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4-02 | 102 | Chapter 4
types and quantities of medical supplies that will be required. If enemy forces have been issued any
chemoprophylaxis, barrier creams, or pretreatments, it may indicate the types of CBRN weaponry available
to them and their likelihood of using those types of weapons. The morale of the enemy and its likelihood of
engaging in sustained combat is often dependent upon the nutritional status of the enemy and the availability
of medical aid should they become injured. A malnourished enemy with little hope of being rescued and
surviving the enemy’s injuries will normally not have the will to continue the fight. Medical personnel must
also be knowledgeable about the enemy doctrine in respect to whether it is likely to abide by the provisions
of international law and the Geneva Conventions pertaining to the protection and respect of medical
personnel. (Refer to Chapter 3 for a discussion of the Geneva Conventions).
TERRAIN AND WEATHER
4-10. The military aspects of terrain and weather are listed in Table 4-1. The AHS planner must continuously
plan for changes in weather and terrain conditions when conducting AHS support operations. The AHS’s
effectiveness and efficiency are based on a system of progressively increasing the complexity of medical
resources and services available from the POI or wounding through the operational area AHS to definitive,
restorative, and rehabilitative care in the CONUS-support base. The fully integrated ground and air
MEDEVAC system sustains the care provided at a lower role as the patient is evacuated to a role of care
capable of providing the required support. This continuum of care is effective in reducing morbidity and
mortality, mitigating long-term disability, and restoring a Soldier’s health and fitness. Any factor that
disrupts this continuum can have an adverse impact on a Soldier’s prognosis and long-term disability.
Therefore, the AHS planner must develop contingency plans for all types of weather scenarios, changes in
topography due to weather (flooding, thawing, or freezing), trafficability/nontrafficability of evacuation
routes, availability of resources (rotary-wing aircraft may be grounded due to visibility issues, sandstorms,
or other weather phenomenon). The types of medical supplies required for an operation may vary depending
upon the terrain/weather. Operations conducted in mountainous terrain may result in more crush injuries,
while operations conducted in jungles may result in significantly higher rates of infection. The disruption or
cessation of MEDEVAC operations would result in a requirement for holding the injured or ill in place;
medical personnel would then be required to provide prolonged care until MEDEVAC operations could be
resumed. This circumstance would require that the treatment elements be augmented with additional holding
capability, more medical supplies, and possible increased surgical or other medical specialty capability. For
an AHS planner, this type of contingency planning, coordinating, and synchronizing needs to occur prior to
an operation, as the health of a patient is perishable and may not withstand delays in treatment and evacuation.
TROOPS AND SUPPORT AVAILABLE
4-11. The AHS planner must not only consider the traditional populations which require support (such as
U.S. forces or multinational forces) but must also determine the population at risk in a more broad context.
During each operation, the population at risk may vary due to political, social, economic, religious, and
humanitarian considerations. The AHS planner must develop a traditional support plan, but must also
develop a number of contingency plans in the event the population at risk and population support changes
during the operation. If the AHS planner does not anticipate an increase in nontraditional populations
supported, the diversion of AHS resources can adversely impact the delivery of health care to our U.S. forces.
The support requirements (food, medicines, and medical supplies) for a civilian population who is
malnourished, has pediatric, obstetrics and gynecological, and geriatric patients, and patients with chronic
medical conditions varies significantly from the items available in the medical equipment sets routinely
carried by United States Army AHS units. Prior planning, coordinating, and synchronization with CONUS-
based organizations is required to ensure the appropriate mix of medical items can be deployed to rapidly
augment United States Army AHS units.
TIME AVAILABLE
4-12. Military commanders assess the time available for planning, preparing, and executing tasks and
operations. This includes the time required to assemble, deploy, and maneuver units in relationship to the
enemy and conditions. Army Health System planners also view time in relationship to the continuum of care
and timeframes required to treat and evacuate patients. For example, if an FST or FRSD is to operate on a
seriously injured Soldier, the FST or FRSD will not be able to displace and move for at least six hours, as the |
4-02 | 103 | Army Health System Operations
Soldier will require a period of time to become hemodynamically stable following surgery if he is to survive
the rigors of evacuation.
CIVIL CONSIDERATIONS
4-13. Civil considerations are the influence of man-made infrastructure, civilian institutions, and activities
of civilian leaders, populations, and organizations within the operational area on the conduct of military
operations. The operational and mission variables are used to analyze to analyze the civil aspects of the area.
Field Manual 3-24/MCWP 3-33.5 provides an in-depth analysis of this model. The AHS planner must always
analyze the local and the regional medical aspects in any given AO. Although the immediate local
considerations are important, in the medical arena the regional aspects may be just as important. Areas such
as blood supply, type, species, and virulence of disease vectors may vary across the operational area and
adversely impact the health of U.S. forces.
TASK-ORGANIZATION
4-14. Task-organization is a tool used by commanders to tailor their forces to specific mission requirements.
Task-organization is a temporary grouping of forces designed to accomplish a particular mission.
Traditionally, task-organization was accomplished by combining entire units; however with the advent of
modularity, commanders are task-organizing elements of the organization rather than the entire organization.
This enables a commander to extract the individual capabilities required for a specific mission, to project the
smallest footprint possible, yet still be able to effectively and efficiently accomplish the mission. Modularly
designed units with deployable functional elements identified with a standard requirements code can be easily
integrated into the time phased force deployment list process to ensure the rapid movement of both the
unit’s/element’s personnel and equipment. Characteristics to examine when task-organizing the force
include, but are not limited to: training, experience, equipage, sustainability, OE, enemy threat, and mobility.
Additional considerations include constraints on manpower (troop ceilings), ability for a unit or element to
be self-sufficient (for example, FST or FRSD must be collocated with a medical company for power
generation, x-ray, laboratory, and other services), and the population at risk (additional augmentation is
required to support chronic medical conditions [present in the contractor and civilian employee force],
pediatric, geriatric, and obstetric patients).
4-15. The MMB is a versatile organization which can serve as the parent unit when developing a medical
task force. The MMB has a diverse staff which can provide the planning and administrative support for the
medical functional elements assigned to the medical task force.
SECTION II — SUPPORT TO DECISIVE ACTION
4-16. Decisive action is the simultaneous combination of offense, defense, and stability or defense support
of civil authority tasks. These tasks require versatile, adaptive medical support, and flexible leadership.
4-17. Operational experience demonstrates that AHS forces trained exclusively for offensive and defensive
tasks are not as proficient at stability tasks. Effective medical training reflects a balance among the elements
of decisive action that produces and sustains proficiency in all the tasks. See ADP 3-0 for additional
information on decisive action.
4-18. The traditional and primary Army Medicine mission is to conserve the fighting strength of the tactical
commander. The Army Medicine rhythm of military operations is that of the operational commander.
Casualties begin to occur immediately upon engagement with the enemy. Due to the necessity to perform
lifesaving interventions for Soldiers suffering combat trauma within minutes of wounding or injury, AHS
resources must be arrayed in close proximity to the forces supported. This also permits the AHS assets to
rapidly clear the battlefield of casualties and enhances the CCDRs ability to quickly take advantage of
opportunities which present themselves during the operation.
4-19. Army Health System planners must be included early-on in the planning cycle for tactical operations
and must fully participate in rehearsals conducted by the operational Army being supported. To ensure
effective and efficient AHS support, AHS support plans must adhere to the AHS principles. Within
noncontiguous operations, the linear array of AHS units will not always occur and AHS units must fully |
4-02 | 104 | Chapter 4
understand the various support relationships described in the OPORDs to ensure that a seamless continuum
of health care is established and can be maintained.
4-20. The MEDEVAC plan for the tactical operation includes both rotary-wing air ambulances and ground
ambulances. The preferred means of evacuation is the air ambulance; however its availability can be affected
by air superiority issues and environmental factors such as visibility, winds, and dust. The evacuation plan
must address the use of ground ambulances when feasible and/or the simultaneous use of both platforms. For
example, if a wounded Soldier cannot be evacuated by air ambulance for at least 1 hour, the combat medic
may evacuate the patient first to the supporting Role 1 (or Role 2) MTF to arrive within 20 minutes for TCCC
performed by the physician assigned to the battalion aid station to further stabilize the patient before he is
evacuated by air ambulance.
OFFENSIVE TASKS
4-21. An offensive task is a task conducted to defeat and destroy enemy forces and seize terrain, resources,
and population centers. The direct action offensive tasks are depicted in Table 4-2 along with key medical
considerations for these types of tasks. For additional information on offensive tasks, refer to FM 3-0.
Table 4-2. Offensive tasks, purposes, and key medical considerations
Offensive tasks Purposes Key medical considerations
Movement to contact Dislocate, isolate, disrupt, and All medical functions fully synchronized.
destroy enemy forces.
Attack Medical information management to document
Seize key terrain. health threat exposures and medical
Exploitation
encounters, to report health surveillance data
Deprive the enemy of
Pursuit and information on the health of the command,
resources.
and to accomplish medical regulating and
Develop intelligence. patient tracking operations.
Deceive and divert the Locate, acquire, stabilize, treat, and evacuate
enemy. injured or ill Soldiers from the battlefield to
Create a secure environment facilitate the operational commander’s ability to
for stability tasks. exploit opportunities on the battlefield.
Trauma care, forward resuscitative care, and en
route medical care to sustain the patient
through medical evacuation to the appropriate
role of care.
Responsive medical logistics which facilitates
and sustains the treatment of patients during
the fight.
Theater hospitalization to provide essential care
in theater to all categories of patients.
DEFENSIVE TASKS
4-22. A defensive task is a task conducted to defeat an enemy attack, gain time, economize forces, and
develop conditions favorable for offensive or stability tasks.
4-23. Army Health System support operations for defensive tasks are similar to those for offensive tasks;
however, normally the timeframe in which the tasks must be conducted is compressed. The only means for
increasing the mobility of AHS units is to evacuate the patients they are holding. When it is anticipated that
rapid shifts will occur in the OE, AHS units must evacuate patients from the potentially affected units to
ensure their agility and to enhance their capacity for newly arriving patients. Table 4-3 (on page 4-9) depicts
the defensive tasks, purposes, and key medical considerations when preparing for these types of tasks. |
4-02 | 105 | Army Health System Operations
Table 4-3. Defensive tasks, purposes, and key medical considerations
Defensive tasks Purposes Key medical considerations
Mobile defense Deter or defeat enemy All medical functions fully synchronized.
offense.
Area defense Medical information management to document
Gain time. health threat exposures and medical
Retrograde
encounters, to report health surveillance data
Achieve economy of force.
and information on the health of the command,
Retain key terrain. and to accomplish medical regulating and
Protect the populace, critical patient tracking operations.
assets, and infrastructure. Emphasis is placed on the rapid acquisition,
Develop intelligence. stabilization, and evacuation of patients
generated by units in contact. This enhances
the mobility of supporting Army Health System
units and facilitates the commander’s ability to
exploit opportunities and leverage the
momentum to mount a counterattack or perform
other maneuvers.
Responsive medical logistics which facilitates
and sustains the treatment of patients during
the fight.
Theater hospitalization to provide essential care
in theater to all categories of patients.
STABILITY TASKS
4-24. Stability is an overarching term encompassing various military missions, tasks, and activities
conducted outside the U.S. in coordination with other instruments of national power to maintain or reestablish
a safe and secure environment, and provide essential governmental services, emergency infrastructure
reconstruction, and humanitarian relief.
4-25. The Army Medicine has historically conducted foreign humanitarian assistance operations when
deployed in overseas areas. In some scenarios, medical forces may be deployed prior to the deployment of
maneuver forces due to the humanitarian nature of their activities and medical personnel are more acceptable
to a host nation than the deployment of the operational Army forces.
4-26. Although the medical commander can provide the CCDR assistance in planning for the primary
stability tasks to restore essential services and support to economic and infrastructure development, the
assistant chief of staff, CA is the responsible staff agency for developing and planning CA operations. This
ensures that all stability activities conducted are in consonance with the CCDRs theater engagement strategy.
4-27. The importance of stability tasks in achieving U.S. national goals and objectives is discussed in DODD
3000.05, ADPs 3-0 and 3-07. Stability task considerations were included in the design of the MEDCOM
(DS) which has CA officers assigned to the staff. The command maintains a regional focus on medical issues
arising within the CCDRs AOR.
4-28. Table 4-4 (on page 4-10) depicts stability tasks, purposes, and key medical considerations for the
preparation for the conduct of these tasks. |
4-02 | 106 | Chapter 4
Table 4-4. Stability tasks, purposes, and key medical considerations
Stability tasks Purposes Key medical considerations
Establish civil Provide a secure Regionally focused medical command and
security (including environment. control to promote unity of purpose of all
security force engaged medical assets.
Secure land areas.
assistance)
Medical information management to document
Meet the critical needs of the
Establish civil control health threat exposures and medical
populace.
encounters, to report health surveillance data
Restore essential
Gain support for host-nation and information on the health of the command,
services
government. and to accomplish medical regulating and
Support to Shape the environment for patient tracking operations.
governance
interagency and host-nation Traditional medical support to a deployed force
Support to economic success. engaged in performing these tasks.
and infrastructure
Medical expertise and consultation to enhance
development
building partnership capacity in public, private,
Conduct security and military health sectors of the host nation.
cooperation
Development of regional theater security
cooperation plans aimed at mitigating or
resolving the underlying causes of health issues
prevalent within the region.
DEFENSE SUPPORT OF CIVIL AUTHORITIES
4-29. Defense support of civil authorities is support provided by U.S. Federal military forces, DOD civilians,
DOD contract personnel, DOD component assets, and National Guard forces (when the Secretary of Defense,
in coordination with the Governors of the affected States, elects and requests to use those forces in Title 32,
United States Code, status). This support is in response to requests for assistance from civil authorities for
domestic emergencies, law enforcement support, and other domestic activities, or from qualifying entities
for special events. Defense support of civil authorities is a task that takes place only in the homeland,
although some of its tasks are similar to stability tasks. Table 4-5 identifies defense support of civil
authorities, tasks, purposes, and key medical considerations. For additional information on these types of
tasks, refer to ADP 3-28.
Table 4-5. Defense support of civil authorities tasks, purposes, and key medical
considerations
Defense support of
Purposes Key medical considerations
civil authorities task
Provide support for Save lives. Coordinate, integrate, and synchronize Army Health
domestic disasters. System resources into the interagency efforts. Further,
Restore essential
providing medical expertise to identify and analyze critical
Provide support for services.
needs emerging within the operational area.
domestic chemical,
Maintain or restore
biological, Medical information management to facilitate medical
law and order.
radiological, and regulating of victims to facilities outside of the
nuclear incidents. Protect disaster/incident site and to document medical treatment.
infrastructure and
Provide support for Assist affected medical infrastructure in saving lives,
property.
domestic civilian law reducing long-term disability, and alleviating human
enforcement Maintain or restore suffering.
agencies. local government.
Assist the local government in conducting rescue
Provide other Shape the operations and providing medical evacuation of victims to
designated support. environment for facilities capable of providing the required care.
interagency
Preventive measures to respond to and resolve emerging
success.
health threats caused by the disaster/incident. |
4-02 | 107 | Army Health System Operations
4-30. Army Health System support to defense support of civil authorities tasks will include both AHS
★
operational and the institutional AHS forces. The U.S. Army Medical Command retains command and
control and provides both medical forces and medical capabilities in support of defense support of civil
authorities tasks. As the Military Health System integrated combat support agency, the Defense Health
Agency (DHA) enables the Services in providing this support.
SECTION III — SETTING THE THEATER, THEATER OPENING, EARLY
ENTRY, AND EXPEDITIONARY MEDICAL OPERATIONS
4-31. As the theater medical command, the MEDCOM (DS) maintains a regional focus that encompasses
the GCC’s entire AOR and is critical for the successful provision of AHS support to set the theater. The
medical commander’s ability to assess host-nation medical capability/capacity and the presence of health
threats prevalent in the AOR, facilitates the planning and execution of regional strategies for establishment
of the theater joint trauma system and mitigation of identified threats.
4-32. The MEDCOM (DS) provides the GCC an effective tool to assist in maximizing the use of scarce
medical resources, shaping the security environment by building partner medical capacity, and alleviating
health conditions that not only impact U.S. military forces, but multinational partners and particular
challenges faced by the host nation. Efforts must also be made to understand the roles and responsibilities
of all agencies involved (to include the Department of State, World Health Organization, partner nations, and
others) for integration and synchronization of all medical capabilities in the region.
4-33. The MEDCOM (DS) also provides AHS support to set the theater through coordination, integration,
and synchronization of strategic medical capabilities from the U.S. sustaining base, global health
engagements, establishment and maintenance of medical support agreements, deploying medical technical
expertise for consultation services and other support, military medical training exercises, as well as the
following:
* Executing AHS support to other Services when directed.
* Ensuring adherence to eligibility criteria for treatment in U.S. military MTFs.
* Recommending theater evacuation policy adjustments.
* Providing theater food protection support.
* Coordinating with USTRANSCOM for patient movement plans.
* Coordinating with the theater signal command to support command and control and medical
information system capabilities.
* Establishing medical logistics capabilities necessary to support health services during early entry
operations and ensure theater MEDLOG operations are connected to strategic enablers.
* Ensuring integration and interoperability of theater medical capabilities.
* Providing AHS support to foreign humanitarian assistance and disaster relief.
* Conducting medical preparation of the OE.
* Maximizing use of host-nation medical capabilities.
* Establishing and executing OEH surveillance programs and countermeasures.
* Coordinating with the National Center for Medical Intelligence, Centers for Disease Control and
Prevention, and other strategic partners for identification and mitigation of regional health threats.
* Planning and coordination for AHS support to—
Noncombatant evacuation operations.
Detainee operations.
Reception, staging, onward movement and integration and theater opening.
Large-scale casualty events and prolonged care.
Other Services.
4-34. Theater opening, early entry, and expeditionary medical operations require the AHS planner to
★
develop flexible, agile, and comprehensive plans to provide effective and efficient AHS support in an austere
environment. Many of the AHS forces deployed will be the organic medical assets of the maneuver forces |
4-02 | 108 | Chapter 4
conducting the operation; however, the MEDCOM (DS) (or other senior medical command in its absence
such as the MEDBDE [SPT]), as the theater medical command will deploy sufficient medical resources to
provide the required support.
4-35. Table 4-6 (page 4-13) provides an example of the types of AHS activities which may be conducted in
these types of operations.
THEATER OPENING AND EARLY ENTRY OPERATIONS
4-36. Theater opening operations involve two types of AHS forces: those organic to the maneuver force and
those AHS organizations deployed to establish the initial medical infrastructure within the AOR and to
support theater opening forces during reception, staging, onward movement, and integration.
4-37. The organic medical resources of the maneuver units provide Roles 1 and 2 AHS support to their parent
organizations. While these organizations are at the port of debarkation/embarkation, operational assembly
areas, or other in-transit locations, AHS support is provided on an area support basis by the AHS
organizations supporting port operations. Army Health System units accompanying the intransit force
normally do not unload and setup their medical equipment and supplies, but rather rely on area support to
accomplish their immediate AHS support mission.
4-38. The focus of AHS support to theater opening operations is to establish a medical infrastructure which
facilitates the smooth transition of incoming AHS assets, provides real-time HSS and FHP data (medical and
OEH surveillance), health risk communications, subsistence inspection programs, and integrates medical
materiel (supplies, blood, and equipment) requisition, distribution, and maintenance.
4-39. Intertheater USAF AE during theater opening operations may be delayed during initial entry with
patients being held in the operational area for evacuation out of theater on airframes of opportunity.
Evacuation at Roles 1 and 2 will be accomplished by organic air and ground evacuation assets. Forward
resuscitative surgery assets will be critical to stabilize nontransportable patients.
EXPEDITIONARY MEDICAL OPERATIONS
4-40. Expeditionary operations are operations that are inherently joint and require strategic reach. During
crisis response, joint force commanders rely on contingency expeditionary forces to respond promptly. The
Army provides ready forces able to operate in any environment- from urban areas to remote, rural regions.
Health service support/FHP planning during expeditionary medical operations must remain flexible and
coordinated, but it must also be adaptable to unique support arrangements (Table 4-6, page 4-13) which
capitalize on the strengths of all units employed in the operational area.
4-41. Army Medicine personnel with an expeditionary and joint mindset have the confidence, skills, and
knowledge to adapt and overcome unique medical challenges in providing a seamless continuum of care to
our deployed forces. During expeditionary medical operations, units may be required to accomplish missions
or coordinate support which they traditionally have not been required to accomplish. For example, the ability
to project surgical resources into austere locations and the extended distances required to affect MEDEVAC
may necessitate Role 2 MTFs and FSTs or FRSDs to coordinate directly with USAF aeromedical liaison
teams and the supporting Theater Patient Movement Requirements Center for patient movement.
4-42. The array of AHS units in the current force was designed under three force design initiatives, Medical
Force 2000, Medical Reengineering Initiative, and the Modular Force. Capabilities in like units under the
three initiatives may vary, but the medical leadership can maximize and capitalize on the strengths of the
various force designs, while minimizing the weaknesses to ensure the operational commander is provided
the most effective and efficient AHS support. |
4-02 | 109 | Army Health System Operations
Table 4-6. Example of Army Health System activities which may be conducted
in theater opening and expeditionary medical operations
Early Entry Modules Theater-Level Capabilities
Operational command post, medical command Medical command (deployment support)/medical
(deployment support), medical logistics brigade, medical logistics management center team,
management center team, medical logistics medical logistics company, medical detachment (blood
company (-), Roles 1 and 2 medical care, support) (-), Roles 1 and 2 medical care, operational
forward surgical team, combat support hospital dental support, forward surgical team, combat support
(-), casualty prevention (operational public hospital, casualty prevention (operational public
health, combat and operational stress control, health, combat and operational stress control, and
and veterinary services), and medical veterinary services), medical evacuation (ground and
evacuation. air), and area medical laboratory services.
Theater Opening Expeditionary
Army Health System support during reception, Force rotation (reception, staging, onward movement,
staging, onward movement, and integration. and integration).
Provide Roles 1 and 2 medical treatment on an Roles 1 and 2 medical treatment on an area basis.
area support basis for units without organic
Provide forward resuscitative surgery to stabilize
medical resources and/or units entering theater
nontransportable patients for evacuation out of
and deploying to other areas within an
theater.
operational environment.
Medical and/or casualty evacuation from point of injury
Medical evacuation and/or casualty evacuation
to medical treatment facility based on availability of
from point of injury to medical treatment facility
medical evacuation platforms.
based on availability of medical evacuation
platforms. Patient evacuation (between medical treatment
facilities).
Intra/Intertheater patient movement (between
Sustainment of Army Health System support
medical treatment facilities).
operations (possible nontraditional sources of support
Provide forward resuscitative surgery to
from other Services, multinational forces, or host
stabilize nontransportable patients for
nation without habitual support relationships).
evacuation out of theater.
Primary care.
Emergency movement of Class VIII (to include
Tactical combat casualty care.
blood), medical personnel, and medical
equipment. Medical specialty care.
Coordinate medical evacuation plan with the Increased emphasis on liaison and coordination with
combat aviation brigade for air ambulance nontraditional sources.
support.
Training prior to deployment as there is decreased
Coordinate with United States Air Force for time for in-country training.
strategic aeromedical evacuation and medical
Adjustment of distribution channels may be required
regulating.
depending on source of support.
Manage patient movement items.
Unit reconstitution may be accomplished using
Conduct medical and OEH surveillance. modular teams.
Conduct health risk assessment and Manage patient movement items.
communications.
Care for detainees (increased requirements for
Provide Roles 1 and 2 veterinary treatment on operational public health support, primary care, care of
an area support basis for military working dogs. chronic diseases/conditions).
Conduct subsistence inspections to ensure Casualty prevention measures to include medical and
quality assurance, food safety, and food OEH surveillance.
defense.
Veterinary support for the inspection of subsistence
and the treatment of military working dogs.
Coordination with United States Air Force for strategic
aeromedical evacuation and medical regulating.
4-43. One of the keys to success in expeditionary medical operations is to ensure that support relationships
are clearly defined in the OPLAN and OPORD. The medical commander must be cognizant of the various
types of support relationships defined in ADP 5-0 to facilitate the seamless provision of health care. Another |
4-02 | 110 | Chapter 4
key to the successful accomplishment of the AHS mission is the synchronization of health care activities
through medical command and control and the technical supervision of ongoing clinical operations. Medical
command and control provides a conduit to obtain reachback medical technical support during early entry
and expeditionary operations conducted in austere environments prior to deployment of some medical
specialty care assets.
SECTION IV — SUPPORT TO DETAINEE OPERATIONS
4-44. 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 Geneva Conventions. 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. See DODD 2310.01E, DODD
2311.01, DODI 2310.08E, JP 3-63, JP 4-02, AR 40-400, AR 190-8, and FM 6-27/MCTP 11-10C.
4-45. The focus of AHS support to detainee operations is depicted in Table 4-7.
Table 4-7. Focus of Army Health System support to detainee operations
Detainee Detainee Theater
Medical activity collection point holding area detention Remarks
facility
Triage Yes Yes Yes
Tactical combat
Yes Yes Yes
casualty care
Monthly weigh-in.
Screening Yes1 Yes1 Yes Nutrition status.
Vision.
If approved by medical
personnel, detainees may
Medications Yes2 Yes2 Yes3 retain emergency medicines
such as fast acting inhalers
or cardiac medicines.
Routine sick call Yes1 Yes1 Yes
Emphasis is on field hygiene
personnel protective and sanitation, disposal of
Yes Yes Yes
measures waste, and personal hygiene
practices.
Medical evacuation Yes3 Yes3 Yes3 Nonmedical guards are
required.
Hospitalization is not
available at collecting points
Hospitalization No No Yes or holding areas. Detainees
requiring hospitalization are
medically evacuated.
Medical specialty Augmentation of treatment
No No Yes
care assets may be required.
1 Dependent upon length of stay.
2 Detainees may not have medications on their person. Any medications the detainee has when detained are collected,
tagged, and identified and provided to medical personnel. Medications are dispensed by medical personnel.
3 Detainees whose medical condition is such that they must be moved to a medical treatment facility for medical care
will be evacuated through medical channels. The echelon commander must provide guards for all detainees
evacuated through medical channels. |
4-02 | 111 | Army Health System Operations
MEDICAL PERSONNEL ORGANIC TO MANEUVER UNITS
4-46. Medical personnel organic to maneuver units may be required to provide TCCC, area medical support,
and MEDEVAC at the point of contact/injury and to temporary concentrations of detainees at detainee
collection points and detainee holding areas. In early-entry operations, the senior medical officer (brigade
surgeon) serves as the detainee operations medical director until follow-on forces are deployed and a detainee
operations medical director is designated for the AO.
4-47. The medical resources required to support detainee operations are task-organized based on mission,
enemy, terrain and weather, troops and support available, time available, and civil considerations. The
detainee operations medical director determines the medical support requirements and develops and provides
technical guidance for all medical resources engaged in detainee medical operations. This guidance is
directed to appropriate medical personnel through their technical channels.
4-48. The detainee operations medical director is normally designated by the MEDCOM (DS) commander
to develop and provide technical guidance on the medical aspects of detainee operations conducted
throughout the operational area. Technical guidance is exercised throughout all echelons of medical channels
and affects all medical personnel and units delivering health care to detainee populations. Technical guidance
encompasses—
* All medical services provided at detainee collection points and detainee holding areas, to include
limited medical screening, TCCC, personnel protective measures (hygiene and sanitation), and
MEDEVAC of seriously injured or ill detainees. The echelon commander must provide guards
and/or escorts when detainees are evacuated through medical channels; medical personnel cannot
perform guard functions.
* All medical services provided in the detention facility, to include:
Initial medical examinations.
Medical treatment (routine care, sick call, emergency services, hospitalization, medical
consultation, and specialty care requirements).
Medical evacuation.
Operational public health (such as medical surveillance, OEH surveillance, hygiene and
sanitation standards and practices, pest management activities, and inspection of water
portability, dining facility and services hygiene, and food preparation practices).
Dental services.
Veterinary support (food inspection and quality assurance, veterinary public health, and
animal medical care).
Behavioral health care.
Neuropsychiatric treatment and stress prevention, as required.
Medical logistics (such as medical supplies, pharmaceuticals, medical equipment and medical
equipment maintenance and repair, blood management, and optical lens fabrication).
Medical laboratory support.
* All medical services provided in U.S. military MTFs which are not part of established detention
facilities. This can include TCCC by combat medics and provided at battalion aid stations and
Role 2 MTFs (medical companies) and forward resuscitative surgery provided by FSTs or FRSDs
to stabilize the patient for further evacuation and hospitalization. Resuscitative care is tactical
combat casualty care and surgery limited to the minimum required to stabilize a patient for
transportation to a higher role of care while forward resuscitative surgery refers to urgent initial
surgery required to render a patient transportable for further evacuation to a MTF staffed and
equipped to provide for the patient's care.
* All medical administrative matters such as the establishment and maintenance of medical records,
documentation of preexisting injuries (to include medical photography, if deemed appropriate),
restrictions on activities based on medical conditions (similar to medical profiles), and
documentation required for legal purposes (such as monthly height and weight records). |
4-02 | 112 | Chapter 4
Note. All documentation pertaining to detainees must be identified with either the capture tag
number or the detainee’s internment serial number.
* Procedural guides and SOPs that are developed and disseminated for reporting suspected detainee
abuse. Medical personnel are trained on procedures to identify injuries resulting from abuse and
the ethical considerations of treating personnel with suspected abuse.
