or injured
Soldier achieving maximum medical improvement.
1-33. Definitive care embraces all care, treatment, and medical interventions provided at any role of medical
care. These interventions can range from self-aid when a Soldier applies a dressing to a grazing bullet wound
that heals without further intervention; to two weeks bed-rest in theater for the treatment of Dengue fever; to
multiple surgeries and extensive rehabilitation with a prosthesis at a CONUS-based medical center or
Department of Veterans Affairs hospital after a traumatic amputation. Injured Soldiers' dispositions may
range from return to full duty without limitations to medical discharge from the military secondary to
persistent physical limitations resulting from illness or injury.
1-34. Definitive treatment refers to the final role of comprehensive care provided to return the patient
to the highest degree of mental and physical health possible. It is not associated with a specific role or
location in the continuum of care; it may occur in different roles depending upon the nature of the
injury or illness.
1-35. As a general rule, no role of care will be bypassed except on grounds of medical urgency, efficiency,
or expediency. The rationale for this rule is to ensure the stabilization/survivability of the patient through
TCCC, and far forward resuscitative surgery is accomplished prior to movement between MTFs (Roles 1
through 3). |
4-02 | 27 | Army Health System Overview
NONMEDICAL PERSONNEL
1-36. Nonmedical personnel performing first aid procedures assist the combat medics in their duties. First
aid is administered by an individual (self-aid or buddy aid) and enhanced first aid is provided by the combat
lifesavers. A combat lifesaver is a nonmedical Soldier of a unit trained to provide enhanced first aid as
a secondary mission. (Currently the proponent is FM 4-02 but will be moved to ATP 4-02.3 when revised).
Self-Aid and Buddy Aid
1-37. Each individual Soldier is trained in a variety of specific first aid procedures. These procedures include
aid for chemical casualties with particular emphasis on lifesaving tasks. This training enables the Soldier or
a buddy to apply first aid to alleviate potential life-threatening situations. Each Soldier is issued an individual
first aid kit to accomplish first aid tasks. First aid (self-aid/buddy aid) refers to urgent and immediate
lifesaving and other measures which can be performed for casualties (or performed by the victim
themselves) by nonmedical personnel when medical personnel are not immediately available.
Combat Lifesaver
1-38. The combat lifesaver is a nonmedical Soldier selected by the unit commander for additional training
beyond basic first aid procedures. A minimum of one individual per squad, crew, team, or equivalent-sized
unit should be trained. The primary duty of this individual does not change. The additional duty of the
combat lifesavers is to provide enhanced first aid for injuries, based on their training, before the combat
medic arrives. Combat lifesaver training is normally provided by medical personnel during direct support of
the unit. The training program is managed by the senior medical person designated by the commander.
Members of Special Forces operational detachment teams receive first aid training at the combat lifesaver
level.
ROLE 1
1-39. The first medical care a Soldier receives is provided at Role 1 (also referred to as unit-level medical
care). This role of care includes:
* Immediate lifesaving measures.
* Disease and nonbattle injury (DNBI) prevention.
* Combat and operational stress preventive measures.
* Patient location and acquisition (collection).
* Medical evacuation from supported units (POI or wounding, company aid posts, or
casualty/patient collection points) to supporting MTFs.
* Treatment provided by designated combat medics or treatment squads. (Major emphasis is placed
on those measures necessary for the patients to return to duty or to stabilize them and allow for
their evacuation to the next role of care. Return to duty refers to a patient disposition which,
after medical evaluation and treatment when necessary, return Soldiers for duty in their
unit. These measures include maintaining the airway, stopping bleeding, preventing shock,
protecting wounds, immobilizing fractures, and other emergency measures, as indicated).
1-40. Role 1 medical treatment is provided by the combat medic or flight paramedic during air evacuation
or by the physician, the physician assistant, or the health care specialist in the battalion aid station/Role 1
MTF. Emergency medical treatment refers to the immediate application of medical procedures to the
wounded, injured, or sick by specially trained medical personnel. In Army special operations forces,
Role 1 treatment is provided by special operations combat medics, Special Forces medical sergeants, or
physicians and physician assistants at forward operating bases, Special Forces operating bases, or in joint
special operations task forces. Role 1 includes:
* Tactical combat casualty care (immediate far forward care) consists of those lifesaving steps that
do not require the knowledge and skills of a physician. The combat medic is the first individual
in the medical chain that makes medically substantiated decisions based on medical military
occupational specialty-specific training. |
4-02 | 28 | Chapter 1
* At the battalion aid station, the physician and the physician assistant are trained and equipped to
provide TCCC to the combat casualty. This element also conducts routine sick call when the
operational situation permits. Like elements provide this role of medical care at brigade and EAB.
* During MEDEVACs, Role 1 treatment is provided by the combat medic (during ground
evacuation) or by the critical care flight paramedic (during air evacuation) to an MTF. Critical
care flight paramedics are trained and equipped to provide advanced en route care to the combat
casualty.
ROLE 2
1-41. At this role, care is rendered at the Role 2 MTF which is operated by the area support squad, medical
treatment platoon of medical companies. Here, the patients are examined and their wounds and general
medical condition are evaluated to determine their treatment and evacuation precedence, among other
patients. Medical treatment including trauma management and beginning resuscitation is continued, and if
necessary, additional emergency measures are instituted, but they do not go beyond the measures dictated by
immediate necessities. The Role 2 MTF provides a greater capability to resuscitate trauma patients than is
available at Role 1. Those patients who can return to duty within 72 hours (1 to 3 days) are held for treatment.
This role of care provides MEDEVAC from Role 1 MTFs and also provides Role 1 medical treatment on an
area support basis for units without organic Role 1 resources. The Role 2 MTF has the capability to provide
packed red blood cells (liquid), limited x-ray, clinical laboratory, operational dental support, combat and
operational stress control (COSC), operational public health, and when augmented, physical therapy and
optometry services.
1-42. Patients who are nontransportable due to their medical condition may require resuscitative surgical
care from an FST or FRSD collocated with a medical company (refer to Army doctrine on the FST or FRSD).
Nontransportable patient is a patient whose medical condition is such that he could not survive further
evacuation to the rear without surgical intervention to stabilize his medical condition. (ATP 4-02.2). The
FST or FRSD is assigned to the medical command (deployment support) or medical brigade and attached to
a CSH or hospital center when not operationally employed however, the FST or FRSD is only attached to a
medical company for resuscitative surgical care capability support when employed.
1-43. Role 2 AHS assets are located in the—
* Medical company (brigade support), assigned to modular brigades which include the armored
BCT, infantry BCT, and the Stryker BCT.
* Medical company (area support) which is an EAB asset that provides direct support to the modular
division and support to EAB units.
1-44. The NATO descriptions of Role 2 are—
* A Role 2 Basic MTF can provide reception, triage, resuscitation, and damage control surgery,
short term holding capacity for at least six and a postoperative care capability for at least two
patients.
* An Enhanced Role 2 MTF can provide enhanced diagnostics and mission essential specialist care
(including in theater surgery). They have at least two surgical teams, with respective emergency
and postoperative care capabilities, x-ray, laboratory, blood bank, pharmacy, sterilization,
dentistry, and a short term holding capacity of 25 patients.
Note. The United States Army forces subscribe to the basic definition of a Role 2 MTF providing
greater resuscitative capability than is available at Role 1. It does not subscribe to the
interpretation used by NATO forces Allied Joint Publication-4.10(B) (Role 2 Basic and Role 2
Enhanced) and JP 4-02 (Role 2 Light Maneuver and Role 2 Enhanced) that a surgical capability
is mandatory at this role.
The United States Army does not provide damage control surgery and does not provide surgical
capability at Role 2 unless a FST or FRSD is collocated with the medical company to provide
forward surgical intervention. |
4-02 | 29 | Army Health System Overview
ROLE 3
1-45. At Role 3, the patient is treated in an MTF staffed and equipped to provide care to all categories of
patients, to include resuscitation, initial wound surgery, damage control surgery, and postoperative treatment.
This role of care expands the support provided at Role 2. Patients who are unable to tolerate and survive
movement over long distances receive surgical care in a hospital as close to the supported unit as the tactical
situation allows. This role includes provisions for—
* Coordination of patient evacuation through medical regulating.
* Providing care for all categories of patients in an MTF with the proper staff and equipment.
* Providing support on an area basis to units without organic medical assets.
1-46. Role 3 AHS assets are located in the—
* Combat support hospital.
* Hospital Center.
ROLE 4
1-47. Role 4 medical care is found in CONUS-based hospitals and other safe havens (to include robust
overseas MTFs). If mobilization requires expansion of military hospital capacities, then the Department of
Veterans Affairs and civilian hospital beds in the National Disaster Medical System are added to meet the
increased demands created by the evacuation of patients from the operational area. The support-based
hospitals represent the most definitive medical care available within the AHS.
ELIGIBILITY OF CARE DETERMINATION
1-48. During unified land operations, one of the most pressing questions is who is eligible for care in a United
States Army-established MTF and the extent of care authorized. Numerous categories of personnel seek care
in U.S. facilities that are located in austere areas where the host-nation civilian medical infrastructure is not
sufficient to provide adequate care. A determination of eligibility and whether reimbursement for services
is required is made at the highest level possible and in consultation with the supporting staff judge advocate.
Additionally, Department of State and other military staff sections (such as the assistant chief of staff, CA)
may also need to be involved in the determination process. Each operation is unique and the authorization
for care is based on the appropriate U.S. and international law and policies. Other factors impacting on the
determination of eligibility are command guidance, practical humanitarian and medical ethics considerations,
availability of U.S. medical assets (in relationship to the threat faced by the force), and the potential training
opportunities for medical forces. The sample format provided in Table 1-2 on page 1-15 is just one approach
to delineate and disseminate this information to MTF personnel and may not be all-inclusive based on specific
scenarios.
Note. The examples for the authority to provide treatment are only illustrative in nature and should
not be used as the basis for providing or denying medical care.
KNOWLEDGE OF HEALTH CARE CAPABILITIES
1-49. The MTF staff must be familiar with the medical care available in the operational area from other
sources. These sources could include unified action partners such as multinational force military (tactical
and strategic), nongovernmental organizations or intergovernmental organizations (such as the United
Nations), and local civilian resources. When appropriate, and by knowing the level and types of care
available, the MTF staff can plan for the continued care of the patient after initial stabilization is provided in
the United States Army MTF and the patient can be transferred to another facility for continued care.
DISSEMINATION OF ELIGIBILITY FOR CARE INFORMATION
1-50. It is essential that eligibility for medical care guidance is disseminated and understood by the chain of
command and all civilians and military members of the deployed force. The AHS commander must be able |
4-02 | 30 | Chapter 1
to articulate the basic principles for medical eligibility determinations. This means that he will need to
condense them into simple, easily understood instructions, and widely disseminate them through electronic
means or other media (such as pocket-sized cards). As the chief planner for medical support operations, the
AHS commander must ensure that this information is contained in appropriate OPLANs and OPORDs and
briefed to the appropriate senior leadership of the command.
DOCUMENTATION
1-51. Basic documents required for determining eligibility of beneficiaries include Army Regulation (AR)
40-400; FM 6-27/MCTP 11-10C; relevant sections of Title 10, United States Code; relevant DODD and
DODI; multinational force compatibility agreements; acquisition and cross-servicing agreements; orders
from higher headquarters; interagency agreements (memorandums of understanding and memorandums of
agreement); status of forces agreements; and appropriate unified action partners guidance for the specific
operation. If contractor personnel are present, a copy of the relevant sections of their contracts should be on
file to delineate specific medical services to be rendered. Additionally, for contract personnel, points of
contact for the contracting company, and for the administration of the contract should be maintained. Finally,
the political-military environment of the operational area must be taken into account as the medical command
and control headquarters and its higher headquarters develop the eligibility matrix.
1-52. The eligibility matrix should be as comprehensive as possible. If necessary, it should include eligibility
determination by name (see example in Table 1-2 on page 1-15). If individuals arrive at the emergency
medical service section of the MTF who are not included in the medical/dental support matrix, the MTF must
always stabilize the individual first and then determine the patient’s eligibility for continued care. The
command point of contact for eligibility determinations should be contacted immediately. Further, care will
be provided in accordance with the standard operating procedure (SOP) pending eligibility determination.
For example, a host-nation civilian presents himself at the gate and requests medical treatment. Although on
the surface it may appear that he is not eligible for care, this determination can only be made after a medical
assessment is completed by competent medical personnel. In some cases, the individual may have to be
brought into the MTF to accomplish an adequate medical assessment. Conducting a medical assessment
does not obligate the U.S. military to provide the full spectrum of medical care. Although it does obligate
the MTF to provide immediate stabilization for life-, limb-, and eyesight-threatening medical conditions and
to prepare the patient for evacuation to the appropriate civilian or national contingent MTF when the patient’s
medical condition permits.
Note. Any individual requesting medical care should receive a timely medical assessment of his
condition. Even though the individual is not eligible for treatment, life-, limb-, or eyesight-saving
procedures warranted by the individual’s medical condition are provided to stabilize the individual
for transfer to the appropriate civilian or other nation MTF.
SAMPLE ELIGIBILITY FOR CARE MATRIX
1-53. Table 1-2 on page 1-15 provides a sample eligibility for medical and dental care support matrix for
treatment in a United States Army MTF. |
4-02 | 31 | Army Health System Overview
Table 1-2. Sample eligibility for medical and dental care support matrix
ELIGIBILITY FOR MEDICAL AND DENTAL CARE
SUPPORT MATRIX
(DATE)
(THIS DOCUMENT IS SUBJECT TO FURTHER VERIFICATION AND AND/OR MODIFICATION)
Category Medical/dental Information/authority*
The following nations have acquisition and cross-
servicing agreements and multinational force com-
Multinational military personnel Yes1 patibility agreements with the U.S. which are
administered by (combatant command): List
nations.
Department of Defense Civilian
Yes Invitational travel order.
employees
U.S. Government employees
Yes2 Invitational travel order.
(non-Department of Defense)
U.S. Embassy personnel Yes U.S. citizens on official business.
U.S. Congressional personnel Yes U.S. citizens on official business.
Army and Air Force Exchange
Yes Invitational travel order.
Service U.S. citizen employees
Army and Air Force Exchange
Service Yes3 U.S. law.
Local national employees
Nonappropriated fund
instrumentality morale, welfare, Yes Invitational travel orders.
and recreation U.S. employees
Contracted college instructors Yes Invitational travel orders.
United Nations personnel
(includes all personnel employed
by the United Nations and its
Yes3 U.S. law.
agencies, such as the United
Nations High Commissioner for
Refugees)
HEALTH INFORMATION TECHNOLOGY
1-54. Information management in support of both Army and Joint health services includes the ability to
identify, capture, organize, disseminate, and synthesize required operational health and medical force
information in support of a commander’s plans, operations, and sustainment activities within the OA.
Deploying units are required to begin using Joint Operational Medicine Information Systems (JOMIS) and
other available medical information systems within 24 hours of the unit’s initial operating capability.
Information systems deployed in the operational environment are required to adopt and use data exchange
standards that are appropriate to, and facilitate interoperability with systems that are used in that domain.
1-55. There are two critical success factor to ensure units are utilizing their assigned systems with 24 hours
of initial operating capability. The first is to introduce health information technology planning, to include
network design, into the early stages of the military decision making process following receipt of an OPORD.
The second is ensuring collaboration among primary staff section leaders and that the S6/Health Information
Systems Officer is working with, and guiding, the chief of clinical operations, medical logistics, patient
administration and operations as it relates to health information technology and communications. |
4-02 | 32 | Chapter 1
Table 1-2. Sample eligibility for medical and dental care support matrix (continued)
ELIGIBILITY FOR MEDICAL AND DENTAL CARE
SUPPORT MATRIX
(DATE)
(THIS DOCUMENT IS SUBJECT TO FURTHER VERIFICATION AND AND/OR MODIFICATION)
Category Medical/dental Information/authority*
Contractor #2 all employees Contractor did not contract for the provision of
Yes3
medical care by military medical treatment facilities.
Contractor stated in writing that they contracted with
the host-nation medical infrastructure for the
POC: Mr. Michaels required care. NOTE: A separate determination
(XXX) XXX-XXXX
No5
may be required for individual cases, as the
ADMIN: Mr. Johns individual may be eligible for care under a different
provision. Contact Mr. Patrick, DSN XXX-XXXX if
DSN XXX-XXXX
additional information is required.
Contractor #4
Mr. Edward Dean
(company name classified) Per Mr. Patrick, Mr. Dean is entitled to full medical
and dental support without reimbursement. The
Yes terms of the contract and the name of the contracting
POC: Ms. Emory
company are classified. Contact Mr. Patrick, DSN
(XXX) XXX-XXXX XXX-XXXX, if additional information is required.
ADMIN: Mr. Johns
DSN XXX-XXXX
Contractor #5
Mr. Michael James
Per Mr. Patrick, Mr. James is entitled to full medical
(company name classified)
and dental support; however, this care is
reimbursable. The terms of the contract and the
Yes6
POC: Ms. Emory name of the contracting company are classified.
(XXX) XXX-XXXX Contact Mr. Patrick, DSN XXX-XXXX, if additional
information is required.
ADMIN: Mr. Johns
DSN XXX-XXXX
Dependents of U.S. active duty Only if space is available and appropriate medical
or retired military personnel services/care are available in the operational setting.
Yes4
AR 40-400. Contact Mr. Patrick, DSN XXX-XXXX, if
additional information is required.
Enemy prisoner of war and detained personnel.
Extent of care rendered is the same as that provided
Personnel in custody of U.S.
Yes to U.S. military forces within the geographical area.
military forces
(Army Techniques Publication 4-02.46, and Field
Manual 27-10).
1-56. The applications from numerous program offices to support the ten medical functions include JOMIS,
the Defense Medical Logistics – Enterprise Systems, U.S. Transportation Command (USTRANSCOM),
Defense Medical Information Exchange, Solutions Delivery Division and Infrastructure and Operations
Division. Combined, these program offices develop and support applications that permit, electronic viewing
and documentation of health care delivery, medical logistics (MEDLOG), medical situational awareness,
medical communication and control and patient movement. Joint Operational Medicine Information Systems
currently provides the Legacy Theater Medical Information Program – Joint suite of applications to the
operating forces. |
4-02 | 33 | Army Health System Overview
Table 1-2. Sample eligibility for medical and dental care support matrix (continued)
Category Medical/dental Information/authority*
U.S. and international law (Field
Manual 6-27) and status of forces
agreements. If the U.S. military
injures an individual (such as in an
automobile accident involving a
Individual injured as a result of military vehicle), the U.S. is
Yes
military operations responsible for providing
immediate care (or paying for local
care). Coordinate with Mr. Patrick,
DSN XXX-XXXX and Lieutenant
Colonel Hall, supporting staff
judge advocate, DSN XXX-XXXX.
LEGEND:
*
Illustrative in nature only.
1 Multinational force member nations are provided food, water, fuel, and medical treatment pursuant to reciprocal
agreements. The amount of food, water, fuel, and medical care provided must be accounted for by the providing
nation to the assistant chief of staff, Civil Affairs operations (G-9). Logistical support is not permitted for those
nations with whom the U.S. does not have both an acquisition and cross-servicing agreement and multinational
force compatibility agreement. However, the acquisition and cross-servicing agreement and multinational force
compatibility agreement requirements may be waived for those nations whom the commander, in conjunction with
the supporting staff judge advocate, feels are supporting the missions of the command.
2 If not working for, contracted to, or on DOD multinational force compatibility agreement for logistical support, non-
DOD U.S. Government employees must pay for meals received at DOD dining facilities.
3 Emergency medical and dental care only. Emergency care is that care required to save life, limb, or eyesight.
4 Space available.
5 Routine.
6 Reimbursable.
Admin administration
AR Army regulation
DOD Department of Defense
DSN Defense Switched Network
POC point of contact
U.S. United States
1-57. Health information technology in support of the AHS will continue to transform and include a
deployable version of MHS GENESIS (the new electronic health record for Role 3/4 military treatment
facilities) designated as JOMIS Increment 1. Other changes will include moving AHS applications to a cloud
based platform and increased use of the JOMIS Mobile Computing Capability (MCC). The following are
the primary systems used to support the AHS in the AO:
* Electronic TCCC- Standard Form (SF) 600 (Chronological Record of Medical Care) and medical
references such as the Algorithm Directed Troop Medical Care Manual are available on the JOMIS
MCC platform. The MCC is currently available as an Android device and is intended for the
combat medic and first responders that are typically operating in a disconnected environment. The
data stored on the device can be transferred to any computing device with access to the Armed
Forces Health Longitudinal Technology Application-Theater (AHLTA-T).
* The AHLTA-T is the operational medicine version of the current AHLTA application utilized in
all MTFs to provide clinicians a system to document health care delivery to include the diagnosis
and treatment of Service members and civilians authorized by Title 10 and Status of Forces
Agreements. Signed/completed medical encounters from AHLTA-T are transmitted to the
Theater Medical Data Store (TMDS) before final submission into the Clinical Data Repository. |
4-02 | 34 | Chapter 1
Patient encounters within the Clinical Data Repository are further available to all authorized health
care providers throughout the MHS regardless of location. The TMDS also transmits discrete data
from each medical encounter related to public health to the Medical Situational Awareness Theater
(MSAT).
* The Joint Legacy Viewer application is accessible within TMDS. The Joint Legacy Viewer is a
Non-classified Internet Protocol Router Network web-application that provides an integrated,
read-only view of Electronic Health Record data from the DOD, Veterans Affairs, and Virtual
Lifetime Electronic Record eHealth Exchange partners, within a single application. The Joint
Legacy Viewer also provides healthcare providers access to view pre-deployment allergy,
documentation, laboratory, medication and radiology records.
* Theater Composite Health Care System Cache (TC2) is used to register and admit patients, order
pharmacy, laboratory and imaging studies (includes computed tomography, digital radiology,
magnetic resonance imagining, and ultra-sound) and document laboratory and imaging results.
Similar to AHLTA-T, signed/completed TC2 encounters are transmitted to TMDS.
* The TMDS is a web-based portal that offers health care delivery professionals several capabilities
to include:
Viewing signed encounters from other locations and points of care.
Managing theater blood inventories.
Access to Service member life-time medical records through the Joint Legacy Viewer.
* The MSAT is web-based portal that aggregates information from multiple sources to provide a
joint medical common operational picture. The MSAT contains 2 distinct features:
The first aggregates clinical data from AHLTA-T and TC2 and uses a complex algorithm to
identify situations involving public health, CBRN issues and exposures.
The second is a unit readiness report providing information related to a variety of information
to personnel, equipment and the overall operating status of medical units such as bed status.
* Medical References are available with the Medical Computing Capability application on Medical
Communications for Combat Casualty Care issued handhelds. The medical reference application
is also available on Medical Communications for Combat Casualty Care laptops and serves as the
medical reference tool that provides a series of medical guides to assist the provider while
performing a clinical diagnosis. The medical reference application provides access to a collection
of databases with disease, drug, acute care, and toxicology information.
* Defense Medical Logistics – Enterprise Systems is the program and portfolio name for all
MEDLOG applications. LogiCole is the name for the refreshed Defense Medical Logistics
Standard Support (DMLSS) environment that integrates all the legacy MEDLOG applications to
include DMLSS, theater electronic warehouse logistics system, joint medical asset repository and
the DMLSS Customer Assistance Module into web-based environment. The DMLSS is used
throughout all CONUS and outside CONUS-based Role 4 MTFs and deployed Role 3 MTFs. The
theater electronic warehouse logistics system and DMLSS Customer Assistance Module are used
by all Roles 1 and 2 MTFs in both combatant command (command authority) (COCOM) and U.S.
Army Forces Command domains to order and manage Class VIII medical supplies.
