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Army Health System

Doctrine Smart Book 1 JUNE 2020

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HEADQUARTERS, DEPARTMENT OF THE ARMY

Foreword

As the Army transitions from counterinsurgency operations to large-scale combat operations (LSCO), the United States Army Medical Center of Excellence must redefine its culture. Training, education, and force modernization must focus on operational medicine in support of LSCO instead of hospital- based health care delivery and limited contingency missions. The foundation of Army operations has always been Army doctrine and it is important for this cultural evolution to reinvigorate our use and understanding of doctrine. The Doctrine Smart Book is an effort to consolidate important doctrinal references in one place and make it easier to find the most significant doctrinal concepts. This document captures all of the Army medical doctrine in one abbreviated publication. Leaders have a responsibility to seek self-development and to develop their subordinates; this Doctrine Smart Book is a useful tool to energize Soldiers to seek more detailed information on how we employ medical capabilities in support of Army, joint, and multinational operations. The Army Health System Doctrine Smart Book will be updated frequently when Army Health System doctrine, as well as Army doctrine, is updated and published to the fielded force. The lead agent for this publication is the United States Army Medical Center of Excellence’s Doctrine Division. It invites input and feedback on improvements to this tool. As we are often reminded, doctrine communicates the units and capabilities that currently exist. Doctrine outlines how capabilities can be employed if they were required now or in the near future. Today, Army Medicine is entering not only a period of transition, but also an era of great opportunity. The strategic environment has grown increasingly complex, demanding a more agile force that must adapt in order to operate in a multi-domain operations (MDO) environment. Technological advances have created new ways to communicate, to understand, and to influence others. At the same time, almost two decades of war has reinforced timeless lessons about the centrality of human beings in all aspects of military operations. We must build on these insights to change how we think about, plan for, and conduct all of our operations. Doctrine will be in a relentless state of revision over the next several years as doctrine developers endeavor to keep up with evolving capability developments related to LSCO and MDO. While we cannot predict the future, we can be certain that the Chief of Staff of the Army will continue to call on Army Medicine to preserve Soldier lethality and survivability. Going forward, Army Medicine will continue to transition in support of MDO and in LSCO. Army Medicine will apply the lessons learned from recent combat to peacetime as we prepare for evolving threats. Our doctrine will keep pace in order to provide the framework by which we provide medical support; it is incumbent upon leaders to ensure our doctrine is inculcated into the training, education, and professional development of our units and Soldiers.

DENNIS P; LEMASTER Major General, U.S. Army Commanding

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1 June 2020 Army Health System Doctrine Smart Book i

1 June 2020

Army Health System Doctrine Smart Book

Contents

Page

PREFACE……………………………………………………………………………………………………… v

PART ONE ARMY HEALTH SYSTEM Introduction ……………………………………………………………………………………………………. 1 Army Health System Operational Framework …………………………………………………….. 1 Operational Environment …………………………………………………………………………………. 2 Roles of Medical Care (Army) (FM 4-02) …………………………………………………………… 4 Army Health System Principles (FM 4-02) …………………………………………………………. 7 Medical Functions (FM 4-02) ……………………………………………………………………………. 9

PART TWO ARMY HEALTH SYSTEM DOCTRINE HIERARCHY AND SUMMARIES Introduction ………………………………………………………………………………………………….. 19 Army Health System Publications …………………………………………………………………… 21

PART THREE ARMY HEALTH SYSTEM UNIT SYNOPSIS Introduction ………………………………………………………………………………………………….. 53 Army Command and Support Relationships …………………………………………………….. 53 Medical Command (Deployment Support) ……………………………………………………….. 57 Medical Brigade (Support) ……………………………………………………………………………… 62 Medical Battalion (Multifunctional) …………………………………………………………………… 67 Combat Support Hospital (248-bed) ………………………………………………………………… 71 Hospital Company (84-bed)……………………………………………………………………………. 73 Hospital Company (164-bed)………………………………………………………………………….. 77 Hospital Center (240-bed) ……………………………………………………………………………… 80 Field Hospital (32-bed) ………………………………………………………………………………….. 87 Hospital Augmentation Detachment (Surgical 24-bed) ………………………………………. 95 Hospital Augmentation Detachment (Medical 32-bed) ……………………………………….. 99 Hospital Augmentation Detachment (Intermediate Care Ward 60-bed) ……………… 103 Medical Detachment, Minimal Care ………………………………………………………………. 106 Hospital Augmentation Team, Head and Neck ……………………………………………….. 109 Forward Resuscitative and Surgical DETACHMENT (FRSD) …………………………… 111 Forward Surgical Team (FST) ………………………………………………………………………. 116 Medical Company (Area Support) …………………………………………………………………. 118 Brigade Support Medical Company (Airborne, Armor, Infantry, and Stryker) ………. 121 121 Medical Company (Air Ambulance) ……………………………………………………………….. 125 Medical Company (Ground Ambulance) ………………………………………………………… 127 Dental Company (Area Support) …………………………………………………………………… 129 Medical Logistics Company ………………………………………………………………………….. 131