* Procedural guides and SOPs that are developed to standardize the credentialing of health care
providers, to define the scope of practice of medical personnel, and to establish the scope of
practice for retained medical personnel.
* Standards of medical care throughout detention facilities within the AO that are established,
inspected, and enforced (the standards used are the same as those for United States Armed Forces).
* Procedures that are established and disseminated for identifying, reporting, and resolving medical
ethics and other legal issues.
* Procedures that are established for ensuring medical proficiencies and competencies, identifying
deficiencies, and providing required training to resolve deficiencies.
* Programs of instruction that are developed to ensure that all medical personnel engaged in detainee
health care have appropriate orientation and training in the detainee’s culture, language (and/or
linguist support), social order, and religion.
MEDICAL PERSONNEL ORGANIC TO MILITARY POLICE UNITS
4-49. The military police detention battalion has organic medical personnel to provide a limited Role 1
medical care capability and operational public health services within the detention facility. When a detainee
operations medical director has been designated within the AO, these medical personnel are under the
technical guidance of the detainee operations medical director.
4-50. The medical personnel assigned to the military police detention battalion assist with in processing
detainees by providing the initial medical examination. They provide routine sick call services and TCCC
and coordinate with the supporting AHS units for Role 2 and above care. They maintain medical records, to
include DA Form 2664-R (Weight Register). When the supporting AHS unit is collocated with the detention
facility, the unit’s scope of practice, schedule, and duty assignments are coordinated through the supporting
AHS unit.
ARMY HEALTH SYSTEM UNITS IN SUPPORT OF DETAINEE
OPERATIONS
4-51. The MEDCOM (DS) theater medical command and is the senior AHS medical command and control
organization within the AOR. The MEDCOM (DS) is responsible for ensuring that the medical care provided
to detainees and other personnel in U.S. custody is provided in compliance with international and U.S. law
and military policies and regulatory guidance. The MEDCOM (DS) plans for and coordinates support for
detention facilities located within CCDR’s AOR. The MEDBDE (SPT) coordinates medical issues related
to detainee operations being conducted by subordinate units with the MEDCOM (DS) detainee operations
medical director.
4-52. The MEDCOM (DS) commander or the commander’s designee (normally the deputy commander,
professional services) serves as the detainee operations medical director and provides oversight, guidance,
and policy on medical ethics issues, standards and availability of care, requirements for field hygiene and
sanitation, nutrition and maintenance of weigh-in registers, and all other medical aspects of confinement
health care.
4-53. The MEDBDE (SPT) coordinates medical issues related to detainee operations being conducted by
subordinate units with the MEDCOM (DS) detainee operations medical director. |
4-02 | 113 | PART TWO
Force Health Protection
The mission sets of the Army Medicine (which historically had been shown under the
combat service support battlefield operating system) are under two warfighting
functions- the protection and sustainment warfighting functions. This change more
closely aligned the Army Medicine mission sets with the overall warfighting functions
of the Army. The FHP mission is discussed in Part Two of this publication, while the
HSS mission is discussed in Part Three. Although Parts Two and Three discuss the
mission sets as separate entities, the medical personnel and staffs that plan,
coordinate, and synchronize these operations are responsible for the execution of both
mission sets. 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 AHS system.
Force Health Protection is a continuous process that begins with the Soldier’s entry
into the military and is continuous throughout the Soldier’s military career. Force
health protection includes establishing and sustaining a healthy and fit force, health
promotion and nutrition programs, the identification of the health threat in all settings
(in both deployed and garrison settings), the development and implementation of
personnel protective measures to reduce exposure to health hazards and mitigating
the adverse effects of the impact of health threats to military personnel.
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. Although nutrition plays a significant role in
maintaining a healthy and fit force, nutrition is discussed as an integral part of the hospitalization
function under the HSS mission.
Chapter 5
Operational Public Health
Public Health is the science and practice of promoting, protecting, improving, and,
when necessary, restoring the health of individuals, specified groups, or the entire
population. As applied in the operational setting it is the preservation, maintenance,
and restoration of health in Army populations through the anticipation, prediction,
identification, surveillance, evaluation, prevention, and control of DNBI. (AR 40-5)
Public Health encompasses a wide range of capabilities, organizations, and
professional disciplines operating in a systematic manner to effectively execute the 10 |
4-02 | 114 | Chapter 5
Essential Public Health Services. It is a major enabler for Army readiness and a major
component of force health protection in its application throughout all Army activities.
Levels of readiness and health in all Army populations are enhanced and sustained by
applying the principles of public health to promote healthy behaviors and to prevent
and minimize the impacts of diseases and injuries. According to the recent published
AR 40-5 (May 2020), field preventive medicine is no longer a valid term. The term
operational public health is now the term to describe the application of Public Health
practices and conduct of Public Health-related activities within a geographic area
where military operations are conducted by TOE units (AR 40-5). Examples of
military operations include training and exercises conducted in field environments or
locations outside of a permanent U.S. military installation, humanitarian support,
contingency operations, and combat or stability operations. When emphasized by
commanders and unit leaders, operational public health can effectively reduce and
prevent DNBI and maximize the fighting strength of the force. For more information
regarding Public Health Program and operational public health, refer to AR 40-5.
MISSION
5-1. The FHP mission set is a continuous process that begins with the entry of the Soldier into the military
and is continuous throughout the Soldier’s military career. Force health protection includes those measures
designed to promote, improve, or conserve the behavioral and physical well-being of Army personnel across
the full range of military activities and operations. The successful employment of FHP activities enables a
healthy and fit force, prevents injury and illness, and protects the force from health hazards.
PROTECTION WARFIGHTING FUNCTION
5-2. Operational public health falls under the protection warfighting function and is concerned with both
the enemy threat and the health threat. The enemy threat produces operational casualties. It depends on the
types of weapons used, the will of the enemy to fight, and other operational concerns. The health threat
consists of diseases, OEH hazards, poisonous or toxic flora and fauna, medical effects of weapons, and
physiological and psychological stressors. To counter the health threat and sustain health readiness, the
following garrison-based public health activities must be considered in an operational setting: health
surveillance, OEH surveillance and OEH risk management, disease vectors and pest management, food
protection, water management, waste management, operational hearing services, health promotion, and heat,
cold, and altitude (climatic injury prevention).
5-3. The success of operational public health requires deliberate and consistent analysis and communication
of health threats to inform individuals, and the implementation and enforcement of unit and individual
countermeasures (for example, exposure controls, chemoprophylaxis, and immunizations) required to reduce
associated health risks. Commanders and unit leaders must remain informed and proactively engaged to
ensure the health of the Force; reduce health threats, stressors, and risks; and promote all available
countermeasures.
ORGANIZATIONS AND PERSONNEL
5-4. Operational public health support is provided by preventive medicine units and staff officers.
Preventive medicine detachments and teams provide operational public health support and consultation in
the areas of health surveillance (inclusive of medical and DNBI surveillance), OEH surveillance (inclusive
of OEH risk management and site assessments), disease vectors and pest management, water management,
food protection, waste management, operational hearing services, and field hygiene and sanitation (inclusive
of climatic injury prevention). Echelons above brigade staff support consists of preventive medicine staff
officers organic to the MEDCOM (DS), MEDBDE (SPT), and MMB. These staff officers serve as the
commander’s principal public health consultants and environmental sciences and engineer advisors. |
4-02 | 115 | Operational Public Health
PRIMARY TASKS
5-5. Table 5-1 discusses the primary tasks and purposes of the operational public health function. See AR
40-5 and DA PAM 40-11, ATP 4-02.5, and ATP 4-02.8 for more information on Army public health.
Table 5-1. Primary tasks and purposes of the operational public health function
Primary task Purposes
Conduct Health Surveillance - Collect, analyze, and interpret health-related data effectively on the
and Epidemiology health status of Army personnel throughout their time in service.
- Identify populations at risk of disease, injury, behavioral, or social
health conditions and the associated risk and protective factors.
Conduct Occupational Health - Prevent injury and illness by identifying and evaluating occupational
health hazards and preventing or limiting those exposures.
- Optimize protection and readiness of Army personnel in all
environments and protect the health of populations exposed to
occupational hazards.
- Provide occupational illness and injury prevention and mitigation.
Monitor environmental health - Prevent injury and illness by identifying and evaluating environmental
health hazards and limiting exposures.
- Optimize Soldier protection and readiness in all environments and
protect the health of personnel and other relevant populations exposed
to environmental hazards.
- Ensure compliance with environmental health standards.
Provide occupational and - Provide consultative support, when requested, for—
environmental medicine • health surveillance and epidemiology services
• non-clinical occupational health services
• environmental health services
- Respond to accidental, intentional, and unintentional exposures to
Army personnel.
Conduct operational public - Ensure healthy and ready forces, sustain health readiness, and provide
health technical consultation support on public health issues.
- Identify and articulate force health protection recommendations, and
direct, lead, and assess operational public health activities.
- Establish baseline health conditions, capture data on occupational and
environment health exposures, prescribe chemoprophylaxis as
necessary, train field sanitation teams, and provide general Public Health
support and consultation for unit leaders.
Conduct Health Risk - Enable risk management in order to optimize Soldier protection.
Assessment
- Estimate risks posed by identified health hazards exposure.
Provide clinical public health - Deliver preventive medicine services to promote protective factors and
mitigate risk factors for disease and disability.
- Provide consultation to other healthcare providers and decision makers
on medical, behavioral, and environmental conditions of public health
significance.
- Provide services necessary for the prevention and control of
communicable diseases.
Provide community-based - Improve health readiness across the force.
prevention and health - Empower individuals and communities to engage in healthy behaviors.
promotion
- Provide health promotion initiatives focused on the Performance Triad. |
4-02 | 116 | Chapter 5
Table 5-1. Primary tasks and purposes of the operational public health functions (continue)
Primary tasks Purposes
Perform public health -Support Army medicine and acquisition, research, and development
toxicology programs.
-Provide toxicological assessments of all new and potentially hazardous
materials.
Perform public health -Provide analytical services in support of Army personnel health
laboratory services readiness.
-Participate in appropriate laboratory networks.
- Provide specialized clinical testing’s; radiochemistry and laboratory
support for health physics; and analysis of diseases of military Public
Health significance.
Deliver public health -Enable the overall Army Public Health Program and supports services
communication to inform, educate, and empower people about health issues.
Provide public health -Provide synchronization ensuring seamless coordination between the
emergency management installation and the local public health community during a public health
emergency.
-Ascertain the existence of cases suggesting a public health emergency
and recommend implementation of control measures (to include
declaration of a public health emergency) to the senior commander. |
4-02 | 117 | Chapter 6
Veterinary Services
The veterinary mission is to execute veterinary service support essential for FHP
including maintaining the health and welfare for military working animals and other
animals entitled to veterinary care by the United States Army; food protection and
veterinary public health missions; and to train, equip, and deploy the veterinary force;
in order to project and sustain a healthy and medically protected force and promote the
health of the Service member.
SECTION I — VETERINARY RESPONSIBILITIES
6-1. The United States Army Veterinary Services under the direction of the Secretary of the Army and
delegated to the United States Army Surgeon General, is the sole provider for veterinary services and retains
responsibility to provide veterinary personnel for operational and tactical support to all DOD components.
6-2. According to DODD 6400.04E, the United States Army Surgeon General has also been delegated to
act on behalf of the DOD EA for the DOD Veterinary Public and Animal Health Services to—
* Develop, support, and evaluate food protection measures (food safety and food defense) to ensure
food ingredients and food products are safe, wholesome, meet quality standards, and are free from
unintentional or intentional contamination and adulteration.
* Collaborate with the Military Services’ public health and preventive medicine authorities to
develop policies.
* Develop military sanitary standards for commercial food (including bottled water) plants
providing products to the DOD Components.
* Maintain and publish approved lists of food suppliers used by all DOD Components.
* Maintain laboratories or contract the capability for laboratory examinations (organic or purchased)
for wholesomeness and quality of food products and diagnosis of animal diseases.
* Inspect food products and provide food protection programs at all food procurement, operational
ration assembly facilities, and subsistence and war reserve stocks storage facilities under the
control of the Defense Logistics Agency.
* Inspect troop support food products on all installations under the control of the Departments of
the Army and Navy.
* Provide food inspection and food protection and, in collaboration with Army and Navy Surgeons’
General preventive medicine or public health authorities, provide food service sanitation programs
at all Defense Commissary Agency and Exchange Service retail convenience stores (for example,
shoppettes and mini-marts) associated with the Departments of the Army and Navy.
* In coordination with the Military Services’ public health and preventive medicine authorities,
develop and maintain the tri-Service Food Code used by all DOD Components.
* Coordinate with the Secretaries of the Navy and Air Force at joint bases to delineate Service
responsibilities for installation food service sanitation and food protection programs.
* Provide clinical and regulatory veterinary services, through appropriated and nonappropriated
funds.
* Operate facilities and establish equipment standards for and monitor standard of care at installation
veterinary facilities.
* Operate the Veterinary Services Central Funds Supplemental Mission Nonappropriated Fund
Instrumentality. |
4-02 | 118 | Chapter 6
* Provide veterinary public health guidance, consultation, and clinical support regarding zoonotic
diseases, including veterinarian participation in installation and command rabies advisory teams
or boards, and in conducting the animal rabies control program.
* Advocate for and provide consultation for animal welfare on DOD installations.
* Provide advocacy, veterinary consultation, and support for DOD Human-Animal Bond Programs,
DOD animal-assisted activity/therapy programs, and service/assistance animals owned by
authorized beneficiaries.
* Provide veterinary coordination, manning, and support to plan and conduct agricultural, veterinary
public health, and animal health activities across the competition continuum (DOD Stabilization;
Defense Support to Civil Authorities; Global Health strategic goals to include cooperative threat
reduction activities to counter weapons of mass destruction through Global Health Security
Agenda initiatives and global health engagement). Refer to DODD 3000.05, DODD 3025.18,
DODD 2060.02, and DODI 2000.30 for more information.
* Train and equip Army veterinary service personnel, including veterinarians and veterinary food
safety officers with relevant specialty training, to enable food protection, animal health and
welfare, veterinary public health, and, when required by the DOD Components, for research,
development, test, and evaluation and training.
* Conduct Food and Water Risk Assessments on hotels, restaurants, caterers, host nation military
dining facilities, and other food facilities being evaluated as a source of food or water for United
States Forces.
* Identify requirements for veterinary services information systems.
6-3. The Secretary of the Air Force provides the food inspection program at Air Force bases and may
develop locally approved lists of food suppliers from which food products are procured only for individual
Air Force installations.
6-4. Appropriate veterinary units provide this support. These units can be task-organized to support food
protection, food protection (food safety and food defense), quality assurance, and/or the medical care mission
for military and contract working dogs, and other government-owned animals. The food protection mission
includes food safety, food defense, and quality assurance inspection and surveillance activities associated
with food sources, distribution, warehousing, bulk storage, food quality, food vulnerability, and food and
water risk assessment. The United States Army Veterinary Service is responsible for publishing a directory
of approved food sources for the AO. Veterinary public health reduces transmission of zoonotic diseases;
monitors, assesses, and mitigates endemic animal disease threats to working animals and CONUS
agricultural systems; monitors animals as sentinels of threats to humans or other animals by investigating
unexplained animal deaths. It is an effective combat multiplier through monitoring endemic animal disease
threats of military significance and zoonotic disease threats to Service members. The animal medical care
mission provides comprehensive medical and surgical care for MWDs, other government-owned animals,
contract working dogs, and other animals authorized care in the AO. The potential of foodborne disease, the
threat of CBRN contamination of subsistence, the need to assess and mitigate the zoonotic and endemic
animal disease threat, and the need to provide animal medical care to working dogs requires a veterinary
presence throughout the entire operational area. Comprehensive veterinary medical and surgical programs
are required to provide casualty care for and maintain the health of military and contract working dogs in
order to optimize their detection and patrol capabilities to protect the Service members. Refer to Table 6-1
for primary tasks and purposes of veterinary services.
Table 6-1. Primary tasks and purposes of veterinary services
Primary task Purpose
Provide veterinary medical care for military and contract working
Provide animal medical care
dogs and other government owned animals.
Conduct food protection Ensure quality, food safety, food defense of food sources and storage
activities areas to ensure wholesome food supply for deployed forces.
Reduce transmission of zoonotic disease threats to deployed forces
Execute veterinary public
and mitigate the impact of animal diseases of operational importance
health activities
to working animals or continental U.S. agricultural systems. |
4-02 | 119 | Veterinary Services
SECTION II — FOOD PROTECTION MISSION
6-5. The food protection mission ensures quality, food safety, and food defense of food sources and food
storage areas for deployed sources to minimize foodborne illness threats. It encompasses all services
performed to include:
* Conducting food protection sanitation audits of commercial food establishments, including
storage facilities for DOD procurement.
* Conducting military sanitary inspections at all food establishments on military installations.
* Conducting contingency CBRN surveillance of potentially contaminated subsistence, as
directed/required and providing guidance on the disposition of CBRN-contaminated subsistence.
* Providing CBRN decontamination instructions for subsistence.
* Conducting surveillance and receipt inspections of operational rations and other government-
owned subsistence intended for consumption or use by DOD personnel.
* Providing basic food microbiological and chemical surveillance of the military food supply (to
include performing rapid, presumptive laboratory testing [screening and surveillance] for
microbial contaminants, pesticides and toxins, and field confirmatory testing for microbial
contaminants in the food supply).
* Providing assessment and guidance on temperature-abused foods.
* Conducting routine inspections of government food storage facilities.
* Participating in foreign humanitarian assistance and other stability tasks as directed.
* Providing food surveillance inspections of dining facilities for security and storage of food
products.
* Assisting in foodborne illness investigations.
* Conducting food and water risk assessments.
SECTION III — ANIMAL CARE MISSION
6-6. The animal care mission provides comprehensive medical and surgical care for MWDs and for
government-owned animals to optimize performance and protect Service members from enemy threats. It
provides preventive and casualty care as authorized for other animals eligible for United States Army-
provided veterinary care. The animal care mission is discussed in a similar fashion as are the roles of medical
care used to describe the successive and increasing capabilities to provide care to our injured and wounded
Service members. The major difference is there are no veterinary assets in the BCT. The majority of
veterinary assets in the operational area are assigned to EAB veterinary units and must be projected forward
to provide care in the brigade area.
Note. Non-veterinary health care providers should only perform medical or surgical procedures
consistent with their medical training and necessary to manage problems for working animals that
immediately threaten life, limb, or eyesight, and to prepare the working dog for evacuation to a
facility that has a veterinary provider. Non-veterinary health care providers should refer to the
Joint Trauma System clinical practice guidelines for MWDs
(http://jts.amedd.army.mil/index.cfm/PI_CPGs/cpgs) and consult with their local military
veterinary providers.
6-7. Veterinary treatment in a deployed environment consists of veterinary Roles 1 through 3 veterinary
treatment support. Treatment is provided by supporting Medical Detachments (Veterinary Service Support)
on an area support basis. No organic veterinary personnel are located in the BCT.
6-8. Table 6-2 on page 6-4 discusses the primary tasks and purposes of veterinary services treatment. |
4-02 | 120 | Chapter 6
Table 6-2. Primary tasks and purposes of veterinary services treatment
Primary task Purpose
Maintenance of health to optimize working dog detection and patrol capability
Provide preventive care
to detect threats to Service members.
Treatment of routine DNBI and noncombat related emergencies as close to
Conduct sick call
the working dog’s unit as possible to minimize lost working days.
Perform K9 tactical combat Provision of lifesaving stabilization and care as close to the working dog’s
casualty care point of injury as possible to maximize survival rates.
Perform resuscitation and
Provision of resuscitative surgical care on an area support basis to maximize
emergency surgical
survival rates.
stabilization
Provision of short-term hospitalization capability (not to exceed 72 hours) for
Provide hospitalization
military and contract working dogs requiring direct veterinary care to reduce
services
medical evacuation and maximize return to duty rates.
In order to maximize survival rates of working dogs during medical
evacuation to higher roles of care, veterinary personnel may be required to
Support medical evacuation
augment standard medical personnel and be allowed access to working dog
patients en route.
VETERINARY ROLE 1 MEDICAL CARE
6-9. This role of veterinary medical care is provided by the animal’s handler and the animal care specialist.
ANIMAL HANDLER
6-10. Non-veterinary personnel, such as MWD, equestrian, livestock, and/or USN marine mammal handlers
perform limited lifesaving and first aid procedures until an animal care specialist or a veterinarian is available.
This paragraph details handler-provided capabilities for MWDs since they are most likely to be encountered
within the AHS. Qualified MWD handlers from all Services provide emergency medical care to their dogs
in three specific areas of concentration: K9TCCC, noncombat emergency care, and preventive medical care.
Tasks reflect current practices based on experience with MWDs injured in combat operations. Tasks reflect
the most current scope of practice for medical care of MWDs by handlers, and focus on tasks that are most
critical to preservation of life, limb, and eyesight of working dogs. Handlers are trained to provide the most
effective immediate care to prevent further injury, reduce effects of trauma and illness, and stabilize the
patient while coordinating rapid evacuation. In conjunction with the tasks and training focus, each handler
has a MWD Handler First Aid Set, which is compartmentalized to ensure the exact medical supplies needed
to perform every task are available. Following appropriate emergency veterinary medical training provided
by a veterinarian, a MWD handler has the following capabilities:
* Perform rapid evaluation of a MWD and application of a muzzle for safety.
* Provide immediate control of hemorrhage.
* Manage the airway (airway obstruction, tracheal intubation, surgical tracheostomy).
* Manage breathing (airway obstruction, open chest wound and tension/closed pneumothorax).
* Manage circulation via intravenous access and fluid resuscitation for shock.
* Prevent and manage hypothermia.
* Bandage open wounds including abdominal wounds.
* Manage heat trauma.
* Manage eye trauma or irritation.
* Provide analgesia.
* Initiate infection control (wound lavage, antibiotic therapy).
* Manage burn injuries or wound.
* Splint distal extremity fracture. |
4-02 | 121 | Veterinary Services
* Perform cardiopulmonary resuscitation.
ANIMAL CARE SPECIALIST
6-11. Animal care specialists are organic to Army engineer, Ranger, USN, and Medical Detachment
(Veterinary Service Support) units. The animal care specialist supervises or provides the care, management,
treatment, and sanitary conditions for animals, with a primary responsibility for the prevention and control
of zoonotic diseases and comprehensive care for government-owned animals.
6-12. Animal Care Specialists can perform the same tasks as the Animal Handler plus the following
capabilities:
* Calculating doses and administering oral and topical medications as directed by the veterinarian
or established protocol approved by a veterinarian.
* Maintaining sanitary conditions for all components of the veterinary facility.
* Cleaning, debriding, and suturing superficial wounds.
* Collecting, preserving, and preparing postmortem specimens (including rabies suspect specimens)
for shipment and evaluation at the appropriate laboratory.
* Coordinating and stabilizing MWDs, equids, and marine mammals for evacuation to veterinary
field unit or treatment facility.
* Performing serial monitoring of vital signs and reporting patient’s clinical status to the
veterinarian.
* Collecting laboratory specimens (blood, urine, feces, skin scraping) and performing routine
diagnostics (chemistry, complete blood count, urinalysis); handling and shipping of samples to
diagnostic laboratories.
* Conducting minor sick call or emergency procedures under the indirect supervision of a
veterinarian (such as teleconsultation or preauthorized protocol). Treatment may include restoring
the airway by invasive procedures; use of intravenous fluids and medications; and applying splints,
bandages, and tourniquets.
* Preventing and managing DNBI (such as heat/cold injuries, gastric dilatation volvulus [bloat],
arthropod/reptile bites/stings, vomiting/diarrhea, and so forth).
* Performing humane euthanasia when instructed by veterinarian.
* Performing advanced lifesaving measures to include triage, tracheotomy, burn and poison
management, venous cutdown, insertion of stomach tubes, gastric trocharization, establishing and
maintaining the airway, controlling hemorrhage, performing first aid for hypovolemic shock, and
splinting or immobilizing fractures.
* Inducing and maintaining general anesthesia (under the supervision of a veterinarian), operating
mechanical ventilators, and monitoring anesthetized patient status.
* Taking radiographs and reviewing images for proper positioning.
* Initiating and maintaining patient medical records.
6-13. Veterinary Role 1 care is provided by the animal care handler, animal care specialist, and veterinarian
assigned individually to various United States Army, United States Air Force, United States Marine Corps,
or United States Navy field units or Veterinary Service Support Teams. Either the animal care specialist or
veterinarian will respond to the emergency call of a MWD, equid, or USN marine mammal handler.
Depending on the type of emergency, the animal care specialist or veterinarian will evaluate the traumatized
or ill animal to provide stabilization with basic first aid equipment or medications so that the patient can
withstand further evacuation to and treatment by either a forward-deployed veterinary Role 2 Veterinary
Service Support Team, veterinary Role 3 Veterinary Medical and Surgical Team, or veterinary Role 4 care
at an Army veterinary hospital. An animal handler can be instructed to perform basic emergency aid
procedures and prepare the animal for transport/evacuation to a higher role of veterinary medical care in the
event the animal care specialist or veterinarian cannot provide veterinary Role 1 care at the POI/illness. |
4-02 | 122 | Chapter 6
Note. Injured or ill MWDs may be evacuated on any transportation means available. The using
unit is responsible for the evacuation of the animal. Use of dedicated MEDEVAC assets (air or
ground ambulances) is authorized based on mission priority and availability. When possible, the
handler should accompany the animal during the evacuation. Using units should include the
location of veterinary treatment facility/support units on mission request. Refer to ATP 4-02.2 for
more information.
VETERINARY ROLE 2 MEDICAL CARE
6-14. Veterinary Role 2 medical care is provided by a forward-deployed Veterinary Service Support Team
veterinarian and an animal care specialist from the Medical Detachment (Veterinary Service Support). This
level of care includes veterinarian-directed resuscitation and stabilization and may include K9TCCC,
emergency medical procedures, and forward emergency resuscitative surgery for military or contract working
dogs, other government owned animals such as equids and USN marine mammals. A Veterinary Service
Support Team provides veterinary Role 2 support for up to 50 military or contract working dogs. There are
five Veterinary Service Support Teams in a Medical Detachment (Veterinary Service Support), which are
geographically dispersed throughout the operational area.
6-15. Veterinary Role 2 medical care includes:
* Basic veterinary clinical laboratory- microscopic examination, complete blood count, blood
chemistry, and urinalysis.
* Limited veterinary pharmacy.
* Limited temporary MWD holding facilities for basic medical disease treatment.
* Sick call.
* Routine preventive care.
* Nonemergent surgical care.
* Emergency medical and limited emergency surgical procedures.
* Ultrasound.
* Limited care for large animals under certain conditions of government interest for stability tasks
and defense support of civil authorities tasks.
* Endemic zoonotic and foreign animal disease epidemiology surveillance and control by
examination of local farm animals in the area, captured wildlife, and stray animals.
6-16. Veterinary patients are treated and returned to duty or are stabilized for transport/evacuation to a higher
veterinary role of medical care. At veterinary Role 2 no organic patient holding capability is available.
Note. There are no kennels at veterinary Role 2. The MWD handler is expected to stay with his
dog. Each MWD handler has a crate for his dog. Dogs can sleep or rest in their crate on the
ground. The horse or USN marine mammal handler is also expected to stay with his animal.
VETERINARY ROLE 3 MEDICAL CARE
6-17. This role of veterinary medical care is provided by the Veterinary Medical and Surgical Team which
consists of a clinical and surgical team designed to care for dogs only. No veterinary Role 3 capability is
available in the operational area for horses or USN marine mammals. If veterinary Role 3 care is required,
the horses, livestock, or USN marine mammals may be transported/evacuated back to CONUS.
6-18. Veterinary Role 3 medical care includes referral for veterinary diagnostic, therapeutic, and surgical
procedures, and requires advanced clinical capabilities. At veterinary Role 3, capability exists to provide
veterinary Role 1 and 2 care for up to 50 military or contract working dogs, and veterinary Role 3 care for a
catchment population of up to 300 military or contract working dogs provided five Veterinary Service
Support Teams are deployed in support to provide veterinary Role 1 and 2 care. There is one Veterinary
Medical and Surgical Team per Medical Detachment (Veterinary Service Support). |
4-02 | 123 | Veterinary Services
6-19. Veterinary Role 3 medical care capabilities include:
* Patient case consultation and acceptance of referrals.
* Comprehensive canine veterinary medical/surgical care (such as orthopedic and extensive soft
tissue surgeries).
* Extensive veterinary laboratory capabilities- complete blood count, chemistry, and urinalysis.
* Robust veterinary pharmacy.
* Diagnostic imaging (radiographs and ultrasound).
* Definitive and restorative MWD dental care to include endodontic procedures.
* Area of operations-wide patient tracking of MWD to include evacuation.
* Established operational area MWD evacuation policy and standards of care.
* Training for unit veterinarians and animal care specialist as well as institutional veterinary training
programs, ranging from university hospitals to local veterinary technician training, for stability
tasks.
* Development of the detachment’s policies for care of government-owned animals.
* Treatment, return to duty, or hospitalization of military or contract working dogs for continued
care or stabilization of MWDs for transport/evacuation to veterinary Role 4 medical care.
6-20. The Veterinary Medical and Surgical Team is staffed and equipped to hospitalize up to five military
or contract working dogs.
VETERINARY ROLE 4 MEDICAL CARE
6-21. Veterinary Role 4 medical care is found in CONUS at the DOD Military Working Dog Veterinary
Service and outside CONUS at the Veterinary Medical Center Europe. Veterinary Role 4 medical care
expands the capabilities available at veterinary Roles 1 through 3 and provides additional specialized
veterinary medical and surgical care, rehabilitative therapy, and convalescent capability.