* The DMLSS Customer Assistance Module allows tactical units to interface with LogiCole, the
Defense Medical Logistics enterprise system used by theater medical supply support activities
to—
Submit medical supply orders and download catalog data, stock availability, order status, and
quality control alerts.
Enable these unit to manage their medical supply levels and generate orders while
disconnected for submission when Non-classified Internet Protocol Router Network
communications are available.
* Personnel can easily access an online nonsecure web-based portal clinical decision support tool.
This tool is for travel medicine practitioners that provides medical professionals access to medical
information to prepare Soldiers and travelers for health threats and other concerns related to
international travel. This online tool supplements DOD medical information with data integrated
from international and regional health organizations plus additional information and analysis |
4-02 | 35 | Army Health System Overview
developed collaboratively through a network of trusted medical advisors. This information is also
integrated in MSAT. For more information, go to www.travax.com.
* The U.S. Transportation Command Regulating and Command and Control Evacuation System
(TRAC2ES) is a web-based portal that provides patient movement and in-transit visibility to
medical facilities. The TRAC2ES combines transportation, logistics and clinical decision
elements in order to support tactical and strategic operations.
1-58. Department of Defense policy requires the Services to document exposures and manage health risks
during all phases of military operations. The Defense Occupational and Environmental Health Readiness
System (DOEHRS) - Industrial Hygiene (IH) is a DOD application funded by the MHS. It is the DOD system
of records used to manage unclassified OEH data, including selected veterinary PH data, for garrison and
deployment operations. The DOEHRS-IH is also the DOD's system of records for informing OEH risk
management, as well as a foundational system for the individual longitudinal exposure record. It contains
seven business areas-Industrial Hygiene, Environmental Health, Food Protection, Radiation, Incident
Reporting, Registries, and Digital Library-and includes a module for filtering and reporting data from these
areas. The DOEHRS-IH is a common access card-enabled, web-based system available at https://doehrs-
ih.csd.disa.mil/.
SECTION V — GLOBAL HEALTH ENGAGEMENT
1-59. Department of Defense Instruction 2000.30 instructs the DOD to conduct global health engagement
activities in support of U.S. national security policy and defense cooperation strategy. The U.S. government
will use the full spectrum of DOD health capabilities to execute and support—
* Force Health Protection (DODD 6200.04).
* Foreign Humanitarian Assistance (JP 3-29).
* Foreign Disaster Relief (DODD 5100.46).
* Humanitarian and Civic Assistance (DODI 2205.02).
* DOD Countering Weapons of Mass Destruction Policy (DODD 2060.02).
* Stability Operations (DODD 3000.05).
* DOD Veterinary Public and Animal Health Services (DODD 6400.04E).
* DOD Policy and Responsibilities Relating to Security Cooperation (DODD 5132.03).
1-60. These health capabilities will be leveraged in military-to-military, military-to-civilian, or multilateral
global health engagement activities as tools to—
* Promote and enhance partner nation’s stability and security.
* Develop military and civilian partner nation capacity.
* Build trust, confidence, and resilience.
* Share information.
* Coordinate mutual activities.
* Maintain influence to enable implementation of the guidance for the employment of the force and
to support the achievement of U.S. government national security objectives.
* Enhance DOD’s awareness of global health engagement and improve its relationship and
interoperability with each partner nation to achieve security cooperation objectives.
* Seek to develop and improve the human and animal health capabilities and capacities of DOD and
partner nation personnel. |
4-02 | 37 | Chapter 2
Army Health System Command and Control
The complexities of the competition continuum, the myriad of medical functions and
assets, and the requirement to provide health care across unified land operations to
diverse populations (U.S., joint, multinational, host nation, and civilian) necessitate a
medical command authority that is regionally focused and capable of utilizing the
scarce medical resources available to their full potential and capacity. Each of the
medical command organizations (medical command [deployment support]
[MEDCOM (DS)], medical brigade [support] [MEDBDE (SPT)], and medical
battalion [multifunctional] [MMB]) is designed to provide scalable and tailorable
command posts for early entry and expeditionary operations which could be expanded
and augmented as the operational area matures and an Army and joint integrated health
care infrastructure is established. The AHS command and control consists of both
formal medical command organizations and the surgeon’s technical supervision at
echelon of medical assets.
SECTION I — OVERVIEW OF ARMY ECHELONS
2-1. To ensure a seamless continuum of care from the POI or wounding to the CONUS-support base exists,
and in order to decrease morbidity and mortality and to reduce disability, a synergistic effort is required
between AHS table of organization and equipment (TOE) (operational forces) and table of distribution and
allowances (the institutional force) organizations and resources and those found in other sectors of the
CONUS-support base. The ability of the deployed medical commander to reach into the CONUS-support
base for medical, technical, clinical, and materiel support is paramount to optimizing the medical outcomes
of our Soldiers who become wounded, injured, or ill while on deployments. This reachback capability
enhances the care given and maximizes the utilization and employment of scarce medical resources.
OPERATIONAL ENVIRONMENT
2-2. The future operational environment and our forces’ challenges to operate across the competition
continuum represents the most significant readiness requirement. The logic chart (Figure 2-1 on page 2-2)
depicted on the next page begins with an anticipated OE that includes considerations during LSCO against a
peer threat. It depicts the Army's contribution to joint operations through the Army’s strategic roles. Within
each phase of a joint operation, the Army's operational concept of unified land operations guides how Army
forces conduct operations. In unified land operations, Army forces combine offensive, defensive, and
stability tasks to seize, retain, and exploit the initiative in order to shape OEs, prevent conflict, conduct large-
scale ground combat operations, and consolidate gains. Mission command guides commanders, staffs, and
subordinates in their approach to command and control. The command and control warfighting function
enables commanders and staffs of theater armies, corps, divisions, and brigade combat teams to synchronize
and integrate combat power across multiple domains and the information environment. Throughout
operations, Army forces maneuver to achieve and exploit positions of relative advantage across all domains
to achieve objectives and accomplish missions.
2-3. The logic chart (Figure 2-1 on page 2-2) depicts how the AHS supports the operating force. The AHS
support logic chart is aligned with ADP 3-0, FM 3-0, ADP 3-37, ADP 4-0, FM 4-0, and JP 4-02.
2-4. For more information on AHS support to the Army strategic roles, refer to Appendix A. |
4-02 | 38 | Chapter 2
Figure 2-1. Army Health System support logic chart |
4-02 | 39 | Army Health System Command and Control
ARMY COMMAND AND SUPPORT RELATIONSHIPS
2-5. Army command and support relationships are similar but not identical to joint command authorities
and relationships. Differences stem from the way Army forces task-organize internally and the need for a
system of support relationships between Army forces. Another important difference is the requirement for
Army commanders to handle the administrative support requirements that meet the needs of Soldiers. These
differences allow for flexible allocation of Army capabilities within various Army echelons. Army command
and support relationships are the basis for building Army task organizations. Certain responsibilities are
inherent in the Army's command and support relationships. For more information on command relationships
for joint force, refer to JP 3-0.
ARMY COMMAND RELATIONSHIPS
2-6. Commanders recognize that effectiveness is built on mutual trust and confidence between superior,
subordinate, supporting and supported organizations. This trust and confidence is developed through
relationships. Generally the longer a relationship lasts, a greater degree of trust and confidence results.
Between organizations that have had long-term habitual relationships, authorities and responsibilities are
typically well known. For more information regarding mission command and command and control of Army
forces, refer to ADP 6-0 and FM 6-0.
2-7. Army command relationships define superior and subordinate relationships between unit commanders.
By specifying a chain of command, command relationships unify effort and enable commanders to use
subordinate forces with maximum flexibility. Army command relationships identify the degree of control of
the gaining Army commander. The type of command relationship often relates to the expected longevity of
the relationship between the headquarters involved, and it quickly identifies the degree of support that the
gaining and losing Army commanders provide. The five Army command relationships include:
* Organic.
* Assigned.
* Attached.
* Operational Control (OPCON).
* Tactical control (TACON).
2-8. See Appendix B for more information regarding Army command relationships according to FM 3-0
and FM 4-0.
ARMY SUPPORT RELATIONSHIPS
2-9. Army support relationships are not a command authority and are more specific than joint support
relationships. Commanders establish support relationships when subordination of one unit to another is
inappropriate. Army support relationships are:
* Direct support.
* General support.
* Reinforcing.
* General support-reinforcing.
2-10. Refer to Appendix B for more information on Army support relationships according to FM 3-0 and
FM 4-0.
2-11. See Figure 2-2 on page 2-4 for an example of AHS organizations’ command and support relationships
during an operation or when deployed. Refer to Appendix C for more information on the synchronization,
coordination, and integration of medical support at echelon between medical and sustainment (FM 4-0),
protection, and other warfighting functions/staff cells. |
4-02 | 40 | Chapter 2
Figure 2-2. Army Health System command and support relationships
THEATER ARMY
2-12. The theater army is the senior Army headquarters in an AOR, and it consists of the commander, staff,
and all Army forces assigned to a combatant command. Each theater army has operational and administrative
responsibilities. Its operational responsibilities include command of forces, direction of operations, and
control of assigned AOs. Its administrative responsibilities encompass the Service-specific requirements for
equipping, sustaining, training, unit readiness, discipline, and personnel matters. As required, the theater
army provides Army support to other services and common user logistics.
2-13. The theater army always maintains an AOR-wide focus, providing support to Army and joint forces
across the AOR, in accordance with the geographic combatant commander (GCC)'s priorities of support. For
example, the theater army continues shape and prevent activities in various operational areas at the same time
it is LSCO.
2-14. The theater army serves as the Army Service component command (ASCC) of the geographic
combatant command. It is organized, manned, and equipped to perform that role. The ASCC is the command
responsible for recommendations to the joint force commander (JFC) on the allocation and employment of
Army forces within a CCDR’s AOR. For additional information refer to FM 3-94.
2-15. According to ATP 3-93 (Theater Army Operations), theater armies are assigned or provided access to
five enabling capabilities (sustainment, signal, medical, military intelligence, and civil affairs), and an
assortment of functional and multifunctional units, based on specific requirements for the area of
responsibility.
2-16. The MEDCOM (DS) is assigned to the ASCC. As one of the theater enabling commands, the
MEDCOM (DS) is the theater medical command responsible for integration, synchronization, and command
and control for the execution of all AHS support operations within the AOR. The MEDCOM (DS) may have
a direct support or general support relationship with the corps or the division. The MEDCOM (DS) has a
command relationship with the ASCC and a general support relationship with the theater sustainment
command (TSC) or expeditionary sustainment command (ESC). A high level of coordination between
command and staff channels develops the situational understanding necessary to recommend priorities and
courses of action to echelon commanders. The medical staff channels (surgeon cells) conduct planning, |
4-02 | 41 | Army Health System Command and Control
coordination, synchronization, and integration of AHS support to plans. Refer to Appendix C for detailed
discussion regarding the coordination, synchronization, and integration of medical support at echelons. The
chain of medical commanders execute the AHS support to OPLANs, and maintain the medical technical
channel throughout echelons.
THEATER ARMY SURGEON'S SECTION
2-17. The ASCC surgeon is the theater army staff proponent responsible for (in coordination with the
MEDCOM [DS] commander) the provision of AHS support within the AOR. The ASCC surgeon has staff
responsibility for medical planning, coordination, and policy development for AHS support to deployed
forces. This officer advises the ASCC commander concerning the health of the command, recommends
changes to the theater evacuation policy, and provides input to and personnel in support of the theater patient
movement requirements center, as required. Organizations from battalion through ASCC level are authorized
a surgeon. The Army Medicine leverages the chain of surgeon's cells (staff channels) and medical command
channels (through the MEDCOM [DS], medical brigade [support], and medical battalion [multifunctional]
to provide AHS support to the deployed force. Integration of these two chains and other elements of
sustainment occur at command headquarters at echelon and not just between sustainment organizations.
2-18. The ASCC surgeon and the surgeon cells at each echelon identify, assess, counter and/or mitigate
health threats across the competition continuum. They advise commanders on medical capabilities and
capacities necessary to support plans, and interface with logistical, financial management, and personnel
elements to coordinate AHS support across the warfighting functions. The ASCC surgeon and the surgeon
cells at each echelon (including the TSC, ESC, and sustainment brigade surgeon cells) work with their staff
to conduct planning, coordination, synchronization, and integration of AHS support to plans to ensure that
all 10 medical functions are considered and included in running estimates, OPLANS, and OPORD in
coordination with the MEDCOM (DS). Refer to Appendix C for more information on the synchronization
and integration of AHS support at echelon.
2-19. The MEDCOM (DS) commander is responsible for maintaining a regional focus in support of the GCC
and ASCC theater engagement plan, while providing effective and timely direct FHP and HSS to tactical
commanders and general support (on an area basis) to theater forces at EAB. The enduring regional focus
of the ASCC drives organizational specialization in the supporting MEDCOM (DS) to address unique health
threats, specific needs of the local populace, availability of other Service medical capabilities, and geographic
factors that are distinctly related to a particular region. The MEDCOM (DS) coordinates with the ASCC
surgeon (as the staff proponent with execution through G-3 channels under the authority of the ASCC
commander) to provide AHS support within the AOR.
2-20. As the theater medical command, the MEDCOM (DS) integrates, synchronizes, and provides
command and control of MEDBDE (SPT), MMBs, and other AHS units providing force health protection
and health service support to tactical commanders. The MEDCOM (DS) employs an operational command
post (CP) and a main CP that can deploy autonomously into an operational area and is employed based on
the size and complexity of operations or the support required. Refer to Figure 2-3 on page 2-6 for an overview
of a theater medical structure. Key tasks of a MEDCOM (DS) in support of the ASCC include:
* Providing command and control of MEDBDE (SPT) and subordinate medical units assigned and
attached.
* Task-organizing medical elements based on specific medical requirements.
* Monitoring health threats within each operational area and ensuring the availability of required
medical capabilities to mitigate those threats. |
4-02 | 42 | Chapter 2
Figure 2-3. Medical structure in theater
THEATER SUSTAINMENT COMMAND
2-21. The TSC is the Army’s command for the integration and synchronization of sustainment in the AOR.
The TSC connects strategic enablers to the tactical formations. It is a theater-committed asset to each ASCC
and focuses on Title 10 support of Army forces for theater security cooperation and the CCDRs daily
operational requirements. The TSC commands assigned human resources sustainment centers and Financial
Management Support Centers. The TSC commander also commands and task organizes attached ESCs,
sustainment brigades, and additional sustainment units. The TSC executes the sustainment concept of
support for planning and executing sustainment-related support to the AOR for all the Army strategic roles
(shape OEs, prevent conflict, prevail in large-scale ground combat, and consolidate gains).
2-22. The TSCs execute sustainment operations through their assigned and attached units. The TSC
integrates and synchronizes sustainment operations across an AOR from a home station command and control
center or through a deployed CP. The TSC has four operational responsibilities to forces in theater: theater
opening, theater distribution, sustainment and theater closing.
2-23. The task-organized TSC is tailored to provide operational-level sustainment support within an assigned
AOR. It integrates and synchronizes sustainment operations for an ASCC including all Army forces forward-
stationed, transiting, or operating within the AOR. The TSC coordinates Title 10, Army support to other
Services, DOD executive agent (EA), and lead service responsibilities across the entire theater.
2-24. The TSC organizes forces, establishes command relationships and allocates resources as necessary to
support mission requirements, and exercises command and control over attached sustainment forces. The
TSC supports the ASCC sustainment cells with planning and coordinating theater-wide sustainment. The
execution of sustainment is decentralized, performed by the human resources sustainment centers, Financial
Management Support Centers, ESCs, sustainment brigades, and other sustainment organizations. The |
4-02 | 43 | Army Health System Command and Control
medical logistics management center (MLMC) forward team collocates with the distribution management
center (DMC) of the TSC or ESC to serve as the liaison to the MEDCOM (DS). The MEDCOM (DS) is
responsible for integrating and executing medical operations. The DMC is the principal staff section for
coordinating sustainment across an operational area. It is headed by the support operations officer and is a
coordinating staff section unique to TSCs and ESCs. The DMC is responsible for sustaining the force in
accordance with the theater army priorities. The staff focuses on detailed planning for operational area
opening, distribution, sustainment, and operational area closing operations. See ATP 4-94 for additional
information.
ARMY MEDICAL SUPPORT TO OTHER SERVICES
2-25. The Surgeon General is the principal military adviser to the Secretary of the Army and the Chief of
Staff of the Army on the health and medical aspects of manning, training, and equipping the Army as in Title
10 United States Code. In this role, The Surgeon General serves as the Headquarters, Department of the
Army medical integrator and synchronizer with expert oversight for material development for assigned
programs and responsible for medical research, development and acquisition functions. United States Army
medical forces provide AHS support to the joint force through oversight and assigned DOD EA or lead
Service responsibilities for a number of medical functions. This requires the synchronization and integration
of operational medical resources across the unified action partners to meet CCDR’s global mission objectives.
The Surgeon General’s EA or lead Service responsibilities include:
* Serves as the DOD EA for medical research for prevention, mitigation, and treatment of blast
injuries.
* Coordinates for joint patient movement across the joint force.
* Provides intratheater aeromedical evacuation (includes medical evacuation from ship-to-shore and
shore-to-ship for United States Navy and Marine personnel).
* Coordinates for medical support to joint special operations forces. See ATP 4-02.43 for additional
information.
2-26. The MEDCOM (DS), MEDBDE (SPT), and subordinate units are responsible to the ASCC
commander (through coordination with the ASCC surgeon) for regionally focused execution and oversight
of AHS support to other Services within the AO. When designated, the MEDCOM (DS) is also responsible
for providing operational medical logistics support to other Services. In cases where the ASCC is designated
by the CCDR as the single integrated medical logistics manager (SIMLM), these functions are most
commonly executed under the direction of the MEDCOM (DS) in coordination with the ASCC surgeon, the
TSC, and the supported service components.
2-27. For the Class VIII single integrated medical logistics manager mission, the MLMC provides
information management and distribution coordination; the medical logistics company provides medical
supply and medical maintenance support; the MEDBDE (SPT) provides planning and supervision; and the
MEDCOM (DS) provides theater-level oversight of MEDLOG operations. The medical detachment (blood
support) provides collection, manufacturing, storage, and distribution of blood and blood products for brigade
and echelons above brigade AHS units and other Services as required. The MEDCOM (DS) maintains a
command link with the MEDBDE (SPT) and coordination link with the TSC and/or ESC through the MLMC
(forward team) collocated with the DMC.
HEALTH CARE AND THE COMMAND SURGEON IN JOINT OPERATIONS
2-28. The AHS is a strategic enabler of joint medical operations and provides the only standing theater-
level medical command and control within the DOD. In joint operations, each Service operates its own health
care delivery system, however, health care facilities, medical equipment, supplies, and personnel may be
provided on a joint basis, when directed by the joint force commander. Although joint staffing is not a
requisite to joint use, staff augmentation from Service components may be required. When one Service uses
personnel or medical elements from another Service, the borrowing Service assumes operational control over
those elements, however, administrative responsibility remains with the lending Service.
2-29. Upon activation of a joint task force, a command surgeon is designated from one of the component
Services. Joint Publication 4-02 states that a joint force surgeon should normally be appointed for each |
4-02 | 44 | Chapter 2
combatant command, subordinate unified command, and joint task force. As a specialty advisor, the joint
force surgeon reports directly to the joint force commander or the joint force land component commander.
The joint force surgeon coordinates medical matters for the joint force commander. The joint force surgeon’s
staff should be jointly manned (when possible) and should be of sufficient size to effectively facilitate joint
coordination of medical initiatives; review of plans; and integration with overall operations. The command
surgeon must assess component forces medical requirements and capabilities and provide guidance to
enhance effectiveness of health care through shared use of assets. Refer to JP 4-02 for additional information
on the duties and responsibilities of the joint force surgeon.
2-30. Liaison must be established between the joint force surgeon and each Service component command
surgeon to ensure that mutual understanding of medical capabilities and procedures, unity of purpose and
action, and joint health care is maintained.
UNIFIED ACTION PARTNERS
2-31. In the OE, a unity of effort must be achieved by all participants and in many scenarios the AHS will
provide responsive medical care to unified action partners within the operations determination of eligibility
for care. Likewise, our unified action partners may provide first responder and health care services for U.S.
troops engaged in multinational operations. The synchronization with our unified action partners of all health
care delivery to U.S. Soldiers and multinational forces is essential to ensure the appropriate medical
resources are available when needed in the OE.
SECTION II — MEDICAL COMMAND AND CONTROL ORGANIZATIONS
2-32. The AHS is a foundational capability that supports the CCDR’s efforts to prevent conflict and shape
OEs. The Army medical forces participate in expeditionary operations, integrate with other Services, and
support unified action partners. Leaders must understand that the Army Health System medical functions
are complex in nature and that medical command and control of FHP and HSS support require integration,
coordination, and synchronization to ensure the interoperability of all medical assets remain in balance to
optimize the effective functioning of the entire system.
2-33. The medical command and control function includes the centralized medical chain of command that
provides command and control of EAB medical assets. Most importantly, it also includes the surgeon’s
technical supervision at echelon of assigned or attached medical assets.
2-34. All command and control headquarters perform the same basic military tasks. According to ADP 6-0,
command and control is the exercise of authority and direction by a properly designated commander over
assigned and attached forces in the accomplishment of the mission. Medical command and control is not just
the exercise of command and control over assigned or attached medical units. It is an overarching function
including the technical, clinical, and medical control of all FHP and HSS support. A key to the successful
accomplishment of the AHS support is the synchronization of health care activities and the surgeon’s
technical supervision at echelon of ongoing medical and clinical operations. For more detailed information
refer to Appendix C. Specific medical command and control tasks are addressed in Table 2-1 on page 2-9. |
4-02 | 45 | Army Health System Command and Control
Table 2-1. Primary tasks and purposes of the medical command and control function
Primary task Purpose
Command forces Ensure unity of Army Health System support effort.
Train subordinates on command and control and the application of
mission command.
Make timely and effective Army Health System support decisions and
act.
Inform and influence leaders to provide the right mix of medical
capabilities.
Control operations Regulate the Army Health Service support of subordinate and supporting
units.
Direct and coordinate the actions of medical assets to meet commander’s
intent.
Ensure the medical functions within the protection and sustainment
warfighting functions are coordinated and synchronized for linkage
between these varied commands and staffs.
Direct actions by establishing responsibilities and limits that prevent
subordinate medical unit actions from impeding one another.
Maintain situational understanding of Army Health Services command
and control systems and the common operational picture.
Drive the operations process Employ the operations process to integrate and synchronize the force
health protection and health service support medical functions.
Integrate numerous processes such as intelligence preparation of the
battlefield, medical intelligence, and the military decision-making
process.
Ensure execution of Army Health System support supports the CCDR's
decisions and intent.
Establish the command and Support the commander’s decision making.
control system
Prepare and communicate directives to subordinate and supporting
medical units.
Facilitate the integration of medical information systems in support of
Army Health System.
Provide technical supervision Advise the commander on the health of the command and how best to
provide Army Health System support for commander’s freedom of
movement.
Ensure medical standards are established, implemented, and monitored
throughout the operational area.
Advise commanders on implementation of protective action posture
including chemoprophylaxis, restriction of movement, isolation, and
quarantine to prevent and control the spread of diseases.
Provide consultation and support to subordinate medical units or
elements.
Provide reachback capability to the Defense Health Agency (DHA)
continental United States-support base medical treatment facilities in the
areas of various medical disciplines and specialties.
Provide oversight over medical care to Soldiers, civilians, and detainees.