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Medical Detachment (Veterinary Service Support) …………………………………………… 135 Medical Detachment, Combat and Operational Stress Control …………………………. 139 Medical Detachment, Preventive Medicine ……………………………………………………… 141 Medical Detachment, Blood Support ……………………………………………………………… 143 Medical Detachment, Optometry …………………………………………………………………… 146 Medical Logistics Management Center …………………………………………………………… 148 Area Medical Laboratory ………………………………………………………………………………. 151

PART FOUR ARMY HEALTH SYSTEM BY ARMY STRATEGIC ROLE Introduction ………………………………………………………………………………………………… 153 Shape ………………………………………………………………………………………………………… 155 Prevent ………………………………………………………………………………………………………. 165 Large Scale Combat Operations ……………………………………………………………………. 175 Consolidate Gains ……………………………………………………………………………………….. 186

SUMMARY ………………………………………………………………………………………………. 199

GLOSSARY ………………………………………………………………………………………………… 1

Section I – Acronyms and Abbreviations ……………………………………………………….. 1

Section II – Terms …………………………………………………………………………………………. 4

Section III – Army Health System Symbology ………………………………………………… 9

Figures

Figure 1-1. Army Health System Operational Framework ………………………………………………………. 1

Figure 1-2. Army Health System Logic Chart ……………………………………………………………………….. 3

Figure 1-3. Ten Army Health System Medical Functions ……………………………………………………….. 9

Figure 3-1. Medical Command (Deployment Support) OCP …………………………………………………. 61

Figure 3-2. Medical Command (Deployment Support) MCP …………………………………………………. 61

Figure 3-3. Medical Brigade (Support), Early Entry Module ………………………………………………….. 65

Figure 3-4. Medical Brigade (Support), Expansion Module …………………………………………………… 66

Figure 3-5. Medical Brigade (Support) Campaign Module ……………………………………………………. 66

Figure 3-6. Medical Battalion (Multifunctional), Early Entry Element ……………………………………… 70

Figure 3-7. Medical Battalion (Multifunctional), Campaign Support Element …………………………… 70

Figure 3-8. Hospital Center (240-bed) ……………………………………………………………………………….. 84

Figure 3-9. Hospital Center (240-bed) ……………………………………………………………………………….. 84

Figure 3-10. Hospital Center (240-bed) ……………………………………………………………………………… 85

Figure 3-11. Hospital Center (240-bed) ……………………………………………………………………………… 85

Figure 3-12. Hospital Center (240-bed) ……………………………………………………………………………… 86

Figure 3-13. Field Hospital (32-bed) ………………………………………………………………………………….. 93

Figure 3-14. Field Hospital (32-bed) ………………………………………………………………………………….. 93

Figure 3-15. Field Hospital (32-bed) ………………………………………………………………………………….. 94

Figure 3-16. Hospital Augmentation Detachment (Surgical 24-bed) ………………………………………. 98

Figure 3-17. Hospital Augmentation Detachment (Surgical 24-bed) ………………………………………. 98

Figure 3-18. Hospital Augmentation Detachment (Medical 32-bed) …………………………………….. 102

Figure 3-19. Hospital Augmentation Detachment (Medical 32-bed) …………………………………….. 102

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Figure 3-20. Hospital Augmentation Detachment (ICW 60-bed) …………………………………………. 105

Figure 3-21. Minimal Care Detachment (120-Bed) ……………………………………………………………. 108

Figure 3-22. Complete Forward Resuscitative Surgical Detachment …………………………………… 114

Figure 3-23. Split-Based Forward Resuscitative Surgical Detachment ………………………………… 114

Figure 3-24. Medical Company (Area Support) ………………………………………………………………… 120

Figure 3-25. Brigade Support Medical Company (IBCT) ……………………………………………………. 124

Figure 3-26. Medical Company (Air Ambulance) ………………………………………………………………. 126

Figure 3-27. Medical Company (Ground Ambulance)………………………………………………………… 128

Figure 3-28. Dental Company (Area Support) ………………………………………………………………….. 130

Figure 3-29. Medical Logistics Company …………………………………………………………………………. 134

Figure 3-30. Medical Detachment (Veterinary Service Support) …………………………………………. 138