SECTION IV — VETERINARY PUBLIC HEALTH
6-22. Veterinary public health includes preventing and mitigating the effects of foodborne disease; reducing
the transmission of zoonotic diseases; monitoring, assessing, and mitigating endemic animal disease threats
to working animals and CONUS agricultural systems; and monitoring animals as sentinels of threats to
humans or other animals by investigating unexplained animal deaths. Using the U.S. Department of
Agriculture’s regulations or the regulations for other countries (depending on the equipment’s final
destination), veterinary services also assists with decontamination guidance for U.S.-owned equipment being
retrograded to CONUS and other nations to prevent the transmission of animal diseases as well as advises
the commander on foreign animal disease that may affect redeployment of military equipment back to the
U.S. Specific services include:
* Support for prevention and control programs to protect Service members from foodborne diseases.
* Evaluation of zoonotic disease data collected in the AO and advice to preventive medicine
elements, patient treatment elements, and higher headquarters on potential hazards to humans.
* Establishment of animal disease prevention and control programs to protect Service members and
other DOD and multinational personnel from zoonotic diseases.
* Assessment of the presence of animal diseases that may impact the CONUS agriculture system if
contaminated equipment or personnel are allowed to redeploy.
* Investigation of unexplained animal deaths to include livestock and wildlife to detect any threats
to Service members, working animals, or U.S. agricultural systems.
* Establishment of animal disease prevention and control programs to protect military working
animals from infectious diseases.
* Technical consultation for zoonotic disease and pest control programs such as rabies advisory
boards and feral animal risk mitigation. For more information on feral animal risk mitigation, see
Armed Forces Pest Management Board Technical Guide No. 3, Feral Animal Risk Mitigation in
Operational Areas. |
4-02 | 124 | Chapter 6
6-23. For more information on Veterinary Services, refer to AR 40-3, AR 40-5, DA PAM 40-11, AR 40-
905, ATP 4-02.8, and ATP 4-02.7. |
4-02 | 125 | Chapter 7
Combat and Operational Stress Control
Combat and operational stress control has always been a commander’s program. To
be successful, commanders must fully understand and appreciate the magnitude of a
potentially traumatic event as it affects exposed organizations and individuals. It is a
harsh reality that combat and operational stress affects everyone engaged in unified
land operations. It should be viewed as a continuum of possible outcomes that each
person will experience with a range from positive growth behaviors to negative and
sometimes disruptive reactions. Effective leadership shapes the experience that they
and their Soldiers go through in an effort to successfully transition units and
individuals, build resilience and promote posttraumatic growth, or increased
functioning and positive change after enduring trauma. Combat and operational stress
control does not take away the experiences faced while engaged in military operations,
it attempts to mitigate those experiences so that Soldiers and units remain combat-
effective and ultimately provide the support and meaning that will allow Soldiers to
maintain the quality of life to which they are entitled.
SECTION I — COMBAT AND OPERATIONAL STRESS CONTROL
RESPONSIBILITIES
7-1. Combat and operational stress control is a program developed and actions taken by military leadership
to prevent, identify, and manage adverse combat and operational stress reactions in units. This medical
function optimizes mission performance; conserves the fighting strength; and prevents or minimizes adverse
effects of combat and operational stress reaction on Soldiers and their physical, psychological, intellectual,
and social health. Its goal is to return Soldiers to duty expeditiously.
SECTION II — PROGRAM AND RESOURCES
7-2. According to DODD 6490.02E, COSC activities include routine screening of individuals when
recruited; continued surveillance throughout military service, especially before, during, and after
deployment; and continual assessment and consultation with medical and other personnel from garrison to
the battlefield. Soldiers who are temporarily impaired or incapacitated with stress-related conditions are
diagnosed as BH disorders. Combat and operational stress control promotes Soldier and unit readiness by―
* Enhancing adaptive stress reactions.
* Preventing maladaptive stress reactions.
* Assisting Soldiers with controlling combat and operational stress reactions.
* Assisting Soldiers with behavioral disorders.
* Teaching warrior resiliency skills.
7-3. For more information on COSC, refer to ATP 4-02.5 and ATP 4-02.8.
BRIGADE COMBAT TEAMS
7-4. In the BCTs, COSC support is provided by mental health sections assigned to the brigade support
medical company of the brigade support battalion. If required, these resources can receive direct support
from the BH personnel assigned to the medical detachment (COSC), if augmentation is required. |
4-02 | 126 | Chapter 7
MEDICAL COMPANY (AREA SUPPORT)
7-5. At EAB, mental health sections are assigned to the medical companies (area support) that are normally
assigned to the MMB. If required, these resources can be augmented with BH personnel assigned to the
medical detachment (COSC).
MEDICAL DETACHMENT, COMBAT AND OPERATIONAL STRESS
CONTROL
7-6. A medical detachment (COSC) is usually assigned to the MMB and provides direct support to the
EAB. In support of an AO, this unit provides support on an area basis and provides additional support to the
BCT as required. The medical detachment (COSC) consists of a detachment headquarters, a main support
section, a Unit Ministry Team, and a forward support section. The main support section consists of its
headquarters and an 18-Soldier BH team made up of social workers, clinical psychologist, psychiatrist,
occupational therapists, psychiatric nurses, BH specialists, and occupational therapy specialist. The forward
support section consists of an 18-Soldier BH team. Each BH team is capable of breaking into six 3-person
subteams, for battalion/company prevention and fitness support activities. This provides for a total of 12
subteams for each detachment, giving supported commanders more teams and more flexibility in the
utilization of those teams.
PRIMARY TASKS
7-7. Table 7-1 discusses the primary tasks of the COSC function. Table 7-2 (on page 7-3) discusses the
primary tasks and purposes of BH/neuropsychiatric treatment.
Table 7-1. Primary tasks and purposes of the combat and
operational stress control function
Primary task Purpose
Implement combat and operational stress control Prevent combat and operational stress reaction.
plan/program
Perform combat and operational stress control Provide command with global assessment of the unit,
unit needs assessment with considerations of multiple variables that may
affect leadership, performance, morale, and
operational effectiveness of the organization.
Conduct traumatic event management for Assist in the transition of units and Soldiers who are
potentially traumatic event exposed to potentially traumatic events by building
resilience, promoting posttraumatic growth, and/or
increasing functioning and positive changes in the
unit.
Screen and evaluate Soldiers with maladaptive Provide diagnosis, treatment, and disposition for
behaviors to rule out neuropsychiatric/behavioral Soldiers with neuropsychiatric/behavioral problems.
health conditions
Conduct combat and operational stress Provide Soldiers rest/restoration within or near their
restoration and reconditioning programs to unit area for rapid return to duty and to prevent
include warrior resiliency training posttraumatic stress disorder.
Perform command-directed evaluation for Determine if Soldiers’ mental state renders them at
Soldier’s behavioral health status risk to themselves or others or may affect their ability
to carry out their mission.
Screen patients with potential behavioral health Rule out mild traumatic brain injury for Soldiers
issues for signs/symptoms of mild traumatic brain seeking assistance with behavioral health issues. If
injury appropriate, refer individuals for follow-up medical
examination. |
4-02 | 127 | Combat and Operational Stress Control
SECTION III — BEHAVIORAL HEALTH AND NEUROPSYCHIATRIC
TREATMENT ASPECTS
7-8. Behavioral health/neuropsychiatric treatment exists when there is an explicit therapist-patient or
therapist-client relationship.
TREATMENT PROVISION
7-9. Behavioral health/neuropsychiatric treatment is provided for Soldiers with behavioral disorders to
sustain them on duty or to stabilize them for referral/transfer. This is usually a brief, time-limited treatment
as dictated by the operational situation. Behavioral health/neuropsychiatric treatment includes counseling,
psychotherapy, and behavior therapy, occupational therapy, and medication therapy. Treatment assumes an
ongoing process of evaluation and may include assessment modalities such as psychometric testing,
neuropsychological testing, laboratory and radiological examination, and COSC providers’ discipline-
specific evaluations.
7-10. Behavioral health/neuropsychiatric treatment is provided to Soldiers with diagnosed behavioral
disorders and who require more intentions for their diagnoses. It is both inappropriate and detrimental to
treat Soldiers with combat and operational stress reactions as if they are behavioral health disorder. A
therapeutic relationship may promote dependency and foster the patient role. Likewise, medication therapy
and the highly structured treatment modalities imply the patient role. Medication for transient symptom relief
(insomnia or extreme anxiety) may not be detrimental if there is no expectation that medication will continue
to be prescribed.
7-11. Treatment standards are the same in the deployed environment as in garrison. When operational
requirements dictate that clinical standards of treatment/care are waived or relaxed, it must be approved by
the AO COSC consultant. Treatment should be tailored to the anticipated availability of the Soldier and the
COSC provider. Short-term interventions are more practical than long-term commitments. If longer-term
treatment is necessary, design the intervention in time-limited modules. Under no circumstances should
treatment diminish the Soldier’s ability to provide self-care and to defend himself. Exceptions include
emergency stabilization and preparation for evacuation. In addition, the Department of Veterans
Affairs/DOD Clinical Practice Guidelines website offers clinicians evidence-based assessment and treatment
algorithms for acute stress disorder, posttraumatic stress disorder, and many other
behavioral/neuropsychiatric disorders.
PRIMARY TASKS
7-12. Table 7-2 discusses the primary tasks and purposes of BH/neuropsychiatric treatment.
Table 7-2. Primary tasks and purposes of behavioral health/neuropsychiatric treatment
Primary task Purpose
Identify and diagnose behavioral Identify and initiate treatment for patients with behavioral health/
health/neuropsychiatric disorder/ neuropsychiatric disease processes.
disease
Stabilize patient Stabilize behavioral health/neuropsychiatric patients for evacuation
from the theater for treatment of disease process in the continental
United States-support base. |
4-02 | 129 | Chapter 8
Dental Services
The Soldier as the centerpiece of the United States Army is the basic guarantor of
mission success. As such, the Soldier’s health and physical fitness are vitally
important. Equally important is the Soldier’s oral and dental health, which if not
properly maintained can result in becoming nondeployable, and if already deployed,
can render this Soldier nonmission-capable.
SECTION I — DENTAL SERVICES PREVENTIVE DENTISTRY
8-1. Preventive dentistry incorporates primary, secondary, and tertiary preventive measures. For more
information on dental services, refer to AR 40-35 and ATP 4-02.19.
PREVENTIVE MEASURES
8-2. Preventive dentistry measures can effectively prevent the development of tooth decay and oral disease.
The application of fluoride and sealants combined with regular dental checkups and oral screenings can
prevent tooth decay and identify oral disease at its most treatable stages. Therefore, Soldiers who incorporate
good preventive dental hygiene practices are far less likely to become dental casualties due to disease while
deployed.
PRIMARY TASKS
8-3. Table 8-1 discusses the primary tasks and purposes of preventive dentistry.
Table 8-1. Primary tasks and purposes of preventive dentistry
Primary task Purpose
Conduct periodic examination of Identify dental deficiencies and recommend follow-up courses of
Soldiers’ teeth, gums, and jaw action.
Classify Soldiers’ dental Determine Soldiers dental classification and dental readiness status.
conditions in the dental
classification system and
determine Soldiers’ dental
readiness status
Provide training to Soldiers and Provide training/education to Soldiers and unit leaders on identifying
units on measures to take to dental threats, taking preventive measures to mitigate or eliminate
mitigate the adverse impact of the dental threat, and ensuring Soldiers are practicing good oral
dental threats hygiene.
SECTION II — DENTAL SERVICES TREATMENT ASPECTS
8-4. The mission of the dental service support system is to promote dental health; prevent and treat oral and
dental disease; provide far forward dental treatment; provide early treatment of severe oral and maxillofacial
injuries; and augment medical personnel (as necessary) during mass casualty operations. |
4-02 | 130 | Chapter 8
LEVELS OF DENTAL SUPPORT
8-5. There are three levels of dental support, previously known as levels of dental care, within the AO.
These levels are defined primarily by the relationship of the dental assets supporting the patient population
within each level. These levels of dental support are exclusive and not synonymous with the medical roles
of care. Reference paragraphs 1-32 through 1-47 for more discussion on the medical roles of care.
LEVEL 1 DENTAL SUPPORT
8-6. The first dental care a Soldier receives is provided by Level 1 dental support (previously known as
unit-level dental care). This level of support consists of those services provided by dental personnel organic
to the supporting medical companies and special forces groups (SFGs).
8-7. This level of support provides operational dental care to Soldiers during a range of military operations
from dental assets in a direct support relationship to an area support task. Major emphasis is placed on those
measures necessary for the patient to return to duty or to stabilize them and allow for their evacuation to the
next role of medical care.
LEVEL 2 DENTAL SUPPORT
8-8. Level 2 dental support (previously known as hospital-level dental care) consists of those services
provided by the hospital dental staff to minimize loss of life and disability resulting from oral and
maxillofacial injuries and wounds. The hospital dental staff provides operational dental care and preventive
dental care to all injured or wounded Soldiers, as well as the hospital staff. The hospital dental staff will not
normally provide Level 1 dental support to organizations outside of the hospital, however they will direct
patients to the Level 3 dental support activity.
8-9. Emphasis is placed on those measures necessary for the patient to return to duty or to stabilize them
and allow for their evacuation to the next role of medical care. If needed the hospital dental staff can
coordinate with the dental company (area support) (DCAS) for patient consultation and treatment.
LEVEL 3 DENTAL SUPPORT
8-10. Level 3 dental support (previously known as area dental support) is provided for units that do not have
organic dental assets or those patients being referred by the Level 2 dental support. This level of support is
provided by the DCAS.
8-11. The DCAS provides operational dental care and has dental assets which can deploy, when and where
necessary, to provide augmentation and/or reinforcement to the area support squads.
CATEGORIES OF DENTAL CARE
8-12. Dental service planning must include the consideration of two categories of dental services in joint and
multinational operations. Operational dental care is provided within the area of operations (AO), and
comprehensive dental care is provided in the support base, normally found only in fixed facilities, out of
theater such as in the joint security area or the strategic support area. These categories are not absolute in
their limits; they are the general basis for defining the dental service capabilities available at the different
AHS roles of care.
OPERATIONAL DENTAL CARE
8-13. Operational dental care is the dental care provided for deployed Soldiers in theater consisting of
emergency dental care and essential dental care (ATP 4-02.19).
Emergency Care
8-14. Emergency dental care is the care given for the relief of oral pain; diagnosis and treatment of infections;
control of life-threatening oral conditions (hemorrhage, cellulitis, or respiratory difficulties); and treatment
of trauma to teeth, jaws (maxilla/mandible), and associated facial structures is considered emergency care |
4-02 | 131 | Dental Services
(ATP 4-02.19). It is the most austere form of dental care provided to deployed Soldiers who are engaged in
tactical operations.
8-15. Common examples of emergency dental treatments include:
* Airway management.
* Hemorrhage control.
* Stabilization of maxillofacial injuries (fracture stabilization, soft tissue injury/lacerations repair).
* Simple extractions.
* Management of maxillofacial infection (antibiotics, incision, and drainage).
* Interim pulp therapy (pulpectomy).
* Pain medication.
* Temporary restorations.
Essential Dental Care
8-16. Essential dental care is the dental care necessary to intercept potential emergencies to prevent lost duty
time and preserve fighting strength (ATP 4-02.19). Essential dental care is the highest category of operational
dental care available in theater. It enhances the individual Soldier’s combat readiness and can prevent lost
duty time. It is for these reasons that essential dental care is made readily available. Soldiers who are
categorized as Class 2 (untreated oral disease) or Class 3 (potential dental emergencies) should receive
essential care as soon as the tactical situation and availability of dental assets permit.
8-17. Essential treatments performed by dental officers may include:
* Basic restorations.
* Extractions.
* Definitive pulp therapy (pulpectomy, obturation).
* Treatment of periodontal conditions.
* Simple prosthetic repairs.
Comprehensive Dental Care
8-18. Comprehensive dental care is the dental treatment to restore and/or maintain a Soldier’s optimal oral
health, function, and aesthetics (ATP 4-02.19).
8-19. This category of care is usually reserved for medical support plans that anticipate an extended period
of reception and training in theater and is also included as a component of the theater hospitalization
capability. The scope of facilities needed to provide this level of dental support should equal that of theater
hospitalization medical treatment facility (MTF) capability.
PRIMARY TASKS
8-20. Table 8-2 discusses the primary tasks and purposes of the dental services function.
Table 8-2. Primary tasks and purposes of the dental services function
Primary task Purpose
Provide comprehensive Restore an individual to optimal oral health, function, and aesthetics.
dental care Normally provided in continental United States-support base.
Provide treatment in austere environments for Soldiers engaged in
Provide operational dental
operations. Operational care is provided in the area of operations and
care
consists of emergency dental care and essential dental care. |
4-02 | 132 | Chapter 8
Table 8-2. Primary tasks and purposes of the dental services function (continued)
Primary task Purpose
Relieve oral pain, eliminate acute infection, control life-threatening oral
Conduct emergency dental
conditions (hemorrhage, cellulitis, or respiratory difficulty) and treat trauma
care
to teeth, jaws, and associated facial structures.
Conduct essential dental Prevent potential dental emergencies and maintain the overall oral fitness
care of Soldiers at levels consistent with combat readiness.
Provide oral maxillofacial surgery capability to minimize loss of life and
Perform oral maxillofacial
disability resulting from oral and maxillofacial injuries and wounds within
surgery
the area of operations. |
4-02 | 133 | Chapter 9
Laboratory Services
This chapter discusses environmental and clinical medical laboratory services.
SECTION I — AREA MEDICAL LABORATORY SUPPORT
9-1. The AML includes capabilities in the identification and theater validation of suspect CBRN agents,
endemic diseases, and OEH hazards. Its focus is the total health environment of the operational area, not
individual patient care.
9-2. The AML is the Army’s specialized theater laboratory that deploys worldwide as a unit or by task-
organized teams to perform surveillance, analytical laboratory testing and health hazard assessments of
environmental, occupational, endemic, and CBRN threats in support of Soldier protection and weapons of
mass destruction missions.
FIELD ENVIRONMENTAL LABORATORY
9-3. The AML tests air, water, soil, food, waste, and vectors (insects, animals) for a broad range of
microbiological, radiological, and/or chemical contaminants under two basic scenarios:
* As a field environmental laboratory (theater validation) in support of theater operations. The AML
provides—
Theater validation level of identification to enable commanders and health care providers to
make data-based decisions.
Support to multiple medical detachments (preventive medicine and veterinary services) with
surveillance/surveillance oversight, sample collection/sample management, and rapid
laboratory analysis and validation.
* In contingency operations (for example, after use of weapons of mass destruction), the AML
provides—
Immediate hazard identification (presumptive or field confirmatory level of identification) in
high risk environments with chemical or biological agent contamination, epidemic disease, or
industrial contamination.
Rapid laboratory analysis and theater validation level of identification to assist commanders
in making operational decisions.
9-4. The AML is organized into teams consisting of the following:
* The staff (headquarters) section provides command, control, and communications support for the
unit and accomplishes all required administrative functions of the unit.
* The analytical chemistry (CBRN) section conducts analytical chemistry support by providing
identification of chemical agents in the environment to include food, water, plants, soil, and
explosives.
* The microbiology (endemic) section conducts biological agent analysis using multiple
methodologies, provides identification of endemic disease agents, and supports animal pathology
and endemic disease surveillance.
* The OEH surveillance (CBRN) section provides identification for environmental samples and
clinical specimens using multiple methodologies. This section also provides diagnostic capability
to identify outbreaks of regionally specific endemic diseases and serves as a resource of
information for higher-level command medical personnel. This section also provides the |
4-02 | 134 | Chapter 9
operational commander the immediate hazard identification (presumptive or field confirmatory
level of identification) of CBRN.
9-5. For more information on the AML, refer to ATP 4-02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3.
Figure 9-1 depicts the four levels of identification where AML serves as a theater validation environmental
laboratory.
Figure 9-1. Four levels of identification
PRIMARY TASKS
9-6. Table 9-1 discusses the primary tasks and purposes of the operational medical laboratory function
performed by the AML.
Table 9-1. Primary tasks and purposes of the operational medical laboratory function
performed by the area medical laboratory
Primary task Purpose
Provide analytical, investigational, Identify chemical, biological, radiological, and nuclear threat agents in
and consultative capabilities biomedical specimens and other samples from the area of operations.
Assist in the identification of OEH hazards and endemic diseases.
Provide special environmental Evaluate biomedical specimens for the presence of highly infectious or
control and containment hazardous agents of operational concern.
Provide data and data analysis Support medical analyses and operational decisions.
Conduct medical laboratory Support the diagnosis of zoonotic and significant animal diseases that
analysis impact on military operations.
Deploy modular sections or Interface with preventive medicine teams, veterinary teams, forward-
sectional teams deployed Army Health System units, biological integrated detection
system teams, and chemical company elements operating in the area
of operations. |
4-02 | 135 | Laboratory Services
SECTION II — CLINICAL LABORATORY SERVICES
9-7. All Role 2 MTFs provide basic clinical laboratory services within the AO. They perform basic
procedures in hematology, urinalysis, microbiology, and serology. Role 2 MTFs receive, maintain, and
transfuse blood products.
9-8. The clinical laboratory in the CSH/hospital center performs procedures in biochemistry, hematology,
urinalysis, microbiology, and serology in support of clinical activities. The CSH/hospital center also provides
blood-banking services.
CHEMICAL, BIOLOGICAL, RADIOLOGICAL, AND NUCLEAR
CLINICAL LABORATORY SUPPORT
9-9. At Role 2, medical laboratory support may be very limited. Diagnostic testing for evidence of CBRN
exposure or disease may be difficult unless technologies are present to ensure high levels of safety (for
example, biological safety cabinets). Laboratory personnel prepare collected suspect CBRN specimens for
submission to supporting medical laboratories while maintaining chain-of-custody.
9-10. At Role 3, medical laboratory support in a CSH or hospital center is intended for providing clinical
laboratory support and is primarily in support of acute surgical cases, blood services, and immediate services
required for intensive care operations. Microbiology services may also be available to include bacterial
culture and antimicrobial sensitivity testing. A polymerase chain reaction technology has been fielded to
most Role 3 MTF laboratories for initial field confirmation analysis of biological warfare agents. Patients
with documented or suspected exposure to CBRN weapons/agents will be medically evaluated; specimens
will be collected, packaged, and a chain-of-custody will be established and forwarded through technical
channels to a supporting medical laboratory for further analysis. For more information, refer to ATP 4-
02.7/MCRP 4-11.1F/NTTP 4-02.7/AFTTP 3-42.3.
PRIMARY TASKS
9-11. Table 9-2 discusses the primary tasks and purposes of the clinical laboratory services function.
Table 9-2. Primary tasks and purposes of the clinical laboratory services
Primary task Purpose
Provide analysis of medical Provide for the identification, diagnosis, and treatment of diseases
specimens and pathogens.
Provide blood-banking services to include capability to type and
crossmatch blood samples and perform limited testing of whole
blood.
Provide blood banking services Provide laboratory support to type and crossmatch blood specimens
for transfusion services.
Provide limited testing of blood products. |
4-02 | 137 | PART THREE
Health Service Support
Health service support pertains to the treatment and MEDEVAC of patients from the
battlefield and the required Class VIII supplies, equipment, and services to necessary
to sustain these operations. Health service support encompasses three components:
direct patient care, MEDEVAC, and MEDLOG.
This part of the publication discusses—
● Direct patient care aspects of the AHS mission. It includes medical treatment
(organic and area support) and hospitalization. Health Service Support includes the
treatment of CBRN patients.
● Medical evacuation to include medical regulating, and the provision of en route
care to patients being transported.
● Medical logistics inclusive of all functional subcomponents and services to
include blood management.
Chapter 10
Direct Patient Care
The mission set of direct patient care comprises of the medical functions of medical
treatment (organic and area support) and hospitalization. Health service support
includes the treatment of CBRN casualties. Although these medical functions are
aligned with specific tasks, the execution of the individual functions are interrelated,
interconnected, and independent and require close coordination and integration to
facilitate effective and efficient provision of AHS support.
SECTION I — MEDICAL TREATMENT (ORGANIC AND AREA SUPPORT)
10-1. The medical treatment function encompasses Roles 1 and 2 medical treatment support. These roles of
care are provided by organic assets (medical platoons of maneuver forces and treatment teams assigned to
sustainment units) or on an area support basis from supporting medical companies or detachments. Within
the BCTs and EAB AHS units, this support is provided by the medical company (brigade support) and the
medical company (area support). The area support function encompasses TCCC, routine sick call, emergency
dental care, operational public health, and COSC support. |
4-02 | 138 | Chapter 10
MEDICAL COMPANY
10-2. At Role 2 MTFs, in addition to the Role 1 capabilities, these additional services are available- x-ray,
medical laboratory, essential dental care, and patient holding capability. Medical companies may also be
augmented with physical therapy services and optometry services and collocated with an FST or FRSD.
10-3. During operations, each medical company is assigned a specific AO to ensure all personnel receive
adequate medical care. Within each company AO, the treatment platoon with its medical treatment squads,
area support treatment squad (dental, x-ray, laboratory, and patient-holding capability) forms the core of the
company’s support scheme. The medical treatment squads are employed geographically to best support the
troop population. Company ambulances are collocated with medical elements to provide a ground
MEDEVAC capability or to evacuate patients to the Role 2 MTF established by the area support section of
the medical company for further treatment or holding.
PRIMARY TASKS
10-4. Table 10-1 discusses the primary tasks and purposes of the medical treatment (organic and area
support) function.
Table 10-1. Primary tasks and purposes of the medical treatment
(organic and area support) function
Primary task Purpose
Provide first aid Decrease killed-in-action rate. This task is performed by nonmedical Soldiers
performing self-aid, buddy aid, and/or combat lifesaver support prior to arrival of
the combat medic and/or other health care personnel.
Provide tactical Provide lifesaving intervention at the point of injury or wounding. This task is
combat casualty care performed by the combat medic who locates, acquires, stabilizes, and evacuates
patients with combat trauma. At echelons above brigade, this task is referred to
as emergency medical treatment in noncombat operations.
Provide forward Provide a damage control surgery capability close to the point of injury or
resuscitative surgery wounding. This care is provided by a forward surgical team collocated with a
Role 2 medical treatment facility.
Conduct routine sick Provide primary care services as close to patient’s unit as possible.
call
Provide patient Provide a short-term holding capability (not to exceed 72 hours) for patients
holding requiring minimal care prior to returning to duty.
Promote casualty Promote wellness and enhance Soldier medical readiness to decrease morbidity
prevention measures and mortality. There are no operational public health or combat and operational
stress control assets at Role 1; however, they are available at Role 2.
Provide medical Provide medical evacuation by ground ambulance on an area support basis and
evacuation to provide en route medical treatment during transport.
Provide physical Role 2 medical treatment facilities may be augmented with a physical therapy
therapy team to provide assistance in strengthening the Soldier’s physical resiliency,
assistance in the prevention of neuromusculoskeletal injuries, and treatment of
Soldiers with neuromusculoskeletal injuries allowing them to return to duty as
soon as possible.
SECTION II — THEATER HOSPITALIZATION
10-5. Theater hospitalization provides essential care within the theater evacuation policy to either return a
patient to duty or stabilize a patient for evacuation to a definitive care facility outside the AO. A hospital is
a medical treatment facility capable of providing inpatient care. It is appropriately staffed and equipped to
provide diagnostic and therapeutic services, as well as the necessary supporting services required to perform
its assigned mission and functions. In addition, a hospital may discharge the functions of a clinic. Often, the
terms hospital and MTF are misused interchangeably. While a Role 3 MTF provides hospitalization, and is
therefore a hospital, Role 1 and 2 MTFs do not provide all of the capabilities included in hospitalization. |
4-02 | 139 | Direct Patient Care
Thus, Role 1 and 2 MTFs are not hospitals. The Army Medicine provides Role 3 medical capabilities with
two organizations, the currently fielded CSH and the recently designed and Army approved hospital center.
Both hospital's assigned medical personnel, facilities, equipment, and materials provide the requisite
capabilities to render significant preventive and curative health care. These highly robust services encompass
primary inpatient and outpatient care; emergent care; and enhanced medical, surgical, and ancillary
capabilities. Inpatient refers to a person admitted to and treated within a Role 3 and 4 hospital and who
cannot be returned to duty within the same calendar day (ATP 4-02.10). While outpatient is a person
receiving medical/dental examination and/or treatment from medical personnel and in a status other than
being admitted to a hospital. Included in this category is the person who is treated and retained (held) in a
medical treatment facility (such as a Role 2 facility) other than a hospital (ATP 4-02.10). The modular design
of the hospital provides the capability to tailor and deploy capabilities as modules or multiple individual
capabilities that provide incrementally increased medical services. The theater hospitals may be augmented
by one or more medical detachments, hospital augmentation teams, or medical teams designed to enhance
the hospital's capabilities to provide HSS to the AO.
10-6. Theater hospital capabilities include triage/emergency care, outpatient services, inpatient care,
pharmacy, clinical laboratory, blood banking, radiology, physical therapy, MEDLOG, operational dental care
(emergency and essential dental care), oral and maxillofacial surgery, nutrition care, and patient
administration services. Triage is the process of sorting casualties based on need for treatment,
evacuation, and available resources. Triage consists of the immediate sorting of patients according to type
and seriousness of injury, and likelihood of survival, and the establishment of priority for treatment and
evacuation to assure medical care of the greatest benefit to the largest number. The categories of triage are:
MINIMAL (OR AMBULATORY) - those who require limited treatment and can be rapidly returned to duty;
IMMEDIATE- patients requiring immediate care to save life, limb or eyesight; DELAYED- patients who,
after emergency treatment, incur little additional risk by delaying further treatment; and EXPECTANT-
patients so critically injured that only complicated and prolonged treatment will improve the chances of
survival.