For a more detailed discussion on command and control, refer to ADP 3-0, ADP 5-0, and ADP 6-0. |
4-02 | 46 | Chapter 2
MEDICAL COMMAND (DEPLOYMENT SUPPORT)
2-35. The MEDCOM (DS) conserves the fighting strength of the operational commander through
integration, synchronization of AHS operations and providing command and control of MEDBDE (SPT),
MMBs, and/or other AHS units assigned/attached to the headquarters providing HSS or FHP to operational
commanders and AO forces while simultaneously conducting stability tasks.
MISSION, ASSIGNMENT, AND BASIS OF ALLOCATION
2-36. The MEDCOM (DS) serves as the theater medical command within the AO. The MEDCOM (DS)
commander identifies and evaluates health care requirements throughout the AO. Within the MEDCOM
(DS) AO, medical resources may be dispersed over an extended area and may include numerous areas with
increased patient densities, transient troop populations, varying levels of hostilities, and significantly
different health care requirements. To successfully execute medical operations, the MEDCOM (DS)
commander must have the ability to rapidly task-organize and reallocate medical assets across command and
geographical boundaries. This ability is crucial to ensure the medical force package is effectively tailored to
optimize the use of scarce medical resources.
2-37. The MEDCOM (DS) is composed of an operational command post (OCP) and a main command post
(MCP) that can deploy autonomously into the AO.
* The OCP is a deployable and versatile module. The OCP can conduct early entry operations and
serves as the forward command and control element of the MEDCOM (DS). The OCP expand
the reach of the MEDCOM (DS) to provide connectivity between the headquarters and
headquarters company, MEDCOM (DS) in CONUS and/or deployed home station and the medical
units in the AO. It—
Provides command and control, administrative assistance and technical supervision of
assigned or attached medical units.
Can deploy autonomously into the AO during early entry and theater opening operations.
Further, the OCP can be deployed to other AOs outside its habitually supported theater to
provide medical command and control in support of another operation.
Provides interface and liaison with supported forces in the AO. The OCP has an assigned
standard requirements code to facilitate the placement of personnel in the command post and
to integrate the command post into the Time Phased Force Deployment List.
Can be incrementally expanded or be augmented as the force builds within the AO.
Builds the structure required to provide campaign-quality health care to the deployed force.
* The MCP provides appropriate staff sections for command, control, and support to assigned or
attached units in the theater of operation. The MCP can be deployed to expand or enhance the
Operational Command Post or remain in a sanctuary as the primary command and control medical
element of the HHC, MEDCOM (DS). The MCP provides connectivity between CONUS and
medical units in the theater. If the OCP is deployed and needs additional personnel or clinical
skills, the MCP can deploy personnel to the OCP to provide more robust command and control
capabilities. The MCP provides a robust planning, controlling, and coordinating capability to
facilitate the provision of health care to expanding forces. The MEDCOM (DS) MCP provides—
Medical staff planning, operational and technical supervision, and administrative assistance
for subordinate units operating in the AO.
Increased capability for medical and surgical consultation services, technical advice, and
policy development in the areas of hospitalization, nursing services, pharmacy, optometry,
medical laboratory, dental services, COSC, behavioral health, and neuropsychiatric services,
veterinary services (zoonotic disease control, investigation and inspection of subsistence, and
animal medicine), nutrition care, and operational public health (entomology, epidemiology,
occupational and environmental health (OEH) surveillance, potable water inspection, pest
management, food facility inspection, and control of medical and nonmedical waste).
2-38. The MEDCOM (DS) possesses the authority to effectively and efficiently task-organize medical
elements based on specific medical requirements. The MEDCOM (DS) serves as the theater medical |
4-02 | 47 | Army Health System Command and Control
command for the AOR and focuses on medical OPLANs and medical contingency plans. It monitors threats
and ensures required medical capabilities to mitigate these health threats, and maintains visibility and
utilization of medical infrastructure, treatment, and evacuation capabilities. It accomplishes Title 10
responsibilities and Army support to other Services for the AO. The MEDCOM (DS) partners and trains
with host-nation and multinational AHS units. It maintains a command relationship with the theater army
and the CCDR to influence and improve the delivery of health care and is linked to the TSC by the MEDLOG
management center for coordination and planning. The MEDCOM (DS) is assigned to the theater army and
is allocated on a basis of one per theater.
2-39. Refer to Figure 2-4 for notional deployed MEDCOM (DS).
Figure 2-4. Notional deployed medical command (deployment support)
CAPABILITIES AND DEPENDENCIES
2-40. The MEDCOM (DS) provides—
* Command and control of AHS units providing medical support within the AO.
* Subordinate medical organizations to operate under the MEDBDE (SPT) and/or the MMB in order
to provide medical capabilities to BCTs.
* Advice to the theater army commander and other senior-level commanders on the medical aspects
of their operations.
* Staff planning, supervision of operations, and administration of assigned and attached AHS units.
* Assistance with coordination and integration of strategic capabilities from the sustaining base to
units in the AO.
* Advice and assistance in facility selection and preparation. |
4-02 | 48 | Chapter 2
* Coordination with the USAF theater patient movement requirements center for medical regulating
and movement of patients from Role 3 MTFs.
* Consultation services and technical advice in all aspects of medical and surgical services.
* Functional staff to coordinate medical plans and operations, hospitalization, operational public
health, operational and strategic MEDEVAC, veterinary services, nutrition care services, COSC,
medical laboratory services, dental services, and area medical support to supported units.
* Coordination and orchestration of MEDLOG operations to include Class VIII, distribution,
medical maintenance and repair support, optical fabrication, and blood management.
* Plan and direct the execution of single integrated MEDLOG manager responsibilities, when
designated.
* Veterinary support for zoonotic disease control, food protection and quality assurance of
subsistence, and animal medical care.
* Operational public health support for medical and OEH surveillance, potable water inspection,
pest management, food facility inspection, and control of medical and nonmedical waste.
* Legal advice to the commander, staff, subordinate commanders, Soldiers, and other authorized
persons.
* Health threats monitoring within the AO and identification of required capabilities to mitigate
threats.
* Religious support to the command. This includes coordination by the MEDCOM (DS)
headquarters chaplain section with subordinate unit ministry teams assigned to subordinate
medical commands for required religious support throughout the AO.
* Maintenance personnel to augment the maintenance unit that performs maintenance on the unit’s
organic vehicles and power generation equipment.
* Coordination with DOD contracting authorities on addressing HSS and FHP challenges associated
with contracted services.
2-41. This unit is dependent upon appropriate elements of the TSC for sustainment, finance, supplemental
transportation, security during operational moves, sustainment area security and area damage control, CBRN
decontamination assistance, and laundry and shower facilities.
2-42. This unit (its TOE and supplies) is 100 percent mobile using organic assets.
2-43. Refer to Figure 2-5 (on page 2-13) for a depiction of a MEDCOM (DS) organizational structure.
REGIONAL FOCUS
2-44. The MEDCOM (DS) maintains a regional focus that encompasses all of the CCDR’s AOR. As in all
regions of the world, neighboring countries often have economic, social, and religious ties and deal with
similar health issues. The issues which may be at the heart of the social unrest in the deployment area can
usually be found to exist in the other countries within the same region. Medical forces, due to their
humanitarian mission, are more acceptable to host nations than the operational Army. The medical
commander’s ability to cultivate medical professional contacts within a nation or group of nations, facilitates
the planning for and execution of regional strategies that will potentially mitigate the underlying social,
economic, cultural, health, and political conditions which can foster civil unrest.
2-45. By establishing linkages to the civilian and governmental health care authorities in each nation, the
senior medical command headquarters can actively monitor existing health threats, develop regional
strategies to mitigate these threats, enhance the host-nation government’s legitimacy with the affected
population, and reduce human suffering. The medical commander provides the CCDR with an effective tool
to assist in shaping the security environment by mitigating the adverse health conditions that impact the
development of strong social, economic, and political infrastructures. The CCDR can deploy medical experts
to provide consultation, training support, and advice to assist host nations in broadening their medical
capacity in both the public and private health sectors through the development and implementation of health
care programs specifically designed to address the particular health challenges faced by the host nation. |
4-02 | 49 | Army Health System Command and Control
Figure 2-5. Medical Command (deployment support) organizational structure
2-46. Military medical training exercises can be mutually beneficial to the host nation and U.S. forces.
These exercises provide a forum for training medical personnel in the identification and treatment of diseases
and conditions that are not endemic in the U.S. and provide the host-nation military or civilian medical
personnel training on emerging state-of-the-art technologies and medical protocols. The care provided which
is incidental to the training mission, assists the host nation in overcoming the adverse impacts of the
diseases/conditions treated and enhances its legitimacy in the eyes of its citizens.
2-47. The effects of focusing on interregional cooperation are to eradicate diseases or the environmental
conditions that promote the growth of disease vectors. The interregional cooperation which results may also
favorably affect the economic, social, and political fabric of the nation, remove obstacles to interregional
cooperation in other sectors, and enhance the standard of living of the host-nation residents. For more
information on MEDCOM (DS) in support of setting the theater, refer to Chapter 5.
STAFF ORGANIZATION
2-48. This section combines various command posts of the MEDCOM (DS) to provide a description of the
composition and capabilities of the command’s coordinating, special, and personal staff structure. For
additional information on the composition, duties, and responsibilities of the various Army staffs refer to
ADP 5-0. Refer to Figure 2-6 on page 2-14 for the depiction of the MEDCOM (DS) coordinating, personal,
and special staff structure. |
4-02 | 50 | Chapter 2
Figure 2-6. Medical command (deployment support) staff structure
Coordinating Staff
2-49. The coordinating staff officers are the commander’s principal staff assistants and are directly
accountable to the chief of staff. Coordinating staff officers are responsible for one or a combination of broad
fields of interest. They help the commander coordinate and supervise the execution of plans, operations, and
activities. Collectively through the chief of staff, they are accountable for the commander’s entire field of
responsibilities. The staff is not accountable for functional areas the commander decides to personally
control.
Special and Personal Staffs
2-50. The special staff helps the commander and other members of the staff in their professional and
technical functional areas. Special staffs are organized according to functional areas.
2-51. The personal staff works under the commander’s immediate control. They also serve as special staff
officers as they coordinate actions and issues with other staff members.
STAFF FUNCTIONS
2-52. This section discusses staff functions.
Command Section
2-53. The command section provides command, control, and management of all MEDCOM (DS) services.
Personnel of this section supervise and coordinate the operations and administration of the command section. |
4-02 | 51 | Army Health System Command and Control
Chief of Staff Section
2-54. The chief of staff section plans, directs, and coordinates the execution of staff functions. It reviews
organizational activities and recommends changes, as necessary, to the MEDCOM (DS) commander. This
section ensures synchronization of staff activities and ensures that required coordination is accomplished.
Deputy Chief of Staff, Personnel
2-55. The deputy chief of staff, personnel serves as the advisor to the commander on personnel issues and
provides administrative services for the command.
Personnel section
2-56. This section is responsible for establishing, monitoring, and assessing MEDCOM (DS) human
resources policies. This section coordinates responsibility for MEDCOM (DS) strength management;
finance support; casualty management; casualty estimates; morale, welfare, and recreation activities;
education; safety and accident prevention; alcohol and drug abuse programs; and equal opportunity activities.
Further, this section provides overall administrative services for the command, to include: personnel
administration, mail distribution, awards and decorations, and leaves. This section coordinates with elements
of supporting agencies for finance, human resources, and administrative services, as required. This section
receives and processes actions including promotions, reassignments, awards, personnel accounting, and
strength management. The section prepares the MEDCOM (DS) personnel estimate and recommends
priorities of fill for replacement to the MEDCOM (DS) commander and the deputy chief of staff,
security/plans/operations.
Personnel Management and Actions Branch
2-57. Personnel management and actions branch develops personnel policies for promotions, appointments,
demotions, classifications, assignments, reassignments, decorations, awards, and separations for the
MEDCOM (DS) according to theater policy. It maintains continuous personnel loss data and obtains
summarized personnel information for use in preparing support plans. In coordination with the CA section,
this branch provides policy and guidance on procurement, administration, and utilization of civilian personnel
in the command. This branch is also responsible for establishing and monitoring Family readiness groups.
Deputy Chief of Staff, Security, Plans, and Operations
2-58. Deputy chief of staff, security, plans, and operations is the principal staff section in matters concerning
security, plans, intelligence, operations, organization, training, and CBRN defensive activities. It prepares
broad planning guidance, policies, and programs for command organizations, operations, and functions. This
section is responsible for plans and operations, deployment, relocation, and redeployment of the MEDCOM
(DS). It directs and coordinates MEDEVAC operations, both ground and air. It provides 24-hour continuous
operations capability. This section develops policies and guidance for training and training evaluation of the
command. This section has four principal functional elements: the current operations branch, the plans
branch, the intelligence and operations branch, and the theater patient movement center.
Current Operations Branch
2-59. The current operations branch is responsible for all operational planning functions to include
deployment, relocation, and redeployment of the MEDCOM (DS).
Plans Branch
2-60. The plans branch provides security, plans and operations, deployment, relocation, and redeployment
of the command. This branch exercises staff supervision over medical activities, assists the commander in
developing and training the unit’s mission essential task list, and identifies training requirements based on
medical missions and the unit’s training status. This branch is responsible for developing and implementing |
4-02 | 52 | Chapter 2
training programs, directives, and orders and maintaining the unit readiness status reports of each unit in the
MEDCOM (DS). It authenticates and publishes OPLANs and OPORDs.
Intelligence/Operations Branch
2-61. The intelligence/operations branch provides security, plans and operations, deployment, relocation,
and redeployment support in the command. The branch acquires, analyzes, and evaluates intelligence, to
include health threat information, medical, and OEH surveillance data. In coordination with the preventive
medicine officer, it identifies DNBI trends and processes data accordingly. The branch identifies the
commander’s critical information requirements and other intelligence requirements. It also presents
intelligence assessments, evaluations, and recommendations to the deputy chief of staff, security, plans, and
operations. The branch provides threat analysis to support operations security planning. The branch develops
plans and requirements for terrain studies, mapping, and charting. It collects and distributes weather data.
The branch assists the deputy chief of staff, security/plans/operations in preparing OPLANs. Further, the
branch provides advice and consultation on all activities comprised by the protection warfighting function
and risk management.
Theater Patient Movement Center
2-62. The theater patient movement center is responsible to the deputy chief of staff,
security/plans/operations for maintaining 24-hour continuous operations and conducting split-based
operations. The theater patient movement center is responsible for medical regulating of all patients in the
operational area and preparation of patient statistical reports. This center coordinates with the theater patient
movement requirements center for intertheater evacuation of all patients leaving the theater and for specific
patient movement item requirements and medical attendant requirements. The theater patient movement
center interfaces with the theater patient movement requirements center for intratheater AE when evacuation
distances exceed the capabilities of United States Army rotary-wing aircraft. This section synchronizes
intratheater evacuation plans with the intertheater evacuation plan to ensure a seamless transition between
operational and strategic evacuation systems. This section performs patient tracking procedures and monitors
in-transit visibility of MEDCOM (DS) patients. Refer to JP 4-02 for additional information on MEDEVAC
and medical regulating. Additionally, this section provides advice and consultation on the maintenance and
disposition of medical records. Refer to AR 40-66 and AR 40-400 for information on the maintenance and
disposition of health records for deployed forces.
Deputy Chief of Staff, Logistics
2-63. The deputy chief of staff, logistics, has primary responsibility for monitoring all logistics support to
MEDCOM (DS) units, including Class VIII supply/resupply, medical equipment, medical equipment
maintenance and repair, optical fabrication, medical gases, medical contractors, general supply, maintenance,
transportation, food services, and construction support. The deputy chief of staff, logistics, integrates those
functions that sustain the MEDCOM (DS) assigned and attached units in the operational area. This section
provides staff supervision and overall coordination for internal logistics support of MEDCOM (DS) units.
2-64. Another section under the Deputy Chief of Staff, Logistics is the Medical Logistics Support Section.
The MEDLOG support section monitors, coordinates, and facilitates MEDLOG operations within the
command. This includes Class VIII supply and resupply, blood management and distribution, medical
equipment maintenance and repair, medical gases, and optical lens fabrication and repair. This section plans
for the single integrated MEDLOG manager mission, when designated. As the single integrated MEDLOG
manager, it coordinates with and provides MEDLOG support to all Services deployed in the operational area.
This section coordinates with and establishes a liaison with the MEDLOG management center forward team.
The MEDLOG management center forward team provides centralized, theater-level management of critical
Class VIII materiel, patient movement items, and medical maintenance. Refer to ATP 4-02.1 for additional
information on the MEDLOG management center. Further, this section coordinates and facilitates
contracting operations in support of the medical mission. (The availability of contracting support for medical
services and supplies may be limited by the stringent requirements of the Food and Drug Administration for
medical supplies and U.S. standards for professional services). |
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Assistant Chief of Staff Civil Affairs Operations
2-65. The G-9 integrates considerations analysis and evaluation planning within the MEDCOM (DS)
operational area. The G-9 plans for the area assessments and estimates on the impact of the local populace
on MEDCOM (DS) operations to include the assessment of the host-/foreign-nation medical infrastructure.
The G-9 facilitates and develops assessments of the host-nation medical infrastructure to assist the
MEDCOM (DS) commander in planning and executing AHS support in the operational area. The G-9 plans
civil reconnaissance and civil engagements with local cultural and religious leaders to facilitate interpersonal
relationships in a host-nation environment. The G-9 assists the MEDCOM (DS) commander in preparing
medical functional studies, assessments, and estimates of how the host-nation civilian and military
populations affect patient workloads in U.S. MTFs. It provides assistance to and liaisons for
nongovernmental organizations and the International Committee of the Red Cross that offers medical
treatment/supplies to the host nation involved in the conflict/operation. The G-9 can provide detailed input
for the requirements, location and establishment of a civil-military operations center, if available, to facilitate
the commander’s civil-military planning and execution.
Note. For detailed information on the requirements and capabilities of the G-9, see FM 6-0,
Commander and Staff Organization and Operations and FM 3-57, Civil Affairs Operations).
Deputy Chief of Staff, Information Management
2-66. The deputy chief of staff, information management is responsible for all aspects of automation and
communications-electronics support within the MEDCOM (DS). This section establishes a medical
automation office and is responsible for medical information systems policy and guidance for all subordinate
commands. This section identifies communications-electronics requirements for data transmission services
and coordinates these requirements with the signal command. This section provides advice and consultation
on the integration of medical information systems in support of AHS and with other command and control
systems within the operational area.
Deputy Chief of Staff, Comptroller
2-67. The deputy chief of staff, comptroller is responsible for budget preparation and resource management
analysis and implementation for the command. It provides staff assistance on budget matters; establishes
funding ceilings for subordinate units; and monitors budget program execution. This section coordinates
funding of foreign humanitarian assistance and other operations which may require special and/or additional
funding. This section funds approved contractual services and materiel. Further, it monitors and provides
advice and assistance on reimbursement for medical services rendered from third parties, other Services, and
multinational forces, as specified by regulations, memorandums of agreement or understanding, or cross-
servicing agreements.
Clinical Services
2-68. The clinical services personnel serve as the commander’s principal consultants and technical advisors
for the command in general medicine, surgical, neuropsychiatry, COSC, behavioral health (BH), pharmacy
services, clinical practices, procedures and protocols, and optometry. This section is responsible for
developing and implementing clinical policies and procedures for the commander. Further, this section
monitors and coordinates with subordinate medical functional staff sections.
This paragraph implements ABCA Standard 2108.
2-69. This staff section is responsible for—
* Neuropsychiatry, BH, and COSC to include establishing and monitoring policies, programs, and
consultation and education services; advising on the MEDEVAC priorities, procedures,
medications, and types of platforms to use for stress-related or mentally ill patients; and
coordinating for reconstitution, reinforcement, or augmentation of forward-deployed BH assets. |
4-02 | 54 | Chapter 2
* Medical and surgical services to include providing consultation and education support; monitoring
patient statistical data on types of wounds, injuries, and illnesses to identify trends; ensuring
required professional skills are available and requesting augmentation when required; monitoring
the care of a detainee or personnel in U.S. custody; and recommending the designation of MTFs
for specific situations or medical conditions (such as for detained patients only or all cases of head
trauma). This section also develops and implements medical and surgical clinical policies and
guidelines which are in consonance with the Defense Medical Materiel Program Office
Deployable Medical Systems Clinical Policy and Guidelines and Patient Treatment Briefs. This
section identifies medical issues requiring research and clinical investigation.
* Pharmacy to include developing and establishing a theater formulary; monitoring pharmacy
operations within the command to ensure compliance with regulatory requirements; providing
consultation and education on prescription and investigational new drugs; establishing policy and
procedures for dispensing over-the-counter drugs; monitoring proficiency of enlisted pharmacy
personnel; and establishing training programs as required.
* Optometry to include monitoring the occupational vision program, providing consultation on all
matters pertaining to vision evaluation and correction, and developing protocols for the diagnosis
and treatment of ocular injuries and diseases in concert with supporting ophthalmologist.
* Medical laboratory to include monitoring medical laboratory operations within the command to
ensure adequate capability is available to meet medical laboratory requirements, coordinating for
reconstitution, reinforcement, or augmentation of medical laboratory resources, as required, and
providing consultation to subordinate medical laboratory personnel.
2-70. This section ensures that health care providers are properly credentialed and their scope of practice is
defined. They also establish quality assurance measures and peer review of technical matters. Further, this
section is responsible for establishing and monitoring professional medical education and training programs
and policies. For more information on health care professional credentialing and privileging assigned to a
multinational medical unit, refer to ABCA Standard 2108.
2-71. This section, in conjunction with the patient administration officers in the theater patient movement
center, monitors the maintenance and disposition of patient medical records.
Dental Services
2-72. Dental services personnel serve as the commander’s principal consultants and the command’s technical
advisor in dentistry. This section directs the establishment and implementation of policy and programs for
all dental activities, this includes preventive dentistry and educational programs, operational dental care
(emergency and essential), and oral and maxillofacial surgical procedures. This section ensures oral health
surveillance policies, programs, and procedures are developed and implemented within the operational area.
It also advises the commander on the dental aspects of foreign humanitarian assistance operations, plans, and
programs, as required.
Veterinary Services
2-73. Veterinary services personnel serve as the commander’s principal consultants and the command’s
technical advisor for veterinary services’ activities and employment of veterinary assets for the joint force.
This section provides technical supervision of food protection, animal medical care, and veterinary public
health support. The United States Army is the sole provider for veterinary services for all Services (DODD
6400.04E) (with the exception of food inspection operations on USAF installations).
2-74. This section develops, plans, and implements veterinary services policies and programs for the joint
operational area. It also evaluates host-nation capabilities and integrates veterinary services policy with
multinational forces. The veterinary services section coordinates with the CA officer to advise the command
and staff concerning local zoonotic disease transmission, providing animal medical care for local livestock
and other animals, and building relationships with local food production facilities and agricultural and
veterinary medical agencies. |
4-02 | 55 | Army Health System Command and Control
Nutrition Care Services
2-75. Nutrition care services personnel serve as the commander’s principal consultant and the command’s
technical advisor in nutrition care. This section ensures the coordination required to obtain medical
supplemental rations is accomplished and that assigned and attached hospitals have required items to prepare
medical diets. This section also coordinates with the chaplain section to ensure appropriate available rations
for hospitalized patients with religion-based dietary restrictions. This section coordinates with CA officers
when nutrition issues arise in the conduct of stability tasks.
Nursing Services
2-76. The chief nurse serves as the commander’s principal advisor on all issues affecting nursing practices
and personnel. This section develops, plans, and implements policies for nosocomial infection control and
quality assurance nursing programs. The chief nurse (nursing consultant) is responsible for nursing policy,
resourcing, and technical supervision of subordinate nursing personnel. This section analyzes and evaluates
nursing care and procedures in subordinate units. The nursing consultant evaluates host-nation health care
delivery systems and hospitalization capabilities and integrates clinical policy with joint and multinational
forces.