Figure 3-31. Combat and Operational Stress Control ………………………………………………………… 140

Figure 3-32. Medical Detachment, Preventive Medicine ……………………………………………………. 142

Figure 3-33. Medical Detachment, Blood Support …………………………………………………………….. 145

Figure 3-34. Medical Detachment, Optometry ………………………………………………………………….. 147

Figure 3-35. Medical Logistics Management Center………………………………………………………….. 150

Figure 3-36. Area Medical Laboratory ……………………………………………………………………………… 152

Figure 4-1. Medical Command and Control in Shaping ……………………………………………………… 156

Figure 4-2. Medical Treatment in Shaping ……………………………………………………………………….. 157

Figure 4-3. Hospitalization in Shaping …………………………………………………………………………….. 158

Figure 4-4. Medical Evacuation in Shaping ………………………………………………………………………. 159

Figure 4-5. Dental Services in Shaping ……………………………………………………………………………. 160

Figure 4-6. Preventive Medicine in Shaping …………………………………………………………………….. 161

Figure 4-7. Combat and Operational Stress Control in Shaping ………………………………………….. 162

Figure 4-8. Veterinary Services in Shaping ………………………………………………………………………. 163

Figure 4-9. Medical Logistics in Shaping …………………………………………………………………………. 164

Figure 4-10. Medical Laboratory in Shaping …………………………………………………………………….. 165

Figure 4-11. Medical Command and Control in Prevent …………………………………………………….. 166

Figure 4-12. Medical Treatment in Prevent ………………………………………………………………………. 167

Figure 4-13. Hospitalization in Prevent ……………………………………………………………………………. 168

Figure 4-14. Medical Evacuation in Prevent …………………………………………………………………….. 169

Figure 4-15. Dental Services in Prevent ………………………………………………………………………….. 170

Figure 4-16. Preventive Medicine in Prevent ……………………………………………………………………. 171

Figure 4-17. COSC in Prevent ……………………………………………………………………………………….. 172

Figure 4-18. Veterinary Services in Prevent …………………………………………………………………….. 173

Figure 4-19. Medical Logistics in Prevent ………………………………………………………………………… 174

Figure 4-20. Medical Laboratory in Prevent ……………………………………………………………………… 175

Figure 4-21. Medical Command and Control in LSCO ………………………………………………………. 177

Figure 4-22. Medical Treatment in LSCO ………………………………………………………………………… 178

Figure 4-23. Hospitalization in LSCO ………………………………………………………………………………. 179

Figure 4-23a. Hospitalization in LSCO (hospital center split) ……………………………………………… 179

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Figure 4-24. Medical Evacuation in LSCO ………………………………………………………………………… 180

Figure 4-25. Dental Services in LSCO ……………………………………………………………………………… 181

Figure 4-26. Preventive Medicine in LSCO ………………………………………………………………………. 182

Figure 4-27. COSC in LSCO ………………………………………………………………………………………….. 183

Figure 4-28. Veterinary Services in LSCO………………………………………………………………………… 184

Figure 4-29. Medical Logistics in LSCO …………………………………………………………………………… 185

Figure 4-30. Medical Laboratory in LSCO ………………………………………………………………………… 186

Figure 4-31. Medical Command and Control in Consolidating Gains …………………………………… 188

Figure 4-32. Medical Treatment in Consolidating Gains …………………………………………………….. 189

Figure 4-33. Hospitalization in Consolidating Gains …………………………………………………………… 190

Figure 4-34. Medical Evacuation in Consolidating Gains ……………………………………………………. 191

Figure 4-35. Dental Services in Consolidating Gains …………………………………………………………. 192

Figure 4-36. Preventive Medicine in Consolidating Gains …………………………………………………… 193

Figure 4-37. COSC in Consolidating Gains ………………………………………………………………………. 194

Figure 4-38. Veterinary Services in Consolidating Gains ……………………………………………………. 195

Figure 4-40. Medical Laboratory in Consolidating Gains …………………………………………………….. 197

Tables

Table 1-1. Medical command function (primary tasks and purposes) (FM 4-02) ……………………… 10

Table 1-2. Medical treatment (organic and area support) function (primary tasks and purposes) (FM 4-02) ………………………………………………………………………………………………………. 11