PRIMARY TASKS
10-7. Table 10-2 on page 10-4 discusses the primary tasks and purposes of theater hospitalization function.
COMBAT SUPPORT HOSPITALS
10-8. The CSH provides hospitalization and outpatient care for all classes of patients within the AO. It is
comprised of a headquarters and headquarters detachment and two hospital companies (one 84-bed and one
164-bed company)
10-9. The CSH provides hospitalization for up to 248 patients and treatment for all classes of patients.
10-10. Surgical capacity is based on six operating room tables staffed for 96 operating table hours per day.
The six operating room tables are contained in three operating room shelters. Surgical capabilities include
general, orthopedic, thoracic, urological, gynecological, and oral maxillofacial.
10-11. Other capabilities include:
* Medical command and control of organic and attached elements include AHS planning, policies,
and support operations with the hospital AO.
* Emergency treatment to receive, triage, and resuscitate casualties to include civilians and enemy
prisoners of war, as required.
* Consultation services for inpatient and outpatient support.
* Pastoral care for staff and patients, as well as ethical advisement on bioethics or end of life issues.
* Pharmacy, psychiatry, public health nursing, clinical laboratory, blood banking, radiology,
physical therapy, and nutrition care services.
* Medical administrative and logistical services.
* Operational dental care treatment.
* Medical logistics support to the FST/FRST, when attached. |
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* Reconstitution of the FST/FRST as directed by higher headquarters or the operation plan.
10-12. For maximum use of the CSH, the entire organization should deploy together, however, due to its
limited mobility and the availability of transportation support, it may be necessary to deploy by
modules/echelons.
Table 10-2. Primary tasks and purposes of theater hospitalization function
Primary task Purpose
Provide essential care Includes first responder care, initial resuscitation and stabilization as well as
treatment and hospitalization in order to either return the patient to duty within
the theater evacuation policy, or to begin initial treatment required for
optimization of outcome.
Perform triage and Provides for the receiving of incoming patients to assess their medical
emergency care condition, provide emergency medical treatment, and transfer them to the
appropriate functional area within the hospital.
Provide outpatient Provides patient care and family medicine consultation services, evaluation
services and treatment of dermatological and gynecological diseases, injuries,
disorders, orthopedic and physical therapy services; sick call operations and
comprehensive routine medical care to include electrocardiographs in the
medical services clinic.
Manage inpatient Provides nursing and medical services in intermediate and intermediate care
care wards in order to prepare patients for surgery, manage postoperative
recovery, monitor patients, and prepare them for further evacuation.
Perform clinical Performs analytical procedures in hematology, urinalysis, chemistry, blood
Laboratory and blood banking, and microbiology screening. Includes all routine blood grouping and
banking typing, abbreviated cross-matching procedures, emergency blood collection,
and storage/issuing liquid blood components and fresh frozen plasma.
Provide radiology Provides radiological services to all areas of the hospital and operates on a
services 24-hour basis to include computed tomography in the newly designed field
hospitals.
Conduct physical Provides a physical-occupational clinic to evaluate and treat
therapy neuromusculoskeletal injuries, minor soft tissue wounds to include burn wound
treatment, behavioral health, injury prevention, and human performance
optimization.
Provide medical Provides Class VIII management, requisitioning, and resupply as well as
logistics maintenance on medical equipment. Coordinates with supporting medical
logistics company and medical detachment (blood support) for required
external medical logistics support.
Provide emergency Provides emergency and essential dental services and consultation for
and essential dental patients and staff in order treat urgent dental cases or prevent dental
care emergencies.
Perform general and Perform initial surgery for battle and nonbattle injuries and follow-on surgery
specialty surgery for patients received from other medical treatment facilities to include general,
orthopedic, and obstetrics-gynecological surgical services in order to return
patients to duty or stabilize them for further evacuation.
Provide anesthesia Provides anesthesia and respiratory services for the hospital that includes
services respiratory therapy by specifically trained technicians and the ability to provide
mechanical respiratory assistance in intensive care units and the operating
rooms.
Provide pharmacy Operates a fully functioning pharmacy and exercises appropriate control,
support accountability, and distribution of medications and controlled substances to
both inpatients and outpatients as prescribed by medical staff.
Manage nutrition care Provides food service management, meal preparation, modified diet food
preparation, and distribution of foods to patients and staff.
Provide behavioral Provides outpatient psychiatry and inpatient neuropsychiatric consultation and
health services education services. |
4-02 | 141 | Direct Patient Care
Table 10-2. Primary tasks and purposes of theater hospitalization function
Primary task Purpose
Provide patient Admission and disposition of patients, maintaining patient records, security of
administration patient valuables, statistical reporting, patient privacy policies, and
services coordination for patient evacuation out of theater.
Provide consultation Provide specialty medical consultation to Role 1 and 2 medical providers to
support enhance the care given in forward areas, potentially eliminating the need to
evacuate some patients rearward.
HOSPITAL CENTER
10-13. The hospital center is a modular MTF designed to provide Role 3 medical capability in a tailored
organizational structure to support the Army’s varied unified operations missions. The organization was
designed to support the Army’s requirement to conduct a mix of offensive, defensive and stability and support
of civil authorities’ tasks simultaneously in a variety of scenarios. Depending on the mission, supported
population, patient at risks, surgical and medical care providing a surgical and medical organizations. The
hospital center provides essential care within the theater evacuation policy to either return the patient to duty
and/or stabilize the patient for evacuation to a definitive care facility outside the AO. The hospital’s assigned
medical personnel, facilities, equipment, and materials provide the requisite capabilities to render significant
preventive and curative health care. These highly robust services encompass primary inpatient and outpatient
care; emergent care; and enhanced medical, surgical, and ancillary capabilities. The modular design of the
hospital provides the capability to tailor and deploy capabilities as modules or multiple individual capabilities
that provide incrementally increased medical services. The field hospital (32 bed) may be augmented by one
or more medical detachments, hospital augmentation teams, or medical teams designed to enhance the
hospital’s capabilities to provide HSS to the AO.
10-14. The enhanced organizational design replaces the current CSH providing a more agile, deployable,
versatile and medically capable hospital.
10-15. The headquarters and headquarters detachment (HHD), hospital center and field hospital (32 bed)
are the core and lowest denominator of the hospital organization. The field hospital (32 bed) represents the
smallest unit that can provide the complete clinical capabilities of a Role 3 MTF. This hospital is deliberately
designed to be self-supporting while remaining light, highly mobile, and expandable. The HHD, hospital
center and field hospital (32 bed) are designed as the first increment to be deployed in support of an
expeditionary force. The HHD, hospital center and field hospital (32 bed) can be expanded incrementally to
a maximum 240 bed hospitalization capability. The HHD hospital center can command one to two field
hospitals (32 bed) in separate locations without augmentation. Combinations of the modular units within the
hospitalization capability would be suitable to support across the competition continuum and fully integrating
operations with joint, interagency, and multinational partners.
10-16. Increases in overall clinical functions of the hospitalization capability include:
* Computed Tomography services.
* Microbiology laboratory services.
* Critical care physicians, (intensivists), to manage patients in the intensive care unit.
* Internal medicine physicians, (hospitalists), to manage patients in the intermediate care ward.
* Emergency room physician assistants in the triage/pre-operative care and emergency medical
treatment section.
* Psychiatry and inpatient neuropsychiatric consultation services.
* Minimal psychiatry inpatient capabilities.
* Increased capacity of intensive care beds.
* Improvements in versatility and agility.
* Command and communications capability to conduct split base operations indefinitely without
augmentation. |
4-02 | 142 | Chapter 10
* Augmentation detachments with specific clinical specialties can be adapted to better support the
mission.
* The hospitalization capability can be built up or scaled down based on the tactical situation.
10-17. Deployability and adaptability:
* The initial hospital capability is a 100 percent mobile field hospital (32 bed) and is dependent on
the HHD, hospital center for transportation support.
* Each element and hospital augmentation detachment has a separate TOE.
* Each hospital augmentation detachment is designed to expand the capabilities and increase the
capacities of the field hospital (32 bed).
* Commanders can tailor the medical forces to support unified land operations, matching the
anticipated mix of capabilities and medical specialties to the population supported and the clinical
challenges they present.
HOSPITAL CENTER COMPONENTS AND EMPLOYMENT
10-18. This section will be discussing hospital center employment.
HEADQUARTERS AND HEADQUARTERS DETACHMENT, HOSPITAL CENTER
10-19. The HHD, hospital center provides command and control, consultation services, for up to two
functioning, dual-based, field hospitals (32 bed) and requisite augmentation detachments, with a combined
maximum of 240 beds. Medical command and control for hospitalization in more than one location presents
unique HSS support planning requirements. The distance between hospital elements as well as requisite
surgical and bed requirements for each location have a significant impact on the planning and employment
process. Medical planners may want to consider employing two HHD, hospital centers if the operations do
not allow adequate command and control, senior medical consultation, and adequate transportation to
transport the hospital center during deployment or moves.
10-20. The HHD, hospital center is dependent on the field hospital (32 bed) for administrative support,
feeding, unit level maintenance, security, power and classes of supply.
FIELD HOSPITAL (32 BED)
10-21. The field hospital (32 bed) is the corner stone of the deployed hospital. It represents the smallest
hospital element with complete requisite clinical capabilities of a Role 3 MTF. This hospital is deliberately
designed to be self-supporting while remaining light, highly mobile, and expandable. Combinations of the
modular units within the hospitalization capability would be suitable to support peacetime military
engagements, limited intervention, peace operations and irregular warfare.
10-22. Capable of providing complete Role 3 hospitalization under the command and control of the HHD,
hospital center with a 72-hour basic load of medical and nonmedical supplies. Hospitalization for up to 32
patients consisting of one ward providing intensive care nursing for up to twelve patients (ten beds are fully
equipped for patients requiring the most intensive monitoring/care) and one ward providing intermediate care
nursing for up to twenty patients. Provides emergency treatment to receive, triage, and prepare incoming
patients for surgery. Surgical capability consisting of general, orthopedic, obstetrical/gynecological surgery
based on two operating tables staffed for 36 operating table hours per day. Provides pharmacy and clinical
laboratory services to include: limited basic microbiology screening, blood banking, computed tomography
and radiology services. The field hospital (32 bed) provides personnel administration, patient administration,
logistical, nutrition care services, and a hospital ministry team for hospital staff and patients.
10-23. The field hospital (32 bed), as an individual unit, was not designed to perform split based operations
for a sustained period of time. If the capabilities of the field hospital (32 bed) are required in a two locations
then two field hospitals and requisite hospital augmentation detachments will be required to support the
medical plan. |
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HOSPITAL AUGMENTATION DETACHMENTS
10-24. Hospital augmentation detachments that may be attached to the field hospital (32 bed) to increase
its bed, surgical and staffing and medical specialty capabilities. The hospital augmentation detachments
consists of a surgical (24 bed) detachment, medical (32 bed) detachment, and an intermediate care ward (60
bed) detachment.
10-25. The hospital augmentation detachment (surgical 24 bed) augments the field hospital (32 bed) with
thoracic, urology, oral maxillofacial surgical capabilities, 24 additional intensive care beds, outpatient service
and microbiology.
10-26. The hospital augmentation detachment (medical 32 bed) augments the field hospital (32 bed) with
operational dental care, one additional intensive care unit, one intermediate care ward, additional
microbiology capabilities and outpatient services for all classes of patients within the Theater.
10-27. The hospital augmentation detachment (intermediate care ward 60 bed) augments the capabilities of
the hospital center as required with three additional intermediate care wards providing intermediate nursing
care and additional personnel to support nutrition and patient administration capabilities.
HOSPITAL CENTER CONFIGURATIONS
10-28. The hospital center has the capability of being deployed in multiple configurations to provide
requisite care to any military or humanitarian operation. The hospital center has the capability of to perform
split-based operations within an AO. Split-based operation limitations include the 240 maximum number of
beds per hospital center and command and control limitations. The HHD, hospital center has the capability
to provide medical command and control and support for up to a 240 bed hospital center when employed in
one or two locations. Table 10-3 (on page 10-8) depicts the bed types and numbers as well as surgical
capabilities available to per hospital center modules.
10-29. The initial entry piece of the hospital will be the HHD, Hospital Center collocated with one field
hospital (32 Bed). With the addition of a second field hospital (32 Bed) and/or the surgical, medical or
intermediate care ward augmentation detachments as many as 240 beds can be deployed in one or two
locations to support a LSCL.
10-30. The field hospital (32 bed) and augmentation detachments are dependent on transportation support
from the HHD, hospital center and may require additional transportation support based on employment
criteria. Refer to dependencies in section one of this document for support.
10-31. Refer to the Table 10-3 on page 10-8 for examples of hospital center configurations that would
support there completion continuum. Table 10-4 on page 10-9 depicts a sample configuration of the hospital
center designed to support a high surgical and intensive care and intermediate care planning scenario during
combat operations. Table 10-5 on page 10-9 depicts a sample configuration emphasizing a treat and return
capability in support of foreign humanitarian assistance or stability operations.
AUGMENTATION TEAMS
10-32. Theater hospitals may be augmented by one or more medical detachments, hospital augmentation
teams, or medical teams. These may include:
* Medical detachment (minimal care) that is capable of providing minimal/convalescent care,
nursing, and rehabilitative services in support of Role 3 MTF’s.
* Forward surgical team/forward resuscitative surgical teams augment the surgical services of the
hospital with general surgery and orthopedic surgery capabilities when not deployed forward with
medical companies to provide forward resuscitative surgical care and damage control surgery.
* Hospital augmentation team (head and neck) provides special surgical care for ear, nose, and
throat surgery, neurosurgery, and eye surgery to support the hospital, plus specialty consultative
services, as required. |
4-02 | 144 | Chapter 10
Table 10-3. Hospital center and hospital augmentation detachment
bed and surgical hour capabilities
Surgical
Intensive Intermediate Minimal Surgical
Organization hours per 24
care beds care beds care beds tables
hours
Headquarters and
Headquarters Detachment, 0 0 0 0 0
Hospital Center
Field Hospital, (32 Bed) 12 20 0 2 24
Hospital Augmentation
Detachment, (Surgical 24 24 0 0 2 36
bed)
Hospital Augmentation
Detachment, (Medical 32 12 20 0 0 0
bed)
Hospital Augmentation
Detachment, (Intermediate 0 60 0 0 0
Care Ward 60 bed)
* Medical detachment (minimal care) provides minimal and convalescent care, nursing, and
rehabilitative services in support of theater hospitalization.
10-33. All Role 2 MTF’s provide basic clinical laboratory services within the AO. They perform basic
procedures in hematology, urinalysis, microbiology, and serology. Role 2 MTF’s receive, maintain, and
transfuse blood products.
10-34. The clinical laboratory in the hospital center performs procedures in biochemistry, hematology,
urinalysis, microbiology, and serology in support of clinical activities. The hospital center also provides
blood-banking services. For more information regarding Role 3 MTF’s primary tasks clinical laboratory
services, refer to Chapter 9. |
4-02 | 145 | Direct Patient Care
Table 10-4. Example hospital center configuration (maximum 240 beds) in
support of full range military operations
Minimal
Intensive Intermediate Surgical Surgical hours
Hospital units care
care beds care beds tables per 24 hours
beds
Field Hospital, (32 Bed) 12 20 0 2 36
Field Hospital, (32 Bed) 12 20 0 2 36
Hospital Augmentation
Detachment, (Surgical 24
24 0 0 2 36
bed)
Hospital Augmentation
Detachment, (Medical 32
12 20 0 0 0
bed)
Hospital Augmentation
Detachment, (Intermediate 0 60 0 0 0
Care Ward 60 bed)
Hospital Augmentation
Detachment, (Intermediate 0 60 0 0 0
Care Ward 60 bed)
TOTALS 60 180 0 6 108
Table 10-5. Example hospital center configuration (maximum 240 beds) in support
of foreign humanitarian assistance or stability operations
Intensive Intermediate Minimal Surgical Surgical hours
Hospital units
care beds care beds care beds tables per 24 hours
Field Hospital, (32 Bed) 12 20 0 2 36
Hospital Augmentation
Detachment, (Surgical 24
24 0 0 2 36
bed)
Hospital Augmentation
Detachment, (Medical 32 12 20 0 0 0
bed)
Hospital Augmentation
Detachment, Minimal Care 0 0 120 0 0
TOTALS 48 40 120 4 72 |
4-02 | 147 | Chapter 11
Medical Evacuation
Medical evacuation encompasses both the evacuation of Soldiers from the POI or
wounding to an MTF staffed and equipped to provide essential care in the AO and
further evacuation from the AO to provide definitive, rehabilitative, and convalescent
care in CONUS.
SECTION I — INTEGRATED MEDICAL EVACUATION SYSTEM
11-1. Medical evacuation is the system which provides the vital linkage between the roles of care necessary
to sustain the patient during transport. This is accomplished by providing en route medical care and
emergency medical intervention, if required, which enhances the individual’s prognosis and reduces long-
term disability.
11-2. Army MEDEVAC is a multifaceted mission accomplished by a combination of dedicated ground and
air evacuation platforms synchronized to provide direct support, general support, and area support within the
AO. At the operational level, organic or direct support MEDEVAC resources locate, acquire, treat, and
evacuate Soldiers from the POI or wounding to an appropriate MTF. Soldiers are then stabilized, prioritized,
and prepared for further evacuation, if required, to an MTF capable of providing required essential care within
the AO. Essential care refers to the absolutely necessary initial, en route, resuscitative, and surgical
care provided to save, stabilize, and return as many Soldiers to duty as quickly as possible. Essential
care is medical care provided by medical providers at all roles of care that focuses on saving life, limb, and
eyesight, and returning as many Soldiers to duty as quickly as possible within the theater evacuation policy
or begin initial treatment required for optimization of outcome and/or stabilization to ensure the patient can
endure evacuation.
11-3. The mission of Army MEDEVAC assets is the evacuation and provision of en route medical care,
however, the essential and vital functions of MEDEVAC resources encompass many additional missions and
tasks that support the AHS. Medical evacuation resources/assets are used to transfer patients between MTFs
within the AO and from MTFs to USAF en route patient staging system; emergency movement of Class VIII,
blood and blood products, medical personnel and equipment; and serve as messengers in medical channels.
11-4. The appropriate roles of medical care must be maintained throughout the continuum of care. A patient
who has received complex care such as damage control resuscitation or damage control surgery requires
continuous maintenance of the critical care support that was initiated at the forward MTF. To avoid the risk
that these patients will deteriorate during transport, the level of care should not be decremented during en
route care. Based on the appropriate level of care, the medical personnel providing en route care may be
paramedics, nurses, or other properly trained medical specialists. When possible, this en route care should
be used as far forward as mission, enemy, terrain and weather, troops and support available, time available,
and civil considerations allows.
THEATER EVACUATION POLICY
11-5. The theater evacuation policy is established by the Secretary of Defense, with the advice of the Joint
Chiefs of Staff, and upon the recommendation of the CCDR. Theater evacuation policy is a command
decision indicating the length in days of the maximum period of non-effectiveness that patients may be held
within the command for treatment, and the medical determination of patients that cannot return to duty status
within the period prescribed requiring evacuation by the first available means, provided the travel involved
will not aggravate their disabilities or medical condition. (ATP 4-02.2). |
4-02 | 148 | Chapter 11
11-6. The medical commander may recommend changes in the theater evacuation policy to adjust patient
flow within the deployed setting to include skip policy and surge capacity when necessary. The policy
establishes, in number of days, the maximum period of noneffectiveness (hospitalization and convalescence)
that patients may be held within the theater for treatment. This policy does not mean that a patient is held in
the theater for the entire period of noneffectiveness. A patient who is not expected to be ready to return to
duty within the number of days established by the theater evacuation policy is treated, stabilized, and then
evacuated out of the theater. This is done providing that the treating physician determines that such
evacuation will not aggravate the patient’s disabilities or medical condition. For example, a theater
evacuation policy of seven days does not mean that a patient is held in the theater for seven days and then
evacuated. Instead, it means that a patient is evacuated as soon as possible after the determination is made
that he cannot be returned to duty within seven days following admission to a Role 3 MTF.
EVACUATION PRECEDENCE
11-7. The initial decision for evacuation priorities is made by the treatment element or the senior nonmedical
person at the scene. Soldiers are evacuated by the most expeditious means of MEDEVAC based on their
medical condition, assigned evacuation precedence, and availability of MEDEVAC platforms. Patients are
evacuated from the POI or wounding to the appropriate MTF. The evacuation precedence for the Army
operations at Roles 1 through 3 are:
* Priority I, URGENT is assigned to emergency cases that should be evacuated as soon as possible
and within a maximum of one hour to save life, limb, or eyesight and to prevent complications of
serious illness and to avoid permanent disability.
* Priority IA, URGENT-SURG is assigned to patients that should be evacuated as soon as possible
and within a maximum of one hour who must receive far forward surgical intervention to save
life, limb, or eyesight and stabilize for further evacuation.
* Priority II, PRIORITY is assigned to sick and wounded personnel requiring prompt medical care.
This precedence is used when the individual should be evacuated within four hours or if the
personnel’s medical condition could deteriorate to such a degree that this person will become an
URGENT precedence, or whose requirements for special treatment are not available locally, or
who will suffer unnecessary pain or disability.
* Priority III, ROUTINE is assigned to sick and wounded personnel requiring evacuation but whose
condition is not expected to deteriorate significantly. The sick and wounded in this category
should be evacuated within 24 hours.
* Priority IV, CONVENIENCE is assigned to patients for whom evacuation by medical vehicle is
a matter of medical convenience rather than necessity.
Note 1. The NATO STANAG 3204 has deleted the category of Priority IV, CONVENIENCE.
However, this category is still included in the U.S. Army evacuation priorities as there is a
requirement for it in an OE.
Note 2. The Army has implemented the AE standard of a one-hour mission completion time for
urgent and urgent surgical missions (time from mission request to delivery of the patient to the
appropriate medical care). If appropriate medical care for urgent and urgent surgical missions can
be reached within the one-hour standard by other transportation conveyances, the one-hour
evacuation standard is met.
RESPONSIBILITIES
11-8. The Service component commander is responsible for evacuation at the operational level and is
responsible for executing the evacuation of casualties. The Army is the only Service with dedicated
MEDEVAC assets and is specifically tasked by DOD to provide intratheater AE. Strategic AE is the
responsibility of the U.S. Transportation Command. |
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11-9. Within Army support to other Services, Army resources may provide ship-to-shore MEDEVAC on an
area support basis. Medical evacuation from shore-to-ship for deployed USN and United States Marine
Corps, as well as direct and general support to United States Marine Corps forces (when tactically operating
on land as a maneuver force) forces could also be available within the Army’s support capabilities.
ORGANIZATIONS
11-10. There are two types of United States Army MEDEVAC platforms- air (rotary-wing) and ground.
These platforms are dedicated and designed, equipped, and staffed to perform the MEDEVAC mission.
MANEUVER BATTALION MEDICAL PLATOON
11-11. The organic medical platoon ground ambulances provide MEDEVAC support from the POI,
company aid post, or casualty collection point to the battalion aid station. A casualty collection point is a
location that may or may not be staffed, where casualties are assembled for evacuation to a medical treatment
facility. (ATP 4-02.2). It is usually predesignated. In armored BCTs depending upon the mission, enemy,
terrain and weather, troops and support available, time available, and civil considerations factors and the
MEDEVAC plan, the tracked ambulances may evacuate the patient to an ambulance exchange point and
transfer the patient to a wheeled ambulance for further movement to an MTF. This enables the tracked
ambulance to keep pace with the maneuvering force.
GROUND AMBULANCES
11-12. Ground ambulances are organic to BCT maneuver battalion medical platoons and to both the medical
company (brigade support) and the medical company (area support). In the maneuver battalion medical
platoons, the actual vehicle platform (wheeled or tracked) varies with the type of parent unit. Both the brigade
support medical company and the medical company (area support) have wheeled vehicles.
Brigade Support and/or Area Support Medical Company Evacuation Platoon
11-13. The medical company (brigade support) evacuation platoon provides MEDEVAC support on an area
basis to units within its assigned AO. Additionally, it provides direct support to evacuate patients from the
supported battalion aid stations to the medical company Role 2 MTF.
11-14. The medical company (area support) provides supported EAB units with MEDEVAC support on an
area basis for those units that do not have organic MEDEVAC resources.
Medical Company (Ground Ambulance)
11-15. The mission of the medical company (ground ambulance) is to provide ground evacuation within
the theater. This unit provides direct support to BCTs and is employed in the EAB to provide area support.
It is tactically located where it can best control its assets and execute its patient evacuation mission. This
unit has a single-lift capability for evacuation of 96 litter patients or 192 ambulatory patients.
AIR AMBULANCES
11-16. The medical company (air ambulance) provides MEDEVAC for all categories of patients with
evacuation precedence and other considerations within the AO on an area and direct support basis. The single
lift evacuation capacity varies among the three different air ambulance companies. See ATP 4-02.2 Medical
Evacuation, for more information. |
4-02 | 150 | Chapter 11
PRIMARY TASKS
11-17. Table 11-1 discusses the primary tasks and purposes of the MEDEVAC function.
Table 11-1. Primary tasks and purposes of the medical evacuation function
Primary task Purpose
Provide a rapid response to acquire wounded, injured, and ill
personnel. Clear the battlefield of casualties and facilitate and
Acquire and locate enhance the tactical commander’s freedom of movement and
maneuver. This task is performed by the medical evacuation crew
of the evacuation platform.
Maintain or improve the patient’s medical condition during transport
Treat and Stabilize and provide en route care as required. This task is performed by
medical evacuation crewmembers and providers when necessary.
Provide rapid evacuation utilizing dedicated assets to the most
appropriate role of care. Provide a capability to cross-level patients
within the theater hospitals and to transport patients being
Provide intra-Theater Medical
evacuated out of theater to staging facility prior to departure. This
Evacuation
task is performed by the evacuation platforms in the medical
company (ground ambulance) and medical company (air
ambulance).
Provide emergency movement of Provide a rapid response for the emergency movement of scarce
medical personnel, equipment, medical resources throughout an operational environment.
and supplies
11-18. For additional information on MEDEVAC and medical regulating, refer to JP 4-02, AR 40-3 and
ATP 4-02.2.
SECTION II — MEDICAL REGULATING
11-19. Medical regulating refers to the actions and coordination necessary to arrange for the movement of
patients through the roles of care and to match patients with a medical treatment facility that has the necessary
health service support capabilities and available bed space. (JP 4-02). This system is designed to ensure the
efficient and safe movement of patients.
11-20. Medical regulating entails identifying the patients awaiting evacuation, locating the available beds,
and coordinating the transportation means for movement. Careful control of patient evacuation to appropriate
hospitals is necessary to—
* Effect an even distribution of cases.
* Ensure adequate beds are available for current and anticipated needs.
* Route patients requiring specialized treatment to the appropriate MTF.
11-21. The factors that influence the scheduling of patient movement include:
* Patient’s medical condition (stabilized to withstand evacuation).
* Operational situation.
* Availability of evacuation means.
* Locations of MTFs with special capabilities or resources.
* Current bed status of MTFs.
* Surgical backlogs.
* Number and location of patients by diagnostic category.
* Location of airfields, seaports, and other transportation hubs.
* Communications capabilities (to include radio silence procedures).
11-22. For more information on medical regulating, refer to ATP 4-02.2. |
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SECTION III — STRATEGIC MEDICAL EVACUATION AND PATIENT
MOVEMENT
11-23. Medical evacuation occurs at the tactical, operational, and strategic levels and requires the
synchronization and integration of Service component MEDEVAC resources and procedures with the DOD
worldwide evacuation system operated by the U.S. Transportation Command.
11-24. A comprehensive MEDEVAC plan is essential to ensure effective, efficient, and responsive
MEDEVAC is provided to all wounded, injured, and ill Soldiers in the AO. The Army MEDEVAC plan
flows from the CCDRs guidance and intent and incorporates all missions and tasks directed by the CCDR to
be accomplished and is synchronized with supporting and supported units. In some scenarios, Army air and
ground evacuation resources may be directed to provide support to sister Services, multinational partners,
and host-nation forces.
11-25. When directed by the CCDR, Army MEDEVAC assets may be tasked to support other than Army
forces engaged in the execution of the joint mission. These additional support missions will be clearly
articulated in the CCDRs OPLAN and OPORD. The theater army surgeon, with the advice of the senior
MEDEVAC planner, will coordinate and synchronize these support operations with the combatant command
surgeon, joint task force surgeon, and the other Services and/or multinational partners as required ensuring
that a comprehensive and effective, efficient, and responsive plan is developed and implemented. |
4-02 | 153 | Chapter 12
Medical Logistics
The Army’s MEDLOG system (including blood management) is an integral part of the
AHS in that it provides intensive management of medical products and services that
are used almost exclusively by the AHS and are critical to its success. Also key to this
success is the delivery of a MEDLOG capability that anticipates the needs of the
customer and is tailored to continuously provide end-to-end sustainment of the AHS
mission throughout the competition continuum. Providing timely and effective AHS
support is a team effort which integrates the clinical and operational aspects of the
mission. This chapter provides an overview of the medical logistics function. Refer
to ATP 4-02.1 for a more detailed description of the Army MEDLOG system.