Preventive Medicine Section
2-77. The preventive medicine section serves as the commander’s principal consultant and the command’s
public health and environmental sciences advisors. This section develops, plans, and implements operational
public health policies and programs for the operational area. These programs include medical surveillance,
OEH surveillance, pest management activities, epidemiological investigations, food service facility
sanitation and hygiene, and inspection of potable water supplies. This section monitors and analyzes DNBI
reports submitted by subordinate AHS units. It performs trend analysis which is used to identify shifts from
the baseline of diseases within the operational area (as a shift may indicate the use of biological warfare
agents against the deployed force). It also evaluates host-nation capabilities and integrates operational public
health policy with joint and/or multinational forces. This section coordinates with the CA section for
operations to restore essential services in the host nation during operations characterized predominantly by
stability tasks. Refer to AR 40-5 and Department of the Army Pamphlet (DA PAM) 40-11 for additional
information on the Army Public Health Program. This section provides advice and consultation on personnel
protective measures and issues arising in theater detention facilities.
2-78. This section, in conjunction with the CBRN officer, advises the deputy chief of staff,
security/plans/operations and the MEDCOM (DS) commander on the medical aspects of CBRN defensive
measures. This includes, but is not limited to, policies, programs, and procedures pertaining to
immunizations; chemoprophylaxis; barrier creams; pretreatments; and the use of investigational new drugs.
For additional information on operational public health refer to Table 5-1 on page 5-3 of this publication.
Inspector General Section
2-79. The inspector general section is responsible to the commander for inquiring into and reporting on
matters that impact the overall efficiency of the command to include the performance of the mission, state of
discipline, operating efficiency, and economy. The inspector general section conducts inspections,
investigations, surveys, and studies as the commander directs and as laws and regulations prescribe.
Public Affairs Section
2-80. The public affairs section serves as the commander’s focal point for command information, public
information, and community relations matters. The MEDCOM (DS) public affairs officer has the overall
responsibility for building an understanding of AHS services/programs within the operational area.
Additionally, as the official spokesperson for the command, releases information, as appropriate, on the
medical aspects of—
* Incidents, engagements, or accidents involving other commands, Services, and/or multinational
forces.
* Stability tasks in conjunction with the CA officer. |
4-02 | 56 | Chapter 2
* Controversial issues that are likely to attract national media attention.
* Detainee medical operations.
Staff Judge Advocate Section
2-81. The functions of the staff judge advocate are to provide legal advice and services to the commander,
staff, subordinate commanders, Soldiers, and other authorized personnel. The staff judge advocate section
develops and executes plans and programs in the fields of criminal law and related military justice,
administrative law, litigation, environmental law, regulatory law, intelligence activities law, labor and
civilian personnel law, and medical jurisprudence. This section advises the commander on the legal aspects
of determining eligibility for care in U.S. military MTFs. This section also advises the commander on any
issues arising with the provisions of the Geneva Conventions and other international treaties or agreements.
Company Headquarters
2-82. The company headquarters is responsible for Soldiers assigned to the MEDCOM (DS) headquarters
that are not assigned or attached to subordinate commands. Besides common staff responsibilities, the
company headquarters is responsible for— developing the MEDCOM (DS) headquarters occupation plan;
ensuring local headquarters security, to include constructing fighting and protective positions; arranging for
and moving the headquarters; training; conducting morale, welfare, and recreation activities for headquarters
personnel; obtaining or providing food service, quarters, medical support, field sanitation, and supply for
headquarters personnel; receiving, accommodating, and orienting visitors and professional filler personnel;
providing and prioritizing motor transportation support (organic to or allocated for use by the headquarters);
and maintaining equipment organic to or allocated for use by the headquarters.
Unit Ministry Team
2-83. The unit ministry team serves as the advisor to the Commander and provides religious support and
pastoral care ministry for assigned staff and subordinate organizations. It advises the commander, staff, and
subordinate commanders on religion, morals, and morale within units, and ethical decision making of the
command. The unit ministry team coordinates with the CA operations staff officer (S-9) to advise the
command and staff concerning operational impact of religious belief and practice of local populations and
leaders in the operational area, building relationships with and conducting Soldier Leader Engagements with
local religious leaders as directed by the command. It coordinates with subordinate commands and their
assigned unit ministry teams to ensure proper coordination of religious support throughout the area of
operations, to include advising commanders and their logistics support personnel on the process for ordering
appropriate available rations within the theater for hospitalized patients with religion-based dietary
restrictions. This team coordinates with subordinate MEDCOM (DS) unit ministry teams to ensure similar
advisement on availability of rations within the operational area for hospitalized patients with religion-based
dietary restrictions. The unit ministry team assigned to medical units also coordinate with adjacent units for
appropriate contingency plans for religious support in mass casualty incidents.
Joint Augmentation
2-84. The MEDCOM (DS) headquarters may be augmented by functional specialists from other Services
based on mission, enemy, terrain and weather, troops and support available, time available, and civil
considerations and availability of joint augmentation resources. Augmentation support to coordinate and
facilitate interoperability in AHS support operations may include:
* United States Air Force AE liaison teams or other medical regulating personnel to enhance
medical regulating and MEDEVAC of MEDCOM (DS) patients by the USAF strategic AE
system.
* United States Navy personnel to expedite and deconflict shore-to-ship/ship-to-shore air medical
evacuation operations conducted by United States Army rotary-wing MEDEVAC aircraft and
hospitalization of United States Army personnel in USN afloat facilities. |
4-02 | 57 | Army Health System Command and Control
* United States Air Force and USN MEDLOG personnel when the United States Army is designated
as the single integrated MEDLOG manager to ensure responsive MEDLOG support, to include
blood management for Service-unique MEDLOG requirements.
* United States Air Force and USN communications personnel to assure communications
connectivity and interoperability of communications equipment and of the automated information
system.
MEDICAL BRIGADE (SUPPORT)
2-85. The MEDBDE (SPT) is a subordinate command organization of the MEDCOM (DS). It serves as the
headquarters for all assigned and attached AHS units. One MEDBDE (SPT) may be providing direct support
to an operational commander, while another may be providing general AHS support to an EAB sustainment
force. These organizations may be providing simultaneous support to stability tasks occurring within their
operational area. The MEDBDE (SPT) may not always be subordinate to a MEDCOM (DS). In an
operational area where the MEDCOM (DS) is not yet deployed, the MEDBDE (SPT) may be the senior
medical command. Refer to Figure 2-7 for a notional deployed MEDBDE (SPT).
Figure 2-7. Notional deployed medical brigade (support)
Mission, Assignment, and Basis of Allocation
2-86. The mission of the headquarters and headquarters company, MEDBDE (SPT) is to organize, resource,
train, sustain, deploy support assigned and attached health care capabilities to provide flexible, responsive,
and effective HSS and FHP to supported force. The MEDBDE (SPT) is assigned to the MEDCOM (DS).
2-87. The basis of allocation for the MEDBDE (SPT) is one per two to six subordinate battalions.
2-88. Organizations and functions combine the early entry, campaign, and expansion modules of the
MEDBDE (SPT) to provide a complete description of the composition and capabilities of the organization.
This unit is designated a Category II unit. (For unit categories, see AR 71-32). |
4-02 | 58 | Chapter 2
2-89. Refer to Figure 2-8 for MEDBDE (SPT) organizational structure.
Figure 2-8. Medical brigade (support) organizational structure
Capabilities and Dependencies
2-90. The MEDBDE (SPT) is composed of three standard requirements code identified modules (the early
entry, expansion, and campaign modules).
2-91. The MEDBDE (SPT) provides—
* Command and control of subordinate and attached units.
* Operational medical augmentation to Role 2 BCT medical companies.
* Advice to the commanders on the medical aspects of their operations.
* Medical staff planning, operational and technical supervision, and administrative assistance for
subordinate or attached units.
* Coordination with the supporting patient movement requirements center for medical regulating
and strategic MEDEVAC.
* Medical consultation and education services in the following areas:
Operational public health.
Behavioral health to include COSC and neuropsychiatric care.
Food services.
Advice and recommendations for the conduct of operations predominated by stability tasks.
Control and supervision of Class VIII supply and resupply to include blood management.
When designated by the CCDR, serves as the single integrated MEDLOG manager.
A joint capable command and control capability when augmented with appropriate joint
assets. |
4-02 | 59 | Army Health System Command and Control
Support as the sole provider for veterinary services.
* Assistance in the coordinated defense of the unit’s area.
* Field maintenance on all organic equipment, except communications-electronics and
communications security.
* Religious support and pastoral care ministry.
2-92. The MEDBDE (SPT) is dependent upon—
* The combat aviation brigade to support the MEDEVAC plan with air ambulance assets.
* The sustainment brigade to arrange legal, administration, finance, human resources, transportation
services, CBRN and decontamination assistance, and laundry and shower services.
* Class I ration support.
* Waste disposal and construction support.
* Supplemental transportation support requirements.
STAFF FUNCTIONS
2-93. This section discusses staff functions assigned to a MEDBDE (SPT).
2-94. Refer to Figure 2-9 on page 2-24 for MEDBDE (SPT) staff structure.
Organization and Function
2-95. Organizations and functions combine the early entry, campaign, and expansion modules of the
MEDBDE (SPT) to provide a complete description of the composition and capabilities of the organization.
This unit is designated a Category II unit. (For unit categories, see AR 71-32.)
Internal Staff and Operations
2-96. The MEDBDE (SPT) coordinating staff (S-staff) and special staff manage the command’s internal
operations through coordination with staffs of higher, lower, and adjacent units. The staff’s efforts support
the commander and subordinate units by providing accurate and timely information. It produces estimates,
recommendations, plans and orders, and monitors execution. The staff streamlines cumbersome or time-
consuming procedures by ensuring that all activities contribute to mission accomplishment. Within the
MEDBDE (SPT) headquarters, staff sections coordinate their functional responsibilities with other
headquarters staff sections as required.
External Coordination
2-97. The MEDBDE (SPT) must coordinate with the MEDCOM (DS) and other headquarters within their
operational area. External coordination with the combat aviation brigade and general support aviation
battalion for air ambulance support is critical.
Command Section
2-98. The command section provides command and control, and management for all MEDBDE (SPT)
operations, activities, and services. The commander has overall responsibility for both the clinical and
operational aspects of all activities and operations conducted within the MEDBDE (SPT). The chief,
professional services is responsible to oversee the day-to-day clinical operations of the command.
Personnel (S-1) Section
2-99. The personnel staff officer (S-1) section provides overall administrative services for the command, to
include personnel administration, and coordinates with elements of supporting agencies for finance,
personnel, legal, and administrative services. |
4-02 | 60 | Chapter 2
Figure 2-9. Medical brigade (support) staff structure
Intelligence (S-2) Section
2-100. The intelligence staff section (S-2) performs all-source intelligence assessments and estimates for
the command. In coordination with the Chemical Officer/noncommissioned officer (NCO) in the S-3 section
or the CBRN unit that supports the MEDBDE (SPT). It advises the commander and staff on nuclear/chemical
surety and potential enemy use of CBRN weaponry and toxic industrial materials.
Operations (S-3) Section
2-101. The operations staff officer (S-3) section is responsible for plans and operations, deployment,
relocation and redeployment of the MEDBDE (SPT), and supervising MEDEVAC operations for both air
and ground.
S-3 Operations Branch
2-102. The S-3 operations branch is responsible for authenticating and publishing plans and orders. It
exercises staff supervision over AHS activities and advises the commander and staff on nuclear/chemical
surety and CBRN operations.
S-3 Plans Branch
2-103. The S-3 plans branch is responsible for the current planning in the MEDBDE (SPT) operational area,
to include deliberate and crisis planning. Additionally, it plans for future operations in excess of 72 hours
and prepares major regional contingency plans for the MEDBDE (SPT). Further, this branch prepares,
authenticates, and publishes medical plans and OPLANs to include the integration of annexes and appendixes
prepared by other staff sections. (Refer to ADP 5-0 for additional information on the operations process). |
4-02 | 61 | Army Health System Command and Control
Patient Movement Branch
2-104. The patient movement branch is responsible for maintaining 24-hour coordination and oversight for
patient regulating and administration within the MEDBDE (SPT) operational area.
Logistics (S-4) Section
2-105. The logistics staff officer (S-4) section plans, monitors, coordinates, and facilitates MEDLOG
operations within the command. This includes Class VIII supply and resupply, blood management and
distribution, medical equipment maintenance and repair, medical gases, optical lens fabrication, spectacle
fabrication and repair, and contracting support. The section is responsible for ensuring service support
functions and directs and supervises the collection, evacuation, and accountability for all classes of supply
classified as salvage, surplus, abandoned, or uneconomically repairable. The section advises the commander
of logistical matters and unit mission capabilities. The section serves as the focal point for property
management and accountability procedures of all assigned or attached units. As a staff office, they advise
the commander on matters regarding supply and services support and other logistical functions. As the
materiel manager, they develop, coordinate, and supervise the supply support portion of an integrated
logistics support plan.
2-106. In the Logistics (S-4) Section is the S-4 Logistics Plans Branch. The S-4 logistics plans branch
completes the logistics staffing to monitor, coordinate, and facilitate MEDLOG operations within the
MEDBDE (SPT). This includes Class VIII supply and resupply, blood management and distribution, medical
equipment maintenance and repair, medical gases, and optical lens fabrication and repair.
Signal (S-6) Section
2-107. The S6 section is responsible for all aspects of automation and communications-electronics support
within the MED BDE (SPT). This section establishes a medical automation office and is responsible for
medical information system policy and guidance for all subordinate commands. This section identifies
communications-electronics requirements for data transmission services and coordinates these requirements
with the external signal organizations. This section provides advice and consultation on the integration of
medical information systems in support of AHS and with other command and control systems within the
operational area.
Civil Affairs Operations (S-9) Section
2-108. The civil affairs operations staff officer (S-9) is the principal staff officer responsible for all matters
concerning civil affairs. The S-9 establishes the civil-military operations center, evaluates civil
considerations during mission analysis, and prepares the groundwork for transitioning the area of operations
from military to civilian control. The S-9 advises the commander on the military’s effect on civilians in the
area of operations, relative to the complex relationship of these people with the terrain and institutions over
time. The S-9 is responsible for enhancing the relationship between Army forces and the civil authorities
and people in the area of operations. The S-9 prepares Annex K (Civil Affairs Operations) to the operation
order or operation plan. (See FM 3-57 for more detailed information on the S-9 duties and responsibilities).
Clinical Operations Section
2-109. The clinical operations section serves as the commander’s principal consultants and technical
advisors for the command in general medicine, nursing services and activities, operational public health,
COSC and BH to include neuropsychiatric care and treatment, veterinary services, dental services, nutrition
and hospital food service activities, and medical laboratory support.
Command Judge Advocate Section
2-110. The command judge advocate section advises the commander on ethical issues as they relate to
health care operations. Further, it advises the commander and the MEDCOM (DS) detainee operations
medical director on issues pertaining to the treatment of detainees in subordinate CSHs, hospital centers, or
other MTFs. This section advises the commander on any issues related to the Geneva Conventions and the |
4-02 | 62 | Chapter 2
protection of medical personnel, patients, facilities, supplies, and transports. The command judge advocate
advises the commander and its staff on the eligibility of care determinations, policies, and procedures.
Company Headquarters
2-111. The company headquarters, MEDBDE (SPT) organizes, resources, trains, sustains, deploys,
exercises command and control to supported forces.
Unit Ministry Team
2-112. The unit ministry team provides two capabilities: first, they provide religious support and pastoral
care ministry for assigned or attached Service members, Family members, and authorized civilians, patients,
and casualties. Second they advise on real and potential impacts of religion, morals, ethics, and morale in
operations. Brigade unit ministry teams supervise and coordinate the provision of these religious support
functions by subordinate unit ministry teams, and provide these capabilities directly for subordinate
commands as needed.
Clinical Operations Responsibilities
2-113. The chief, professional services, has the responsibility to monitor the impact of all of the medical
functions on the clinical services provided within the command. The chief, professional services
accomplishes this mission through the activities of the staff and coordinating and synchronizing clinical
requirements with other MEDBDE (SPT) staff sections. The chief, professional services coordinates with—
* The S-1 for all personnel matters relating to clinical staff personnel. The chief, professional
services, recommends the priority of fill and assignment of all clinical personnel to subordinate
MTFs. As required, he requests augmentation support for medical specialties not represented on
the TOE.
* The S-2 for medical intelligence support. The clinical operations section develops, recommends,
and submits priority intelligence requirements and essential elements of friendly information for
information impacting clinical operations (to include the potential enemy use of CBRN weaponry
and toxic industrial material releases). This includes health threats within the operational area,
potential diseases present in the multinational force, and the health status of enemy forces who
may become detained personnel (to include new or exotic diseases in enemy forces).
* The S-3 for operational planning and medical regulating support. The clinical operations section
monitors current operations and assists in planning future operations by providing clinical input
into the development of AHS estimates and plans. They must evaluate proposed courses of action
for their impact on clinical capabilities and activities and recommend whether they are feasible
from a clinical viewpoint. Further, the clinical operations section must closely monitor medical
regulating activities, bed status, and/or operating room delays, if any, of subordinate hospitals,
patient movement items requirements, delays in the timely evacuation of patients to and from
MEDBDE (SPT) MTFs, and requirements for providing medical attendants for en route patient
care on USAF evacuation assets, if critical care air transport team support is not available. The
clinical operations section recommends clinical capabilities (task-organized) required to be
deployed forward to support EAB personnel deployed in the operational area to provide direct
support. The patient administration officer assigned to the intratheater patient movement center
serves as a consultant to the clinical operations section when issues concerning medical record
management arise.
* The S-4 for MEDLOG support of critical Class VIII items required for patient care, to include
medical supplies, pharmaceuticals, medical equipment, and blood. The clinical operations section
monitors the blood distribution and reporting processes (Technical Manual [TM] 8-227-12) to
determine the impact on clinical operations of shortages and delays. Further, they monitor the
status of medical supplies, medical equipment, and medical equipment maintenance and repair to
ensure that sufficient quantities are on hand and/or on order to sustain patient care activities within
the command. They also work closely with the S-4 in identifying and obtaining pharmaceuticals
to treat diseases (to include biological warfare agents) not usually present in U.S. forces (such as
for detainees). This section also advises the command on the management and disposition of |
4-02 | 63 | Army Health System Command and Control
captured enemy medical supplies and equipment. The pharmacy officer assigned to the S-4 serves
as a consultant to the clinical operations section on all issues pertaining to pharmaceuticals.
* The S-6 for information management, automated information system requirements, and
communications-electronics support.
* The command judge advocate section for all medical-legal matters to include the determination of
eligibility for medical care in U.S. MTFs. Further, the command judge advocate section provides
guidance on the provisions of the Geneva Conventions as they affect medical personnel,
equipment, evacuation platforms, and Class VIII supplies. He also provides guidance on any legal
issues involving care to detained personnel.
* The unit ministry team on religious matters that affect AHS operations to include faith-based
dietary restrictions and assistance in COSC programs and activities.
Technical Supervision
2-114. The chief, professional services exercises technical supervision of all AHS clinical activities through
his staff. The chief, professional services develops policies, procedures, and protocols for clinical activities
within subordinate MTFs. Treatment protocols implemented in the command are developed according to
Defense Medical Materiel Program Office standards and requirements, ARs, appropriate doctrinal
publications, and sound medical practice. The chief, professional services ensures that investigational new
drug protocols are followed. The chief, professional services also monitors the use of chemoprophylaxis,
pretreatments, immunizations, and barrier creams. The chief, professional services ensures credentialing
policies are in place and are being adhered to. The chief, professional services further ensures that a quality
assurance program is implemented within the command which encompasses patient safety, risk management,
infection control, peer review, and quality assurance. The chief, professional services monitors the
MEDEVAC and medical regulating activities to ensure necessary medical requirements and clearances for
patients being evacuated are accomplished. Further, develops patient preparation protocols for patients
entering the USAF evacuation system, as required. The chief, professional services monitors the area support
mission of assigned/attached Role 2 MTFs to ensure adequate AHS support to transient troop populations
within the MEDBDE (SPT) operational area. The chief, professional services compiles and analyzes
wounded-in-action data to determine trends in wounding patterns, to forecast specialized care requirements,
and to recommend protective measures as appropriate. The chief, professional services identifies medical
issues which require medical research and development. The duties and functions of The chief, professional
services’ staff include the:
* Chief nurse, who is the senior nurse in the command and provides technical supervision of the
MEDBDE (SPT) subordinate MTFs nursing personnel (officer and enlisted). This individual
establishes nursing policies and reviews and monitors nursing practices. The chief nurse monitors
staffing levels, personnel shortages, and advises the chief, professional services on the impact of
nursing shortfalls on the capability to provide required patient care. The chief nurse recommends
to the chief, professional services the priority of assignment for nursing care personnel. The chief
nurse also ensures educational and training requirements are met and monitors in-service training
activities of subordinate MTFs. The chief nurse monitors mass casualty planning of subordinate
MTFs, provides consultation to subordinate MTF mass casualty coordinators during rehearsals of
the mass casualty plan, and ensures that if training shortfalls are identified that appropriate
refresher/sustainment training is provided. Mass casualty refers to any number of human
casualties produced across a period of time that exceeds available medical support capabilities.
(JP 4-02). This individual ensures that documentation of medical treatment provided is
appropriately documented in the individual health record using the prescribed forms and/or
electronic media. The chief nurse directs routine reporting requirements and establishes format
and frequency of all formal nursing reports. The chief nurse monitors the quality assurance
program through records and reports provided by the subordinate MTFs. Quality assurance
programs are the responsibility of the subordinate MTF leadership and further delegated to the
assistant chief nurse, public health nurses, or clinical nurse officer-in-charge or to a senior NCO.
In early phases of operations, the focus of MTFs is on quality combat casualty care; it is essential
that the major duties of all clinicians be directly related to the delivery of patient care, rather than
administrative oversight. As the operational area matures and the types of patient conditions being |
4-02 | 64 | Chapter 2
treated evolves from acute trauma to DNBIs, the delegated quality assurance officer can devote
more time to administrative oversight of the quality assurance program.
* Preventive medicine officer, environmental science officer, and senior preventive medicine NCO,
who monitor all public health activities and requirements of the command. The preventive
medicine officer establishes reporting requirements and frequency of reports (such as the weekly
DNBI report). This individual consolidates subordinate unit DNBI reports and analyzes the data
submitted to identify trends and to compare incoming data with already established baselines. If
trends are identified, he recommends and develops effective medical countermeasures and
disseminates this information to all subordinate, adjacent, and higher headquarters. The
preventive medicine officer and environmental science officer analyze the data for indicators of
the potential exposure of U.S. forces to enemy employment of biological and chemical warfare
agents (increases in endemic disease rates in one specific geographic location or the appearance
of diseases which can be weaponized and are not endemic to the operational area) and to OEH
hazards. The preventive medicine officer, environmental science officer, and senior preventive
medicine NCO receives, monitors, reviews, and forwards supporting laboratory analysis of CBRN
samples/specimens and chain of custody documents for CBRN samples/specimens. This
individual ensures that medical surveillance and OEH surveillance activities are developed and
implemented for the health threat present in the operational area. The preventive medicine officer,
environmental science officer, and senior preventive medicine NCO monitors pest management,
potable water inspection, and inspection of field feeding/dining facility sanitation activities, toxic
industrial materials sources and hazards, and further ensures the procedures for the disposal of
medical waste are being adhered to. The preventive medicine NCO ensures that field hygiene and
sanitation training and unit field sanitation team training for subordinate units and personnel is
current and adequate.