Table 1-3. Hospitalization function (primary tasks and purposes) (FM 4-02) …………………………… 12

Table 1-4. Medical evacuation function (primary tasks and purposes) (FM 4-02) ……………………. 13

Table 1-5. Medical logistics function (primary tasks and purposes) (FM 4-02) ………………………… 13

Table 1-6. Preventive dentistry (primary tasks and purposes) (FM 4-02) ……………………………….. 14

Table 1-7. Dental services function (primary tasks and purposes) (FM 4-02) ………………………….. 14

Table 1-8. Preventive medicine function (primary tasks and purposes) (FM 4-02) …………………… 15

Table 1-9. Combat & operational stress control function (primary tasks & purposes) (FM 4-02) .. 16

Table 1-10. Behavioral health/neuropsychiatric treatment (primary tasks & purposes) (FM 4-02) 16

Table 1-11. Veterinary services function (primary tasks and purposes) (FM 4-02) ………………….. 16

Table 1-12. Veterinary services treatment (primary tasks and purposes) (FM 4-02) ………………… 17

Table 1-13. Medical laboratory services function (primary tasks and purposes) (FM 4-02) ………. 17

Table 1-14. Clinical laboratory services (primary tasks and purposes) (FM 4-02) ……………………. 17

Table 3-1. Army command and support relationships ………………………………………………………….. 55

Table 3-2. Army support relationships ……………………………………………………………………………….. 56

Table 4-1. List of abbreviations for Figures 4-1 through 4-40 ………………………………………………. 154

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Preface

The Army Health System Doctrine Smart Book is a concise collection of Army Health System summaries that reflects current approved doctrine. Part One provides a summary of the Army Health System and its ten medical functions. Part Two provides a visual representation of the Army Health System’s doctrinal hierarchy and its corresponding Army and joint doctrine. It illustrates the hierarchy as it applies to the Joint Publication 4-02, Joint Health Services; Field Manual 4-02, Army Health System; and Army Health System Army techniques publications. It follows on with one-page synopses of each current approved Army Health System doctrinal publication. Each synopsis contains the characteristics, fundamentals, terms, and ideas as they are discussed in each publication. Part Three consists of doctrinal synopses of each Army Health System unit. Each synopsis contains the table of organization and equipment, task organization, personnel breakdown, and doctrinal employment as they are discussed in various Army Health System doctrinal publications. Part Four discusses the Army Health System by Army strategic role (shape, prevent, large scale ground combat operations, and consolidate gains). The principal audience for this publication is all readers of Army Health System doctrine—military, civilian, and contractor. This publication uses Department of Defense terms where applicable. The proponent and preparing agency of the Army Health System Doctrine Smart Book is the United States Army Medical Center of Excellence (MEDCoE), Doctrine Literature Division. Send questions, comments, and recommendations to Commander, MEDCoE, ATTN: MCCS-FD (Army Health System Doctrine Smart Book), 2377 Greeley Road, Joint Base San Antonio, Fort Sam Houston, Texas 78234- 7731 or by e-mail to usarmy.jbsa.medical-coe.mbx.ameddcs-medical-doctrine@mail.mil.

mailto:usarmy.jbsa.medical-coe.mbx.ameddcs-medical-doctrine@mail.mil
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PART ONE

ARMY HEALTH SYSTEM

INTRODUCTION

The Army Health System (AHS) is a component of the Military Health System (MHS) that is responsible for operational management of the health service support (HSS) and force health protection (FHP) missions for training, predeployment, deployment, and postdeployment operations. Army Health System includes all mission support services performed, provided, or arranged by the Army Medicine to support HSS and FHP mission requirements for the Army and as directed, for joint, intergovernmental agencies, coalition, and multinational forces. The AHS is a complex system of systems that is interdependent and interrelated and requires continual planning, coordination, and synchronization to effectively and efficiently clear the battlefield of casualties and to provide the highest standard of care to our wounded or ill Soldiers.

ARMY HEALTH SYSTEM OPERATIONAL FRAMEWORK

1-1. The AHS supports and is in consonance with joint doctrine, as described in Joint Publication (JP) 4-02. Figure 1-1 below depicts the AHS medical command and control (C2) operational framework.