SECTION I — MEDICAL LOGISTICS MANAGEMENT IN AN OPERATIONAL
ENVIRONMENT
12-1. The MEDLOG system encompasses planning and executing all Class VIII supply support operations
to include management of the following functions: medical materiel (Class VIIIA), medical equipment
maintenance and repair, patient movement items, medical gases, blood (Class VIIIB) storage and distribution,
regulated medical waste (including hazardous material), health facilities planning and management, and
medical contracting.
SECTION II — MEDICAL LOGISTICS SYSTEM
12-2. The theater MEDLOG system consists of the following organizations:
* Medical logistics management center.
* Medical Logistics Company.
* Medical detachment (blood support).
* Medical team (optometry).
* Medical command and control headquarters (to include the MEDCOM [DS], MEDBDE [SPT],
and MMB).
MEDICAL LOGISTICS MANAGEMENT CENTER
12-3. The MEDLOG management center provides theater-level centralized management of critical Class
VIII commodities, patient movement items, medical contracting support, and medical equipment
maintenance in accordance with the theater surgeon’s policy. The MEDLOG management center provides
two forward support teams (early entry) and two forward support teams (follow-on). The MEDLOG
management center is capable of deploying these teams, while maintaining base operations in CONUS. One
forward support team (early entry) and one forward support team (follow-on) combine to make one complete
forward support team. The forward support teams (follow-on) are not meant to deploy independently of the
forward support team (early entry). One team is deployed per theater. When deployed, the forward support
team is subordinate to the MEDCOM (DS) or senior medical headquarters (such as the MEDBDE [SPT])
and collocates with the distribution management center of the TSC/ESC. When so designated, the MEDLOG
management center, with the MEDLOG Company, serves as the single integrated MEDLOG manager for
joint operations. The MEDLOG management center also provides technical guidance to medical contracting
personnel within the AO. |
4-02 | 154 | Chapter 12
MEDICAL LOGISTICS COMPANY
12-4. The MEDLOG company provides medical materiel, field and limited sustainment medical equipment
maintenance and repair, optical lens fabrication and repair, and patient movement items support to BCTs and
EAB AHS units operating within the AO. One MEDLOG company is deployed per 13 short tons of Class
VIII supplies per day and provides 220 hours of field-level maintenance per day. The MEDLOG Company
can deploy one early entry team, three contact repair teams, and three forward distribution teams. The
MEDLOG Company has no organic blood support capability. The MEDLOG Company has the capability
for limited self-sustainment during initial operations, meeting the requirement for early entry into the AO or
as part of a task force organization. The company is normally under the command of the headquarters and
headquarters detachment, MMB.
MEDICAL DETACHMENT (BLOOD SUPPORT)
12-5. The medical detachment (blood support) provides collection, manufacturing, storage, and distribution
of blood and blood products for brigade and EAB AHS units and other Services as required. The detachment
receives and stores up to 5,100 refrigerated and/or frozen blood products from CONUS or other U.S. MTFs
and further distributes these products to supported MTFs and AHS units. This unit also coordinates the
movement of blood and blood products and tracks shipments to ensure proper delivery. The detachment is
assigned to the MMB.
MEDICAL DETACHMENT OPTOMETRY
12-6. The medical detachment (optometry) provides optometry care and optical fabrication and repair
support for brigade and EAB units on an area basis. The detachment consists of six personnel that can be
divided into two teams. Each team is capable of providing optometry support to include routine eye
examinations, refractions, optical fabrication, frame assembly, and repair services. The optometry
detachment is assigned to the MEDCOM (DS) or MEDBDE (SPT) with further attachment to an MMB or
BCT.
PRIMARY TASKS
12-7. Table 12-1 (on page 12-3) describes the primary tasks and purposes of the medical logistics function.
12-8. Refer to JP 4-02, TM 4-02.70, TM 8-227-3, TM 8-227-11, TM 8-227-12, and ATP 4-02.1.
SECTION III — STRATEGIC MEDICAL LOGISTICS SUPPORT
12-9. Strategic logistics functions are performed in CONUS and within each within each of the combatant
commands. Medical logistics activities at the strategic level include:
* Determination of materiel requirements.
* Acquisition, assembly, and fielding of medical supplies and equipment.
* Management of strategic programs for medical force modernization and materiel readiness.
12-10. Strategic medical logistics capabilities also include planning and executing the release or acquisition
of Class VIII materiel to complete the outfitting of medical units at the time of deployment and coordination
for movement into the theater and staging areas. Strategic medical logistics support is provided by a number
of organization to include the Defense Logistics Agency, U.S. Army medical Research and Development
Command, and Army Materiel Command. These organizations use multiple sources for support to operating
force to include: commercial supplier networks Defense Logistics Agency stocks, Army pre-positioned
stocks, operational project stocks, and other materiel readiness programs as well as the following: |
4-02 | 155 | Medical Logistics
Table 12-1. Primary tasks and purposes of the medical logistics function
Primary task Purpose
Program funding, develop, acquire, and field the most cost-effective
and efficient medical materiel support to satisfy materiel
Execute medical materiel requirements generated by doctrinal and organizational revisions to
procurement tables of organization and equipment, as well as user-generated
requirements, state-of-the-art advancements, and initiatives to
enhance materiel readiness.
Provide intensive management and coordinated distribution of
Conduct Class VIII management specialized medical products and services required to operate an
and coordinate distribution integrated Army Health System anywhere in the world in peace and
throughout the competition continuum.
Perform appropriate maintenance checks, services, repairs, and
Perform medical equipment tests on medical equipment set component equipment items as
maintenance and repair specified in applicable technical manuals or manufacturer operating
instructions.
Fabricate and repair prescription eyewear that includes spectacles,
Conduct optical fabrication and protective mask inserts, and similar ocular devices for eligible
repair personnel in accordance with applicable Army policies and
regulations.
Provide collection, manufacturing, storage, and distribution of blood
and blood products to echelons above brigade Army Health System
Provide blood management (and
units. Provide coordination for distribution of blood and blood
coordination for distribution)
products to Role 2 medical treatment facilities and forward surgical
teams.
Support in-transit patients, exchange in-kind patient movement
Perform centralized management items without degrading medical capabilities, and provide prompt
of patient movement items recycling of patient movement items from initial movement to the
patient’s final destination.
Provide a reliable inventory of facilities that meet specific codes and
Conduct health facilities planning standards, maintains accreditation, and affords the best possible
and management health care environment for the Soldiers, Family members, and
retired beneficiaries.
Provide medical contracting Ensure the establishment and monitoring of contracts for critical
support medical items and services.
Ensure the proper collection, control, transportation, and disposal of
Ensure hazardous medical waste
regulated medical waste in accordance with applicable Army and
management and disposal
host-nation policies and regulations.
Ensure the production, receipt, storage, use, inspection,
Ensure production and distribution
transportation, and handling of medical gases and their cylinders in
of medical gases
accordance with all applicable regulations.
* The Defense Logistics Agency, as the DOD executive agent for medical materiel, coordinates
medical prime vendor and other strategic acquisition programs to enable operational and strategic
level MEDLOG organizations to order and receive materiel directly from commercial suppliers.
The Defense Logistics Agency also coordinates these programs with the United States
Transportation Command to enable direct delivery to Army medical materiel centers in theater
without intermediate government inventory or handling.
* The U.S. Army Medical Research and Development Command is the Army’s medical materiel
developer, with responsibility for medical research, development, and acquisition. The U.S. Army
Medical Research and Development Command manages and executes research in military
infectious diseases, combat casualty care, military operational medicine, chemical biological
defense, and clinical and rehabilitative medicine. The command’s product line includes vaccines,
pharmaceuticals, medical devices, medical equipment, and information technology. They work |
4-02 | 156 | Chapter 12
closely with Army Materiel Command’s Army Medical Logistics Command to ensure timely
procurement and fielding of lifesaving products to the deployed force.
* The U. S. Army Materiel Command is the Army’s materiel integrator providing national-level
sustainment, acquisition integration support, contracting support, and selected logistics support to
Army forces. Army Materiel Command provides related common support to other Services,
multinational, and interagency partners. Army Materiel Command’s capabilities are diverse and
are accomplished through its various major subordinate commands which include the Army
Medical Logistics Command for strategic-level medical logistics support. Refer to FM 4-0 for
additional information.
12-11. The U.S. Army Medical Logistics Command is the life cycle management command for MEDLOG.
The Army Medical Logistics Command manages and sustains medical programs for operational forces in the
Total Army and delivers/fields medical solutions (on behalf of the Army Medical Program Executive Office).
The command manages strategic-level medical materiel and logistics services required to generate and deploy
ready medical forces and sustain Army and Joint health services. The Army Medical Logistics Command’s
core competencies include management of medical supply (Class VIIIA), MEDLOG operations that include
theater-level medical logistics support, medical equipment maintenance and recapitalization, optical
fabrication, and the Army’s globally employed centralized medical materiel readiness programs. The Army
Medical Logistics Command’s subordinate organizations include the:
* U.S. Army Medical Materiel Agency
* U.S. Army Medical Materiel Center-Europe
* U.S. Army Medical Materiel Center-Korea
12-12. The U.S. Army Medical Materiel Agency’s mission is to develop, tailor, deliver and sustain medical
materiel capabilities and provide worldwide operational MEDLOG support. The Agency has a wide range
of strategic roles including materiel fielding, centrally managed MEDLOG programs, Army supply
cataloging and set assembly, and medical equipment maintenance and repair. The U.S. Army Medical
Materiel Agency has two deployable teams: the MEDLOG Support Team and the Forward Repair Activity-
Medical Team.
* The MEDLOG support team is a deployable table of distribution and allowances organization
consisting of MEDLOG personnel military, DA Civilians, and contractors. The mission of the
MEDLOG support team is to deploy to designated locations worldwide, to provide medical
materiel and medical equipment maintenance capabilities and solutions in support of Army
strategic and contingency programs. Upon initial deployment for hand-off of Army Pre-positioned
Stock, the MEDLOG support team is normally under the operational control of the United States
Army Materiel Command’s Army field support brigade. The primary role of the MEDLOG
support team is the issue of medical Army pre-positioned stocks, unit sets, and sustainment stocks
pre-positioned around the world. After completing the Army Pre-positioned Stocks transfer or
other assigned mission, the MEDLOG support team redeploys to CONUS. Refer to ATP 4-02.1
for additional information.
* The Forward Repair Activity-Medical Team provides sustainment-level medical equipment
maintenance support and technical expertise to deployed medical units in theater. The team is
operated as a deployable section with the U.S. Army Medical Materiel Agency depot-level
maintenance activities to extend sustainment maintenance capabilities to augment theater
intermediate-level organizations as required. The members of the Forward Repair Activity-
Medical Team are technical experts in one of five commodities including laboratory equipment,
pulmonary, oxygen generation, anesthesia equipment, or medical imaging systems. The team may
deploy as part of the MEDLOG support team for issue of medical Army Pre-positioned Stock.
Upon completion of the Army Pre-positioned Stock transfer, the team may redeploy to CONUS
or remain to augment theater medical equipment maintenance capabilities under the operational
control of the theater medical materiel center.
12-13. The U.S. Army Medical Materiel Center-Europe provides and projects MEDLOG support across
the competition continuum to the U.S. European Command, U.S. Central Command, U.S. Africa Command,
and the U.S. Department of State. |
4-02 | 157 | Medical Logistics
12-14. The U.S. Army Medical Materiel Center-Korea serves as U.S. Forces Korea’s theater lead agent for
medical materiel and is responsible for ensuring that tactical units are integrated into the medical supply
chain. The Medical Materiel Center also assists the CCDR in MEDLOG support planning and contributes
to the Eighth Army’s medical readiness by managing and fielding countermeasures used to protect and treat
Soldiers in the event of a CBRN attack.
SECTION IV — MEDICAL LOGISTICS SUPPORT FOR ROLES 1 AND 2
MEDICAL TREATMENT FACILITIES
12-15. The Class VIII supply functions for AHS units/elements operating Roles 1 and 2 MTFs are primarily
the management of medical equipment sets, basic ordering for replenishment, and field-level medical
equipment maintenance and repair support. Within the BCT, these functions are performed by the brigade
medical supply office of the brigade support medical company and the MEDLOG Company operating at
echelons above brigade. Refer to ATP 4-02.1 for information on MEDLOG.
SECTION V — MEDICAL LOGISTICS SUPPORT FOR ROLE 3 MEDICAL
TREATMENT FACILITIES
12-16. Theater hospitalization is provided by Army Role 3 CSHs and hospital centers operating at EAB.
Class VIII support for Role 3 MTFs is a vital part of its mission and includes management of a commodity
that must be adapted to specific theater health care requirements distribution plans and capabilities provided
by sustainment organizations.
12-17. During port operations and reception, staging, onward movement, and integration these AHS units
must be capable of operations immediately upon initial entry of forces. Therefore, MEDLOG support must
be included in planning for port opening and early entry operations. Port operations may also include the
issue of AHS unit sets from Army Pre-positioned Stocks as well as integration of potency and dated items,
refrigerated, and controlled substances. In almost every operation, lessons learned reflect that theater
MEDLOG units must also provide Class VIII materiel for unit shortages that were not filled prior to unit
deployment.
12-18. Class VIII sustainment of CSHs and hospital centers present the most complex medical materiel
requirements and may consume materiel at a tremendous rate when providing trauma care in support of
operations. Specialty care for burn injuries, orthopedic injuries and surgeries, and neurosurgery often require
materiel and equipment that is not standard and may not have been anticipated or stocked in sufficient
quantities prior to deployment. Combat support hospitals are typically made direct customers of a MEDLOG
company/element that is capable of meeting the unit’s mission requirements.
12-19. Theater hospitalization is provided by CSHs and hospital centers that operate Role 3 MTFs. Army
CSHs and hospital centers are located at EAB. Role 3 MTF and forward surgical teams/forward resuscitative
surgical detachments deployed from the CSH or hospital center are dependent on their supporting MEDLOG
Company for Class VIII resupply and medical equipment maintenance and repair, and the medical
detachment (blood support) for distribution of blood and blood products.
SECTION VI — MEDICAL LOGISTICS SUPPORT TO JOINT HEALTH
SERVICES
12-20. Theater lead agent for medical materiel is an organization or unit designated to serve as a major
theater medical distribution node and provide the customer support interface for MEDLOG and supply chain
management. The designation of a Service organization to serve as the theater lead agent for medical material
(TLAMM) is a critical element of the Defense Logistics Agency’s implementation of the Executive Agent
for Medical Materiel. A TLAMM operates in the DOD medical supply chain using business processes and
systems developed and standardized by the Defense Logistics Agency and Military Health System to promote
effectiveness and efficiency. According to DODI 5101.15, the Defense Logistics Agency Director, in
coordination with the CCDR, Chairman of the Joint Chiefs of Staff, and the Secretaries of the Military |
4-02 | 158 | Chapter 12
Departments, recommend the designation of a TLAMM as necessary to ensure effective and efficient medical
supply chain support to the CCDR. Once designated, the unit serving as the TLAMM remains within the
chain of command of their parent organization (such as the parent combatant command, DOD component,
or other headquarters element). As designated TLAMMs, the Army’s theater medical materiel centers use
DOD standard business processes and systems to provide theater-level Class VIIIA supply support to joint
forces operating in their supported area of responsibility.
12-21. Title 10, United States Code requires that each Service provide its own logistics support, which
makes MEDLOG support a Service responsibility. However, in joint operations, a CCDR may assign
specific common user logistics functions, to include both planning and execution, to a lead Service. The
Army is typically the predominant provider of forces in unified land operations and owns the preponderance
of MEDLOG capability. Therefore, CCDRs often assign the ASCC (or Army component of a joint task
force) responsibility to plan and execute MEDLOG support to all Services and multinational partners (when
directed) operating in the theater. This function is known as SIMLM support. When assigning SIMLM
responsibility, the CCDR specifies the scope and duration of MEDLOG support to be provided (such as
medical supply, medical equipment maintenance, or optical fabrication). The performance of SIMLM
responsibilities requires close coordination with the ASCC surgeon, MEDCOM (DS), and medical elements
of the supported Services to ensure mutual understanding of requirements, expectations, and processes for
MEDLOG support. Refer to ATP 4-02.1 and JP 4-02 for additional information. |
4-02 | 159 | Appendix A
Army Health System Support to the Army’s Strategic Roles
The Army's primary mission is to organize, train, and equip its forces to conduct
prompt and sustained land combat to defeat enemy ground forces and seize, occupy,
and defend land areas. The Army accomplishes its mission by supporting the joint
force in four strategic roles: shape OEs, prevent conflict, conduct large-scale ground
combat operations, and consolidate gains. For more information on the Army’s
strategic roles, refer to FM 3-0.
SHAPE OPERATIONAL ENVIRONMENTS
A-1. Shaping activities are continuous within an area of responsibility. The CCDR (command authority)
uses them to improve security within partner nations, enhance international legitimacy, gain multinational
cooperation, and influence adversary decision making. This cooperation includes information exchange and
intelligence sharing, obtaining access for U.S. forces in peacetime and crisis, and mitigating conditions that
could lead to a crisis.
A-2. Army forces conduct operations to shape OEs with various unified action partners through careful
coordination and synchronization facilitated by the theater army through the GCC, and when authorized,
directly with the partner nation's military forces. Army forces provide security cooperation capabilities area
of responsibility-wide, including building defense and security relationships and partner military capacity
through exercises and engagements, gaining or maintaining access to populations, supporting infrastructure
through assistance visits, and fulfilling EA responsibilities. Military-to-military contacts and exchanges,
joint and combined exercises, various long-term persistent military engagements, and other security
cooperation activities provide the foundation of the GCC's theater campaign plan. Key medical
considerations in support of operations to shape include:
* Regionally focused medical command and control to promote unity of purpose of all engaged
medical assets.
* Medical information management to document health threat exposures and medical encounters,
to report health surveillance data and information on the health of the command, and to accomplish
medical regulating and patient tracking operations.
* Traditional medical support to a deployed force engaged in performing these tasks.
* Medical expertise and consultation to enhance building partnership capacity in public, private, and
military health sectors of the host nation.
* Development of regional theater security cooperation plans aimed at mitigating or resolving the
underlying causes of health issues prevalent within the region.
* Army Health System support for maintenance and execution of medical support agreements.
* Home station medical readiness and training activities, and tailored force generation of medical
combat power.
* Army medical support to other Services and unified action partners, as well as assessment and
release of theater Army prepositioned stocks and other medical logistics support.
* Capability gaps and determine mitigation plan.
* Theater evacuation policy adjustments.
* Coordination with USTRANSCOM for patient movement plans.
* Integration and interoperability of theater medical capabilities.
* Army Health System support to foreign humanitarian assistance and disaster relief.
* Medical preparation of the OE. |
4-02 | 160 | Appendix A
A-3. See Figure A-1 for an example depiction of AHS support during operations to shape.
Figure A-1. Army Health System support during operations to shape
PREVENT CONFLICT
A-4. The intent of operations to prevent is to deter adversary actions and stop further deterioration of a
particular situation. Prevent activities enable the joint force to gain positions of relative advantage prior to
future combat operations. Operations to prevent are characterized by actions to protect friendly forces and
indicate the intent to execute subsequent phases of a planned operation. With the shift from shaping to
deterrence, the theater army shifts to refining contingency plans and preparing estimates for land power based
on GCC's guidance. The theater army and subordinate Army forces perform the following major activities
during operations to prevent:
* Execute flexible deterrent options and flexible response options.
* Set the theater.
* Tailor Army forces.
* Project the force.
A-5. The AHS support during operations to prevent includes coordination, integration, and synchronization
of strategic medical capabilities from the U.S. sustaining base, global health engagements, establishment and
maintenance of medical support agreements, as well as the following:
* Executing AHS support to other Services when directed.
* Recommending theater evacuation policy adjustments.
* Providing theater food protection support.
* Coordinating with USTRANSCOM for patient movement plans.
* Ensuring integration and interoperability of theater medical capabilities.
* Conducting medical preparation of the OE. |
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* Maximizing use of host-nation medical capabilities.
* Establishing and executing OEH surveillance programs and countermeasures.
* Coordinating with the National Center for Medical Intelligence, Centers for Disease Control and
Prevention, and other strategic partners for identification and mitigation of regional health threats.
* Planning and coordination for AHS support to—
Noncombatant evacuation operations.
Detainee operations.
Reception, staging, onward movement, and integration, and theater opening.
Large-scale casualty events and prolonged care.
Other Services.
A-6. See Figure A-2 for an example depiction of AHS support during operations to prevent.
Figure A-2. Army Health System support during operations to prevent
CONDUCT LARGE SCALE GROUND COMBAT OPERATIONS
A-7. During large-scale ground combat operations, Army forces defeat the enemy. Defeat of enemy forces
in close-combat operations is normally required to achieve campaign objectives and national strategic goals
after the commencement of hostilities. Planning for sequels to consolidate gains at higher levels should be
informed by combat operations and vice versa. However, the demands of large-scale ground combat
operations consume all available staff capability at the tactical level.
A-8. In large-scale ground combat operations against a peer threat, commanders conduct decisive action to
seize, retain, and exploit the initiative. This involves the orchestration of many simultaneous unit actions in
the most demanding of operational environments. Large-scale ground combat operations introduce levels of
complexity, lethality, ambiguity, and speed to military activities not common in other operations. Large- |
4-02 | 162 | Appendix A
scale ground combat operations require the execution of multiple tasks synchronized and converged across
multiple domains to create opportunities to destroy, dislocate, disintegrate, and isolate enemy forces.
A-9. Army forces defeat enemy organizations, control terrain, protect populations, and preserve joint force
and unified action partner freedom of movement and action in the land and other domains. Commanders are
directly concerned with those enemy forces and capabilities that can affect their current and future operations.
Medical command and control gives subordinate medical units at all echelons the freedom to provide a rapid
response to acquire wounded, injured, and ill personnel clearing the battlefield of casualties and facilitating
and enhancing the tactical commander's freedom of movement and maneuver.
A-10. Large-scale ground combat operations place a significant burden on medical resources due to the
magnitude and lethality of the forces involved. Medical units must anticipate large numbers of casualties in
a short period of time due to the capabilities of modern conventional weapons and the possible employment
of weapons of mass destruction. These mass casualty situations can rapidly exceed the capabilities of medical
assets. Careful planning and coordination is necessary to minimize the extent to which medical capabilities
are overwhelmed. Casualty evacuation must occur concurrently with operations. Units that cease aggressive
maneuver to evacuate casualties while in enemy contact are likely to both suffer additional casualties while
stationary and fail their mission. Effective management of mass casualty situations depends on established
and rehearsed unit-level mass casualty plans. There are a number of other variables which can ensure the
success of a unit's mass casualty response. These include, but are not limited to:
* Coordination of additional medical support and augmentation of- medical evacuation support,
forward resuscitative and surgical detachments, combat support and field hospitals, casualty
collection points, ambulance exchange points, and established Class VIII resupply.
* Rapid clearance of casualties from the battlefield (independent of MEDEVAC).
* Providing effective tactical combat casualty care for the injured.
* Continuous flow of casualties to the MTFs at the next higher role of care.
* Use of alternative assets when the number of casualties overwhelms the capacity of available
medical evacuation systems.
A-11. The AHS support during large-scale ground combat operations include but not limited to:
* Provide organic Roles 1 and 2 medical treatment and on an area basis.
* Provide Role 3 medical treatment.
* Medical evacuation and/or CASEVAC from POI to MTF.
* Intra/Intertheater patient movement (between medical treatment facilities).
* Provide forward resuscitative surgery to stabilize nontransportable patients for evacuation out of
theater.
* Emergency movement of Class VIII (to include blood), medical personnel, and medical
equipment.
* Coordinate medical evacuation plan with the combat aviation brigade for air ambulance support.
* Coordinate with United States Air Force for strategic aeromedical evacuation and medical
regulating.
* Manage patient movement items.
* Conduct medical and OEH surveillance.
* Conduct health risk assessment and communications.
* Provide veterinary medical treatment for MWDs and government-owned animals.
* Force rotation (reception, staging, onward movement, and integration).
* Sustainment of AHS support operations (possible nontraditional sources of support from other
Services, multinational forces, or host nation without habitual support relationships).
* Unit reconstitution may be accomplished using modular teams.
* Care for detainees (increased requirements for public health support, primary care, care of chronic
diseases/conditions).
A-12. See Figure A-3 for an example depiction of AHS support during large-scale ground combat operations. |
4-02 | 163 | Army Health System Support to the Army’s Strategic Roles
Figure A-3. Army Health System support during large-scale ground combat operations
CONSOLIDATE GAINS
A-13. Army forces provide the joint force commander the ability to capitalize on operational success by
consolidating gains. Consolidate gains is an integral part of winning armed conflict and achieving success
across the competition continuum. It is essential to retaining the initiative over determined enemies and
adversaries. Army forces reinforce and integrate the efforts of all unified action partners when they
consolidate gains.
A-14. Army forces consolidate gains in support of a host nation and its civilian population, or as part of the
pacification of a hostile state. These gains may include the establishment of public security temporarily by
using the military as a transitional force, the relocation of displaced civilians, reestablishment of law and
order, performance of humanitarian assistance, and restoration of key infrastructure. Concurrently, corps and
divisions must be able to accomplish these activities while sustaining, repositioning, and reorganizing
subordinate units to continue operations in the close area. Refer to ATP 3-91 and ATP 3-92 for more
information.
A-15. Upon successful termination of large-scale ground combat operations, Army forces in the close area
transition rapidly to the conduct of consolidation of gains activities. Alternatively, they may be relieved in
place by another unit. Consolidation of gains activities may encompass a lengthy period of post conflict
operations prior to redeployment. This transition to consolidation of gains may occur even if large-scale
ground combat operations are occurring in other parts of an AO in order to exploit tactical success.
Anticipation and early planning for activities after large-scale ground combat operations ease the transition
process.
A-16. The joint force commander defines the conditions to which an AO is to be stabilized. The theater army
is normally the overseer of the orderly transition of authority to appropriate U.S., international, interagency,
or host-nation agencies. The theater army and subordinate commanders emphasize those activities that |
4-02 | 164 | Appendix A
reduce post-conflict or post-crisis turmoil and help stabilize a situation. Commanders address the
decontamination, disposal, and destruction of war materiel. They address the removal and destruction of
unexploded ordnance and the responsibility for demining operations.
A-17. The consolidation of friendly and available enemy mine field reports is critical to this mission.
Additionally, the theater army must be prepared to provide AHS support, emergency restoration of utilities,
support to social needs of the indigenous population, and other humanitarian activities as required. (See ADP
3-07 and FM 3-07 for more information on the performance of stability tasks). Army Health System support
during operations to consolidate gains includes but not limited to:
* Coordinate, integrate, and synchronize AHS resources into the interagency efforts. Provide
medical expertise to identify and analyze critical needs emerging within the operational area.
* Manage medical information to facilitate medical regulating of victims to facilities outside of the
operational area and to document medical treatment.
* Assist affected host nation medical infrastructure in saving lives, reducing long-term disability,
and alleviating human suffering.
* Assist the local government in conducting rescue operations and providing medical evacuation of
victims to facilities capable of providing the required care.
* Advise local animal, agricultural, and veterinary industry personnel; assess damage of veterinary
and animal infrastructure; and provide animal medical care to local animals.
* Conduct preventive measures to respond to and resolve emerging health threats caused by the
LSCO.
* Conduct health risk assessment and communications.
* Assist host nation to reestablish its own ability to provide medical services for its population to a
reasonable level it possessed prior to hostilities and to support the legitimacy of the host nation.
* Continue to assess running estimates and be prepared to provide all aspects of roles of medical
care while reducing capacities in support of redeployment operations and downsizing the footprint
in theater (for example, reducing the number of intensive care unit and intermediate care ward
beds).
A-18. See Figure A-4 (on page A-7) for an example depiction of AHS support during operations to
consolidate gains. |
4-02 | 165 | Army Health System Support to the Army’s Strategic Roles
Figure A-4. Army Health System support during operations to consolidate gains |
4-02 | 167 | Appendix B
Command and Support Relationship
This appendix is derived from FM 3-0. It discusses command and support relationships
for joint and Army forces. This appendix delineates the four types of joint command
relationships, Army command relationships, and Army command support
relationships. Command and support relationships provide the basis for unity of
command and unity of effort in operations.
FUNDAMENTAL CONSIDERATIONS
B-1. Establishing clear command and support relationships is a key aspect of any operation. Large-scale
combat operations present unique and complex challenges that demand well-defined command and support
relationships among units. These relationships establish responsibilities and authorities between subordinate
and supporting units. Some command and support relationships limit the commander's authority to prescribe
additional relationships. Knowing the inherent responsibilities of each command and support relationship
allows commanders to effectively organize their forces and helps supporting commanders understand their
unit's role in the organizational structure.
JOINT COMMAND RELATIONSHIPS
B-2. As part of a joint force, Army commanders and staffs must understand joint command relationships.
JP 1 specifies and details four types of joint command relationships:
* Combatant command (command authority).
* Operational control (OPCON).
* Tactical control (TACON).
* Support.
COMBATANT COMMAND (COMMAND AUTHORITY)
B-3. Combatant command is a unified or specified command with a broad continuing mission under a single
commander established and so designated by the President, through the Secretary of Defense and with the
advice and assistance of the Chairman of the Joint Chiefs of Staff (JP 1). Title 10, United States Code, section
164 specifies this authority in law. Normally, the CCDR exercises this authority through subordinate JFCs,
Service component commanders, and functional component commanders.