* Veterinary preventive medicine officer and the food safety officer, who are responsible for
oversight of the implementation and conduct of programs for the inspection of food and food
sources for procurement, quality assurance, food safety, food defense, and sanitation. The
veterinary preventive medicine officer also oversees working animal medical care activities and
identifies MEDLOG shortfalls that will impact on these activities. The veterinary preventive
medicine officer provides technical consultation for implementation and conduct of public health
programs such as feral animal risk mitigation, rabies advisory boards, and any zoonotic and/or
endemic animal disease surveillance and mitigation efforts. The veterinary staff advises other
staff elements on appropriate veterinary global health engagement activities and coordinates with
veterinary staff elements at higher headquarters on these initiatives to ensure synchronization with
Theater Campaign Plan priorities and objectives. The veterinary preventive medicine officer
coordinates with the senior veterinarian in the theater and the supporting staff judge advocate to
develop a veterinary eligibility for care determination and the extent of care authorized in
accordance with applicable law and DOD and theater policy. Veterinary staff officers also identify
the metrics and frequency of reporting requirements for the various aspects of the veterinary
service support mission.
* Psychiatrist, behavioral science officer, and the BH NCO, who monitor all COSC activities and
the treatment of BH and neuropsychiatric cases within subordinate MTFs. The psychiatrist
ensures that all treatment programs for combat and operational stress are founded on proven
principles of combat psychiatry and are established and administered in accordance with current
doctrinal principles. The psychiatrist monitors the stress level of subordinate unit medical
personnel and provides consultation on traumatic event management support to health care
providers after mass casualty situations or other high stress events. The psychiatrist coordinates
policies, procedures, and protocols for the treatment of BH and neuropsychiatric disorders with
the senior subordinate unit psychiatrist or behavioral science officer and provides consultation on
the requirements for the MEDEVAC of psychiatric patients. The psychiatrist also provides advice
and guidance on any BH issues arising within the theater detention facility if located in the
MEDBDE (SPT) operational area.
* Dietitian and senior nutrition NCO, who monitors the status of medical diet supplemental rations,
hospital food service operations, and command health promotion program. The dietitian provides
consultation to subordinate hospitals on special diet requirements and preparation. The dietitian |
4-02 | 65 | Army Health System Command and Control
further coordinates with the unit ministry team on faith-based dietary restrictions. In foreign
humanitarian assistance operations, he provides consultation and advice on refeeding operations
for malnourished children and adults, dislocated person populations, and victims of man-made or
natural disasters. The dietitian also provides consultation on special dietary requirements for
patients being evacuated through the USAF evacuation system.
* The chief, dental services, who monitors dental activities for the command. The chief, dental
services, receives reports from subordinate units and consolidates this data for forwarding to
higher headquarters. The chief, dental services, establishes and coordinates policies, procedures,
and protocols for the treatment of dental conditions and preventive dentistry programs. The chief
also serves as the command’s dental surgeon.
2-115. Not all functional specialties are fully represented on the MEDBDE (SPT) headquarters staff.
Therefore the clinical operations section coordinates with subordinate AHS units for expertise in the
following areas:
* The senior subordinate surgeon serves as the principal consultant to the chief, professional
services, on all matters pertaining to surgical policy and employment of FSTs or FRSDs. The
senior subordinate surgeon maintains visibility of the joint trauma system patient treatment issues,
wounding patterns, and weapons effects in order to ensure subordinate MTFs are informed,
equipped, and supplied to provide appropriate treatment. Additionally, the chief, professional
services, can consult with the surgical consultant on the MEDCOM (DS) staff.
* The senior subordinate medical laboratory officer serves as the principal consultant to the chief,
professional services, on all matters pertaining to clinical laboratory support. The senior
subordinate medical laboratory officer advises the chief, professional services, on blood-banking
and storage capabilities of Roles 2 and 3 MTFs within the command. The senior medical
laboratory NCO on the MEDBDE (SPT) staff monitors the performance of MEDBDE (SPT)
medical laboratories, identifies deficiencies, and recommends solutions. Issues arising that exceed
the NCO skill set are referred to the senior subordinate medical laboratory officer for resolution.
This officer monitors the performance of MEDBDE (SPT) medical laboratories, to include area
medical laboratory (AML) activities (including CBRN sample/specimen processing and chain of
custody requirements) and MTF clinical laboratory practices. The senior subordinate medical
laboratory officer advises the chief, professional services, on blood-banking and storage
capabilities of Roles 2 and 3 MTFs within the command. This officer monitors Class VIII support
as it impacts on medical laboratory capabilities and advises the chief, professional services, of any
shortfalls which adversely impact on the performance of laboratory procedures.
* The senior subordinate optometry officer serves as the principal consultant to the chief,
professional services, on all matters pertaining to optometric support and optical laboratory
support. If no optometry personnel are assigned to the command, the chief, professional services,
coordinates with the optometry officer on the MEDCOM (DS) staff.
* The senior subordinate nuclear medicine officer serves as a consultant to the chief, professional
services, on all nuclear medicine issues. If there are no nuclear medicine officers assigned to
subordinate units, the chief, professional services, coordinates for this support with the MEDCOM
(DS) staff.
* When required, the preventive medicine officer coordinates for support from subordinate
preventive medicine units for entomology and environmental engineering support. If these
preventive medicine specialties are not available in subordinate units, the preventive medicine
officer coordinates with the MEDCOM (DS) preventive medicine section for this support.
2-116. The clinical operations section coordinates with the higher and, when appropriate, adjacent medical
headquarters on any clinical issues which cannot be resolved at this level or that will adversely impact clinical
operations in other adjacent or higher commands. The clinical operations section monitors medical specialty
capabilities of subordinate hospitals and coordinates with its higher headquarters when medical specialty
augmentation team support is required.
2-117. The clinical operations section coordinates with and provides consultation to the medical section of
the theater detention facility and resettlement facilities established within the MEDBDE (SPT) operational
area for the treatment and hospitalization of detained personnel. |
4-02 | 66 | Chapter 2
2-118. To facilitate monitoring clinical operations of subordinate MTFs, the clinical operations section
determines what reports are required, formats to be used, and at what frequency the reports will be submitted.
The intratheater patient movement center receives bed status reports and requests for medical regulating and
evacuation which should include the clinical operations section on distribution. The S-4 receives medical
supply status from all subordinate facilities which the clinical operations section must review to determine if
the medical supply status of subordinate facilities will adversely impact patient care. Additionally, he may
develop a medical situation report for the clinical aspects of subordinate MTF operations to remain apprised
of daily or weekly operations. The clinical operations section also receives medical situation reports from
forward deployed FSTs or FRSDs to determine if reconstitution, replacement, and reinforcement of these
assets is required. This report also provides information on the types of surgical cases that will require follow-
on surgery at subordinate MEDBDE (SPT) hospitals.
MEDICAL BATTALION (MULTIFUNCTIONAL)
2-119. Force structure changes occurring within the modular Army necessitated a redesign of the functional
medical battalions (area support, MEDEVAC, and MEDLOG) into a multifunctional organization. The
medical battalion (multifunctional) is an EAB headquarters. This unit provides command and control,
administrative assistance, logistical support, and technical supervision for assigned and attached medical
functional organizations (companies, detachments, and teams) task-organized for support to deployed forces
operating within the area of responsibility. Modularity has resulted in a smaller deployed medical footprint
through enhancing the capability to rapidly task-organize scalable medical capabilities. The medical
battalion (multifunctional) can be deployed to provide command and control of medical forces during early
entry operations and facilitate the reception, staging, onward movement, and integration of theater medical
forces. All EAB medical companies, detachments, and teams in theater may be assigned, attached, or placed
under the OPCON of a medical battalion (multifunctional). The medical battalion (multifunctional) is a
subordinate command and control of the MEDBDE (SPT) and/or MEDCOM (DS). Refer to Figure 2-10 (on
page 2-31) for notional deployed MMB.
MISSION, ASSIGNMENT, AND BASIS OF ALLOCATION
2-120. The mission of the MMB is to provide scalable, flexible, and modular medical command and control,
administrative assistance, logistical support, and technical supervision capability for assigned and attached
medical functional organizations (companies, detachments, and teams) task-organized for support of
deployed BCTs and EAB forces.
2-121. This TOE will be assigned to the MEDBDE (SPT) or the MEDCOM (DS). An MMB is allocated
as one per combination of three to six subordinate medical companies/medical detachments size units. This
basis of allocation is computed on the aggregate of total companies, detachments, and teams assigned or
attached. This unit is designated a Category II unit. (For unit categories, see AR 71-32). Refer to Figure 2-
11 (on page 2-32) for MMB organizational structure. |
4-02 | 67 | Army Health System Command and Control
Figure 2-10. Notional deployed medical battalion (multifunctional)
2-122. The MMB is the battalion-level medical headquarters in the AO. When fully manned, it provides—
* Command and control staff planning supervision of operations medical and general logistics
support as required, and administration of the assigned and attached units conducting medical
operations in the support AO.
* Task organization of EAB health care assets to meet the projected patient workload.
* Advice to senior commanders in the AO on the health care aspects of their operations.
* Coordination of medical regulating and patient movement with the MEDBDE (SPT) intratheater
patient movement center or the MEDCOM (DS) theater patient movement center, as required.
* Monitoring, planning, and coordinating of medical ground and air MEDEVAC within the MMB
AO. Coordinating requests with the supporting aviation unit for air MEDEVAC support
requirements and synchronization of air ambulances into the overall MEDEVAC plan.
* Guidance for facility site selection and area preparation.
* Consultation and technical advice on operational public health (medical entomology, and medical
and OEH surveillance), pharmacy procedures, COSC and BH, medical records administration,
veterinary services, nursing practices and procedures, and medical laboratory procedures to
supported units. Monitors and provides advice and consultation on dental support activities within
the MMB AO. |
4-02 | 68 | Chapter 2
Figure 2-11. Medical battalion (multifunctional) organizational structure
* Monitoring and supervision of MEDLOG operations, to include Class VIII supply/resupply,
medical equipment maintenance and repair support, optical fabrication and repair support, and
blood management.
* Planning and coordination of Role 1 and Role 2 medical treatment, to include staff advice on an
area support basis for EAB units without organic health care assets.
* Unit-level maintenance for wheeled vehicles and power generation equipment and wheeled
vehicle recovery operations support to assigned or attached units.
* Organizational communications equipment maintenance support for the battalion.
* Food service support for staff and other medical elements dependent upon the battalion for food
service.
* Maintenance of a consolidated property book for assigned units.
* Religious support for the battalion staff, unit personnel of assigned/attached medical elements,
and patients in subordinate MTFs in the MMB AO.
CAPABILITIES AND DEPENDENCIES
2-123. The MMB headquarters is composed of two standard requirements code identified modules (the
early entry element and the campaign support element) to facilitate the deployment and integration of the
unit on the time-phased force deployment list. This headquarters conducts operational planning for assigned
and attached medical functional companies, detachments, and teams. The early entry element can be
deployed independently or task-organized with a CSH or hospital center as a medical multifunctional task
force. The MMB headquarters should only be deployed as far forward as the division AO. Even in this
circumstance, the MMB would remain under the direct command and control of the MEDBDE (SPT) and
not directly attached to the BCT. Detachments and teams assigned or attached to the MMB may be further
attached to the brigade support medical company to augment or reconstitute BCT medical elements. The
array of health care units assigned and attached will vary depending upon mission, enemy, terrain and
weather, troops and support available, time available, and civil considerations factors. The MMB staff
structure is depicted in Figure 2-12. |
4-02 | 69 | Army Health System Command and Control
Figure 2-12. Medical battalion (multifunctional) staff structure
STAFF ORGANIZATIONS AND FUNCTIONS
2-124. This section discusses staff organizations and functions in MMB.
Internal Staff and Operations
2-125. The MMB’s coordinating staff and special staff sections manage the command’s internal operations
through coordination with staffs of higher, lower, and adjacent units. The staff’s efforts support the
commander and subordinate units. The staff supports the commander by providing accurate and timely
information. It produces estimates, recommendations, plans and orders, and monitors execution. The staff
streamlines cumbersome or time-consuming procedures by ensuring that all activities contribute to mission
accomplishment. Within the MMB headquarters, staff sections coordinate their areas of interest with other
headquarters staff sections as required.
Battalion Command Section
2-126. The battalion command section provides command and control and administrative services for
assigned and attached medical companies and detachments.
S-1 Section
2-127. The S-1 section provides overall administrative services for the command, to include personnel
administration, and coordinates with elements of supporting agencies for finance, legal, and administrative
services. This section maintains the unit status reports for each subordinate unit. |
4-02 | 70 | Chapter 2
S-2 and S-3 Section
2-128. The intelligence staff officer/operations staff officer (S-2 and S-3) section is responsible for security,
plans, and operations, deployment, relocation, and redeployment of the battalion and its assigned and attached
units. It prepares broad planning guidance, policies, and programs for command organization, operations,
and functions. This section assists the commander in developing and training the unit’s mission essential
task list. It identifies training requirements, based on FHP missions and the unit’s training programs,
directives, and orders. This section maintains the unit status reports for each subordinate unit. This section
performs all-source intelligence assessments and estimates for the command. Further, it advises the
commander and staff on nuclear/chemical surety and CBRN operations. It acquires, analyzes, and evaluates
intelligence to include health threat information and medical and OEH surveillance data. This section
provides a 24-hour continuous operations capability.
S-4 Section
2-129. The S-4 section coordinates issues pertaining to medical and general supply for MMB operations,
hazardous waste disposal, contracting support with other staff sections and maintains consolidated property
book for the battalion.
Force Health Protection Operations Section
2-130. The FHP operations section coordinates and monitors the execution of area medical support,
MEDEVAC, and dental support within the MMB AO. The section is responsible for existing and future
medical planning in the MMB AO, to include deliberate and crisis planning. Additionally, it plans future
operations in excess of 72 hours and prepares major regional contingency plans for the MMB. Further, it
prepares, authenticates, and publishes medical plans and OPLANs to include the integration of annexes and
appendixes prepared by other staff sections. This section supervises the activities of the MEDLOG, medical
operations, preventive medicine, and BH sections. The section coordinates with each internal staff
organization planning activities and support requirements for subordinate medical functional companies,
detachments, and teams assigned and attached to the MMB.
2-131. The FHP operations section coordinates with—
* S-1 on matters pertaining to personnel replacement and the priority of fill for subordinate AHS
units.
* S-2 and S-3 on matters pertaining to—
Health threat and medical intelligence requirements. Develops, recommends, and submits
priority information requests and essential elements of friendly information for information
impacting clinical operations (to include the potential enemy use of CBRN weaponry and
toxic industrial materials releases). This includes health threats and potential diseases present
in the AO and the health status of enemy forces who may become detained personnel (to
include new or exotic diseases in enemy forces).
Operational, planning, and medical regulating support. This section monitors current
operations and assists in planning future operations by developing and coordinating estimates
and plans. They must evaluate proposed courses of action for their impact on MMB
capabilities and activities and recommend whether they are feasible. Further, they must
closely monitor medical regulating activities delays in the timely evacuation of patients to
and from MMB MTFs. The FHP operations section recommends clinical and operational
capabilities (task-organized) required to be deployed forward to support MMB personnel
deployed to the BCT or to areas within the EAB to provide direct support.
* S-4 for MEDLOG support of critical Class VIII items required for patient care, to include medical
supplies, pharmaceuticals, medical equipment, and blood. The FHP operations section monitors
the blood distribution and reporting processes (TM 8-227-12) to determine the impact on medical
company (area support) clinical operations of shortages and delays. Further, they monitor the
status of medical supplies, medical equipment, and medical equipment maintenance and repair to
ensure that sufficient quantities are on hand and/or on order to sustain patient care activities within
the command. They also work closely with the MEDCOM (DS) and MEDBDE (SPT) logistics
in identifying and obtaining pharmaceuticals to treat diseases (to include biological warfare |
4-02 | 71 | Army Health System Command and Control
agents) not usually present in U.S. forces (such as for detainees). This also includes medications
and medical equipment required to treat nontraditional populations, such as U.S. government
contractors, geriatric, pediatric, and obstetric patients. This section also advises the command on
the management and disposition of captured enemy medical supplies and equipment.
* Battalion maintenance section on issues related to assigned wheeled vehicle maintenance, power-
equipment maintenance, and wheeled vehicle.
* S-6 on matters pertaining to connectivity, information management, automation, and
communications. Ensures automated systems for MEDLOG management are established and
maintained and ensures connectivity to other medical information programs such as the U.S.
Transportation Command Regulating and Command and Control Evacuation System, Theater
Medical Information Program-Joint, and Medical Communications for Combat Casualty Care
System. Additionally ensures connectivity of medical platforms deployed in supported BCT areas
are adequately equipped with systems such as Force XXI battle command—brigade and below or
blue force tracker.
* Detachment headquarters for logistical and administrative support requirements throughout the
headquarters for unit members.
Medical Logistics Section
2-132. The MEDLOG section is responsible for the planning, coordination, and execution of the Class VIII
mission within the MMB AO. This includes blood and medical maintenance management.
Medical Operations Section
2-133. The medical operations section is responsible for the planning, coordination, and execution of the
medical area support mission within the MMB AO.
Preventive Medicine Section
2-134. The preventive medicine section is responsible for planning, coordination, and execution of the
operational public health and veterinary services mission within the MMB AO. This includes the
management of preventive medicine and veterinary assets. This section ensures medical and OEH
surveillance programs are planned for, established, and implemented within the MMB AO. They monitor
DNBI reports from subordinate units to determine the development of trends or the possible use of biological
warfare agents on deployed forces. This section plans for and monitors veterinary food protection programs,
animal medical care operations, and veterinary public health activities pertaining to the transmission of
zoonotic and endemic animal diseases.
Mental Health Section
2-135. The mental health section is responsible for the planning, coordination, and execution of the COSC
mission with the MMB AO. The section collects and records social and psychological data.
S-6 Section
2-136. The S6 section is responsible for all aspects of automation and communications-electronics support
within the MMB. This section establishes a medical automation office and is responsible for medical
information system policy and guidance for all subordinate commands. This section identifies
communications-electronics requirements for data transmission services and coordinates these requirements
with the external signal organizations. This section provides advice and consultation on the integration of
medical information systems in support of AHS and with other command and control systems within the AO.
Detachment Headquarters
2-137. The detachment headquarters provides for billeting, filed feeding, discipline, security, training, and
administration for Soldiers assigned to the headquarters. |
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Unit Ministry Team
2-138. The battalion unit ministry team provides two required capabilities to the command. First, religious
support and pastoral ministry for assigned or attached Service members, authorized civilians, patients, and
casualties. Second, they advise on religion, morals, and morale within units, and ethical decision making of
the command. The unit ministry team also supports and advises subordinate commanders and COSC units,
as required.
External Coordination
2-139. The MMB must coordinate externally with the MEDBDE (SPT)/MEDCOM (DS) and in early entry
operations when a senior medical command headquarters is not present, with the sustainment brigade staff
and other supported units to accomplish the medical mission. This coordination is conducted mainly through
command surgeon channels for synchronization of the medical plan and external coordination with the
combat aviation brigade for MEDEVAC. Coordinates and synchronizes the planning and execution of AHS
actions.
2-140. In the performance of their AHS mission, the MMB staff may be required to coordinate with medical
personnel/organizations of the other Services. For example, the USAF staff provides aeromedical liaison
teams to facilitate AE aboard USAF resources. The MMB may be required to coordinate directly with
CONUS for support services under control of Department of the Army (DA), DOD, and Secretary of Defense.
These include depots, arsenals, data banks, plants, research laboratories, and factories associated with the
United States Army Medical Research and Materiel Command.
SECTION III — MEDICAL COMMANDER, COMMAND SURGEON, AND LINE
COMMANDER
2-141. The medical commander exercises command and control (authority and direction) over the
subordinate medical resources.
MEDICAL COMMANDER
2-142. As discussed in Army doctrine on unified land operations, the medical commander is the focus of
command and control and uses two processes in the decision-making process. The commander uses an
analytic approach to evaluate information and data systematically, proposes courses of action, and determines
which course of action will provide the optimal results. The commander also makes decisions intuitively.
For the medical commander, the intuitive decision-making process is guided by professional judgment gained
from experience, knowledge, education, intelligence, and intuition. Experienced staff members use their
intuitive ability to recognize the key elements and implications of a particular problem or situation, reject the
impractical, and select an adequate solution.
2-143. The leader-developed medical professional has been trained in critical thinking, assessing situations,
determining requirements for follow-on services, and decisive decision-making skills since the beginning of
leader’s professional career. These are essential and critical skills which have been taught, nurtured, and
cultivated throughout commander’s professional medical education and training. The medical commander’s
experience base cannot be viewed from a purely military perspective of when the commander entered the
Army, but must be viewed holistically to encompass all of the training, education, and experience this leader
received. The military and leader development training, education, and experience coupled with proven
critical thinking skills and ability to take decisive action make this officer the most qualified commander to
determine how medical assets will be employed in support of the operational commander and to successfully
accomplish Title 10 responsibilities for the care of assigned Soldiers.
2-144. The construct of mission command provides for centralized planning and decentralized execution
and is driven by mission orders. Successful mission command demands that subordinate leaders at all
echelons exercise disciplined initiative, aggressive action, and to independently accomplish the mission
within the commander’s intent. Mission command gives the subordinate leaders at all echelons the greatest
possible freedom of action. While command and control restrains higher-level commanders from
micromanaging subordinates, it does not remove them from the fight. Rather, mission command frees these |
4-02 | 73 | Army Health System Command and Control
commanders to focus on accomplishing their higher commander’s intent and on critical decisions only they
can make. The medical command and control structure enables the MEDCOM (DS) commander to retain a
regional focus in support of the CCDR and the operational area engagement plan, while still providing
effective and timely direct support to the supported operational commanders and providing general support
on an area basis to theater forces at EAB (such as those conducting aerial ports of debarkation, sea ports of
debarkation, and operational assembly areas operations or to other temporary or permanent troop
concentrations). One consequence of the enduring regional focus of the Army AO is to drive specialization
in its subordinate MEDCOM (DS) since unique health threats, local needs and capabilities, other Service
capabilities, and geographic factors are distinctly related to a particular region. This characteristic is in
contrast to some other staff and subordinate unit functions that are performed in much the same ways
regardless of region.
COMMAND SURGEON
2-145. At all levels of command, a command surgeon is designated. This Army Medicine officer is a
member of the commander’s personal and special staff charged with planning, coordinating, and ensuring
the AHS mission is executed. At the lower levels of command, this officer may be dual-hatted as an AHS
unit commander; further, the command surgeon may have a small staff section to assist in planning,
coordinating, and synchronizing the AHS effort within the operational area. For detailed information
regarding the surgeon and surgeon section at echelon, refer to Appendix C.
2-146. The command surgeon is responsible for ensuring that all Army Medicine functions are considered
and included in running estimates, OPLANs, and OPORDs. The command surgeon retains technical
supervision of all AHS operations. At the higher levels of command, the scope of duties and responsibilities
expand to include all subordinate levels of command.
2-147. Through mission command, the command surgeon may be empowered to act somewhat
independently; however, the nonmedical commander can retain the authority to make the decisions which he
feels are critical. Mission command, to be successful, requires an environment of trust and mutual
understanding which may be challenging to establish for newly assigned staff members who have not had a
previous supporting relationship with the command.
2-148. The duties and responsibilities of command surgeons may include, but are not limited to:
* Advising the commander on the health of the command.
* Monitoring the three phases of TCCC.
* Developing and coordinating the HSS and FHP portion of OPLANs to support the CCDRs
decisions, planning guidance, and intent.
* Preparing and developing the medical concept of support and medical common operating picture.