Figure 1-1. Army Health System Operational Framework

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OPERATIONAL ENVIRONMENT

1-2. The future operational environment (OE) and our forces’ challenges to operate across the range of military operations represents the most significant readiness requirement. The logic chart (Figure 1-2) begins with an anticipated OE that includes considerations during LSCO against a peer threat. Next, it depicts the Army’s contribution to joint operations through the Army’s strategic roles. Within each phase of a joint operation, the Army’s operational concept of unified land operations guides how Army forces conduct operations. In large-scale ground combat, Army forces combine offensive, defensive, and stability tasks to seize, retain, and exploit the initiative in order to shape OEs, prevent conflict, conduct large-scale ground combat, and consolidate gains. The philosophy of mission command guides commanders, staffs, and subordinates in their approach to operations. The mission command warfighting function enables commanders and staffs of theater armies, corps, divisions, and brigade combat teams (BCTs) to synchronize and integrate combat power across multiple domains and the operational environment. Throughout operations, Army forces maneuver to achieve and exploit positions of relative advantage across all domains to achieve objectives and accomplish missions.

1-3. The logic chart (Figure 1-2) also depicts how the AHS supports the operating force to support FHP and HSS mission requirements for the Army and as directed, for joint, inter-governmental agencies, coalition, and multinational forces during LSCO. For more information on AHS support to the Army strategic roles, refer to Field Manual (FM) 4-02, Appendix B.

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Figure 1-2. Army Health System Logic Chart

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ROLES OF MEDICAL CARE (ARMY) (FM 4-02)

1-4. A basic characteristic of organizing modern AHS support is the distribution of medical resources and capabilities to facilities at various levels of command, diverse locations, and progressive capabilities, which are referred to as roles of care.

1-5. Definitive care refers to (1) that care which returns an ill or injured Soldier to full function, or the best possible function after a debilitating illness or injury. Definitive care can range from self- aid when a Soldier applies a dressing to a grazing bullet wound that heals without further intervention, to two weeks bed rest in theater for Dengue fever, to multiple surgeries and full rehabilitation with a prosthesis at a continental United States (CONUS) medical center or Department of Veteran’s Affairs hospital after a traumatic amputation. (2) That treatment required to return the Service member to health from a state of injury or illness. The Service member’s disposition may range from return to duty to medical discharge from the military. It can be provided at any role depending on the extent of the Service member’s injury or illness. It embraces those endeavors which complete the recovery of the patient. (FM 4-02)

1-6. Definitive treatment refers to the final role of comprehensive care provided to return the patient to the highest degree of mental and physical health possible. It is not associated with a specific role or location in the continuum of care; it may occur in different roles depending upon the nature of the injury or illness. (FM 4-02)

1-7. As a general rule, no role of care will be bypassed except on grounds of medical urgency, efficiency, or expediency. The rationale for this rule is to ensure the stabilization/survivability of the patient through tactical combat casualty care (TCCC), and far forward resuscitative surgery is accomplished prior to movement between medical treatment facilities (MTFs) (Roles 1 through 3).

Nonmedical Personnel

1-8. Nonmedical personnel performing first aid procedures assist the combat medic in their duties. First aid is administered by an individual (self-aid or buddy aid) and enhanced first aid is provided by the combat lifesavers. A combat lifesaver is a nonmedical Soldier of a unit trained to provide enhanced first aid as a secondary mission (currently the proponent for this term is FM 4-02 but will be moved to Army Techniques Publication (ATP) 4-02.3 when revised).

Self-Aid and Buddy Aid

1-9. Each individual Soldier is trained in a variety of specific first aid procedures. These procedures include aid for chemical casualties with particular emphasis on lifesaving tasks. This training enables the Soldier or a buddy to apply first aid to alleviate potential life-threatening situations. Each Soldier is issued an individual first aid kit to accomplish first aid tasks. First aid refers to urgent and immediate lifesaving and other measures which can be performed for casualties (or performed by the victim himself) by nonmedical personnel when medical personnel are not immediately available (currently the proponent for this term is FM 4-02 but will be moved to ATP 4-02.11 when published).

Combat Lifesaver

1-10. The combat lifesaver is a nonmedical Soldier selected by his unit commander for additional training beyond basic first aid procedures. A minimum of one individual per squad, crew, team, or equivalent-sized unit should be trained. The primary duty of this individual does not change. The additional duty of the combat lifesaver is to provide enhanced first aid for injuries, based on his training, before the combat medic arrives. Combat lifesaver training is normally provided by medical personnel during direct support of the unit. The training program is managed by the senior medical person designated by the commander. Members of Special Forces operational detachment teams receive first aid training at the combat lifesaver level.