OPERATIONAL CONTROL
B-4. Operational control is the authority to perform those functions of command over subordinate forces
involving organizing and employing commands and forces, assigning tasks, designating objectives, and
giving authoritative direction necessary to accomplish the mission (JP 1). Operational control normally
includes authority over all aspects of operations and joint training necessary to accomplish missions. It does
not include directive authority for logistics or matters of administration, discipline, internal organization, or
unit training. The CCDR must specifically delegate these elements of COCOM. Operational control does
include the authority to delineate functional responsibilities and operational areas of subordinate JFCs. In
two instances, the Secretary of Defense may specify adjustments to accommodate authorities beyond
OPCON in an establishing directive- when transferring forces between CCDRs or when transferring
members or organizations from the military departments to a combatant command. Adjustments will be
coordinated with the participating CCDRs. |
4-02 | 168 | Appendix B
TACTICAL CONTROL
B-5. Tactical control is the authority over forces that is limited to the detailed direction and control of
movements or maneuvers within the operational area necessary to accomplish missions or tasks assigned (JP
1). Tactical control is inherent in OPCON. It may be delegated to and exercised by commanders at any
echelon at or below the level of combatant command. Tactical control provides sufficient authority for
controlling and directing the application of force or tactical use of combat support assets within the assigned
mission or task. Tactical control does not provide organizational authority or authoritative direction for
administrative and logistic support; the commander of the parent unit continues to exercise these authorities
unless otherwise specified in the establishing directive.
SUPPORT
B-6. Support is the action of a force that aids, protects, complements, or sustains another force in accordance
with a directive requiring such action (JP 1). Support is a command authority in joint doctrine. A supported
and supporting relationship is established by a superior commander between subordinate commanders when
one organization should aid, protect, complement, or sustain another force. Designating supporting
relationships is important. It conveys priorities to commanders and staffs planning or executing joint
operations. Designating a support relationship does not provide authority to organize and employ commands
and forces, nor does it include authoritative direction for administrative and logistic support. Joint doctrine
divides support into the categories listed in Table B-1 (page B-3).
ARMY COMMAND AND SUPPORT RELATIONSHIPS
B-7. As discussed in Chapter 2, Army command relationships include:
* Organic.
* Assigned.
* Attached.
* OPCON.
* TACON.
B-8. See Table B-1 (on page B-3) for an illustration of Army command relationships.
ORGANIC
B-9. Organic forces are those assigned to and forming an essential part of a military organization as listed
in its table of organization for the Army, Air Force, and Marine Corps, and are assigned to the operating
forces for the Navy (JP 1). Joint command relationships do not include organic because a JFC is not
responsible for the organizational structure of units. That is a Service responsibility.
B-10. The Army establishes organic command relationships through organizational documents such as tables
of organization and equipment and tables of distribution and allowances. If temporarily task-organized with
another headquarters, organic units return to the control of their organic headquarters after completing the
mission. To illustrate, within a BCT, all subordinate battalions are included on the BCT table of organization
and equipment. In contrast, within most functional and multifunctional brigades, there is a base of organic
battalions and companies and a variable mix of assigned and attached battalions and companies.
ASSIGNED
B-11. Assign is to place units or personnel in an organization where such placement is relatively permanent,
and/or where such organization controls and administers the units or personnel for the primary function, or
greater portion of the functions, of the unit or personnel (JP 3-0). Unless specifically stated, this relationship
includes administrative control (ADCON). |
4-02 | 169 | Command and Support Relationship
Table B-1. Army command relationships
Then inherent responsibilities
Can impose
Unless Establish
Have Are on gained
If relation- May be modified, and Have
command assigned Provide unit further
ship is— relation- task ADCON position liaison maintain priorities command or
organized responsi- communi- establish-
ship or AO to— support
by— bility goes cations ed by—
with— by— relationship
through— with—
of—
All Army HQ
Attached;
organic specified
OPCON;
forces Organic in Organic Organic
Organic N/A N/A TACON;
organized HQ organizin HQ HQ
GS; GSR;
with the g
R; DS
HQ document
As
OPCON As ASCC or
require As required
Gaining Gaining Gaining chain of required Service-
Assigned d by by OPCON
unit HQ Army HQ comman by assigned
OPCO HQ
d OPCON HQ
N
As Attached;
require Unit to OPCON;
Gaining Gaining Gaining Gaining Gaining
Attached d by which TACON;
unit unit Army HQ unit unit
gaining attached GS; GSR;
unit R; DS
Parent
unit and
gaining As
As
unit; required OPCON;
require
Gaining gaining Parent Gaining by gaining Gaining TACON;
OPCON d by
unit unit may unit unit unit and unit GS; GSR;
gaining
pass parent R; DS
unit
OPCON unit
to lower
HQ1
As
As
required
require TACON;
Gaining Parent Parent Gaining by gaining Gaining
TACON d by GS; GSR;
unit unit unit unit unit and unit
gaining R; DS
parent
unit
unit
Note. 1In NATO, the gaining unit may not task-organize a multinational force. (See TACON.)
ADCON administrative control HQ headquarters
AO area of operations N/A not applicable
ASCC Army Service component command NATO North Atlantic Treaty Organization
DS direct support OPCON operation control
GS general support R reinforcing
GSR general support-reinforcing TACON tactical control
ATTACHED
B-12. Attach is the placement of units or personnel in an organization where such placement is relatively
temporary (JP 3-0). A unit may be temporarily placed into an organization for the purpose of conducting a
specific operation of short duration. Attached units return to their parent headquarters (assigned or organic)
when the reason for the attachment ends. The Army headquarters that receives another Army unit through
assignment or attachment assumes responsibility for the ADCON requirements, and particularly sustainment,
that normally extend down to that echelon, unless modified by directives. |
4-02 | 170 | Appendix B
OPERATIONAL AND TACTICAL CONTROL
B-13. For discussion on OPCON and TACON, refer to joint command relationship above.
ARMY SUPPORT RELATIONSHIPS
B-14. Table B-2 (page B-5) lists Army support relationships. As discussed in Chapter 2, the Army support
relationships are-
* Direct support.
* General support.
* Reinforcing.
* General support-reinforcing.
B-15. Commanders assign a support relationship for several reasons. They include when-
* The support is more effective if a commander with the requisite technical and tactical expertise
controls the supporting unit rather than the supported commander.
* The echelon of the supporting unit is the same as or higher than that of the supported unit. For
example, the supporting unit may be a brigade, and the supported unit may be a battalion. It would
be inappropriate for the brigade to be subordinated to the battalion; hence, the echelon uses an
Army support relationship.
* The supporting unit supports several units simultaneously. The requirement to set support
priorities to allocate resources to supported units exists. Assigning support relationships is one
aspect of mission command.
B-16. Army support relationships allow supporting commanders to employ their units' capabilities to achieve
results required by supported commanders. Support relationships are graduated from an exclusive supported
and supporting relationship between two units-as in direct support-to a broad level of support extended to all
units under the control of the higher headquarters-as in general support. Support relationships do not alter
administrative control. Commanders specify and change support relationships through task organization.
B-17. Direct support is a support relationship requiring a force to support another specific force and
authorizing it to answer directly to the supported force's request for assistance. A unit assigned a direct
support relationship retains its command relationship with its parent unit, but it is positioned by and has
priorities of support established by the supported unit. (Joint doctrine considers direct support a mission
rather than a support relationship.) A field artillery unit in direct support of a maneuver unit is concerned
primarily with the fire support needs of only that unit. The fires cell of the supported maneuver unit plans
and coordinates fires to support the maneuver commander's intent. The commander of a unit in direct support
recommends position areas and coordinates for movement clearances where the unit can best support the
maneuver commander's concept of the operation.
B-18. General support is that support which is given to the supported force as a whole. It is not given to any
particular subdivision of the force. Units assigned a general support relationship are positioned and have
priorities established by their parent unit. A field artillery unit assigned in general support of a force has all
of its fires under the immediate control of the supported commander or the designated force field artillery
headquarters.
B-19. Reinforcing is a support relationship requiring a force to support another supporting unit. Only like
units (for example, artillery to artillery) can be given a reinforcing mission. A unit assigned a reinforcing
support relationship retains its command relationship with its parent unit, but it is positioned by the reinforced
unit. A unit that is reinforcing has priorities of support established by the reinforced unit, then the parent
unit. For example, when a direct support field artillery battalion requires more fires to meet maneuver force
requirements, another field artillery battalion may be directed to reinforce the direct support battalion. |
4-02 | 171 | Command and Support Relationship
Table B-2. Army support relationships
Then inherent responsibilities
Have May be Receive Are Provide Establish Have Can
comman task- sustain- assigned liaison and prioritie impose on
If d organize ment position to— maintain s gained unit
relation- relation- d by— from— or an communi establis further
ship is— ship area of -cations h-ed command
with— operatio with— by— or support
ns by— relationshi
p of—
Direct Parent Parent Parent Supporte Supporte Parent Suppor See note1
support1 unit unit unit d unit d unit unit; ted unit
supporte
d unit
Reinforci Parent Parent Parent Reinforc Reinforc Parent Reinfor Not
ng unit unit unit ed unit ed unit unit; ced applicable
reinforce unit;
unit then
parent
unit
General Parent Parent Parent Parent Reinforc Reinforc Parent Not
support- unit unit unit unit ed unit ed unit unit; applicable
reinforcin and as and as then
g required required reinforc
by by ed unit
parent parent
unit unit
General Parent Parent Parent Parent As As Parent Not
support unit unit unit unit required required unit applicable
by by
parent parent
unit unit
Note. 1Commanders of units in direct support may further assign support relationships between their
subordinate units and elements of the supported unit after coordination with the supported commander.
B-20. General support-reinforcing is a support relationship assigned to a unit to support the force as a whole
and to reinforce another similar-type unit. A unit assigned a general support-reinforcing support relationship
is positioned and has its priorities established by its parent unit and secondly by the reinforced unit. For
example, an artillery unit that has a general-support-reinforcing relationship supports the force as a whole
and provides reinforcing fires for other artillery units.
ADMINISTRATIVE CONTROL
B-21. Administrative control is direction or exercise of authority over subordinate or other organizations in
respect to administration and support (JP 1). ADCON is not a command or support relationship; it is a
Service authority. It is exercised under the authority of and is delegated by the Secretary of the Army.
ADCON is synonymous with the Army's Title 10 authorities and responsibilities.
B-22. ADCON responsibilities of Army forces involve the entire Army, and they are distributed between the
Army institutional force and the operating forces. The institutional force consists of those Army
organizations whose primary mission is to generate and sustain the operating force's capabilities for
employment by JFCs. Operating forces consist of those forces whose primary missions are to participate in
combat and the integral supporting elements thereof. Often, commanders in the operating force and
commanders in the institutional force subdivide specific responsibilities. Army institutional force
capabilities and organizations are linked to operating forces through co-location and reachback.
B-23. The ASCC is always the senior Army headquarters assigned to a CCDR. Its commander exercises
command authorities as assigned by the CCDR and ADCON as delegated by the Secretary of the Army. |
4-02 | 172 | Appendix B
ADCON is the Army's authority to administer and support Army forces even while in a combatant command
area of responsibility. The COCOM is the basic authority for command and control of the same Army forces.
The Army is obligated to meet the CCDR's requirements for the operating forces. Essentially, ADCON
directs the Army's support of operating force requirements.
B-24. Unless modified by the Secretary of the Army, administrative responsibilities normally flow from the
Department of the Army through the ASCC to those Army forces assigned or attached to that combatant
command. ASCCs usually "share" ADCON for at least some administrative or support functions. "Shared
ADCON" refers to the internal allocation of Title 10, U.S. Code, section 3013(b) responsibilities and
functions. This is especially true for Reserve Component forces. Certain administrative functions, such as
pay, stay with the Reserve Component headquarters, even after unit mobilization. Shared ADCON also
applies to direct reporting units of the Army that typically perform single or unique functions. The direct
reporting unit, rather than the ASCC, typically manages individual and unit training for these units. The
Secretary of the Army directs shared ADCON. |
4-02 | 173 | Appendix C
Surgeon and Surgeon Section
Organizations from battalion through ASCC level are authorized a surgeon. Army
Medicine leverages the chain of surgeon's cells (staff channels) and medical command
and control channels (MEDCOM [(DS], MEDBDE [SPT], and [MMB]) to provide
AHS support to the deployed force. Integration of these two channels and other
warfighting function elements occur at command headquarters (HQs) at different
echelons.
The surgeon is a member of the commander’s personal and special staff. Through
medical command and control, the surgeon coordinates and synchronizes the medical
functions within the protection and sustainment warfighting functions and serves as a
link between these varied commands and staffs.
Surgeons at the ASCC/theater, corps, division, and brigade level are authorized a
surgeon staff. The surgeon’s staff is considered special staff and executes the actions
required of the surgeon.
The surgeon and the surgeon sections at each echelon work with their commands and
staffs to conduct planning, coordination, synchronization, and integration of AHS
support. This ensures the consideration of all ten medical functions is included in the
command’s running estimates, OPLANs, and OPORDs.
SURGEON
C-1. The surgeon is a Medical Corps officer and member of the commander’s personal and special staff.
The surgeon normally work under the staff supervision of the chief of staff/executive officer. The surgeon
is responsible for coordinating health assets and operations within the command. This officer provides and
oversees medical care to Soldiers, civilians, and detainees. The surgeon prepares Appendix 9 (Force Health
Protection) of Annex E (Protection) and Appendix 3 (Health Service Support) of Annex F (Sustainment) to
the operation order or operation plan. If operating in a joint headquarters (Theater/Corps), they have the
responsibility of writing Annex Q (Medical Services) to the joint operation order or operation plan (Refer to
JP 4-02, Joint Health Services). The surgeon advises the commander and their staff on all medical or medical-
related issues. The surgeon’s responsibilities include, but are not limited to:
* Advises the commander on the health of the command.
* Responsible for the creation of or contribution to the medical common operating picture and
medical concept of support.
* Provides medical treatment (to include CBRN).
* Provides status of the wounded.
* Coordinates MEDEVAC including Army dedicated MEDEVAC platforms (air and ground).
* Determines requirements for the requisition, procurement, storage, maintenance, distribution
management, and documentation of Class VIII supplies within the organization.
* Plans for and implements operational public health (including initiating measures to counter the
health threat, and establishing medical and OEH surveillance).
* Advises on the effects of the health threat on personnel, rations, and water. |
4-02 | 174 | Appendix C
* Advises on health threat requirements including the examination, processing of captured medical
supplies, and recommending use of captured medical supplies in support of detainees and other
recipients.
* Coordinates dental services.
* Coordinates COSC.
* Ensures the establishment of a viable veterinary services program (including inspection of
subsistence and outside the continental U.S. food production and bottled water facilities,
veterinary preventive medicine, and animal medical care).
* Ensures an area medical laboratory capability or procedures for obtaining this support from out of
theater resources are established for the identification and confirmation of the use of suspect
biological and chemical warfare agents by opposition forces. This includes the capability for
specimens and samples, packaging and establishing handling requirements, and escort and chain
of custody requirements.
* Coordinates clinical laboratory capabilities, including blood banking.
* Advises how operations affect the public health of personnel and the indigenous populations.
* Provides recommendations on allocation, redistribution, determining requirements, and
assignment of medical personnel.
* Coordinates with medical unit commanders (to include leaders of medical platoons and sections)
for continuous AHS support.
* Provides consultation, mentoring, and technical supervision of subordinate surgeons, physicians,
and physician assistants.
* Submits to higher HQs those recommendations on professional medical problems that require
research and development.
* Determines AHS training requirements and provides health education and training.
* Ensures field medical records and/or electronic medical records, when available, are maintained
on each Solder at the primary MTF according to AR 40-66.
* 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 varies depending upon the scenario, and could include:
Obtaining pieces of equipment of clothing not usually carries (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 crushing 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.
C-2. Through medical command and control, the surgeon coordinates and synchronizes the medical
functions within the protection and sustainment warfighting functions and serves as a link between these
varied commands and staffs (See Figure C-1; on page C-3).
C-3. Although AHS is broken down into two components; FHP which falls in the protection warfighting
function and HSS which resides within the sustainment warfighting function, the AHS is functionally aligned
with other warfighting fighting functions. Figure C-2 (on page C-3) below builds on Figure C-1 (on page
C3) and depicts the 10 medical functions and how they are aligned within three warfighting functions. |
4-02 | 175 | Surgeon and Surgeon Section
Figure C-1. Surgeon link to medical and warfighting functions
Figure C-2. Ten medical functions aligned with warfighting functions
SURGEON SECTION
C-4. The surgeon section works with many personal, special, and coordinating staffs. At different echelons,
they work closely with two functional cells, protection and sustainment. At the theater, corps, and division
level, there are chiefs of protection and sustainment. At the brigade and battalion level, the S-3 is responsible
for protection and the S-4 is responsible for sustainment. Force health protection falls within the chief of
protection/S-3’s functional area. Health service support falls within the chief of sustainment’s/S-4 functional
area. The responsibility of the entire AHS support structure, which includes both FHP and HSS medical
functions, rests with the surgeon. Figure C-3 on page C-4 depicts the coordination and synchronization
relationship shared between the surgeon, their staffs, and the chief of the protection/S-3 and chief of
sustainment/S-4 cells. |
4-02 | 176 | Appendix C
Figure C-3. Surgeon and protection/sustainment cell coordination and synchronization matrix
C-5. The staff of the surgeon is considered special staff and resides in the sustainment cells within corps,
divisions, and brigades HQs. The surgeon staff varies in size depending on the echelon (See Table C-1; page
C-5). It assists the surgeon in planning and conducting AHS support operations. Functionally, the surgeon’s
staff section “advises the commander” on medical capabilities and capacities necessary to support plans, and
interfaces with operations, intelligence, protection cells, civil affairs, sustainment cells, and host nation
authorities to coordinate AHS support across the warfighting functions. Specific functions of the surgeon
staff include, but are not limited to:
* Plans and ensures Roles 1 thru 3 medical support for the command is provided in a timely and
efficient manner.
* Recommends, develops, and maintains medical troop basis, revises as required, to ensure task
organization for mission accomplishment.
* Plans and coordinates AHS support operations for the command and attached/OPCON medical
assets. This includes reinforcement and reconstitution.
* Prepares and presents, as directed by the surgeon, the AHS support portion of the command and
operational briefings.
* Coordinates with the G-1 (S-1) for tracking critical medical areas of concentration and military
occupational specialties.
* Assists the G-1 (S-1) in casualty operations and estimates.
* Collects and disseminates health threat information and coordinates medical intelligence
requirements with the G-2 (S-2).
* Facilitates functional integration between AHS and military intelligence staff elements within the
command. This supports the G-2/S-2’s intelligence preparation of the battlefield. |
4-02 | 177 | Surgeon and Surgeon Section
* Coordinates with the G-3 (S-3) for prioritizing the reallocation of organic and attached/OPCON
medical augmentation assets as required by the tactical situation.
* Oversees command tactical standard operating procedures (TSOPs), plans, policies, and
procedures for AHS support as prescribed by the surgeon.
* Oversees individual and collective medical training and provides information to the surgeon and
commander.
* Coordinates with the G-3 (S-3), G-4 (S-4), and command chemical officer for nonmedical assets
for assisting with mass casualties and patient decontamination operations.
* Coordinates with the G-3 (S-3) for additional evacuation assets, as required.
* Coordinates and prioritizes patient evacuation or movement within the command.
* Coordinates patient evacuation from organic MTFs to higher-level roles of medical care.
* Coordinates the MEDEVAC of all detainee casualties.
* Monitors medical regulating and patient tracking operations.
* Coordinates and prioritizes MEDLOG and blood management requirements for the command.
* Coordinates and manages the disposition of captured medical materiel.
* Coordinates, plans, and prioritizes public health missions.
* Monitors disease trends within the command.
* Coordinates dental support when the tactical situation permits.
* Coordinates with the supporting veterinary element pertaining to subsistence and animal disease
surveillance.
* Develops and publishes the medical reporting schedule for Force XXI Battle Command Brigade
and Below in accordance with FM 6-99 and the commander’s guidance. Initiates other reports as
necessary (see Table C-2 on page C-6).
* Maintains situational understanding by coordinating for current AHS information with surgeons
of the next higher, adjacent, and subordinate headquarters.
* Coordinates, monitors, and synchronizes the execution of AHS support for the command for each
war-gamed course of action to ensure a fit and healthy force.
* The surgeon and their sections are responsible for coordinating with many personal, special, and
coordinating staffs. This list is not limited to Table C-3 (on page C-7). These tasks and
responsibilities are outlined in FM 3-94 and ATPs 3-91, 3-92, and 3-94. For more information,
refer to these doctrinal publications.
Table C-1. Surgeon section by echelon
Surgeon Echelon Personnel required
ASCC surgeon section 6-15 personnel required (dependent on type of HQs assigned)
Corps surgeon section 12 personnel required
Division surgeon section 12 personnel required
Brigade surgeon section 3-11 personnel required (dependent on type of brigade assigned) |
4-02 | 178 | Appendix C
Table C-2. Medical reports
Report Title Report Acronym
Bed Availability and Element
BEDAVAIL
Status
Bed Designations BEDDESIG
Bed Request BEDREQ
Blood Shipment Report BLDSHIPREP
Casualty Report CASREP
Daily Blood Report DBLDREP
Medical Evacuation Request MEDEVAC
Medical Situation Report MEDSITREP
Medical Spot Report MEDSPTREP
Medical Status Report MEDSTAT
THEATER ARMY SURGEON
C-6. The ASCC surgeon is a theater level officer and member of the commander’s personal and special
staff. The ASCC surgeon is charged with leading the planning and coordination of the AHS support mission
within the theater. 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.
C-7. Through medical command and control, the theater army surgeon coordinates and synchronizes the
ten medical functions split between the protection and sustainment warfighting functions and serves as a link
between these varied commands and staffs.
SURGEON HEADQUARTERS SECTION
C-8. Specific functions of the surgeon HQs section include, but are not limited to:
* Advises the theater army commander on the health of the command and the occupied or friendly
territory within the theater AO.
* Determines the health threat and provides advice concerning the medical effects of the
environment and of CBRN weapons and personnel, military and contract working dogs, rations,
and water. Develops and manages programs to identify health threats, apply risk management,
and mitigate such risks.
* Maintains situational understanding by coordinating for current AHS information with the medical
operations staffs of subordinate HQs.
* As a member of a joint staff, provides Annex Q (Medical Services) to all operation plans and
orders.
* Participates in the sustainment cell working group to integrate and synchronize HSS tasks.
Prepares a portion of Annex F (Sustainment) to the operation orders and plans.
* Participates in the protection cell-working group to integrate and synchronize FHP tasks and
systems for each phase or transition of an operation or major activity. Prepares a portion of Annex
E (Protection) to the operation orders and plans.
* Coordinates with the surgeon general for AHS information and resources.
* Provides for health services in the AOR.
* Monitors execution of AHS support to ensure it supports the CCDR's decisions and intent. |
4-02 | 179 | Surgeon and Surgeon Section
Table C-3. Coordinations between surgeon/surgeon section and staff elements
Coordinating Staff Supported Surgeon/Surgeon Section Responsibilities
As part of a joint HQs, coordinates with the staff judge advocate and
Commander/Staff Judge
chain of command to determine eligibility for medical care in a military
Advocate
MTF.
Ensure that the division current and future operations and plans are
MEDCOM (DS) / MEDBDE
coordinated with the MEDCOM (DS) and the supporting MEDBDE
(SPT)
(SPT).
Assistant Chief of Staff, G-1 (S- Coordinates and assists with all casualty and DNBI estimates and
1), Personnel reporting related issues (casualty operations).
Assistant Chief of Staff, G-2 (S- Coordinates on all medical information of a potential intelligence value
2), Intelligence or medical intelligence related issues.
Assistant Chief of Staff, G-3 (S-
Coordinates to establish environmental vulnerability protection levels.
3), Operations
Assistant Chief of Staff, G-3 (S-
Coordinates for medical support requests.
3), Operations
Assistant Chief of Staff, G-3 (S- Coordinates for the task organization of corps support medical
3), Operations elements.
Assistant Chief of Staff, G-3 (S-
Coordinates for medical contingency operations.
3), Operations
Assistant Chief of Staff, G-3 (S-
Coordinates in regards to ground MEDEVAC within the command.
3), Operations
Coordinates in regards to aeromedical and nonstandard air platform
G-3 (S-3) Air
evacuation within the command.
Assistant Chief of Staff, J-3,
As part of a joint HQs, develops Annex Q (Medical Services)
Operations
Assistant Chief of Staff, G-4 (S- Participates in the sustainment cell-working group.
4), Logistics (Chief of Provides the chief of sustainment with HSS input for Annex F
Sustainment) (Sustainment) Appendix 3 (HSS).
Assistant Chief of Staff, G-4 (S-
Provides forecasts of the division’s MEDLOG requirements during the
4), Logistics (Chief of
defense.
Sustainment)
Assistant Chief of Staff, G-4 (S-
Refer to ATP 3-91, para 5-80 for list of medical coordinations required
4), Logistics (Chief of
for a mobile defense.
Sustainment)
Assistant Chief of Staff, G-4 (S-
4), Logistics (Chief of Coordinates for food and water inspections.
Sustainment)
Provides a member to the civil affairs operations working group.
Assistant Chief of Staff, G-9 (S-
Coordinates on the military use of civilian MTFs, medical materiels,
9), Civil Affairs Operations
and supplies.
Participates in the protection cell working group.
Chief of Protection Provides the chief of protection with FHP input for Annex E
(Protection), Appendix 9 (FHP).
Coordinates AHS support requirements for CBRN operations. (Annex
CBRN Officer
E (Protection, Appendix 10).
Coordinates the employment of COSC teams with the chaplain to best
Chaplain
meet the needs of division Soldiers for stress control.
Detainee operations Provides a member to the detention operations staff battle drill.
Senior, adjacent, and Provides the current AHS support plan/MEDCOP to the
subordinate command surgeons/medical operations staffs of senior, adjacent, and
surgeons subordinate HQs to maintain medical situational awareness. |
4-02 | 180 | Appendix C
Table C-3. Coordinations between surgeon/surgeon section and staff elements (continued)
Coordinating Staff Supported Surgeon/Surgeon Section Responsibilities
As part of a division staff, establishes a division liaison with the MTFs
MTF Liaison through which sick, injured, or wounded Soldiers move as they are
evacuated outside the division AO.
Coordinates with local authorities concerning environmental and health
Host nation local authorities
concerns.
Works with civil affairs staff and other unified action partners to obtain up-
Unified action partners
to-date medical intelligence for a projected area of operations.
LEGEND:
AHS – Army Health System DS – Direct Support MEDCOP – Medical Common
Operating Picture
AO – Area of Operations FHP – Force Health Protection MEDEVAC – Medical Evacuation
ATP – Army Technique Publication HQ – Headquarters MEDLOG – Medical Logistics
CBRN – Chemical, Biological, HSS – Health Service Support MTF – Medical Treatment Facility
Radiological, Nuclear
COSC - Combat and Operational MEDBDE – Medical Brigade SPT – Support
Stress Control
DNBI – Disease Nonbattle Injury MEDCOM – Medical Command
* Synchronizes AOR medical resources to ensure effective and consistent treatment of wounded,
injured, or sick personnel as to return to full duty or evacuate from the AOR.
* Provides staff oversight for all ten AHS medical functions.
* Coordinates AHS support (including, but not limited to, operational public health,
inpatient/outpatient care, ancillary support, medical logistics, patient evacuation, hospitalization,
dental support, return to duty, and veterinary services) in preparing and sustaining theater forces.
* Coordinates with the staff judge advocate and chain of command to determine eligibility for
medical care in an MTF.
* Determines the policy for the requisition, procurement, storage, maintenance, distribution
management, and documentation of Class VIII material, blood and blood products, and special
designation of a TLAMM and the assignment of missions for the single integrated MEDLOG
manager (SIMLM)
* Recommends changes to the theater evacuation policy and provides input and personnel to the
theater patient movement requirements center, as required.
* Recommends theater policy for medically evacuating contaminated patients.
SURGEON MEDICAL OPERATIONS ELEMENT
C-9. Specific functions of the surgeon medical operations element include, but are not limited to:
* Coordinates patient evacuation from theater.
* Manages movement of patients within and from theater.
* Manages flow of casualties within the AOR.
* Monitors the flow of patients to MTFs within the combatant command AOR or for inter-theater
evacuation.
* Communicates with the theater patient movement requirements center and the global patient
movement requirement center.
* Develops mass casualty plans and determines the medical workload requirements based upon the
casualty estimate.
* Recommends medical evacuation policies and procedures, changes to the theater evacuation
policy, and provides input to the theater patient movement requirements center.
* Monitors medical regulating and patient tracking operations. |
4-02 | 181 | Surgeon and Surgeon Section
SURGEON SUPPORT OPERATIONS ELEMENT
C-10. Specific functions of the surgeon support operations element include, but are not limited to:
* Manages health services resources in the AO to provide effective and consistent treatment of
wounded, injured, or sick personnel as to return to full duty or evacuate from the theater.
* Monitors policies, protocols, and procedures pertaining to the medical and dental treatment of
sick, injured and wounded personnel.
* Determines requirements and priorities for medical logistics.
* Evaluates and interprets medical statistical data.
MEDICAL COMMAND (DEPLOYMENT SUPPORT) ROLE
C-11. 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 (GS) (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.
C-12. As the theater medical command, the MEDCOM (DS) integrates, synchronizes, and provides
command and control of MEDBDE (SPT), MMB, and other AHS units providing FHP and HSS to tactical
commanders. The MEDCOM (DS) employs an operational CP and a main CP that can deploy autonomously
into an operational area and employ 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.
* 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.
CORPS SURGEON
C-13. The corps surgeon is a corps level officer and member of the commander’s personal and special staff.