* Determining the medical workload requirements (patient estimates) in coordination with the
assistant chief of staff, personnel (the assistant chief of staff, personnel’s casualty estimate
includes only those casualties that require replacements). A patient estimate refers to estimates
derived from the casualty estimate prepared by the personnel staff officer/assistant chief of staff,
personnel. The patient medical workload is determined by the Army Health System support
planner. Patient estimate only encompasses medical casualty (ATP 4-02.55).
* Determining, in conjunction with the staff judge advocate and the chain of command, the
eligibility for medical care in a U.S. Army MTF.
* Maintaining situational understanding. The AHS units/elements to satisfy all mission
requirements.
* Recommending policies concerning support of stability tasks.
* Monitoring the availability of and recommending the assignment, reassignment, and utilization of
Army Medicine personnel within the AO.
* Developing, coordinating, and synchronizing health consultation services.
* Evaluating and interpreting medical statistical data.
* Monitoring implementation of Army medical information programs. |
4-02 | 74 | Chapter 2
* Recommending policies and determining requirements and priorities for MEDLOG (to include
blood and blood products, medical supply/resupply, medical equipment maintenance and repair,
production of medicinal gases, optometric support, and fabrication of single- and multivision
optical lens spectacle fabrication and repair, and contract support).
* Recommending policies and determining requirements for medical information systems. The
usage of these systems will enable theater-wide visibility in support of AHS functions and joint
HSS.
* Recommending MEDEVAC policies and procedures.
* Monitoring medical regulating and patient tracking operations.
* Determining AHS training requirements.
* Developing policies, protocols, and procedures pertaining to the medical and dental treatment of
sick, injured, and wounded personnel. These policies, protocols, and procedures will be in
consonance with applicable regulations, directives, and instructions; higher headquarters policies;
SOPs; applicable multinational force compatibility agreements; memorandums of understanding
or agreement; and Status of Forces Agreements.
* Ensuring patient safety, quality assurance, infection control, and risk management programs are
established and implemented.
* Ensuring field medical records and/or electronic medical records, when available, are maintained
on each Soldier at the primary care MTF according to AR 40-66. This includes documentation of
any radiological exposures and integration with U.S. Army Dosimetry Center and radiation safety
officer as necessary.
* Ensuring compliance with the theater blood bank service program.
* Ensuring a viable veterinary program (to include inspection of subsistence and outside the
continental U.S. food production and bottled water facilities, veterinary public health, and animal
medical care [including establishing a military working dog (MWD) evacuation policy]) is
established.
* Ensuring a medical laboratory capability or procedures for obtaining this support from out of
theater resources are established for the identification and confirmation and/or theater validation
of the use of suspect biological warfare and chemical warfare agents by opposition forces. This
also includes the capability for collecting specimens/samples, packaging, and handling
requirements and escort/chain of custody requirements. For additional information on AHS
support in a CBRN environment refer to Army medical doctrine.
* Planning for and implementing public health operations and facilitating health risk
communications (to include operational public health activities and initiating personnel protective
measures to counter the health threat).
* Planning for and ensuring pre- and postdeployment health assessments are accomplished.
* Establishing and executing a medical surveillance program (refer to DODD 6490.02E, DODI
6490.03, and AR 40-66 for an in-depth discussion).
* Establishing and executing an OEH surveillance program.
* Recommending COSC, BH, and substance abuse control programs.
* Coordinating for medical intelligence with the supporting intelligence officer, section, and unit.
Refer to Appendix D for more information on medical intelligence. Pursuing other avenues to
obtain medical intelligence and/or medical information such as the—
National Center for Medical Intelligence.
Army Public Health Center.
Centers for Disease Control and Prevention.
United States Public Health Services.
The Office of The Surgeon General, Intelligence and Security Division.
Intergovernmental organizations (such as the United Nations, the World Health Organization,
or the Pan American Health Organization, and other nongovernmental organizations).
Information gathered from MSAT, site visits to host-nation medical facilities. |
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* Identifying commander’s critical information requirements, priority intelligence requirements,
essential elements of friendly information, and friendly forces information requirements as they
pertain to the health threat; ensuring they are incorporated into the command’s intelligence
requirements.
* Coordinating for foreign humanitarian assistance, disaster relief, and medical response to weapons
of mass destruction or terrorist incidents, and defense support of civil authorities, when authorized.
* Advising commanders on AHS CBRN defensive actions (such as immunizations, use of
chemoprophylaxis, pretreatments, and barrier creams).
* Ensuring individual informed consent is established before the administration of investigational
new drugs as described in AR 40-7.
* Assessing special equipment and procedures required to accomplish the AHS mission in specific
environments such as urban operations, mountainous terrain, extreme cold weather operations,
jungles, and deserts. Requirements are varied, depending upon the scenario, and could include:
Obtaining pieces of equipment or clothing not usually carried (piton hammers, extreme cold
weather parka, jungle boots, or the like).
Adapting medical equipment sets for a specific scenario to include adding items based on the
forecasted types of injuries to be encountered (such as more crush injuries and fractures in
urban operations or mountain operations). In certain scenarios (such as urban operations),
some medical supplies and equipment may not be carried into the fight initially (such as sick
call materials), but rather brought forward by follow-on forces. In mountain operations, bulky
or heavy items (such as extra tentage) may not accompany the force because of the difficulty
in traversing the terrain.
Having individual Soldiers carry additional medical items, such as bandages and intravenous
fluids.
* Recommending disposition instructions for captured enemy medical supplies and equipment.
Under the provisions of the Geneva Conventions, medical supplies and equipment are protected
from intentional destruction and should be used to initially treat sick, injured, or wounded
detainees. Refer to Chapter 3 for additional information on the Geneva Conventions.
* Submitting to higher headquarters those recommendations on medical problems/conditions that
require research and development.
* Recommending theater policy for medically evacuating contaminated patients.
* Coordinating and monitoring patient decontamination operations to include:
Theater policies on patient decontamination operations.
Layout and establishment of patient decontamination site.
Use of collective protection.
Use of nonmedical Soldiers to perform patient decontamination procedures under medical
supervision.
This paragraph implements STANAG 2132.
2-149. The command surgeon is responsible for the standard of care (scope of practice) which is provided
to sick, injured, and wounded Soldiers by subordinate medical personnel, he—
* Ensures that standardized protocols for the alleviation of pain (to include the administration of
pain relief medications by nonphysician health care providers) are established and disseminated.
Further, he must ensure and certify that each military occupational specialty 68W Soldier (combat
medic), working under the supervision of a physician, has received sufficient training to—
Recognize when pain management measures and medications are required.
Provide pain management measures (elevation, immobilization, and ice [when available]).
Select the appropriate medication (such as acetaminophen, ibuprofen, or morphine sulfate);
determine the mode of administration (oral or parenteral); be knowledgeable of the possible
side effects and how to treat them; and administer the appropriate medication. |
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Document the treatment provided DD Form 1380 (Tactical Combat Casualty Care [TCCC]
Card), to include the marking of individuals who have received morphine sulfate).
Note. When morphine is administered to a casualty in the field, the dose, Greenwich Mean Time
(ZULU time), date, route of entry, and name of the drug must be entered onto the DD Form 1380.
Additionally, the combat medic (or other health care provider) must mark the casualty with the
letter “M” (for morphine) and the hour of injection (such as “M 0830”) on the patient’s forehead
with a skin pencil or another semipermanent marking substance. The empty syrette, injection
device, or its envelope should be attached to the patient’s clothing.
Is also responsible for ensuring that all controlled substances are stored, safeguarded, issued,
and accounted for in accordance with the provisions of AR 40-3. The medical equipment set
for the combat medic includes morphine sulfate. When the mission supported involves a high
risk of trauma, the command surgeon may authorize the combat medic to carry morphine
sulfate to alleviate severe pain caused by trauma or wounding. This medication must be
accounted for when issued to the combat medic and upon mission completion.
TACTICAL COMMANDER AND OPERATIONAL ARMY
2-150. The deployed medical force ensures that the operational commander has the right mixture of medical
professional (operational, technical, and clinical) expertise to synchronize the complex system of medical
functions required to maintain the health of the command by promoting health and fitness, preventing
casualties from DNBI, and promptly treating and evacuating those injured in the OE. Only a focused,
responsive, dedicated medical effort can reduce morbidity and mortality and ensure that the operational
commander can maintain the health of the Soldiers and uniformed members from the other Services entrusted
to the commander’s care by our Nation. According to ADP 1, an Army professional is a member of the
Army Profession who meets the Army’s certification criteria of competence, character, and commitment.
COMMANDER
2-151. Commanders and unit leaders must take an active role to counter the health threat to their deployed
forces. Command emphasis and support is required in the areas of health promotion, field hygiene and
sanitation, identification and treatment of Soldiers with potential mild traumatic brain injury, and in
promoting the COSC programs to include suicide prevention.
2-152. According to FM 3-0, LSCO is intense, lethal, and brutal. Their conditions include complexity,
chaos, fear, violence, fatigue, and uncertainty. Future battlefields will include noncombatants, and they will
be crowded in and around large cities. Enemies will employ conventional tactics, terror, criminal activity,
and information warfare to further complicate operations. Large-scale combat operations present the greatest
challenge for Army forces. Army Health System support must maintain a balance between supporting the
commander’s scheme of maneuver during LSCO while still retaining the focus of patient care.
HEALTH PROMOTION
2-153. Health promotion is a leadership program that encompasses the assets of educational, environmental,
and AHS support services that enable individuals to increase control over and improve their health in support
of Army well-being. Commanders and leaders must raise the awareness of health promotion programs and
informational sources and establish a command climate which encourages Soldiers to develop healthy habits
and make the lifestyle changes required to maximize their personal health and fitness. Refer to ATP 6-22.5
for more information on health and fitness.
2-154. Army health promotion is defined as any combination of health education and related organizational,
political, and economic interventions designed to facilitate behavioral and environmental changes conducive
to the health and well-being of the Army community. It focuses on the integration of primary prevention and
public health practices into community and organizational structure to ensure that health and well-being are
part of the way the Army does business. Health is the product of many personal, environmental, and |
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behavioral factors. Health promotion programs must consider a broad range of health-related factors and
should address the following areas:
* Health education and the health promotion process.
* Behavioral health programs.
* Physical programs.
* Spiritual programs.
* Environmental and social programs.
2-155. Army health promotion involves—
* Identifying community health needs and setting priorities.
* Developing, adjusting, and implementing health promotion programs to meet identified needs.
* Evaluating the effectiveness of these programs.
* Promoting resiliency.
* Promoting and enhancing quality of life.
* Promoting wellness along with well-being.
2-156. The health promotion process is similar to the risk management process described in ATP 5-19.
FIELD HYGIENE AND SANITATION
2-157. To counter the health threat, commanders and leaders must ensure that field hygiene and sanitation,
, feral animal risk mitigation measures, inspection of potable water and field feeding facilities, sleep
discipline (including work and rest schedules), and personal protective measures are instituted and receive
command emphasis. Field hygiene and sanitation combines with personal protective measures, to include
correctly wearing the uniform and using insect repellent, sunscreen, and insect netting. Leaders must ensure
that Soldiers practice these activities continuously during the force projection through postdeployment cycles
and processes. Guidance for establishing, training, and employing unit field sanitation teams can be found
in ATP 4-25.12.
MILD TRAUMATIC BRAIN INJURY/CONCUSSION
2-158. Mild traumatic brain injury or concussion is a major health threat facing Soldiers and is recognized
as a matter of significant military and operational concern. Concussive injuries are associated with
explosions or blasts and blows to the head during training activities or contact sports. Leaders and Soldiers
at all echelons must be aware of this invisible injury and receive mild traumatic brain injury/concussion
education and training to help decrease stigma associated with seeking medical assistance. Commanders
must also be aware of leader reporting requirements, mandatory medical evaluations, and medical reporting
requirements. Leaders also have a responsibility to ensure their Soldiers receive a medical evaluation
following a concussive event, no matter how mild. Prompt medical attention as soon as possible after an
injury maximizes recovery, decreases risk of a subsequent concussion while the brain is healing, and
ultimately preserves combat power. Education, training, treatment, and tracking of injured Soldiers are the
keys to the Army’s Traumatic Brain Injury Management Strategy.
COMBAT AND OPERATIONAL STRESS
2-159. Stress in response to threatening or uncertain situations is a reality in all types of military operations
including major combat, stability, and defense support of civil authorities as well as during training exercises,
in garrison, and issues related to Family and home life. Soldiers are exposed to various types of combat and
operational stress throughout their military experience. Combat and operational stress control refers to a
coordinated program of actions taken by military leadership to prevent, identify, and manage
reactions to traumatic events that may affect exposed organizations and individuals during unified
land operations. Also called COSC. Combat and operational stress control does not take away the
experiences faced while engaged in such operations, but provides mechanisms to mitigate reactions to those
experiences so that Soldiers remain combat effective and maintain the quality of life to which they are
entitled. |
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SOLDIERS AND THEIR FAMILIES
2-160. It is essential to the morale and effectiveness of our Soldiers and their units that Soldiers recognize
and believe they will receive the best and most effective medical care possible should they be wounded or
injured. The AHS must ensure that it can provide responsive medical care to our injured or wounded Soldiers
regardless of their physical location. Our Soldiers must also be confident that their Family members will
receive the highest quality, responsive, and compassionate care at their home station while they are deployed.
This confidence in the ability of the AHS to care for both the Soldier and the Soldier’s Family is instrumental
in reducing and mitigating some of the combat and operational stresses associated with lengthy deployments.
SECTION IV — ARMY HEALTH SYSTEM TEAM OF TEAMS
2-161. The AHS is a system of systems which is comprised of 10 medical functions. The AHS team is
composed of a myriad of professional medical, scientific, research, operational, and administrative teams
dedicated to the single purpose of providing the best medical care and treatment to our Nation’s Soldiers,
Sailors, Marines, Airmen and their Families, deployed DOD civilian employees and defense contractors, and
to other eligible beneficiaries in their time of need. To achieve this aim, the AHS team must be ready,
reliable, responsive, and relevant (Figure 2-13).
Figure 2-13. Army Health System—a team of teams
Ready
2-162. The AHS views readiness from two perspectives: medical personnel (ready medical force) and the
operational Army (medically-ready force).
Medical Personnel
2-163. Medical personnel contribute to the success of military operations by applying medical skills and
knowledge to problems on the battlefield. Medical personnel undergo institutional and organizational
training to ensure they gain appropriate initial qualifications and maintain currency in their discipline.
Ongoing training is essential to avoid skill and knowledge fade, and ensures practitioners adapt to evolving
clinical practice guidelines, and advances in technology and treatment protocols. The training continuum
comprises initial training in a specialty, sustainment training (including medical continuing education
requirements), refresher training and pre-deployment training. AHS units (both in the institutional force and
the operational Army) participate in realistic and rigorous training focused on reinforcing Soldier skills in
the field and exercising the entire scope of battlefield medicine from point-of-injury, through the roles of |
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care, to evacuation from the operational area. Training must be integrated with combatant elements to ensure
friction points are revealed and resolved before exposure to the added difficulties and uncertainty of actual
combat operations. Mastery of the basics of battlefield medicine by all medical personnel is the pivotal
component of supporting LSCO. To prepare for combat operations, medical personnel must also be afforded
the opportunity to hone their skills and knowledge in demanding clinical environments (e.g., hospitals,
emergency medical services and remote clinics).
Operational Army
2-164. The AHS collaborates with line commanders to ensure that Soldiers maintain a healthy lifestyle, are
physically and mentally fit for deployments, and are medically screened to ensure they do not have on-going
medical conditions which could be aggravated by conditions in the AO. Health promotion programs,
nutrition programs and counseling, personnel protective measures to include health risk communications and
mitigation techniques, preventive dentistry, and COSC programs all focus on maintaining the Soldier’s health
both in garrison and when deployed.
RELIABLE
2-165. As discussed under partnerships, the Soldier, commander, and Families have confidence that the
AHS will always be prepared to provide the appropriate medical care whenever and wherever it may be
required. This trust between the AHS and its beneficiaries is at the center of all that the AHS does. It is
imperative to the fighting morale of our forces, that each Soldier believes that if injured, he will promptly be
given medical care for those wounds and will be medically evacuated from the battlefield. It is also essential
that should the Soldier’s Family face a medical emergency while the Soldier is deployed, the Family member
will receive state-of-the-art medical care. This in turn relieves some of the stressors the Soldier must manage
during deployments and separation from the Soldier’s Family. The AHS system of health is a proven system
which has provided reliable health care throughout its history regardless of where needed on the battlefield
or in garrison operations.
RESPONSIVE
2-166. Both the operational Army and the institutional force must be responsive to the changing OE and
the resulting medical implications.
Operational Army
2-167. Army Health System planning must be flexible, scalable, and adaptable to optimize the full
utilization and integration of scarce medical resources in the accomplishment of the health care delivery
mission. The medical command and control organizations must leverage all available medical resources
within an AO to optimize patient care to include medical capabilities of sister Services, U.S. governmental
agencies, and multinational forces.
Institutional Force
2-168. The institutional force is responsive to the health care needs of all Soldiers stationed throughout the
world. Combat capability developers use observations, insights, and lessons learned from on-going
operations to identify requirements and gaps in order to develop TOE medical organizations which are more
modular and adaptive to changes on the battlefield and to incorporate emerging technologies to enhance the
effectiveness and efficiency of medical materiel. Medical research and development is a vital link between
the Army Medicine and the educational and industrial base within CONUS. It enables the MEDCoE to
capitalize on emerging technologies and treatment protocols to refine and enhance the state-of-the-art care
provided to our Soldiers and other eligible beneficiaries. The military medical education provided within the
AHS includes leadership training, enlisted military occupational specialty skills, refresher and sustainment
training, medical continuing education, individual Soldier skills, and collective training. Further, if training
deficiencies are identified during a deployment, the MEDCoE may develop additional predeployment
training packages and assist United States Army Forces Command with predeployment certification of
individual and unit skill sets. When appropriate, new equipment training teams provide collective training |
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to units located throughout the world to ensure the medical personnel are properly trained on how to deploy
and employ the new equipment. For example, during the initial stages of Operation Enduring Freedom and
Operation Iraqi Freedom, a new collective protection shelter system was fielded and training teams from the
Army Medicine were deployed to unit locations worldwide to facilitate the transition and use of this new
shelter system.
2-169. The institutional force provides a vital link in ensuring the medical readiness of forces to be
deployed. Mobilization stations within CONUS ensure Soldiers are medically processed for overseas
deployments to include immunizations, eyewear, dental care, medications, resiliency training, and individual
patient records are initiated and/or maintained. This ensures the operational commander has a healthy and
fit force. For more information, refer to Appendix E.
2-170. The institutional force provides the reachback capability for deployed forces. Requirements for
medical specialty personnel generated during the conduct of operations are met by mobilizing and deploying
medical resources in the institutional force to meet theater-specific requirements. Additionally, the
institutional force provides definitive health care services; restorative, rehabilitative, and convalescent care
to enhance and expand on the essential care provided to Soldiers in the deployment area.
RELEVANT
2-171. The AHS must provide relevant care based on current operational and strategic plans. The AHS
must be adaptive and use innovative approaches and solutions for identified gaps and shortfalls, such as was
done to establish the Wounded Warrior Program and to staff Warrior transition units to ensure that our
Soldiers’ medical, rehabilitative, and convalescent needs were effectively addressed, as well as providing the
appropriate command climate and unit support to either return the Soldier to military duty or to transition
back to civilian life as a productive member of society.
Clinical Aspects
2-172. The clinical aspects of the operation involve the provision of medical care to sick, injured, and
wounded Soldiers (or other designated beneficiaries) and the prevention of DNBI by medically trained
individuals. The care extends from the place of injury or wounding and is usually provided initially by the
combat medic assigned to a movement and maneuver or fires unit or by a health care provider at the battalion
aid station through the successive roles of care to the CONUS-support base, if the patient’s medical condition
so warrants. As patients are evacuated between roles of care, they receive en route medical care to sustain
them, thus reducing the potential for their medical condition to deteriorate while in-transit.
Operational Aspects
2-173. The operational aspects of the mission include such military tasks as:
* Maintaining situational understanding of the ongoing and future operations.
* Providing timely support to the maneuver forces.
* Maintaining the unit’s readiness posture.
* Ensuring the survivability of the unit (such as unit perimeter defense, hasty firing positions, and
patient bunkers). See ATP 3-37.34 Survivability Operations for more information.
* Ensuring compliance with the law of land warfare (to include the Geneva Conventions).
2-174. To accomplish the Army Medicine mission, a synchronization of the clinical and operational aspects
must be achieved. It accomplishes nothing for a unit to provide the best clinical care, if it cannot survive the
operation. Likewise, a unit that can execute all of its military tasks is not successful if the patients entrusted
to its care die or their conditions deteriorate because no consideration was given to their clinical needs during
an operational relocation.
2-175. A balance must be achieved in prioritizing the requirements generated from both the operational and
clinical aspects of the mission. Without synchronizing the response to the overall requirements, both
operational and clinical, a shortfall in one sphere may have serious ramifications on mission success. A
shortage of scalpel blades for an FST or FRSD adversely impacts the patient care mission as would a shortage
of ammunition for use in perimeter defense which could lead to mission failure in an operational sense. If |
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neither item is available, the FST or FRSD cannot provide the required surgical care to stabilize patients for
further evacuation and the unit cannot survive in the OE because it lacks a means for defense.
2-176. To enhance the delivery of health care in the OE and to provide a seamless medical system from the
POI or wounding through progressive roles of care to the CONUS-support base, the Army Medicine team
must integrate their special skills and knowledge, leverage technology, maximize the use of scarce resources,
and synchronize their collective efforts. The accomplishment of the Army Medicine mission necessitates a
cohesive unity of effort to provide the care our Soldiers deserve. |
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Army Health System and the Effects of the Law of Land
Warfare and Medical Ethics
The U.S. is a party to numerous conventions and treaties pertinent to warfare on land.
Collectively, these treaties are often referred to as The Hague and Geneva Conventions.
Whereas the Hague Conventions concern the methods and means of warfare, the
Geneva Conventions concern the victims of war or armed conflict. The Geneva
Conventions are 4 separate international treaties, signed in 1949. The Conventions are
very detailed and contain many provisions, which are tied directly to the medical
mission. These Conventions are entitled—
* Convention (I) for the Amelioration of the Condition of the Wounded and Sick in Armed Forces
in the Field.
* Convention (II) for the Amelioration of the Condition of Wounded, Sick and Shipwrecked
Members of Armed Forces at Sea.
* Convention (III) relative to the Treatment of Prisoners of War.
* Convention (IV) relative to the Protection of Civilian Persons in Time of War.
SECTION I — THE LAW OF LAND WARFARE
3-1. The conduct of armed hostilities on land is regulated by the law of land warfare. Refer to FM 6-27 for
more information. This body of law is inspired by the desire to diminish the evils of war by—
* Protecting both combatants and noncombatants from unnecessary suffering.
* Safeguarding certain fundamental human rights of persons who fall into the hands of the enemy,
particularly detainees, the wounded and sick, and civilians.
* Facilitating the restoration of peace.
3-2. The law of land warfare places limits on the exercise of a belligerent’s power in the interest of
furthering that desire (diminishing the evils of war) and it requires that belligerents—
* Refrain from employing any kind or degree of violence which is not actually necessary for military
purposes.
* Conduct hostilities with regard for the principles of humanity and chivalry.
3-3. Refer to DODD 2311.01 (DOD law of War Program) and FM 6-27/MCTP 11-10C (The Commander’s
Handbook on the Law of Land Warfare) for additional information on the law of land warfare.
SECTION II — GENEVA CONVENTIONS
3-4. The essential and dominant idea of the GWS is that the Soldier who has been wounded or who is sick,
and for that reason is out of the combat in a disabled condition, is from that moment protected. Friend or foe
must be tended with the same care. From this principle, numerous obligations are imposed upon parties to a
conflict.