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Role 1

1-11. The first medical care a Soldier receives is provided at Role 1 (also referred to as unit-level medical care). This role of care includes—

 Immediate lifesaving measures.

 Disease and nonbattle injury (DNBI) prevention.

 Combat and operational stress preventive measures.

 Patient location and acquisition (collection).

 Medical evacuation (MEDEVAC) from supported units (point of injury [POI] or wounding, company aid posts, or casualty/patient collection points) to supporting MTFs.

 Treatment provided by designated combat medics or treatment squads. (Major emphasis is placed on those measures necessary for the patient to return to duty or to stabilize him and allow for his evacuation to the next role of care. Return to duty refers to a patient disposition which, after medical evaluation and treatment when necessary, returns a Soldier for duty in his unit. (FM 4-02) These measures include maintaining the airway, stopping bleeding, preventing shock, protecting wounds, immobilizing fractures, and other emergency measures, as indicated.)

1-12. Role 1 medical treatment is provided by the combat medic or flight paramedic during air evacuation or by the physician, the physician assistant, or the health care specialist in the battalion aid station (BAS)/Role 1 MTF. Emergency Medical Treatment (EMT) refers to the immediate application of medical procedures to the wounded, injured, or sick by specially trained medical personnel. (FM 4-02) In Army special operations forces, Role 1 treatment is provided by special operations combat medics, special forces medical sergeants, or physicians and physician assistants at forward operating bases, special forces operating bases, or in joint special operations task forces. Role 1 includes—

 The TCCC (immediate far forward care) consists of those lifesaving steps that do not require the knowledge and skills of a physician. The combat medic is the first individual in the medical chain that makes medically substantiated decisions based on medical military occupational specialty-specific training.

 At the BAS, the physician and the physician assistant are trained and equipped to provide TCCC to the combat casualty. This element also conducts routine sick call when the operational situation permits. Like elements provide this role of medical care at brigade and echelons above brigade (EAB).

 During MEDEVACs, Role 1 treatment is provided by the combat medic (during ground evacuation) or by the critical care flight paramedic (during air evacuation) to an MTF. Critical care flight paramedics are trained and equipped to provide advanced en route care to the combat casualty.

Role 2

1-13. At this role, care is rendered at the Role 2 MTF which is operated by the area support squad, medical treatment platoon of medical companies. Here, the patient is examined and his wounds and general medical condition are evaluated to determine his treatment and evacuation precedence, as a single patient among other patients. Tactical combat casualty care including beginning resuscitation is continued, and if necessary, additional emergency measures are instituted, but they do not go beyond the measures dictated by immediate necessities. The Role 2 MTF has the capability to provide packed red blood cells (liquid), limited x-ray, clinical laboratory, operational dental support, combat and operations stress control (COSC), preventive medicine, and when augmented, physical therapy and optometry services. The Role 2 MTF provides a greater capability to resuscitate trauma patients than is available at Role 1. Those patients who can return to duty within 72 hours (1 to 3 days) are held for treatment. This role of care provides MEDEVAC from Role 1 MTFs and also provides Role 1 medical treatment on an area support basis for units without organic Role 1 resources.

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1-14. Patients who are nontransportable due to their medical condition may require resuscitative surgical care from a forward surgical team (FST) or forward resuscitative and surgical team (FRSD) collocated with a medical company (refer to Army doctrine on the FST or FRSD). Nontransportable patient is a patient whose medical condition is such that he could not survive further evacuation to the rear without surgical intervention to stabilize his medical condition. (Currently the proponent is FM 4-02 but will be moved to ATP 4-02.2 when published). The FST or FRSD is assigned to the medical command (deployment support) MEDCOM [DS] or medical brigade (support) (MEDBDE [SPT]) and attached to a combat support hospital (CSH) or hospital center when not operationally employed. However, the FST or FRSD is only attached to a medical company for resuscitative surgical care capability support when employed.

1-15. Role 2 AHS assets are located in the—

 Brigade support medical companies (BSMCs), assigned to modular brigades which include the airborne, armored, infantry, and the Stryker brigade combat teams (SBCTs).

 Medical companies (area support) (MCAS) which is an EAB asset that provides direct support to the modular division and support to EAB units on an area basis.

 The North Atlantic Treaty Organization (NATO) descriptions of Role 2 are—

 A Role 2 basic MTF can provide reception, triage, resuscitation, and damage control surgery, short term holding capacity for at least six and a postoperative care capability for at least two patients.