They normally work under the staff supervision of the corps chief of staff. The corps surgeon is charged
with leading the planning and coordination of the AHS support mission within the corps. However, as
personal staff, the corps surgeon is the principal advisor to the commander on the health status of the corps
and has direct access to the corps commander on all AHS support or medical-related issues. The corps
surgeon is responsible for the technical oversight of all medical activities in the command. The corps surgeon
oversee and coordinate AHS support activities through the corps surgeon section. The corps surgeon also
monitor, prioritize, synchronize, and assess AHS support; serve as medical contract officer for the corps; and
provides an analysis of the health threat.
C-14. Through medical command and control, the corps surgeon coordinates and synchronizes the ten
medical functions split between the protection and sustainment warfighting functions and serves as a link
between these varied commands and staffs.
SURGEON ELEMENT
C-15. The corps surgeon resides in the tactical command post within the surgeon element. This element is
responsible for, but not limited to:
* Oversees, monitors, and coordinates AHS support operations.
* Provides current information on the corps AHS support plan/medical common operating picture
(MEDCOP) to surgeons/medical operations staffs of the next higher, adjacent, and subordinate
HQs to maintain medical situational awareness. |
4-02 | 182 | Appendix C
* As a member of a joint staff, provides Annex Q (Medical Services) to all operation plans and
orders.
* Participates in the sustainment cell-working group to integrate and synchronize HSS tasks.
Prepares a portion of Annex F (Sustainment) to the operation orders and plans.
* Participates in the protection cell-working group to integrate and synchronize FHP tasks and
systems for each phase or transition of an operation or major activity. Prepares a portion of Annex
E (Protection) to the operation orders and plans.
* Provides recommendations on allocation and redistribution of medical personnel and Class VIII
items.
* Oversees MEDLOG for the command.
* Provides patient disposition and reports.
* Evaluates and interprets AHS statistical data.
* Monitors and coordinates FHP operations.
* Develops health consultation services within the corps.
* Provides technical advice to the Corps Commander for occupational, environmental health, and
medical surveillances, sanitary inspections, and potential CBRN contamination.
* When operating as a joint headquarters, coordinates with the staff judge advocate and chain of
command to determine eligibility for medical care in an MTF.
* When operating as a joint headquarters, recommends theater policy for medically evacuating
contaminated patients.
* Determines corps AHS training policies and programs as required.
* Initiate operational public health programs (to include medical surveillance, and OEH
surveillance) within the corps.
SURGEON SECTION
C-16. The surgeon section in the corps resides in the MCP. The surgeon section is normally functionally
organized under the sustainment warfighting function, but may be directly under the corps chief of staff
depending on the desires of the corps commander. This section is responsible for, but not limited to:
* Provides reachback capability for the forward deployed surgeon in the tactical command post.
* Reviews all Corps OPLANs and contingency plans to identify potential health threats associated
with geographical locations and climatic conditions.
* Assists tactical command post in monitoring and coordinating AHS support operations.
* Ensures AHS support is provided across the conflict continuum. Various types of mission support
(traditional support to a deployed force, operations predominantly characterized by stability tasks,
and defense support of civil authorities) are provided simultaneously in various locations
throughout the corps area of operations. AHS planners anticipate the types of support required
and develop flexible plans that are rapidly adjusted to changes in the level of violence and tempo,
as well as to transition from one type of task to the next.
* Coordinates access to intelligence of medical interest with the Assistant Chief of Staff, G-2,
Intelligence and ensures that the health threat, medical intelligence, and intelligence of medical
interest are integrated into AHS OPLANS and OPORDS.
* Coordinates HSS, including the treatment and MEDEVAC of patients from the battlefield and the
required Class VIII supplies, equipment, and services necessary to sustain these operations.
* Coordinates FHP to include, operational public health, veterinary services, AML services and
support, dental services and COSC.
* Develops, in conjunction with higher headquarters, corps evacuation policy.
DIVISION SURGEON
C-17. The division surgeon is a division level officer and member of the commander’s personal and special
staff. The division surgeon normally work under the staff supervision of the division chief of staff. The
division surgeon is the principal advisor to the commander on the health status of the division and advise the |
4-02 | 183 | Surgeon and Surgeon Section
division commander and their staffs on all medical or medical-related issues. The division surgeon operating
from within the section coordinates EAB medical support and ensures information is integrated into the
commander’s ground tactical plan. As the chief of the division surgeon section, the division surgeon is able
to contribute to the division’s warfighting capability by providing timely and effective AHS support planning
(to include developing patient estimates) for inclusion in the division planning process and the conduct of
conducting LSCO. They are also responsible for the technical oversight of all medical activities in the
command. The division surgeon ensure that the division’s current and future operations and plans are
coordinated with the MEDCOM (DS) and the supporting MEDBDE (SPT).
C-18. Through medical command and control, the division surgeon coordinates and synchronizes the ten
medical functions split between the protection and sustainment warfighting functions and serves as a link
between these varied commands and staffs.
SURGEON ELEMENT
* The division surgeon position is in the tactical command post surgeon element. They oversee and
coordinate AHS support activities through the division surgeon section. This element is
responsible for, but not limited to:
* Advises the commander on the health of the command.
* Oversees, monitors, and coordinates divisional AHS support operations to include both FHP and
HSS activities.
* Ensure that the division current and future operations and plans are coordinated with the
MEDCOM (DS) and the supporting MEDBDE (SPT).
* Oversees, monitors, and coordinates medical treatment (to include CBRN) provided to personnel
in the division AO.
* Provides status of the wounded.
* Coordinate MEDEVAC including Army dedicated MEDEVAC platforms (air and ground).
* Provides recommendations on allocation and redistribution of medical personnel and Class VIII
items.
* Oversees all MEDLOG for the command.
* Monitors and coordinates dental services within the division.
* Monitors and coordinates COSC.
* Monitors and coordinates veterinary services within the division.
* Provides patient disposition and reports.
* Monitors and coordinates public health operations.
* Oversees medical civil-military operations.
* Provides technical advice to the Division Commander for OEH surveillance, health threat analysis,
medical surveillance, facility sanitation inspections, and potential CBRN contamination.
* Participates in the sustainment cell working group to integrate and synchronize HSS
* tasks. Prepares a portion of Annex F (Sustainment) to the OPORD or OPLAN.
* Participates in the protection cell working group to integrate and synchronize FHP tasks and
systems for each phase or transition of an operation or major activity. Prepares a portion of annex
E (Protection) to the operation order or operation plan.
* Refines the division’s FHP medical support plan during the preparatory phase of defensive tasks.
* Identifies additional medical resources needed to support additional divisional attachments
received in the joint operations area and those elements of the civilian population whose needs are
not meet by civilian medical assets.
* Coordinates for Role 4 CONUS-support based MTF support.
* Oversees medical training for division medical personnel. |
4-02 | 184 | Appendix C
SURGEON SECTION
C-19. The division surgeon section resides in the MCP. Its mission is to plan, coordinate, and synchronize
the division’s AHS support under the supervision of the division surgeon. The division AHS support
planning also involves the division's staff and the division’s projected supporting MEDBDE (SPT) and next
higher echelon Army or joint surgeon's staff section. This coordination focuses on how the medical
command’s plans impact the provision of AHS support within the division. A series of planning, in-progress
reviews, coordination meetings, and rehearsals are required to tailor an AHS support plan to sustain the
division's anticipated operations. This section is responsible for, but not limited to:
* Provides reachback capability for the forward deployed surgeon in the tactical command post.
* Reviews all division OPLANs and contingency plans to identify potential health threats associated
with geographical locations and climatic conditions.
* Oversees division TSOPs, plans, policies, and procedures for AHS support as prescribed by the
division surgeon.
* Assists tactical command post in monitoring and coordinating AHS support operations.
* Provides current information on the division AHS support plan/MEDCOP to surgeons/medical
operations staffs of the next higher, adjacent, and subordinate HQs to maintain medical situational
awareness.
* Plans and ensures Roles 1 and 2 AHS support for the division is provided in a timely and efficient
manner.
* Establishes links from the medical brigade supporting the division to the medical platoons and
teams in its brigades as each brigade completes its deployment. Division medical support includes
both air and ground ambulance platforms and embedded forward surgical, COSC, and preventive
medicine detachments and teams.
* Utilizes casualty and DNBI estimates and forecasts evacuation, treatment, and Class VIII
requirements. Commanders pre-position medical treatment and evacuation capabilities forward
to efficiently evacuate casualties to where they can receive the appropriate medical care. When
developing the AHS support plan, the surgeon section planner considers many factors (Refer to
ATP 4-02.55). The forms of maneuver, as well as the threat’s capabilities, influence the character
of the patient workload and its time and space distribution. The analysis of this workload
determines the allocation of medical resources and the location or relocation of MTFs.
* Establishes links to the theater MEDLOG infrastructure to begin the Class VIII resupply process
once deployed. The division surgeon section anticipates customer Class VIII unit requisitions.
They identify and store adequate Class VIII stocks in medical brigade Role 3 MTFs supporting
the division to reduce the resupply turnaround times for forward surgical detachments in the
brigades.
* Determines situationally appropriate medication resupply protocols for cold packages, birth
control, and sexually transmitted diseases.
* Tracks the expenditures of prophylaxis means, such as anthrax and smallpox vaccinations.
* Coordinates relationships of organic medical units and medical units/elements under OPCON or
attached to the division for GS or direct support (DS).
* Coordinates for both air and ground ambulance support beyond the capabilities of BCT medical
companies with the division’s supporting medical unit(s) and combat aviation brigade.
* Coordinates the prompt evacuation of casualties from the division’s Role 1 and 2 MTFs to
supporting Role 3 MTFs provided by the division’s supporting medical unit.
* Coordinates with G-1/S-1 casualty operation personnel to ensure patient tracking is performed.
* Ensures medical supplies are available to division medical personnel.
* Develops and maintains the medical troop basis, revising as required, to ensure task organization
for mission accomplishment.
* Plans and coordinates AHS support operations for division and attached/OPCON corps medical
assets. This includes reinforcement and reconstitution.
* Prepares and presents, as directed by the division surgeon, routine AHS support portion of the
division briefings. |
4-02 | 185 | Surgeon and Surgeon Section
* Coordinates with the G-3 for prioritizing the reallocation of organic and corps medical
augmentation assets as required by the tactical situation.
* Works with the protection cell to provide staff supervision of the implementation of FHP actions
by the division’s subordinate units. Medical personnel monitor the division’s area of operations
for disease; conducts preventive services such as: immunizations and prophylaxes; and help when
Soldiers are exposed to hazards. Medical personnel establish medical, occupational, and
environmental health screening as required. Through field sanitation team training and water
assessments, medical personnel educate Soldiers and noncombatants on disease and nonbattle
injury prevention.
* Coordinates for prophylactic medical treatment for the division’s projected AO and with projected
supporting medical organizations to ensure they can support the division’s projected operations
and resupply divisional medical units and combat lifesavers with Class VIII (medical materiel).
* Works with the theater army surgeon, civil affairs staff, and other unified action partners to obtain
up-to-date health threat analysis on the division’s projected area of operations. Pre-deployment
behavioral health surveys should be conducted as part of deployment processing.
BRIGADE SURGEON
C-20. The brigade surgeon is a member of the commander’s personal and special staff. The brigade surgeon
is assigned to the headquarters and Headquarters Company of a brigade, and normally work under the staff
supervision of the brigade executive officer. The brigade surgeon plans and coordinates the brigade AHS
support activities with the brigade’s personal, special, and coordinating staffs. The brigade surgeon is
responsible for the technical control of all medical activities in the command. The brigade surgeon oversees
and coordinates AHS support activities through the brigade surgeon section and the brigade S-3. The brigade
surgeon keeps the brigade commander informed on the status of AHS support for brigade operations and the
health of the command. The brigade surgeon provides input and obtains information to facilitate medical
planning. The brigade surgeon’s specific duties in this area include, but are not limited to:
* Ensures implementation of the AHS support section of the brigade TSOP.
* Participates in the S-4’s sustainment cell working group to integrate and synchronize HSS tasks.
Prepares a portion of Annex F (Sustainment) to the operation orders and plans.
* Participates in the S-3’s protection cell working group to integrate and synchronize FHP tasks and
systems for each phase or transition of an operation or major activity. Prepares a portion of Annex
E (Protection) to the operation orders and plans.
* Determines the allocation of medical resources within the brigade.
* Supervises technical training of medical personnel and the combat lifesaver program within the
brigade.
* Determines procedures, techniques, and limitations in the conduct of routine medical care,
emergency medical treatment, and trauma management.
* Monitors aeromedical and ground ambulance evacuation.
* Monitors the implementation of automated medical systems.
* Informs the division surgeon on the brigade’s AHS support situation.
* Monitors the health of the command and advises the commander on measures to counter disease
and injury threats.
* Exercises technical supervision of subordinate battalion surgeons and physician assistants.
* Provides consultation and mentoring for subordinate battalion surgeons, physicians, and physician
assistants.
* Provides the medical estimate and health threat for inclusion in the commander’s estimate.
C-21. The brigade surgeon utilizes medical command and control to coordinate and synchronize the ten
medical functions split between the protection and sustainment warfighting functions and serve as a link
between these varied commands and staffs. |
4-02 | 186 | Appendix C
SURGEON SECTION
C-22. The brigade surgeon section is assigned to the headquarters and Headquarters Company of the brigade
and operates out of the brigade tactical operations center. This section is an integral part of the brigade’s
main CP and the staff of the brigade surgeon is intimately involved with the S-3 and their staff in the planning
process. The section, in coordination with the brigade S-4, the brigade support medical company commander,
and battalion surgeons, is responsible for the development of the medical portion of the brigade
OPLAN/OPORD and takes part in the brigade operations process. This section is responsible to the brigade
commander for staff supervision of AHS support within the brigade. The brigade surgeon section is also
responsible for coordinating GS and DS relationships of organic medical units and medical units/elements
whether OPCON or attached to the brigade. This section updates the brigade commander as required on the
status of AHS support in the brigade. The staff of the brigade surgeon section assists the brigade surgeon in
planning and conducting brigade AHS support operations. Specific functions include, but are not limited to:
* Provides current information on the brigade AHS support plan/MEDCOP to surgeons/medical
operations staffs of the next higher, adjacent, and subordinate HQs to maintain medical situational
awareness.
* Plans and ensures the timely and efficient establishment of Roles 1 and 2 AHS support for the
brigade.
* Plans and coordinates AHS support operations for brigade medical assets, attached, or OPCON
EAB assets. This includes reinforcement and reconstitution.
* Coordinates with the division surgeon section for prioritizing the reallocation of organic and corps
medical augmentation assets as required by the tactical situation.
* Ensures that the medical annex of the brigade TSOPs, plans, policies, and procedures for AHS
support, prescribed by the brigade surgeon, are prepared and executed.
* Oversees medical training and provides information to the brigade surgeon and brigade
commander.
* Coordinates and prioritizes MEDLOG and blood management requirements for the brigade.
* Collects health threat information and coordinates medical intelligence requirements with the
brigade S-2.
* Coordinates and directs patient evacuation from forward areas to supporting MTFs.
* Coordinates the MEDEVAC of all detainee casualties from the brigade AO.
* Coordinates the disposition of captured medical materiel.
* Coordinates, plans, and prioritizes operational public health missions.
* Coordinates with the supporting veterinary element for subsistence and animal disease
surveillance.
* Coordinates and monitors patient decontamination operations to include:
Layout and establishment of patient decontamination site.
Use of collective protection.
Use of nonmedical Soldiers to perform patient decontamination procedures under medical
supervision.
BATTALION SURGEON
C-23. The battalion surgeon/medical officer is a member of the commander’s personal and special staff. The
battalion surgeon also serve as the medical advisor to the battalion commander and the staff. In this role, the
battalion surgeon advises the battalion commander on the employment of the medical platoon and on the
health of the battalion. The battalion surgeon are also the supervising physician (medical officer/field
surgeon) of the medical platoon’s treatment squad. This officer is responsible for all AHS support provided
by the platoon. The brigade support medical company commander, with consultation by the senior physician,
performs many related responsibilities mentioned below within the brigade support battalion. Units not
assigned a battalion surgeon will utilize their assigned senior medical Service member in order to accomplish
the below listed responsibilities. Responsibilities include, but are not limited to:
* Advises the commander on the health of the battalion. |
4-02 | 187 | Surgeon and Surgeon Section
* Provides current information on the battalion AHS support plan/MEDCOP to surgeons/medical
operations staffs of the next higher and adjacent HQs to maintain medical situational awareness.
* Advises the battalion commander and their staff on AHS support operations and the health threat.
* Advises the commander on the effects of the Geneva Conventions on AHS support.
* Plans and directs Role 1 AHS support for the battalion or within the brigade support area.
* Supervises the health, welfare, organizational training, administration, discipline, and
maintenance of equipment, supply functions, and employment of medical platoon or company
personnel.
* Supervises and oversees all medical treatment provided by platoon or company personnel.
* Examines, diagnoses, treats, and prescribes courses of treatment for patients, to include DNBI,
TCCC, and trauma management.
* Supervises the battalion COSC program to include training troop leaders in the preventive aspect
of stress on Soldiers.
* Supports humanitarian assistance programs, when directed.
* Provides operational public health support for the battalion.
* Requests operational public health support from the brigade for requirements beyond their
(battalion surgeon) capabilities.
* Plans and oversees public health training for battalion personnel.
* Monitors the command operational public health program to include health risk assessment and
medical surveillance.
* Oversees the Army warrior task training, continuing medical education, and clinical training of
subordinate medical personnel.
* Oversees the training of combat lifesavers.
* Oversees the training of unit field sanitation teams.
* Ensures that field health records are maintained.
* Coordinates and monitors patient decontamination operations to include:
Layout and establishment of patient decontamination site.
Use of collective protection.
Coordinates the establishment and training of nonmedical personnel for patient
decontamination teams.
Use of nonmedical Soldiers to perform patient decontamination procedures under medical
supervision.
C-24. Only when a battalion surgeon is assigned does the overall responsibility for the medical platoon
belong to someone other than the medical services corps officer. Based upon command discretion, the
medical operations officer may be designated as the medical platoon leader. They work with both the
battalion surgeon and physician assistant to ensure medical treatment and AHS support requirements are met
for the battalion. This officer is the principal assistant to the battalion surgeon and the primary leader for
medical platoon operations, administration, and logistics.
Note. In the absence of a battalion surgeon, the physician assistant is the principal advisor to the
battalion commander and their staff in the area of health and medical readiness. |
4-02 | 189 | Appendix D
Medical Intelligence
Medical intelligence is developed through the leveraging of all-sourced intelligence
assessments and products. Medical intelligence results from collection, evaluation,
analysis, and interpretation of foreign medical, bioscientific, and environmental
information that is of interest to strategic planning and to military medical planning.
This information is pertinent to operations for the conservation of the fighting strength
of friendly forces and the formation of assessments of foreign medical capabilities in
both military and civilian sectors. Military intelligence includes only finished
intelligence products produced by an authorized agency. Military Intelligence Soldiers
and other intelligence professionals, through the intelligence warfighting function,
collect, process and exploit, analyze, disseminate, and evaluate information collected
from a variety of sources to generate intelligence. Medical elements require
intelligence support in order to not lose the medical personnel's protected status under
Article 24 of the1949 Geneva Convention for the Amelioration of the Condition of the
Wounded and Sick in Armed Forces in the field by performing tasks that are
inconsistent with their noncombatant role such as intelligence collection. To develop
medical intelligence, information is gathered, evaluated, and analyzed on the following
subjects:
* Endemic, emerging, epidemic and pandemic diseases, public health standards and capabilities,
and the quality and availability of medical services.
* Foreign military and civilian medical capabilities, including MTFs, medical personnel, emergency
and disaster responses, MEDLOG (to include blood processing), and medical pharmaceutical
industries.
* Integrated databases on all medical treatment, training, pharmaceutical, and research and
production facilities.
* Environmental risks that can degrade force health or effectiveness including: chemical and
microbial contamination of the environment, toxic industrial materials and radiation accidents,
and environmental terrorism.
* Impact of foreign environmental health issues and trends on environmental security and national
policy.
* Infectious disease risks that can degrade mission effectiveness of deployed forces.
* Foreign and applied biomedical and biotechnological developments of military medical
importance.
* Foreign scientific and technological medical advances for defense against CBRN warfare agents.
SIGNIFICANCE OF MEDICAL INTELLIGENCE
D-1. At the strategic level, the objective of medical intelligence is to contribute to the formulation of
national-based policy. The policy will be based in part on assessments of foreign military and civilian
capabilities of the medical or bioscientific community.
D-2. At the operational level, the objective of medical intelligence is to support the development of AHS
strategies that—
* Identify the health threat.
* Are responsive to the unique aspects of a particular AO. |
4-02 | 190 | Appendix D
* Enable the commander to accomplish the operation.
* Conserve the fighting strength of friendly forces.
SOURCES OF MEDICAL INTELLIGENCE
D-3. Medical intelligence is provided to the AHS planner by intelligence organizations. The AHS planner
must identify the medical intelligence requirements and provide a request for information and or updated
commander's critical information requirements and other requirements to the supporting intelligence element
within the command. Up-to-date medical intelligence assessments can be obtained by contacting Director,
Defense Intelligence Agency, Attention: Director, National Center for Medical Intelligence, Fort Detrick,
Maryland 21702-5000 or via the contact information listed at: https://www.ncmi.detrick.army.mil. The
National Center for Medical Intelligence can provide finished all-source intelligence products that assess
foreign medical facilities and capabilities; infectious disease/chemical/radiological health threats in the
operational environment; foreign CBRN medical countermeasures; and emerging and disruptive
biotechnology with military applications. The AHS planner should use all available intelligence elements to
obtain information and intelligence which supports the military operation. The National Center for Medical
Intelligence 24-hour service request for information telephone number is commercial (301) 619-7574 or
Defense Switched Network 343-7574. Refer to DODI 6420.01 for more information.
D-4. A supporting intelligence element exists in the AHS unit's chain of command. This element will be
the primary source for the AHS planner to access the necessary intelligence for the execution of AHS support
operations.
MEDICAL ASPECTS OF INTELLIGENCE PREPARATION OF THE
BATTLEFIELD
D-5. Consideration of the medical aspects of the IPB is a systematic process that is designed to aid AHS
planners in analyzing various enemy, environmental, and health threats in a specific AO. Determining the
medical aspects of the IPB process occurs during the first step in the mission analysis phase of the military
decision-making process. The information derived from conducting a proper assessment of the medical
aspects of the intelligence is specific to the geographic region where the AO is located. The Phase I
assessments that are part of the medical aspects of IPB are the cornerstone to developing detailed and
effective AHS estimates and plans. Some portions of the template will be more or less applicable depending
on the assigned mission. For more information on IPB, see ATP 2-01.3/MCRP 2-3A, Intelligence
Preparation of the Battlefield/Battlespace.
D-6. The Phase I assessments that are part of the medical aspects of IPB are to—
* Define the OE.
* Describe the operational effects on deployed forces and AHS operations.
* Conduct threat integration (enemy, environment, and health) and information consolidation.
IDENTIFY SIGNIFICANT CHARACTERISTICS OF THE
OPERATIONAL ENVIRONMENT
D-7. The first task of the AHS planner is to define the OE. The AHS planner identifies and describes the
significant characteristics of the environment to be able to assess the impact on AHS support operations and
the health of the command.
D-8. The significant characteristics of the OE must be evaluated from both a military perspective and a
civilian perspective. The AHS planner must determine what aspects of the OE will impact the delivery of
health care to U.S. forces and conversely what impact military medical operations will have on the civilian
population in the AO. As the provision of medical care is a humanitarian activity, the patient workload of
deployed forces can be affected when forces are deployed in medically underserved areas or in areas where
the civilian medical infrastructure has been disrupted or is underdeveloped. The AHS planner can use the
memory aid political, military, economic, social, information, infrastructure, physical environment, time
(operational variables) or mission, enemy, terrain and weather, troops and support available, time available,
and civil considerations factors (mission variables) to frame the analysis of the OE based on the situation. |
4-02 | 191 | Medical Intelligence
For the AHS planner, the civil considerations must be thoroughly explored and analyzed, even if the
immediate mission does not recognize a requirement for the provision of health services to a host-nation
population. The AHS planner must be prepared to provide support or have a plan in place in the event a
civilian medical emergency should arise and the military forces are directed to provide support. Without
prior planning, the diversion of military medical assets to support civilian medical emergencies will adversely
impact the AHS support provided to deployed forces and could potentially overwhelm available medical
resources. The AHS plan must not only conform to the tactical commander's concept of operation and
scheme of maneuver, it must also be in consonance with the CCDRs theater engagement strategy so that any
humanitarian activities conducted are not done haphazardly and are part of the regional strategy for the AO.
GEOSPATIAL INFORMATION
D-9. Geospatial information includes hydrological data, elevation data, soil composition, and vegetation.
GEOGRAPHY AND WEATHER
D-10. The geography and weather factors include climate, weather, terrain (to include urban terrain), and
altitude. They may also contain information on possible weather/environmental threats such as earthquakes,
volcanoes, monsoons, or other such conditions.
CLIMATE AND WEATHER EFFECTS
D-11. Information contained in the climate and weather effects includes the effects of extreme
heat/cold/humidity; effects of the predominant weather patterns (such as monsoons) on AHS operations (such
as MEDEVAC effects of heavy rains or snow; the phase of the moon and its effect on operations (such as
fullness/brightness when military forces are infiltrating an area); how the weather may affect enemy
biological and chemical warfare agents use; and climatic effects on medical supplies and equipment.
TERRAIN ANALYSIS
D-12. Terrain analysis includes determining the effect on friendly/enemy maneuver capability; effect on
friendly/enemy ability to sustain health care; effects on timely MEDEVAC; and natural lines of patient drift.
Lines of patient drift refers to natural routes along which wounded Soldiers may be expected to go back for
medical care from a combat position. (ATP 4-02.2). Terrain analysis also impacts on MTF site selection
factors; where the mobility corridors are located and their effects on friendly/enemy actions; effects of
weather conditions on terrain/mobility; effect of overhead cover (canopy) and vegetation; effect of projected
action on terrain/mobility; and where potential sources of potable water are located.
ALTITUDE EFFECTS
D-13. Altitude effects include effect of high-altitude operations on force capability, rotary-wing MEDEVAC
assets, MEDEVAC procedures and methods (higher incidence of litter evacuation and longer evacuation
times for manual evacuation), and standard medical treatment protocols.
DESCRIBE THE BATTLEFIELD EFFECTS
D-14. The purpose of this phase of the IPB process is to analyze and integrate various factors of the OE.
Conducting a detailed analysis of these factors helps commanders and planners understand how the
significant characteristics the OE can affect friendly and threat operations. The AHS planner will focus on
identifying the medical aspects of battlefield effects on friendly and threat forces and operations.
LIMITS OF COMMAND
D-15. The AO is the geographic area where the commander is assigned the responsibility and authority to
conduct military operations. The AHS planner must identify the—
* Geographic AO that may include the macroview or the microview depending upon the level of
command and the size of the geographic area. |
4-02 | 192 | Appendix D
* Total population at risk which includes all U.S. and unified action partners, local civilian
population, dislocated persons, DOD and other U.S. governmental employees and or contractors,
and nongovernmental organizations personnel. In addition to identifying the total population at
risk, the planner must also determine what the supported population at risk is (those
individuals/groups deemed as eligible beneficiaries for health care provided by United States
Army medical assets. The supported population includes:
All supported U.S. units which include sister Services and elements from U.S. governmental
agencies and DOD contractors.
All supported multinational units/elements. This paragraph should discuss unit troop
strengths, locations, and missions. It may also include organic medical resources and
capabilities; multinational medical assets (military, paramilitary, and civilian) which are
approved for use for U.S. personnel; identification of multinational (military, paramilitary,
and civilian) requirements; identification of unique medical support requirements (such as
endemic diseases in the multinational force that are not present in the deployment [host
nation] AO); and the current level of health and dental fitness among the supported
populations. For veterinary services, the number of military working and contract dogs and
other government owned animals that will be used by the multinational force also need to be
identified and included in planning.
All personnel in U.S. custody (detainees).
* Others as directed.
LIMITS OF THE AREA OF INFLUENCE AND THE AREA OF INTEREST
D-16. The area of influence and the area of interest are geographic areas from which information is required
to facilitate planning. The area of influence and the area of interest usually fall outside the AO and may or
may not be applicable to a particular operation. Army Health System support outside the AO includes:
* Army Health System support provided by organizations/elements outside of the AO. This can
include organizations such as CONUS-support base or other safe haven hospitals, MEDLOG
support (Defense Logistics Agency or Army Materiel Command), and global patient regulating
support (such as the Global Patient Movement Requirements Center).
* Location and time/distance factors for medical resources that could be used for augmenting/
reinforcing/reconstituting AHS units/personnel within the AO. This information can include
discussions on units/elements in the CONUS-support base or adjacent AOs.
* Coordination and synchronization with command and control assets outside the AO which assures
the reach capability within the AHS and the ability to rapidly deploy medical specialty care
resources as the need arises in the AO.
* Follow-on operations or operations being conducted simultaneously outside the AO which can
include a range of military activities.
D-17. Army Health System planners—
* Identify the level of detail required and the time available to conduct the medical aspects of the
IPB process.
* Evaluate existing information/intelligence of medical significance and identify intelligence gaps.