PROTECTION AND CARE
3-5. Article 12 of the GWS imposes several specific obligations regarding the protection and care of the
wounded and sick. |
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* The first paragraph of Article 12, GWS, states: “Members of the armed forces and other persons
mentioned in the following Article, who are wounded or sick, shall be respected and protected in
all circumstances.”
The word respect means “to spare, not to attack” and protect means “to come to someone’s
defense, to lend help and support.” These words make it unlawful to attack, kill, ill-treat, or
in any way harm a fallen and unarmed enemy soldier. At the same time, these words impose
an obligation to come to aid and give him such care as his condition requires.
This obligation is applicable in all circumstances. The wounded and sick are to be respected
just as much when they are with their own army or in no man’s land as when they have fallen
into the hands of the enemy.
Combatants, as well as noncombatants, are required to respect the wounded. The obligation
also applies to civilians; Article 18, GWS, specifically states: “The civilian population shall
respect these wounded and sick, and in particular abstain from offering them violence.”
The GWS does not define what wounded or sick means, nor has there ever been any definition
of the degree of severity of a wound or a sickness entitling the wounded or sick combatant to
respect. Any definition would necessarily be restrictive in character and would thereby open
the door to misinterpretation and abuse. The meaning of the words wounded and sick is thus
a matter of common sense and good faith. It is the act of falling or laying down of arms
because of a wound or sickness which constitutes the claim to protection. Only the soldier
who is himself seeking to kill may be killed.
The benefits afforded the wounded and sick extend not only to members of the armed forces,
but to other categories of persons as well, classes of whom are specified in Article 13, GWS.
Even though a wounded person is not in one of the categories enumerated in the article, we
must still respect and protect that person. There is a universal principle which says that any
wounded or sick person is entitled to respect and humane treatment and the care which his
condition requires. Wounded and sick civilians have the benefit of the safeguards of the
Geneva Conventions.
* The second paragraph of Article 12, GWS, provides that the wounded and sick “…shall be treated
humanely and cared for by the Party to the conflict in whose power they may be, without any
adverse distinction founded on sex, race, nationality, religion, political opinions, or any other
similar criteria.”
All adverse distinctions are prohibited. Nothing can justify a belligerent in making any
adverse distinction between wounded or sick that require his attention, whether they are friend
or foe. Both are on equal footing in the matter of their claims to protection, respect, and care.
The foregoing is not intended to prohibit concessions, particularly with respect to food,
clothing, and shelter, which take into account the different national habits and backgrounds
of the wounded and sick.
The wounded and sick shall not be made the subjects of biological, scientific, or medical
experiments of any kind which are not justified on medical grounds and dictated by a desire
to improve their condition.
The wounded and sick shall not willfully be left without medical assistance, nor shall
conditions exposing them to contagion or infection be created.
* The only reasons which can justify priority in the order of treatment are reasons of medical
urgency. This is the only justified exception to the principle of equality of treatment of the
wounded.
* Paragraph 5 of Article 12, GWS, provides that if we must abandon wounded or sick, we have a
moral obligation to, “as far as military considerations permit,” leave medical supplies and
personnel to assist in their care. This provision is in no way bound up with the absolute obligation
imposed by paragraph 2 of Article 12 to care for the wounded. A belligerent can never refuse to
care for enemy wounded on the pretext that his adversary has abandoned them without medical
personnel and equipment. |
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ENEMY WOUNDED AND SICK
3-6. The protections accorded the wounded and sick apply to friend and foe alike without distinction.
Certain provisions of the GWS; however, specifically concern enemy wounded and sick. There are also
provisions in the GPW which, because they apply to prisoners of war generally, also apply to enemy wounded
or sick.
* Article 14 of the GWS states that persons who are wounded and then captured have the status of
prisoners of war, however, that wounded soldier is also a person who needs treatment. Therefore,
a wounded soldier who falls into the hands of an enemy who is a Party to the GWS and the GPW,
such as the U.S., will enjoy protection under both Conventions until his recovery. The GWS will
take precedence over the GPW where the two overlap.
* Article 16 of the GWS requires the recording and forwarding of information regarding enemy
wounded, sick, or dead. (See AR 190-8 and FM 3-63 for disposition of detainees after hospital
care.)
* When intelligence indicates that large numbers of detainees may result from an operation, medical
units may require reinforcement to support the anticipated additional detainee patient workload.
SEARCH FOR AND COLLECTION OF CASUALTIES
3-7. Article 15 of the GWS imposes a duty on combatants to search for and collect the dead and wounded
and sick as soon as circumstances permit. It is left to the operational commander to judge what is possible
and to decide to commit the commander’s medical personnel to this effort. If circumstances permit, an
armistice or suspension of fire should be arranged to permit this effort.
ASSISTANCE OF THE CIVILIAN POPULATION
3-8. Article 18, GWS, addresses the civilian population. It allows a belligerent to ask the civilians to collect
and care for wounded or sick of whatever nationality. This provision does not relieve the military authorities
of their responsibility to give both physical and moral care to the wounded and sick. The GWS also reminds
the civilian population that they must respect the wounded and sick, and in particular, must not injure them.
ENEMY CIVILIAN WOUNDED AND SICK
3-9. Certain provisions of the Geneva Conventions are relevant to the medical mission.
* Article 16 of the GC provides that enemy civilians who are “…wounded and sick, as well as the
infirm, and expectant mothers, shall be the object of particular protection and respect.” The Article
also requires that, “As far as military considerations allow, each Party to the conflict shall facilitate
the steps taken to search for the killed and wounded [civilians], to assist…other persons exposed
to grave danger, and to protect them against pillage and ill-treatment [emphasis added].”
The “protection and respect” to which wounded and sick enemy civilians are entitled is the
same as that accorded to wounded and sick enemy military personnel.
While Article 15 of the GWS requires Parties to a conflict to search for and collect the dead,
wounded, and sick members of the armed forces, Article 16 of the GC states that the Parties
must “facilitate the steps taken” in regard to civilians. This recognizes the fact that saving
civilians is the responsibility of the civilian authorities rather than of the military. The military
is not required to provide injured civilians with medical care in a combat zone, however, if
we start providing treatment, we are bound by the provisions of the GWS. Provisions for
treating civilians (enemy or friendly) will be addressed in EAB regulations.
* In occupied territories, the Occupying Power must accord the inhabitants numerous protections as
required by the GC. The provisions relevant to medical care include:
Requirement to bring in medical supplies for the population if the resources of the occupied
territory are inadequate.
Prohibition on requisitioning medical supplies unless the requirements of the civilian
population have been taken into account. |
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Duty of ensuring and maintaining, with the cooperation of national and local authorities, the
medical and hospital establishments and services, public health, and hygiene in the occupied
territory.
Requirement that medical personnel of all categories be allowed to carry out their duties.
Prohibition on requisitioning civilian hospitals on other than a temporary basis and then only
in cases of urgent necessity for the care of military wounded and sick and after suitable
arrangements have been made for the civilian patients.
Requirement to provide adequate medical treatment to detained persons.
Requirement to provide adequate medical care in detention camps.
MEDICAL REPATRIATION
3-10. The Geneva Conventions provide for the repatriation of—
* Retained health care personnel once they are no longer needed to provide health care to members
of their own forces (Articles 28 and 39, GWS).
* Seriously wounded and sick prisoners of war (POWs).
3-11. Parties to the conflict are bound to send back to their own country, regardless of number or rank,
seriously wounded and seriously sick POWs, after having cared for them until they are fit to travel. No sick
or injured prisoner of war may be repatriated against his will during hostilities (Article 109, GPW).
3-12. The following shall be directly repatriated (Article 110, GPW):
* Incurably wounded and sick whose mental or physical fitness seems to have been gravely
diminished.
* Wounded and sick who, according to medical opinion, are not likely to recover within one year,
whose condition requires treatment, and whose mental or physical fitness seems to have been
gravely diminished.
* Wounded and sick who have recovered, but whose mental or physical fitness seems to have been
gravely and permanently diminished.
3-13. The following may be accommodated in a neutral country (Article 110, GPW):
* Wounded and sick whose recovery may be expected within one year of the date of the wound or
the beginning of the illness, if treatment in a neutral country might increase prospects of a more
certain and speedy recovery.
* Prisoners of war whose behavioral or physical health, according to medical opinion, is seriously
threatened by continued captivity.
3-14. The conditions which POWs accommodated in a neutral country must fulfill in order to permit their
repatriation will be fixed, as shall likewise their status, by agreement between the Powers concerned. In
general, POWs who have been accommodated in a neutral country, and who belong to the following
categories, should be repatriated:
* Those whose state of health has deteriorated so as to fulfill the conditions laid down for direct
repatriation.
* Those whose mental or physical powers remain, even after treatment, considerably impaired.
3-15. Upon the outbreak of hostilities, Mixed Medical Commissions will be appointed to examine sick and
wounded POWs and to make all appropriate decisions regarding them (Article 112, GPW). However, POWs
who, in the opinion of the medical authorities of the Detaining Power, are manifestly seriously injured or
seriously sick, may be repatriated without having been examined by a Mixed Medical Commission.
PROTECTION AND IDENTIFICATION OF MEDICAL PERSONNEL
3-16. Article 24 of the GWS provides special protection for “Medical personnel exclusively engaged in the
search for, or the collection, transport or treatment of the wounded or sick, or in the prevention of disease,
[and] staff exclusively engaged in the administration of medical units and establishments . . . [emphasis
added].” Article 25 provides limited protection for “Members of the armed forces specially trained for |
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employment, should the need arise, as hospital orderlies, nurses or auxiliary stretcher-bearers, in the search
for or the collection, transport or treatment of the wounded and sick . . . if they are carrying out these duties
at the time when they come into contact with the enemy or fall into his hands [emphasis added].”
PROTECTION
3-17. There are two separate and distinct forms of protection.
* The first is protection from intentional attack if medical personnel are identifiable as such by an
enemy in a combat environment. Normally, this is facilitated by medical personnel wearing an
armband bearing the distinctive emblem (a Red Cross or Red Crescent on a white background),
or by their employment in a medical unit, establishment, or vehicle (including medical aircraft and
hospital ships) that displays the distinctive emblem. Persons protected by Article 25 may wear an
armband bearing a miniature distinctive emblem only while executing medical duties.
* The second protection provided by the GWS pertains to medical personnel who fall into the hands
of the enemy. Article 24 personnel are entitled to “retained person” status. They are not deemed
to be POWs, but otherwise benefit from the protections of the GPW. Article 28 of the GWS states
they are authorized to carry out medical duties only, and “. . . shall be retained only in so far as
the state of health . . . and the number of POWs require.” Article 25 personnel are POWs, but
shall be employed to perform medical duties in so far as the need arises. They may be required to
perform other duties or labor, and they may be held until a general repatriation of POWs is
accomplished upon the cessation of hostilities.
SPECIFIC CASES
3-18. Army Medicine personnel and non-Army Medicine personnel assigned to medical units fall into the
category identified in Article 24 provided they meet the exclusively engaged criteria of that article. The
United States Army does not have any personnel who officially fall into the category identified in Article 25.
While it is not a violation of the GWS for Article 24 personnel to perform nonmedical duties, it should be
understood; however, that Article 24 personnel lose their protected status under that article if they perform
duties or tasks inconsistent with their noncombatant role. Should those personnel later take up their medical
duties again, a reasonable argument might be made that they cannot regain Article 24 status since they have
not been exclusively engaged in medical duties and that such switching of roles might at best cause such
personnel to fall under the category identified in Article 25.
* While only Article 25 refers to nurses, nurses are Article 24 personnel if they meet the criteria of
that article.
* The AHS officers and NCOs assigned to nonmedical positions in a brigade support battalion or a
sustainment brigade are neither Article 24 nor Article 25 personnel. Such assignments place them
in the role of a combatant. Examples of such personnel are—
The AHS officers serving as commanders of brigade support battalions with responsibility
for base or base-cluster defense, as well as command and control of medical and nonmedical
units.
The AHS officers and NCOs assigned to nonmedical staff positions with a brigade support
battalion with responsibility for planning and supervising the sustainment support for a BCT
or other combat unit.
* Article 24 personnel who might become Article 25 personnel by virtue of their switching roles
could include the following:
A medical company commander, a physician, or the executive officer (a Medical Service
Corps officer) detailed as convoy march unit commander with responsibility for medical and
nonmedical unit routes of march, convoy control, defense, and repulsing attacks.
Helicopter pilots, who are permanently assigned to a dedicated air ambulance unit, but fly
helicopters not bearing the Red Cross emblem on standard combat missions during other
times.
* The GWS does not itself prohibit the use of Article 24 personnel in perimeter defense of
nonmedical units such as areas or base clusters under overall security defense plans, but the policy |
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of the United States Army is that Article 24 personnel will not be used for this purpose. Adherence
to this policy should avoid any issues regarding their status under the GWS due to a temporary
change in their role from noncombatant to combatant. Medical personnel may guard their own
unit without any concurrent loss of their protected status.
IDENTIFICATION CARDS AND ARMBANDS
3-19. Medical personnel who meet the exclusively engaged criteria of Article 24, GWS, are entitled to wear
an armband bearing the distinctive emblem of the Red Cross and carry the medical personnel identification
card authorized in Article 40, GWS (in the U.S. Armed Services, DD Form 1934 [Geneva Conventions
Identity Card for Medical and Religious Personnel Who Serve in or Accompany Armed Forces]). Article 25
personnel and medical personnel serving in positions that do not meet the exclusively engaged criteria of
Article 24 are not entitled to carry the medical personnel identification card or wear the distinctive emblem
armband. Such personnel carry a DOD Common Access Card, and under Article 25, may wear an armband
bearing a miniature distinctive emblem when executing medical duties.
The following paragraph implements STANAGs 2060, 2454, and 2931.
PROTECTION AND IDENTIFICATION OF MEDICAL UNITS,
ESTABLISHMENTS, BUILDINGS, MATERIEL, AND MEDICAL
TRANSPORTS
3-20. There are two separate and distinct forms of protection: protection from intentional attack and
protection when falling into the hands of the enemy.
PROTECTION FROM INTENTIONAL ATTACK
3-21. The first is protection from intentional attack if medical units, establishments, or transports are
identifiable as such by an enemy in a combat environment. Normally, this is facilitated by medical units or
establishments flying a white flag with a Red Cross and by marking buildings and transport vehicles (aircraft
or ground) with the distinctive emblem.
* It follows that if we cannot attack recognizable medical units, establishments, or transports, we
should allow them to continue to give treatment to the wounded in their care as long as this is
necessary.
* All vehicles employed exclusively on medical transport duty are protected in the operational area.
Medical vehicles being used for both military and medical purposes, such as moving wounded
personnel during an evacuation and carrying retreating belligerents, are not entitled to protection.
* Medical aircraft, like medical transports, are protected from intentional attack, but with a major
difference—they are protected “. . . while flying at heights, times and on routes specifically agreed
upon between the belligerents concerned.” (Article 36, GWS.) Such agreements may be made
for each specific case or may be of a general nature, concluded for the duration of hostilities. If
there is no agreement, belligerents use medical aircraft at their own risk and peril.
* Article 37, GWS specifies that “. . . medical aircraft of Parties to the conflict may fly over the
territory of neutral Powers, land on it in case of necessity, or use it as a port of call.” The medical
aircraft will “. . . give the neutral Powers previous notice of their passage over the said territory
and obey all summons to alight, on land or water.” The aircraft will be “ . . . immune from attack
only when flying on routes, at heights and at times specifically agreed upon between the Parties
to the conflict and the neutral Power concerned.” It further states that “The neutral Powers may,
however, place conditions or restrictions on the passage or landing of medical aircraft on their
territory.”
* The second paragraph of Article 19 imposes an obligation upon those responsible to “. . . ensure
that the said medical establishments and units are, as far as possible, situated in such a manner that
attacks against military objectives cannot imperil their safety.” Hospitals should be sited alone, |
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as far as possible from military objectives. The unintentional bombardment of a medical
establishment or unit due to its presence among or in proximity to valid military objectives is not
a violation of the GWS. Legal protection is certainly valuable, but it is more valuable when
accompanied by practical safeguards.
PROTECTION WHEN FALLING INTO THE HANDS OF THE ENEMY
3-22. The second protection provided by the GWS pertains to medical units, establishments, materiel, and
transports that fall into the hands of the enemy.
* Captured mobile medical unit materiel is to be used first to treat the patients in the captured unit.
If there are no patients in the captured unit, or when those who were there have been moved, the
materiel is to be used for the treatment of other wounded and sick persons.
* Generally, the buildings, materiel, and stores of fixed medical establishments will continue to be
used to treat wounded and sick, however, after provision is made to care for remaining patients,
operational commanders may make other use of them. All distinctive markings must be removed
if the buildings are to be used for other than medical purposes.
* The materiel and stores of fixed establishments and mobile medical units are not to be intentionally
destroyed, even to prevent them from falling into enemy hands. In certain extreme cases, buildings
may have to be destroyed for operational reasons.
* Medical transports that fall into enemy hands may be used for any purpose once arrangement has
been made for the medical care of the wounded and sick they contain. The distinctive markings
must be removed if they are to be used for nonmedical purposes.
* A medical aircraft is supposed to obey a summons to land for inspection. If it is performing its
medical mission, it is supposed to be released to continue its flight. If examination reveals that an
act “harmful to the enemy” (for example, if the aircraft is carrying munitions) has been committed,
it loses the protections of the Conventions and may be seized. If a medical aircraft makes an
involuntary landing, all aboard, except the medical personnel, will be POWs. A medical aircraft
refusing a summons to land is a fair target.
IDENTIFICATION
3-23. The GWS contains several provisions regarding the use of the Red Cross emblem on medical units,
establishments, and transports. (The identification of medical personnel has been previously discussed.)
* Article 39 of the GWS reads as follows: “Under the direction of the competent military authority,
the emblem shall be displayed on the flags, armlets and on all equipment employed in the Medical
Service.”
There is no obligation of a belligerent to mark his units with the emblem. Sometimes a
commander (generally no lower than a brigade commander for NATO forces) may order the
camouflage of his medical units in order to conceal the presence or real strength of his forces.
The enemy must respect a medical unit if he knows of its presence, even one that is
camouflaged or not marked. The absence of a visible Red Cross emblem, however, coupled
with a lack of knowledge on the part of the enemy as to the unit’s protected status, may render
that unit’s protection valueless.
The distinctive emblem is not a Red Cross alone; it is a Red Cross on a white background.
Should there be some good reason, however, why an object protected by the Convention can
only be marked with a Red Cross without a white background, belligerents may not make the
fact that it is so marked a pretext for refusing to respect it.
Some countries use the Red Crescent on a white background in place of the Red Cross. This
emblem is recognized as an authorized exception under Article 38, GWS. Additional Protocol
III to the Geneva Conventions also recognizes the Red Crystal. The Red Crystal replaces the
Red Star of David.
The initial phrase of Article 39 shows that it is the military commander who controls the
emblem and can give or withhold permission to use it. He is at all times responsible for the |
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use made of the emblem and must see that it is not improperly used by the troops or by
individuals.
* Article 42 of the GWS specifically addresses the marking of medical units and establishments.
“The distinctive flag of the Convention shall be hoisted only over such medical units and
establishments as are entitled to be respected under the Convention, and only with the consent
of the military authorities.” (Paragraph 1, Article 42, GWS.) Although the Convention does
not define “the distinctive flag of the Convention,” what is meant is a white flag with a Red
Cross in its center. Also, the word “flag” must be taken in its broadest sense. Hospitals are
often marked by one or several Red Cross emblems painted on the roof. Finally, the military
authority must consent to the use of the flag (see the above comments on Article 39) and must
ensure that the flag is used only on buildings entitled to protection.
“In mobile units, as in fixed establishments, it [the distinctive flag] may be accompanied by
the national flag of the Party to the conflict to which the unit or establishment belongs.”
(Article 42, GWS.) This provision makes it optional to fly the national flag with the Red
Cross flag. It should be noted that in an operational area the national flag is a symbol of
belligerency and is therefore likely to provoke attack.
In a NATO conflict, NATO STANAG 2931 provides for camouflage of the Geneva emblem
on medical facilities where the lack of camouflage might compromise operations. Medical
facilities on land, supporting forces of other nations, will display or camouflage the Geneva
emblem in accordance with national regulations and procedures. When failure to camouflage
would endanger or compromise operational operations, the camouflage of medical facilities
may be ordered by a NATO commander of at least brigade level or equivalent. Such an order
is to be temporary and local in nature and countermanded as soon as the circumstances permit.
It is not envisaged that fixed, large, medical facilities would be camouflaged. The STANAG
defines “medical facilities” as “medical units, medical vehicles, and medical aircraft on the
ground.”
Note. There is no such thing as a “camouflaged” Red Cross. When camouflaging a medical unit
either cover up the Red Cross or take it down. A black cross on an olive drab or any other
background is not a symbol recognized under the Geneva Conventions.
3-24. For additional guidance on the marking of air ambulances, refer to AR 40-3 and TM 1-1500-345-23.
For more information on approved medical symbols, refer to Appendix F.
LOSS OF PROTECTION OF MEDICAL ESTABLISHMENTS AND UNITS
3-25. Medical assets lose their protected status by committing acts “harmful to the enemy.” (Article 21,
GWS.) A warning must be given to the offending unit and a reasonable amount of time allowed to cease
such activity.
ACTS HARMFUL TO THE ENEMY
3-26. The phrase “acts harmful to the enemy” is not defined in the Convention, but should be considered to
include acts the purpose or effect of which is to harm the enemy, by facilitating or impeding military
operations. Such harmful acts would include, for example, the use of a hospital as a shelter for able-bodied
combatants, as an arms or ammunition dump, or as a military observation post. Another instance would be
the deliberate sitting of a medical unit in a position where it would impede an enemy attack.
WARNING AND TIME LIMIT
3-27. The enemy has to warn the unit to put an end to the harmful acts and must fix a time limit on the
conclusion of which he may open fire or attack if the warning has not been complied with. The phrase in all
appropriate cases recognizes that there might obviously be cases where no time limit could be allowed. A
body of troops approaching a hospital and met by heavy fire from every window would return fire without
delay. |
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USE OF SMOKE AND OBSCURANTS
3-28. The use of smoke and obscurants during MEDEVAC operations for signaling or marking landing zones
does not constitute an act harmful to the enemy, however, employing such devices to obfuscate a medical
element’s position or location is tantamount to camouflaging; it would jeopardize its entitlement privilege
status under the GWS. Refer to Army doctrine for MEDEVAC for additional information on the use of
smoke and obscurants for medical operations.
CONDITIONS NOT DEPRIVING MEDICAL UNITS AND
ESTABLISHMENTS OF PROTECTION
3-29. Article 22 of the GWS reads as follows: “The following conditions shall not be considered as depriving
a medical unit or establishment of the protection guaranteed by Article 19: (1) That the personnel of the unit
or establishment are armed, and that they use the arms in their own defense (sic), or in that of the wounded
and sick in their charge. (2) That in the absence of armed orderlies, the unit or establishment is protected by
a picket or by sentries or by an escort. (3) That small arms and ammunition taken from the wounded and
sick and not yet handed to the proper service, are found in the unit or establishment. (4) That personnel and
material (sic) of the veterinary service are found in the unit or establishment, without forming an integral part
thereof. (5) That the humanitarian activities of medical units and establishments or of their personnel extend
to the care of civilian wounded or sick.”
ACTS
3-30. These five conditions are not to be regarded as acts harmful to the enemy. These are particular cases
where a medical unit retains its character and its right to immunity, in spite of certain appearances which
might lead to a contrary conclusion or, at least, create some doubt.