 An enhanced Role 2 MTF can provide enhanced diagnostics and mission essential specialist care (including in theater surgery). They have at least two surgical teams, with respective emergency and postoperative care capabilities, x-ray, laboratory, blood bank, pharmacy, sterilization, dentistry, and a short term holding capacity of 25 patients.

Note. The United States Army forces subscribe to the basic definition of a Role 2 MTF providing greater resuscitative capability than is available at Role 1. It does not subscribe to the interpretation used by NATO forces Allied Joint Publication-4.10(B) (Role 2 basic and Role 2 enhanced) and JP 4-02 (Role 2 light maneuver and Role 2 enhanced) that a surgical capability is mandatory at this role.

1-16. The United States Army does not provide damage control surgery and does not provide surgical capability at Role 2 unless a FST or FRSD is collocated with the medical company to provide forward surgical intervention.

Role 3

1-17. At Role 3, the patient is treated in an MTF staffed and equipped to provide care to all categories of patients, to include resuscitation, initial wound surgery, damage control surgery, and postoperative treatment. This role of care expands the support provided at Role 2. Patients who are unable to tolerate and survive movement over long distances receive surgical care in a hospital as close to the supported unit as the tactical situation allows. This role includes provisions for—

 Coordination of patient evacuation through medical regulating.

 Providing care for all categories of patients in an MTF with the proper staff and equipment.

 Providing support on an area basis to units without organic medical assets.

Role 4

1-18. Role 4 medical care is found in CONUS-based hospitals and other safe havens. If mobilization requires expansion of military hospital capacities, then the Department of Veteran’s Affairs and civilian hospital beds in the National Disaster Medical System are added to meet the increased demands created by the evacuation of patients from the area of operations (AO). The support-based hospitals represent the most definitive medical care available within the AHS.

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ARMY HEALTH SYSTEM PRINCIPLES (FM 4-02)

1-19. The principles of the AHS are the foundation—enduring fundamentals—upon which the delivery of health care in a field environment is founded. The principles guide medical planners in developing operation plans (OPLANs) which are effective, efficient, flexible, and executable. AHS plans are designed to support the operational commander’s scheme of maneuver while still retaining a focus on the delivery of health care.

1-20. The AHS principles apply across all medical functions and are synchronized through medical mission command and close coordination and synchronization of all deployed medical assets through medical technical channels.

Conformity

1-21. Conformity with the operation order (OPORD) is the most basic element for effectively providing AHS support. In order to develop a comprehensive concept of operations, the medical commander must have direct access to the operational commander. AHS planners must be involved early in the planning process to ensure that we continue to provide AHS support in support of the Army’s strategic roles of shape, prevent, LSCO, and consolidate gains. Once the plan is established it must be rehearsed with the forces it supports. In operations with a preponderance of stability tasks, it is essential that AHS support operations are in consonance with the combatant commander’s (CCDR’s) area of responsibility (AOR) engagement strategy and have been thoroughly coordinated with the supporting assistant chief of staff, civil affairs (CA).

Proximity

1-22. Proximity is to provide AHS support to sick, injured, and wounded Soldiers at the right time and the right place and to keep morbidity and mortality to a minimum. AHS support assets are placed within supporting distance of the maneuver forces which they are supporting, but not close enough to impede ongoing operations. To support the operational commander’s plan, it is essential that AHS assets are positioned to rapidly locate, acquire, treat, stabilize, and evacuate combat casualties. Peak workloads for AHS resources occur during combat operations.

Flexibility

1-23. Flexibility is being prepared to, and empowered to, shift AHS resources to meet changing requirements. Changes in plans or operations make flexibility in AHS planning and execution essential. In addition to building flexibility into the OPLAN to support the commander’s scheme of maneuver, the medical commander must also ensure that he has the flexibility to rapidly transition from one level of violence to another across the range of military operations. As the current era is one characterized by persistent conflict, the medical commander may be supporting simultaneous actions characterized by different decisive actions, such as offensive, defensive, or stability tasks. The medical commander exercises his command authority to effectively manage his scarce medical resources so that they benefit the greatest number of Soldiers in the AO. For example, there are insufficient numbers of FSTs or FRSDs to permit the habitual assignment of these organizations to each BCT. Therefore, the medical commander, in conjunction with the command surgeon, closely monitors these valuable assets so that he can rapidly reallocate or recommend the reallocation of this lifesaving skill to the BCTs in contact with the enemy and where the highest number of Soldiers will potentially receive traumatic wounds and injuries. Prolonged combat, intense engagements, and large-scale combat operations diminish unit combat effectiveness. When a medical unit is degraded to become combat ineffective and no longer able to provide AHS support effectively, reconstitution may be required.