(Sources include: National Center for Medical Intelligence; Defense Intelligence Agency; the
Army Public Health Center; The Office of The Surgeon General, Intelligence and Security
Division (division or higher staff for intelligence); country studies; supporting intelligence staff
officer/assistant chief of staff, intelligence or military intelligence unit; Central Intelligence
Agency World Fact Book; open source information system; tourist maps and brochures; public
health resources; World Health Organization; Pan American Health Organization; Department of
State; and internet, libraries, and other informational sources).
* Identify and submit collection requirements to the supporting intelligence staff
section/element/unit.
* Collect required information to fill gaps. |
4-02 | 193 | Medical Intelligence
Note. If medical personnel gain information of potential intelligence value through casual
observation of activities in plain view while in the performance of their humanitarian duties, they
are required to report it to their supporting intelligence staff officer/assistant chief of staff,
intelligence.
Population Demographics
D-18. Population demographics include the effect on the delivery of health care to supported forces and the
effect on the AHS if required to support the local populace and nongovernmental organizations. It also
includes the political effects of providing care/not providing care to the host-nation populace,
nongovernmental organizations, and dislocated persons and the effects of cultural, religious, or language
barriers on medical treatment. Other AHS population demographic concerns include:
* Condition of the general population (and or supported population) to include an analysis of the
health of the general population and the impact of it on deployed forces; analysis of the infant
mortality rate as this serves as an indicator of the overall health of the population; leading causes
of death; identification of the status of nutrition; and state of advancement of the medical
infrastructure.
* What effect will clans, tribes, gangs, opposition groups, or paramilitary organizations/groups and
organized crime have on the ability to provide AHS support to deployed forces and other eligible
beneficiaries?
* What effect/additional requirements will dislocated persons and detained personnel have on the
AHS system? This is of particular importance for the operational public health arena as camps
require sanitation, pest management, and potable water support. Other requirements include the
provision of sick call services, outpatient treatment, hospitalization, MEDEVAC, veterinary
technical consultation and support, MEDLOG support (to include sorting, repackaging,
inventorying, and disseminating donated medical supplies and equipment), and other functional
concerns.
Threat Forces Capabilities/Effects
D-19. The effects of enemy ideology, goals, and missions includes an analysis of the enemy's will to fight;
what they are trying to accomplish and why (military objectives); compliance with the Geneva Conventions
(to include respect and protection of medical personnel, units, and transports); type of enemy forces (such as
paramilitary, conventional, special operations, and or terrorists); philosophy concerning collateral damage,
civilian casualties, disruption of utilities (sewage, waste disposal, sanitation, water, electricity, and gas), and
generating dislocated persons. Threat forces capabilities or effects encompass the following:
* The threat characteristics include the affects enemy doctrine has on deployed forces, to include
AHS personnel and units. This information facilitates forecasting what units/elements/
organizations are most likely to sustain heavy casualties.
* Enemy force structure and weapons systems include the analysis of the accuracy and range of
enemy weapons systems; analysis of the size and composition of the enemy force; and what types
of friendly wounds will be generated by enemy weapons systems (such as piercing, blast injuries,
concussion, blunt trauma, burns, or combined injuries).
* Enemy medical doctrine and capabilities include the analysis of enemy medical doctrine and
capabilities; priority and availability of medical care and MEDEVAC; status of the medical
infrastructure and training to accomplish the medical mission; and the potential for the enemy to
treat their own casualties or to leave them in the care of friendly forces.
* Effects of enemy CBRN weapons to include an analysis of enemy CBRN capabilities; effect of
enemy CBRN use on friendly forces; the likelihood of its use; whether the enemy can continue
the mission in a CBRN environment; and whether the enemy's delivery systems are accurate,
reliable, and effective.
* Military information support operations and unconventional warfare capabilities and effects
include an analysis of the probable impact of psychological operations on friendly forces; analysis |
4-02 | 194 | Appendix D
of unconventional warfare capabilities; probability of unconventional warfare forces targeting
friendly areas and AHS assets/resources; and the effect unconventional warfare will have on the
delivery of health care.
INFRASTRUCTURE
D-20. The infrastructure includes transportation systems (land, sea, and air); communications systems
(telephone, cellular, digital, mass media, and electronic means); and, utilities (water, electricity, and
sanitation).
TRANSPORTATION
D-21. Transportation systems include the effect of available transportation systems on timely MEDEVAC or
CASEVAC, MEDLOG supply/resupply operations (to include time-sensitive blood distribution and other
perishable and dated pharmaceuticals; analysis of likely avenues of approach; effect of the transportation
system on mobility and military operations; effect of military operations on the transportation system; and
impact of transportation networks on enemy/friendly courses of action).
COMMUNICATIONS SYSTEMS
D-22. Communication systems architecture includes the communications networks that are established in
the operational area; the level of technology for these systems; and the level of access of the communications
infrastructure by the population (for example, if the civilian population does not have telephones, radios,
televisions, or computers, other methods for disseminating public health information and health risk
communications information must be established).
Utilities
D-23. Utilities (water, electricity, and sanitation) include the analysis of water quality (portability) and
distributions systems; analysis of the reliability of electrical power generation; effectiveness and efficiency
of sanitation systems; effects of enemy/friendly military actions on the utilities infrastructure; and the impact
a disruption of utilities would have on the health of the general population and/or deployed forces.
Industry
D-24. Industry includes the types of industry present, their effect on the economy, and the potential threat
from toxic industrial materials either used in the manufacturing process or as an end product.
Medical Infrastructure
D-25. A checklist for assessing the foreign medical infrastructure is provided in Table D-1 (on page D-7).
D-26. A checklist for assessing foreign MTF capabilities and services is provided in Table D-2 (on page
D-8).
D-27. Analysis of local medical supply and equipment sources includes an analysis of local quantity, quality,
and availability of medical supplies and equipment; analysis of the availability of blood and blood products;
availability of supplies for use for local populace, dislocated persons, and detained persons (to include
donated supplies or those of a nongovernmental organization/intergovernmental organization such as the
United Nations); availability of supplies approved for use by U.S. forces; analysis of local medical supply
production facilities; impact of military operations on the local medical supply infrastructure; and availability
and quality of medical gases. |
4-02 | 195 | Medical Intelligence
Table D-1. Checklist for assessing a foreign medical infrastructure
Public health and Number of public health personnel, facilities, and capabilities.
health threat Names and titles of key personnel within the public and private health care
infrastructures.
Leading causes of death of the general population or specified subpopulations.
Prevalence of endemic and epidemic diseases (both human and animal) in the
area of operations.
Prevalence of human immunodeficiency virus/acquired immunodeficiency
syndrome.
Status of host nation’s food safety/defense program.
Environmental health risk (to include heat and cold injury, exposure to toxic
industrial materials, and poisonous or toxic flora and fauna).
Hospitalization/ Nutritional status of the general population or specified subpopulations.
medical clinics Immunization level of general population or specified subpopulations.
Infant mortality rate and other indices.
Hospitals by type and location (such as general medical, psychiatric, or
orthopedic).
Number of hospital beds by type (such as surgical, intensive care, or general
medicine).
Number of operating room tables and table hours.
Medical clinics (private or public), locations, and accessibility.
Services and Number of physicians per population.
providers Number of physicians by specialty.
Ancillary services available (such as physical therapy, occupational therapy,
orthotics capability, community/public health nurses, magnetic resonance imaging,
computed tomography scan, or respiratory therapy).
Number of nonphysician health care providers (such as physician assistants,
physical therapists, occupational therapists, nurse practitioners, podiatrists, or
optometrists) by type.
Number of dental providers and types of dental care available (such as emergency
and essential care and or oral surgery).
Number of behavioral health clinics and available services.
Number and types of behavioral health personnel (such as psychologists, social
workers, and the like).
Veterinary medical personnel, facilities, and capabilities.
Medical Medical evacuation/casualty transport systems (public, private, and dedicated
evacuation military ground and air ambulances or platforms of opportunity).
Medical research/ Number and types of medical research facilities.
education What toxic industrial materials does the facility use and or produce (chemical,
biological, and nuclear and radiation hazards).
Number, types, and location of medical schools or medical training centers.
D-28. Analysis of MEDEVAC services includes the analysis of local MEDEVAC services and capabilities;
training and education level of medical attendants; coordination and synchronization of local evacuation
services/resources to evacuate civilian patients; availability of and quality of local MTFs; and impact of
military operations on local evacuation services.
D-29. Effects of disease and other OEH threats include the identification of disease and OEH threats that
affect friendly forces and the delivery of medical support; identification of personnel protective measures
which are required to counter the health threat; analysis of the effect of protective measures on friendly
forces; analysis of the impact that disease and environmental threats have on enemy actions; and the
identification of additional disease and environmental health hazards which may be created and/or aggravated |
4-02 | 196 | Appendix D
by military operations and the analysis of services provided by nongovernmental organizations and other
intergovernmental organizations.
Table D-2. Checklist for assessing foreign medical treatment facility capabilities and services
Is the medical treatment facility a private, public, or military institution?
Is the medical treatment facility a hospital, clinic (such as outpatient, emergency, or substance abuse),
doctor’s office, or long-term/rehabilitative care facility?
Where is the medical treatment facility located? How accessible is it (such as on a major thoroughfare,
on side streets, or accessible by air)?
What type of care does the medical treatment facility provide (such as emergency and general medicine,
surgical, orthopedic, maternity/obstetrics, and psychiatric, pediatric, rehabilitative, or long-term care)?
What are the number and types of beds (such as surgical, intensive care, intermediate care, minimal
care, or general medicine)?
What ancillary services are available (such as physical therapy, occupational therapy, respiratory therapy,
diagnostic x-ray, nuclear medicine, pharmacy services, or diagnostic laboratory services)?
What is the staffing level of the medical treatment facility?
Does the medical treatment facility provide outpatient services? If so, what types of care?
What is the standard of care provided at the medical treatment facility? How does it compare to U.S.
facilities?
How are medical professionals credentialed? What is their scope of practice?
What is the nosocomial infection disease rate for the medical treatment facility?
Does the medical treatment facility have the capability to isolate infectious disease patients?
What is the patient accident or injury rate for the medical treatment facility (such as falling out of bed,
injury caused by faulty equipment, or the like)?
What types of medical equipment are available in the medical treatment facility (such as diagnostic
computed tomography scan or magnetic resonance imaging, rehabilitative, or patient care [ventilators,
respirators, or orthopedic])?
What types of support services are available (such as laundry, housekeeping, or food service)? Are
these services shared services with another medical treatment facility? If not, how are patients fed (such
as by relatives)?
Does the medical treatment facility have an emergency room? Is it staffed and equipped to provide
trauma care?
What is the capacity of the medical treatment facility to respond to a mass casualty situation (resulting
from urban operations, terrorist incidents, man-made or natural disasters, or employment of CBRN
weapons)?
What is the level of medical supplies maintained within the medical treatment facility (days of supply)?
How is the medical treatment facility resupplied with expendable and nonexpendable medical supplies?
Are medicines readily available or must they be obtained on an individual case basis? Is local vegetation
collected and used for medical purposes?
Does the medical treatment facility have the capability to collect, test, and store blood? What diseases is
the blood tested for?
If the medical treatment facility cannot collect and test blood, where do blood and blood products come
from? Has it been tested? Does the medical treatment facility have a refrigerated storage capability?
What is the maximum number of units of blood which can be stored?
Does the medical treatment facility have its own ambulances (number and type [air and ground]) or is this
a service which is provided by another agency/business?
Is the medical treatment facility accredited by its parent nation and or hospital organization (such as in the
U.S. by the Joint Commission on the Accreditation of Health Care Organizations)?
Does the medical treatment facility perform its own medical equipment maintenance or must it be sent out
for repair?
Does the medical treatment facility have dependable electric service? Does it have a backup generator
for power outages? |
4-02 | 197 | Medical Intelligence
Table D-2. Checklist for assessing foreign medical treatment facility capabilities and services
(continued)
Does the medical treatment facility have running water? If not, from what source does the staff obtain
water? Is it potable or does it require treatment before use? Does the medical treatment facility have
access to sterile water?
Does the medical treatment facility have a working environmental control system? Heat? Air
conditioning?
What sanitation facilities are available in the medical treatment facility? Restrooms for patients and staff?
Bathtubs/showers for patients? Handwashing stations/capabilities in patient care areas? Disposal
capabilities for general, medical, and human waste? Disposal capabilities for waste water?
Does the medical treatment facility have a pest management problem (rats, ants, flies, lice, and/or other
animals and insects)?
Does the hospital have its own oxygen generation capability? If not, how are medical gases supplied?
Describe the physical plan of the medical treatment facility. Does it have flooring materials or dirt floors,
adequate ventilation, operational damage, or any other situation which would impact patient care?
Other. Any other issues, concerns, or situations which affect the specific medical treatment facility being
evaluated?
INTEGRATION
D-30. The object of threat integration is to relate how essential elements of information identified in
analysis of the medical aspects of IPB process will affect the health of the command, the employment of
AHS resources, as well as enemy/friendly courses of action as they pertain to medical issues. Further,
information that is gathered relating to resources and background information should be consolidated in a
usable format for use as the need arises. Some useful formats for managing information and medical
intelligence include overlays, spreadsheets, matrices, and databases.
D-31. Threat integration can be broken down into three major categories. It is important to note that in
each category the threat relates only to the health of the command or medical issues. Similarly, the type of
threat can vary greatly with the type of mission or operation (offensive, defensive, and stability tasks). These
categories are—
* What friendly courses of action are best supported from an AHS standpoint? What friendly AHS
courses of action best support the mission?
* What probable enemy courses of action could affect friendly AHS units/resources/services?
* What geographic-related threat issues impact AHS support? Geographic-related threats include
climatic/weather-related threats and their impact on the need for and delivery of AHS and terrain-
related issues that can best be depicted by creating a modified combined obstacle overlay.
CONSOLIDATION
D-32. Understanding and consolidating additional elements of medical information/intelligence into
concise formats assists the planner in future planning efforts or other possible contingencies. Databases are
particularly useful for managing general information. |
4-02 | 199 | Appendix E
Institutional Force Support to the Operational Army
E-1. The Army Medicine has a long tradition of providing world-class medical care across global
operational areas, OEs, and under austere and challenging conditions to the joint force. Wherever an injured
or ill Service member is located, the United States Army will project its resources to locate, acquire, treat,
stabilize, and evacuate our wounded Service members to MTFs capable of providing world-class health care
to enhance the prognosis, mitigate disability, and empower them to lead full and productive lives.
E-2. Historically, Army Medicine has provided acute trauma care, curative, restorative, rehabilitative, and
convalescent care within the AO. Soldiers were not evacuated for care in the CONUS-support base unless
their recovery time exceeded the theater evacuation policy (in some cases up to 60 days).
E-3. With the advent of technological innovations in transportation and medicine the last few years, Soldiers
can be stabilized and rapidly evacuated from austere OEs to world-class fixed MTFs in CONUS or other safe
havens in a matter of hours to days from the time of injury or wounding. These advancements have—
* Enabled the essential care in the operational area concept to be implemented.
* Reduced the medical footprint present in a deployed setting without reducing the quality of
medical care provided to our Soldiers.
* Optimized the use of scarce medical resources.
* Enabled wounded and ill Soldiers to more rapidly be reunited with their Families and personal
support structures to facilitate and enhance the healing process.
MISSION FOCUS
E-4. The mission of the institutional force is to generate and sustain operational Army capabilities. The
Army does not organize the institutional force into standing organizations with a primary focus on specific
operations. Rather, when the institutional force capabilities perform specific functions or missions in support
of and at the direction of joint force commanders, it is for a limited period of time. Upon completion of the
mission, the elements and assets of those institutional force capabilities revert to their original function.
E-5. All elements of the Army, whether the institutional force or operational Army, perform functions
specified by U.S. law. The Army executes Title 10 and Title 32 USC directives, to include organizing,
equipping and training forces for the conduct of prompt and sustained combat operations on land;
accomplishing missions assigned by the President of the United States, Secretary of Defense and CCDRs;
and changing the force to meet current and future demands. Below is the list of USC Title 10, Armed Forces,
Subtitle B, Army functions:
* Recruiting.
* Organizing.
* Supplying.
* Equipping (including research and development).
* Training.
* Servicing.
* Mobilizing.
* Demobilizing.
* Administering (including morale and welfare of personnel).
* Maintaining.
* Constructing, maintaining, repairing buildings structures, utilities, and acquiring real property
and interests in real property necessary to carry out the responsibilities specified in this section. |
4-02 | 200 | Appendix E
E-6. The Army Medicine serves as a critical link between medical formations in the operational and
institutional force to leverage capability and capacity across the Total Army. The Army Medicine and joint
force medical formations Service members receive the best health care anywhere in the world.
THE SURGEON GENERAL
E-7. According to General Order 2020-01, para 37, 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 and serves as the principal military adviser to the Assistant Secretary of the
Army (Manpower and Reserves Affairs) for health affairs.
E-8. The Surgeon General is responsible for—
* Assisting the Assistant Secretary of the Army (Manpower and Reserves Affairs) in developing
policies and programs for the Army system for health and planning and supervising the execution
of those policies and programs.
* Representing Army health policies and military health readiness requirements to DOD, executive
departments, Congress, and nongovernmental organizations.
* Providing technical advice and assistance to the Secretariat and Army Staff for matters on public
health, readiness of the force, warrior transition care, medical force structure and equipping, force
development, medical materiel and research and development, medical training and education,
medical evacuation, and medical military construction.
* Developing and directing the Army’s Planning, Programming, Budgeting, and Execution process
for the Defense Health Program.
* Assessing Assistant Secretary of Defense for Health Affairs and DHA health affairs policies and
programs.
DEFENSE HEALTH AGENCY
E-9. The DHA is a Tri-Service, integrated combat support agency that enables the United States Army,
Navy, and Air Force to provide a medically ready force and ready medical forces to the combatant commands
in support competition continuum. The DHA supports the delivery of integrated, affordable, and high quality
health services to beneficiaries of the Military Health System and is responsible for driving greater integration
of clinical and business processes across the Military Health System. The DHA leads the Military Health
System's integrated system of readiness and health to deliver increased readiness, better health, and lower
cost. In support of a cohesive, globally integrated, affordable, and high quality Military Health System, the
DHA directs the execution of ten joint directorates and manages and administers the following Enterprise
Support Activities:
* TRICARE Health Plan.
* Pharmacy Programs.
* Health Information Technology.
* Education and Training.
* Public Health.
* Medical Logistics.
* Facility Management.
* Budget and Resource Management.
* Research, Development, and Acquisition.
* Procurement and Contracting.
E-10. The DHA's administration of the TRICARE Health Plan provides worldwide medical, dental, and
pharmacy programs for over 9.4 million members of the uniformed Services, retirees, and Family members.
SUPPORT TO THE TACTICAL COMMANDER
E-11. The institutional force fulfills numerous critical roles with regards to supporting the Soldiers deployed
in an operational area. Army Medicine organizations conduct operational development activities and medical |
4-02 | 201 | Institutional Force Support to the Operational Army
research and development to discover and field advanced technologies to mitigate the health threat faced by
our deployed forces. Army Medicine institutional forces facilitate and enhance medical readiness of Soldiers
through the promotion of fitness and healthy lifestyles, the Performance Triad, and the prevention of diseases
and injuries. Army Medicine institutional forces provide mobilization and predeployment support to ensure
that Soldiers are mentally and physically ready to be deployed (immunizations, predeployment health
assessments, dental, vision, and hearing readiness testing and treatment, and health risk communications on
health hazards in the operational environment. During deployments, they provide reach back support through
medical specialty areas and can deploy teams comprised of physicians, scientists, technicians, and other
health care providers to provide solutions to unique health threats or medical conditions and issues occurring
during the deployment.
EDUCATION
E-12. Educational requirements within the health care professions are significantly more complex than in
other branches of the Army. Formal accredited schooling is required for fields within Army Medicine and
professional education is received in civilian educational and DOD medical organizations. Medical
education is a lengthy process, which is often accomplished in phases (such as, medical school, internship,
and residency). Medical professionals require credentialing and licensure before they can practice medicine.
Credentials are most often obtained from non-DOD affiliated civilian organizations. Health professions also
require continuing education to maintain certification. Headquarters, Department of the Army, Office of The
Office of The Surgeon General facilitates this process by providing global opportunities to fulfill the
continuing education requirements health care professionals across the Total Army.
TRAINING
E-13. All medical military occupational specialties require school training. Medical skills are perishable
and require continual practice and refresher training. The MEDCoE provides military occupational specialty-
specific training for award of medical military occupational specialties and provides refresher training for
some low-density for Reserve Component forces and United States Army National Guard when mobilized.
Additionally, the MEDCoE develops and fields collective training materials and distance learning programs.
In some medical specialty areas, the didactic portion is completed at the MEDCoE while the resident phase
is conducted at Role 4 MTFs.
ARMY MEDICAL ACTION PLAN
E-14. Military personnel are treated at DOD MTFs in conjunction with the Department of Veterans
Affairs, and civilian medical facilities to provide world-class health care and services for their dedication and
sacrifices to the nation. In support of this plan, the Chief of Staff of the Army approved the actions to be
implemented to include:
* Establish and institutionalize a command and control structure for Service members undergoing
long-term definitive, rehabilitative, and convalescent care.
* Prioritize mission support and create ownership of actions and processes.
* Flex housing policies and focus on Family support issues.
* Develop training and doctrine to facilitate and ensure a system which provides timely and effective
support.
* Create full patient visibility throughout the Army and Military Health Systems continuum of care
and facilitate medical information sharing across agencies to improve patient outcomes.
* Improve the medical evaluation board process and eliminate delays in the process.
E-15. The intent of this action plan is for the Army to provide a continuum of integrated care and services
from POI or wounding, illness, or disease to return to duty or transition from active duty. It is vital that the
Army coordinates execution of the necessary changes at the strategic, operational, and tactical level to ensure
a simultaneous transformation of care and services over all lines of operations to achieve the desired end
state. |
4-02 | 202 | Appendix E
THE ARMY RECOVERY CARE PROGRAM
E-16. The Army Recovery Care Program (ARCP) (formerly the Warrior Care and Transition Program)
serves as the proponent for the case management and transition of the Army's seriously wounded, ill, and
injured Soldiers. The program provides oversight, guidance, and advocacy for wounded, ill, and injured
Soldiers, Veterans, and Families through a comprehensive recovery plan aimed at successful reintegration
back into the force or into the community with dignity, respect, and self-determination. The ARCP includes
an oversight and policy headquarters (a staff directorate of the U.S. Army Medical Command) and 14 Soldier
Recovery Units.
E-17. The Soldier Recovery Units (see Figure E-1) are strategically postured at 14 installations aligned to
division and corps headquarters with the capacity to manage care for 2,800 active, U.S. Army Reserve and
Army National Guard Soldiers. The ARCP provides a total force solution for wounded, ill, and injured
Soldiers and the program utilizes multi-component cadre designed to meet the needs of the population. More
than 80,000 Soldiers have entered the ARCP, with a population peak of nearly 12,500 Soldiers in 2008. The
program's motto, "Recover and Overcome," helps inspire Soldiers that their condition does not define them
or their legacy. The health, humanity, dignity and respect of each individual Soldier remains paramount as
the program remains scalable to meet future Army requirements. The foundation of the program includes:
* Single entry criteria for all components concentrating medical and administrative resources on
Soldiers with complex case management requirements.
* Program and policy that supports goals and requirements based on individual Soldier requirements
and point of recovery.
* Advocacy and non-clinical case management through transition to Veteran status and beyond.
* A comprehensive recovery plan supported by an interdisciplinary team including military leaders,
transition coordinators, adaptive reconditioning specialists, and behavioral health professionals to
help Soldiers realize their transition or career goals.
Figure E-1. The Soldier Recovery Unit
SOLDIER RECOVERY UNITS
E-18. The Soldier Recovery Unit is a total force solution open to Soldiers, regardless of mechanism of
injury (in the line of duty), who meet the single entry criteria. The Soldier Recovery Unit is comprised of
four platoons: Headquarters platoon, Complex Care platoon, Veteran Track platoon, and Return to Duty
platoon. Each platoon is designed to meet the case management requirements of Soldier Recovery Unit
Soldiers, and Soldiers are assigned to platoons depending on the primary stage of their recovery. This
organization enables the Soldier Recovery Unit to concentrate personnel and services in accordance with
each Soldier's individual recovery requirements. Two critical components of the Soldier Recovery Unit are
the Triad of Leadership (TOL) and Triad of Care. |
4-02 | 203 | Institutional Force Support to the Operational Army
E-19. The TOL consists of senior commanders/command sergeants major, MTF commander/MTF ASCCs
commanders/command sergeants major, and Soldier Recovery Unit commanders/command sergeants major.
Soldier Recovery Unit entry packets are reviewed by the TOL but the senior commander on a Soldier
Recovery Unit installation is the final decision authority for Soldier Recovery Unit entry.
E-20. The triad of care consists of the Soldier Recovery Unit Medical Provider, nurse case manager, and
platoon sergeant/squad leader. The TOL and Triad of Care work together in conjunction with the
interdisciplinary team to ensure advocacy for Warriors, continuity of care, and a seamless transition into the
force or return to a productive civilian life. |
4-02 | 205 | Appendix F
Army Health System Symbols
This appendix depicts and describes a variety of symbols and control measures related
to AHS tactical mission tasks. The appendix does not attempt to produce all
conceivable combinations for AHS symbols or control measures, but rather, it shows
several examples of each type as a starting point. Readers should refer to MIL-STD
2525D and ADP 1-02 for more information about military symbols.
F-1. Military symbols are governed by the rules in MIL-STD 2525D. Army Doctrine Publication 1-02 is
the Army proponent publication for all military symbols and complies with MIL-STD 2525D.
F-2. Army Doctrine Publication 1-02 provides a single standard for developing and depicting hand drawn
and computer-generated military symbols for situation maps, overlays, and annotated aerial photographs for
all types of military operations. A military symbol is a graphic representation of a unit, equipment,
installation, activity, control measure, or tactical task relevant to military operations that is used for planning
or to represent the common operational picture on a map, display, or overlay. Chapters 4–7 of ADP 1-02
also provide an extensive number of icons and modifiers for building a variety of framed symbols. Refer to
Table F-1 for medical main icons.
Table F-1. Medical main icons
Function Icon Example
Note. The icon has been
enlarged for better visibility
and is not proportional to the
orientation or example
Hospital
(medical treatment facility)
Medical
(Geneva cross)
F-3. Sector 1 modifiers depict unit capabilities. These modifiers show the specific functions that the unit
is organized and equipped to perform. Refer to Table F-2 (on page F-2) for medical sector 1 modifiers. |
4-02 | 206 | Appendix F
Table F-2. Medical sector 1 modifier
Function Icon Example
Note. The icon has been
enlarged for better visibility
and is not proportional to the
orientation or example
NATO medical role 1 1
NATO medical role 2 2
NATO medical role 3 3
NATO medical role 4 4
Medical evacuation
F-4. Sector 2 icons. Sector 2 modifiers reflect the mobility; size, range, or altitude of unit equipment; or
additional capability of units. Refer to Table F-3 for medical sector 2 modifiers.
Note. Modifiers for medical units are offset to the right to avoid overlapping with the main icon. |
4-02 | 207 | Army Health System Symbols
Table F-3. Medical sector 2 modifiers
Function Icon Example
Note. The icon has been
enlarged for better
visibility and is not
proportional to the
orientation or example
Blood
.
COSC
Dental
Medical bed
Medical laboratory LAB
Optometry
Patient evacuation coordination PEC
Preventive medicine
Surgical
Veterinary V |
4-02 | 208 | Appendix F
F-5. Activities symbols are applicable across the competition continuum, but they normally focus on
stability activities and defense support of civil authorities’ activities. Activities can affect military operations.
Activities represented by icons can include acts of terrorism, sabotage, organized crime, a disruption of the
flow of vital resources, and the uncontrolled movement of large numbers of people. Many of these icons
represent emergency first response activities used in the civilian community. Icons in the main sector reflect
the main function of the symbol. Refer to Table F-4 for medical main icons for activities; refer to Table F-5
for medical sector 1 modifiers for activities and Table F-6 for medical CBRN control measures.
Table F-4. Medical main icons for activities
Function Icon Example
Note. The icon has been
enlarged for better visibility
and is not proportional to the
orientation or example
Emergency medical operations
.
Point of injury POI
.
Triage
Table F-5. Medical sector 1 modifiers for activities
Function Icon Example
Emergency collection evacuation ECEP
point
Table F-6. Medical CBRN control measures
Control Measure Template Example
Decontamination site
Wounded personnel
LEGEND:
CBRN – Chemical, Biological, Radiological, Nuclear DCN - Decontamination
UK – United Kingdom W - Wounded |
4-02 | 209 | Army Health System Symbols
F-6. A control measure symbol is a graphic used on maps and displays to regulate forces and warfighting
functions. Control measure symbols (refer to Table F-7) are organized by the six warfighting functions:
command and control, movement and maneuver, fires, protection, sustainment, and intelligence. Control
measure symbols generally fall into one of three categories: points, lines, or areas. The coloring and labeling
of control measure symbols are almost identical to framed symbols
Table F-7. Medical sustainment control measures
Construct example and
Control Measure Main Icon (Field A)
symbol translation
Ambulance exchange point
A location where a patient is AXP
transferred from one ambulance
to another en route to a medical
treatment facility.
Ambulance control point
A point where ambulances may ACP
take one of two or more
directions to reach loading
points.
Ambulance load point
A point where one or more ALP
ambulances are stationed ready
to receive patients for
evacuation.
Ambulance relay point
ARP
A point where one or more empty
ambulances are stationed.
Casualty collection point
A specific location where CCP
casualties are assembled to be
transported to an MTF, for
example, a company aid post.
Medical evacuation pickup
point |
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