DEFENSE OF MEDICAL UNITS AND SELF-DEFENSE BY MEDICAL PERSONNEL
3-31. A medical unit is granted a privileged status under the law of land warfare. This status is based on the
view that medical personnel are not combatants and that their role in the combat area is exclusively a
humanitarian one. In recognition of the necessity of self-defense, however, medical personnel may be armed
for their own defense or for the protection of the wounded and sick under their charge. To retain this
privileged status, they must refrain from all aggressive action and may only employ their weapons if attacked
in violation of the Conventions. They may not employ arms against enemy forces acting in conformity with
the law of land warfare and may not use force to prevent the capture of their unit by the enemy (it is, on the
other hand, perfectly legitimate for a medical unit to withdraw in the face of the enemy). Medical personnel
who use their arms in circumstances not justified by the law of land warfare expose themselves to penalties
for violation of the law of land warfare. Provided they have been given due warning to cease such acts, they
may also forfeit the protection of the medical unit or establishment which they are protecting.
* Medical personnel are not authorized crew-served or offensive weapons. They may carry small
arms, such as rifles, pistols, squad automatic weapons, or authorized substitutes in the defense of
medical facilities, equipment, and personnel/patients without surrendering the protections
afforded by the Geneva Conventions. Further, Army Medicine and non- Army Medicine
personnel in medical units are not required to train and qualify on crew-served weapons, however,
Army Medicine personnel attending training at Noncommissioned Officer Education System
courses will receive weapons instruction that is part of the curriculum. This will ensure the
successful completion of the course is not jeopardized by failure to attend the weapons training
portion of the curriculum. (Refer to AR 350-1 for further information).
* The presence of machine guns, grenade launchers, booby traps, hand grenades, light antitank
weapons, or mines (regardless of the method by which they are detonated) in or around a medical
unit or establishment would seriously jeopardize its entitlement privilege status under the GWS.
The deliberate arming of a medical unit with such items could constitute an act harmful to the
enemy and cause the medical unit to lose its protection, regardless of the location of the medical
unit. |
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Guarding Medical Units
3-32. As a rule, a medical unit is to be guarded by its own personnel, however, it will not lose its protected
status if the guard is performed by a number of armed Soldiers. The military guard attached to a medical
unit may use its weapons, just as armed medical personnel may, to ensure the protection of the unit. But, as
in the case of medical personnel, the Soldiers may only act in a purely defensive manner and may not oppose
the occupation or control of the unit by an enemy who is respecting the unit’s privileged status. The status
of such Soldiers is that of ordinary members of the armed forces. The mere fact of their presence with a
medical unit will shelter them from attack. In case of capture, they will be POWs.
Arms and Ammunition taken from the Wounded
3-33. Wounded persons arriving in a medical unit may still be in possession of small arms and ammunition,
which will be taken from them and handed to authorities outside the medical unit. Should a unit be captured
by the enemy before it is able to get rid of these arms, their presence is not of itself cause for denying the
protection to be accorded the medical unit under the GWS.
Personnel and Materiel of Veterinary Services
3-34. The presence of personnel and materiel of Veterinary Services with a medical unit is authorized, even
where they do not form an integral part of such unit.
Care of Civilian Wounded and Sick
3-35. A medical unit or establishment protected by the GWS may take in civilians, as well as military
wounded and sick, without jeopardizing its privileged status. This clause merely sanctions what is actually
done in practice.
THE 1977 PROTOCOLS TO THE GENEVA CONVENTIONS
3-36. Amendments to the Geneva Conventions have been ratified by some of our allies and potential
adversaries. The U.S. representative to the diplomatic conference signed these amendments, but they have
not been officially ratified by our government.
COMPLIANCE WITH THE GENEVA CONVENTIONS
3-37. The U.S. is a party to the 1949 Geneva Conventions. Two of these Conventions afford protection for
medical personnel, facilities, and evacuation platforms (to include aircraft on the ground). All medical
personnel should thoroughly understand the provisions of the Geneva Conventions that apply to medical
activities. Violation of these Conventions can result in the loss of the protection afforded by them. Medical
personnel should inform the operational commander of the consequences of violating the provisions of these
Conventions. The consequences can include the following:
* Medical evacuation assets subjected to attack and destruction by the enemy.
* Medical capability degraded. Captured medical personnel becoming POWs rather than retained
persons. They may not be permitted to treat fellow prisoners.
* Loss of protected status for medical unit, personnel, or evacuation platforms (to include aircraft
on the ground).
3-38. Because even the perception of impropriety can be detrimental to the mission and U.S. interests,
medical commanders must ensure that they do not give the impression of impropriety in the conduct of
medical operations. For example, the MMB commander included in the operational SOP rules governing
the use of crew-served weapons, it would give the impression that the unit possessed and intended to use
these types of weapons. Under the provisions of the GC, medical units are only authorized individual small
arms and squad automatic weapons for use in the defense of the patients under their care and for themselves.
Even though the unit did not possess these types of weapons, the entry in the operational SOP could be
misinterpreted and a case made that the commander intended to use these weapons in violation of the Geneva
Conventions. |
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MEDICAL CARE FOR DETAINED PERSONNEL
3-39. It is DOD policy that the U.S. military Services shall comply with the principles, spirit, and intent of
the international law of war, both customary and codified, to include the GCs. As such, captured or detained
personnel will be accorded an appropriate legal status under international law and conventions. Personnel in
U.S. custody will receive medical care consistent with the standard of medical care that applies for U.S.
military personnel in the same geographic area. Refer to DODD 2310.01E, DODI 2310.08E, JP 3-63, JP 4-
02, AR 40-400, AR 190-8, and ATP 4-02.46 for additional information on medical care for detained
personnel.
SECTION III — MEDICAL ETHICS
3-40. Health care personnel are well-trained in and guided by the ethics of their professional calling. This
training and ethical principles, coupled with the requirements of international law as it pertains to the
treatment of detainees, and civilians during conflict will ensure the ethical treatment of all sick and wounded
personnel.
ETHICAL CONSIDERATIONS FOR THE MEDICAL TREATMENT OF
DETAINEES
3-41. Health care personnel (particularly physicians) perform their duties consistent with the following basic
principles:
* Health care personnel have a duty in all matters affecting the physical and BH of detainees to
perform, encourage, and support, directly and indirectly, actions to uphold the humane treatment
of detainees. They must ensure that no individual in the custody or under the physical control of
the DOD, regardless of nationality or physical location, shall be subject to cruel, inhuman, or
degrading treatment or punishment as defined in U.S. law.
* Health care personnel charged with the medical care of detainees have a duty to protect detainees’
physical and BH and provide appropriate treatment for disease. To the extent practicable,
treatment of detainees should be guided by professional judgments and standards similar to those
applied to personnel of the United States Armed Forces.
* Health care personnel shall not be involved in any professional provider-patient treatment
relationship with detainees the purpose of which is not solely to evaluate, protect, or improve their
physical and BH.
* Health care personnel, whether or not in a professional provider-patient treatment relationship,
shall not apply their knowledge and skills in a manner that is not applicable law or the standards
set forth in DODD 2310.01E.
* Health care personnel shall not certify, or participate in the certification of, the fitness of detainees
for any form of treatment or punishment that is not in consonance with applicable law, or
participate in any way in the administration of any such treatment or punishment.
* Health care personnel shall not participate in any procedure for applying physical restraints to the
person of a detainee unless such a procedure is determined to be necessary for the protection of
the physical or BH or the safety of the detainee, or necessary for the protection of other detainees
or those treating, guarding, or otherwise interacting with them. Such restraints, if used, shall be
applied in a safe and professional manner.
3-42. Health care personnel engaged in a professional provider-patient treatment relationship with detainees
shall not participate in detainee-related activities for purposes other than health care. Such health care
personnel shall not actively solicit information from detainees for other than medical purposes. Health care
personnel engaged in nontreatment activities, such as forensic psychology, behavioral science consultation,
forensic pathology, or similar disciplines, shall not engage in any professional provider-patient treatment
relationship with detainees (except in emergency circumstances in which no other health care providers can
respond adequately to save life or prevent permanent impairment).
* During the initial screening of detainees any preexisting medical conditions, wounds, fractures,
and bruises should be noted. Documentation of these injuries/conditions provides a baseline for |
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each detainee which facilitates the identification of injuries which may have occurred in the
detention facility.
* Detainees who report for routine sick call should be visually examined to determine if any unusual
or suspicious injuries are apparent. If present, the health care provider should determine from the
detainee how the injuries occurred. Any injuries which cannot be explained or for which the
detainee is providing evasive responses should be noted in the medical record and should be
reported to the chain of command, technical medical channels, and United States Army Criminal
Investigation Command.
* Health care personnel may enter the holding areas of the facility for a variety of reasons. These
can include, but are not limited to, conducting sanitary inspections, providing TCCC, and
dispensing medications. When in the holding areas of the facility, health care personnel must be
observant. Should they observe anything suspicious which might indicate that detainees are being
mistreated, they should report these suspicions immediately to the chain of command. Should
they observe a detainee being mistreated, they should take immediate action to stop the abuse and
then report the incident.
3-43. Detained personnel must have access to the same available standard of medical care as the U.S. and
unified action partners to include respect for their dignity and privacy. In general, the security of detainees’
medical records and confidentiality of medical information will be managed the same way as for the U.S.
and multinational forces. During detainee operations, the patient administrator, the United States Army
Criminal Investigation Command, the International Committee of the Red Cross, and the medical chain of
command can have access to detainee medical records besides the treating health care personnel.
3-44. Health care personnel shall safeguard patient confidences and privacy within the constraints of the law.
Under U.S. and international law and applicable medical practice standards, there is no absolute
confidentiality of medical information for any person. Detainees shall not be given cause to have incorrect
expectations of privacy or confidentiality regarding their medical records and communications, however,
whenever patient-specific medical information concerning detainees is disclosed for purposes other than
treatment, health care personnel shall record the details of such disclosure, including the specific information
disclosed, the person to whom it was disclosed, the purpose of the disclosure, and the name of the medical
unit commander (or other designated senior medical activity officer) approving the disclosure. Similar to
legal standards applicable to U.S. citizens, permissible purposes include preventing harm to any person,
maintaining public health and order in detention facilities, and any lawful law enforcement, or national
security-related activity.
3-45. In any case in which the medical unit commander (or other designated senior medical activity officer)
suspects that the medical information to be disclosed may be misused, he should seek a senior command
determination that the use of the information will be consistent with the applicable standards.
3-46. The information disclosed to a physician during the course of the relationship between physician and
patient is confidential to the greatest possible degree. The patient should feel free to make a full disclosure
of information to the physician in order that the physician may most effectively provide needed services. The
patient should be able to make this disclosure with the knowledge that the physician will respect the
confidential nature of the communication. The physician should not reveal confidential communications or
information without the express consent of the patient, unless required to do so by law. The obligation to
safeguard patient confidences is subject to certain exceptions, which are ethically and legally justified
because of overriding social considerations. Where a patient threatens to inflict serious bodily harm to
another person or to himself and there is a reasonable probability that the patient may carry out the threat, the
physician should take reasonable precautions for the protection of the intended victim, including notification
of law enforcement authorities.
3-47. Patient consent for the release of medical records is not required. The MTF commander or
commander’s designee, usually the patient administrator, determines what information is appropriate for
release. Only that specific medical information or medical record required to satisfy the terms of a legitimate
request will be authorized for disclosure.
3-48. Because the chain of command is ultimately responsible for the care and treatment of detainees, the
detention facility chain of command requires some medical information. For example, detainees suspected |
4-02 | 95 | Army Health System and the Effects of the Law of Land Warfare and Medical Ethics
of having infectious diseases such as tuberculosis should be separated from other detainees. Guards and
other personnel who come into contact with such patients should be informed about their health risks and
how to mitigate those risks.
3-49. Releasable medical information on internees includes that which is necessary to supervise the general
state of health, nutrition, and cleanliness of internees and to detect contagious diseases. Such information
should be used to provide health care; to ensure health and safety of internees, soldiers, employees, or others
at the facility; to ensure law enforcement on the premises; and to ensure the administration and maintenance
of the safety, security, and good order of the facility.
3-50. For additional information on medical ethics refer to the Textbooks of Military Medicine: Military
Medical Ethics, Volumes I and II, and The Emergency War Surgery Handbook. Both of these publications
are available electronically at the Borden Institute website.
3-51. The provision of health care to detainees within MTFs or other facilities (such as dispensaries located
within detention or holding facilities) is a unique role within the military structure. This role is governed by
rules and regulations designed to ensure the provision of health care while ensuring personal safety and
maintenance of security, custody, and discipline in a detention/holding facility environment. Health care
personnel must ensure that their actions, both on- and off-duty, do not undermine their ability to function
effectively among detainees or compromise established health care, safety, security, and custody guidelines.
Note. The process of abiding by the principles of ethical treatment of personnel regardless of
national/adversarial affiliation and navigating rules regarding employment of weapon systems,
markings, and duties, can be challenging. Units are strongly encouraged to consult with their
servicing Staff Judge Advocate and Unit Ministry Team for advisement. |
4-02 | 97 | Chapter 4
Army Health System Operations
Army Health System support is provided across the competition continuum and
various types of mission support (traditional support to a deployed force, operations
predominantly characterized by stability tasks, and defense support of civil authorities)
may be provided simultaneously in various locations throughout the operational area.
SECTION I — PLANNING FOR ARMY HEALTH SYSTEM SUPPORT
4-1. Army Health System planners must anticipate the types of support that may be required and develop
flexible plans that can be rapidly adjusted to changes in the level of violence and operational tempo, as well
as to transition from one type of task to the next.
UNIFIED LAND OPERATIONS
4-2. Unified land operations describe the character of the dominant major operation being conducted at any
time within the land force commander’s AO. The competition continuum helps convey the nature of the
major operation to the force to facilitate common understanding of how the commander broadly intends to
operate. See ADP 3-0 on unified land operations for an in-depth discussion of the competition continuum.
Further, refer to AHS doctrine for medical planning considerations.
4-3. Unified land operations are executed through decisive action by means of Army core competencies
that are guided by mission command. The Army’s core competencies are combined arms maneuver and wide
area security (ADP 1) with a number of enabling competencies. These enabling competencies include
security cooperation, tailoring forces, entry operations, flexible command and control, the support we provide
to the joint force.
4-4. As all major operations are joint in nature, the competition continuum can be used to group similar
types of activities under a predominant theme. Unified land operations are simultaneous offensive, defensive,
and stability or defense support of civil authorities’ tasks to seize, retain, and exploit the initiative to shape
OEs, prevent conflict, consolidate gains, and win our Nation’s wars as part of unified action (ADP 3-0).
OPERATIONAL VARIABLES
4-5. As the OE is comprised of all of the factors, both military and civilian, that affect the conduct of
military operations in an operational area, the medical commander must define how the different elements
will impact on the concept of operations. The operational variables are a means for exploring and describing
an OE that focuses on the human aspects of the environment. Commanders and planners can use political,
military, economic, social, information, infrastructure, physical environment, and time (operational
variables) to ensure all elements are considered. The operational variables are used by strategic planners in
the development of plans and information may be broader than required for mission analysis at the tactical
level, however, as medical issues often have a regional focus and may be the result of environmental,
socioeconomic, political, and religious practices, it is essential for the AHS planner to consider the medical
aspects of an operation on a much broader scale than the immediate AO. As the theater medical command,
the MEDCOM (DS) provides this regional focus in support of the CCDRs theater engagement strategy. For
a detailed discussion of each of the political, military, economic, social, information, infrastructure, physical
environment, time (operational variables) considerations, refer to ADP 5-0. |
4-02 | 98 | Chapter 4
4-6. Table 4-1 provides medical aspects for consideration in relation to the operational variables and
subvariables. This table is not an all-inclusive listing but does provide the AHS planner with some initial
considerations.
Table 4-1. Medical aspects of the operational variables
Variable Subvariables Medical aspects
Political Attitude toward the United States. Health status of population.
Centers of political power. Public health issues.
Type of government. Accessibility to health care.
Government effectiveness and Nutritional status of the population and/or subgroups
legitimacy. of the population.
Influential political groups.
International relationships.
Military Military forces. Development of military medical infrastructure.
Government paramilitary forces. Level of education and training of military medical
Nonstate paramilitary forces. personnel.
Trauma care capabilities.
Unarmed combatants.
Medical evacuation (ground and air).
Nonmilitary armed combatants.
Military functions. Forward surgical/damage control surgical
capabilities.
• Command and control.
Hospitalization capabilities.
• Maneuver.
Disease and nonbattle injury rates.
• Information operations.
Identification and treatment of mild traumatic brain
• Reconnaissance, security, injuries and traumatic brain injuries.
and surveillance
Dental care services.
capabilities acquisition.
Blood supply and blood-banking capabilities.
• Fire capabilities.
Organic medical assets.
• Protection.
Area medical support capabilities.
• Sustainment.
Availability of medical supplies and equipment.
• Cyberspace operations and
Medical equipment maintenance and repair.
electronic warfare
capabilities. Medical logistics system to include medical gases
and optical fabrication and repair.
• Special operations
capabilities. Behavioral health and treatment of combat and
operational stress reaction capabilities.
Rehabilitative and convalescent care capabilities to
include prosthetics.
Food inspection and laboratory analysis.
Veterinary care for military working dogs and other
government-owned animals and veterinary public
health capabilities including zoonotic diseases and
food protection infrastructure/programs. |
4-02 | 99 | Army Health System Operations
Table 4-1. Medical aspects of the operational variables (continued)
Variable Subvariables Medical aspects
Economic Economic diversity. The economic base can affect health care for both
Employment status. the human and the animal populations in the nation.
Economic activity. The types of injuries and health issues may vary
significantly based upon whether it is an agricultural
Illegal economic activity.
society or an industrialized nation and/or region.
Banking and finance. This affects the types of health care available
including restorative and rehabilitative services and
programs and the availability of health care to the
populace.
The gross national product and the per capita
income of the population affect the availability of
resources for the government to expend on public
health concerns and health care in general.
When the Army Health System planner examines the
economic factors of a nation or region, it is important
to determine what influence it has on how much
money is expended in the health sector (both private
and public) as this will affect health care, medical
equipment, and pharmaceuticals availability.
Social Demographic mix. Age, gender, and genetics affect how individuals are
Social volatility. affected by disease and existing environmental
factors.
Education level.
Religion affects how people view medical
Ethnic diversity.
intervention; it can affect how a person will comply
Religious diversity. with medical treatment regimens and whether they
Population movement. will accept recommended treatments (such as the
use of blood transfusions).
Common languages.
Persons who are uprooted may be more susceptible
Criminal activity.
to disease because of lowered immunity status due
Human rights. to fatigue, restricted food intake, poor living
Centers of social power. conditions, inadequate shelters, and poor sanitation.
Basic cultural norms and If public health and disease prevention programs are
values. not instituted, the general health of the population or
the affected subpopulation will decrease.
Populations where education and literacy are not
widespread will often have a lower standard of living,
less appreciation for public health and disease
prevention practices, less skilled workers, and be
more difficult to reach with public health alerts and
programs.
Cultural, ethnic, and religious beliefs often influence
who will seek medical care and who will not. Privacy
issues may require that consideration of the
provider’s gender is relevant in addressing women's
health issues.
Providers must be cautious in using graphic aids to
communicate with their patients, as the explicit
graphics may be considered offensive. |
4-02 | 100 | Chapter 4
Table 4-1. Medical aspects of the operational variables (continued)
Variable Subvariables Medical aspects
Social Medical personnel should develop a guide for
(continued) asking medical questions in the local language
dialect.
Information Public communications media. Availability of mass communications enablers for
• Telephone/cell phones. public health warnings, alerts, and information.
• Print Media. • Telephones.
• Broadcast media (TV, radio). • Televisions.
• Public Webpages. • Radios.
• Newspapers/periodicals.
• Computers/e-mail.
Infrastructure1 Construction pattern. Availability of electricity and potable water.
Urban zones. Number of medical providers (by category).
Urbanized building density. Numbers of primary, secondary, and tertiary
Utilities present. medical treatment facilities.
Utility level. Status of waste disposal.
Transportation architecture. Sanitation practices and standards (availability of
toilets, showers, and bathing facilities).
Urbanization can increase the spread of infectious
diseases due to inadequate living space,
improper ventilation, poor sanitation practices,
and lowered immunity.
Accessibility issues (roads [paved and unpaved],
commercial transportation systems [buses, taxis,
rail, and air], vehicles and/or pack animals, and
natural barriers [mountains, streams, jungles, and
deserts]).
Availability of transportation assets for medical
evacuation or other medical purposes in the event
of natural or man-made disaster or other mass
casualty situation.
Physical Terrain Are brick and mortar structures available for use
environment • *Observation and fields of fire. as medical treatment facilities?
Climate and weather effects on—
• *Avenues of approach.
• Disease vectors.
• *Key terrain.
• Categories and types of injuries.
• *Obstacles.
• Acclimatization issues pertaining to heat,
• *Cover and concealment.
cold, or altitude.
• Landforms.
• Medical evacuation operations.
• Vegetation. |
4-02 | 101 | Army Health System Operations
Table 4-1. Medical aspects of the operational variables (continued)
Variable Subvariables Medical aspects
Physical • Terrain complexity. Topography and hydrology considerations
environment include:
• Mobility classification.
(continued) • Character and types of injuries to be
Natural hazards. encountered.
Climate. • Natural barriers to medical evacuation.
Weather. • Lines of patient drift.
• Suitable for farming and for grazing
• *Precipitation.
animals.
• *High temperature—heat Natural resources to include the availability of
index. medicinal herbs.
• *Low temperature—chill index. Presence of toxic plants and animals and
whether they pose a health hazard to deployed
• *Wind.
troops.
• *Visibility.
• *Cloud cover.
• *Relative humidity.
Time Cultural perception of time. Time affects not only the provision of medical
care, but also may affect the types of diseases
Information offset.
and injuries which may occur. Short duration
Tactical exploitation of time.
operations require emphasis on rapidly treating
Key dates, time periods, or events. Soldiers with traumatic injuries, while longer
duration operations require emphasis on disease
prevention and the management of chronic
medical conditions.
NOTE: Subvariables marked with an asterisk (*) are also the military aspects of terrain and weather used in
analyzing mission, enemy, terrain and weather, troops and support available, time available, and civil considerations.
MISSION VARIABLES
4-7. Mission variables are used by AHS planners to determine the impact they will have on medical
operations. Mission variables describe characteristics of the operational area, focusing on how they might
affect a mission. The mission variables are discussed below. In Table 4-1 above, the subvariables which are
the same as mission variable considerations are marked with an asterisk (*). For an in-depth discussion of
the mission variables, refer to ADP 5-0.
MISSION
4-8. The mission refers to the overall mission of the operational commander, as well as the specific mission
of the supporting AHS unit. In order to develop a flexible and responsive support plan, the AHS planner
must have a clear understanding of the operational mission, the purpose of that mission, and the tasks/actions
to be performed and the rationale for accomplishing those actions. The AHS planner must be able to forecast
where AHS support assets should be positioned to best support the CCDRs plan and also anticipate if
augmentation of medical resources will be required and preplan, coordinate, and synchronize the employment
of this augmentation support should the need arise.
ENEMY
4-9. The second variable the AHS planner must consider is the enemy. The elements of dispositions
(including organization, strength, location, and operational mobility), doctrine, equipment, capabilities,
vulnerabilities, and probable courses of action are considered by the operational planners and the important
factors are normally reflected in the OPORD. The AHS planner must also analyze the potential impacts on
the provision of AHS support to our forces. The enemy weapons systems will indicate the types of wounds
which U.S. forces may experience (conventional weapons, blast, CBRN, or improvised weapons [such as
punji sticks used in Vietnam that resulted in countless numbers of infected wounds and improvised explosive
devices used in Operation Iraqi Freedom, and Operation Enduring Freedom]) and give an indication on the |
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