1-24. Reconstitution consists of those actions that commanders plan and implement to restore units to a desired level of combat effectiveness commensurate with mission requirements and available resources (ATP 3-21.20). Reconstitution may include—removing a unit from combat; replenishing it with external assets; reestablishing a chain of command; training a unit for future operations; and

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reestablishing unit cohesion. Reconstitution operations include reorganization and regeneration. For more information on reconstitution, refer to FM 4-95 (reconstitution doctrine) and ADP 3-90.

1-25. Reorganization is the action to shift resources within a degraded unit to increase its combat effectiveness. Medical commanders use reorganization to restore capability and improve health service support (HSS) effectiveness within a degraded unit. Reorganization is possible at tactical level.

1-26. Regeneration is the rebuilding of a unit. It requires large-scale replacement of personnel, equipment, and supplies. Medical units also undergo regeneration and are rebuilt through large- scale replacement of personnel, equipment, and Class VIII resupply. Regeneration requires support from higher, is time sensitive, and more resource intensive.

1-27. Maximizing the return to duty rate of injured or ill personnel in forward operating units is a major portion of the AHS contribution to the reconstitution effort. Maximizing the return to duty rate of combat Soldiers contributes to the pool of personnel available for reconstitution of degraded units.

Mobility

1-28. Mobility is the principle that ensures that AHS assets remain in supporting distance to support maneuvering forces. The mobility, survivability (such as armor plating), and sustainability of AHS units organic to maneuver elements must be equal to the forces being supported. Major AHS headquarters (HQs) in EAB continually assess and forecast unit movement and redeployment. AHS support must be continually responsive to shifting medical requirements in an OE. In noncontiguous operations, the use of ground ambulances may be limited depending on the security threat in unassigned areas and air ambulance use may be limited by environmental conditions and enemy air defense threat. Therefore, to facilitate a continuous evacuation flow, MEDEVAC must be a synchronized effort to ensure timely, responsive, and effective support is provided to the tactical commander. The only means available to increase the mobility of AHS units is to evacuate all patients they are holding. AHS units anticipating an influx of patients must medically evacuate patients they have on hand prior to the start of the engagement.

Continuity

1-29. Continuity in care and treatment is achieved by moving the patient through progressive, phased roles of care, extending from the POI or wounding to the CONUS-support base. Continuity of care refers to an attempt to maintain the role of care during movement at least equal to the care provided at the preceding facility. (FM 4-02) Each type of AHS unit contributes a measured, logical increment in care appropriate to its location and capabilities. In recent operations, lower casualty rates, availability of rotary-wing air ambulances, and other mission, enemy, terrain and weather, troops and support available, time available, and civil considerations (METT-TC) factors often enable a patient to be evacuated from the POI directly to the supporting CSH or hospital center. In more traditional operations, higher casualty rates, extended distances, and patient condition may necessitate that a patient receive care at each role of care to maintain his physiologic status and enhance his chances of survival. The medical commander, with his depth of medical knowledge, his ability to anticipate follow-on medical treatment requirements, and his assessment of the availability of his specialized medical resources can adjust the patient flow to ensure each Soldier receives the care required to optimize patient outcome. The medical commander can recommend changes in the theater evacuation policy to adjust patient flow within the deployed setting. A major consideration and an emerging concern in future conflicts is providing prolonged care within all roles of care when evacuation is delayed. The Army’s future OE is likely to be complex and challenging and widely differs from previous conflicts. Operational factors will require the provision of medical care to a wide range of combat and noncombat casualties for prolonged periods that exceed current evacuation planning factors.

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Control

1-30. Control is required to ensure that scarce AHS resources are efficiently employed and support the operational and strategic plan. It also ensures that the scope and quality of medical treatment meets professional standards, policies, and United States (U.S.) and international law. As the AHS is comprised of 10 medical functions which are interdependent and interrelated, control of AHS support operations requires synchronization to ensure the complex interrelationships and interoperability of all medical assets remain in balance to optimize the effective functioning of the entire system. Within the AO, the most qualified individual to orchestrate this complex support is the medical commander due to his training, professional knowledge, education, and experience. In a joint and multinational environment it is essential that coordination be accomplished across all Services and unified action partners to leverage all of the specialized skills within the AO. Due to specialization and the low density of some medical skills within the MHS force structure, the providers may only exist in one Service (for example, the United States Army has the only veterinary corps officers in the MHS).

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