LESSON ASSIGNMENT
LESSON 5
Combat Health Support in the Corps and Echelons Above
Corps
LESSON ASSIGNMENT Paragraphs 5-1--5-15
LESSON OBJECTIVES
After completing this lesson, you should be able to:
5-1. Identify the units to their corresponding missions.
5-2. Select the echelon of CHS provided by the unit.
5-3. Select the hospital component, hospital, or medical unit
that provides a given capability.
5-4. Identify the medical facility to which the modular and
the non-modular belong.
5-5. Identify the capabilities of a corps hospital and the EAC
hospital.
LESSON 5
COMBAT HEALTH SUPPORT IN THE
CORPS AND ECHELONS ABOVE CORPS
5-1. THE HOSPITAL SYSTEM AND MODULAR COMPONENTS
The three hospitals of the Army hospital system are the combat support hospital
(CSH), the field hospital (FH), and the general hospital (GH). The CSH, FH, and GH
are designed under a four-module concept.
5-2. HOSPITAL UNIT, BASE
a. Can Operate Independently. The hospital unit, base (HUB), the cornerstone
of each hospital, can operate independently. The other three modules [the hospital
unit, surgical (HUS); hospital unit, medical (HUM); and hospital unit, holding (HUH)] are
added to the HUB based on mission requirements. Augmenting it with medical and
surgical teams may also enhance the capability of the HUB.
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b. Surgical Capabilities. Surgical capabilities of the HUB include:
(1) Four operating room (OR) tables.
(2) Forty-eight OR hours, total, per day.
c. Wards. The HUB contains intensive, intermediate, and minimal care nursing
wards as well as a neuropsychiatric care ward. These wards can hold a total of 236
patients.
d. Additional Services. The HUB also provides:
(1) Consultations for outpatients referred by other MTFs.
(2) Echelon 1 CHS, for organic personnel only.
(3) Pharmacy, clinical laboratory, blood bank, radiology, and occupational
therapy.
(4) Medical administrative and logistical services to support work loads.
(5) Oral and maxillofacial services, oral surgical consult and referral services to
area support dental units, and general dental services for patients and staff.
5-3. HOSPITAL UNIT, SURGICAL
a. Dependent on a Hospital Unit, Base. In the previous paragraph, we saw that
the HUB could operate independently. The remaining modules of the CSH, FH, and
GH (the HUS, HUM, and HUH)) need a HUB in order to operate. They do not function
independently of a HUB.
b. Capabilities. Surgical capabilities, hospitalization capacity, and radiological
augmentation services of the HUS include:
(1) Four OR tables.
(2) Ninety-six OR hours, total, per day.
(3) Hospitalization capacity (intensive nursing care wards), up to 60 patients.
(4) Radiological augmentation.
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5-4. HOSPITAL UNIT, MEDICAL
The HUM is the third module associated with the GH. It has intermediate nursing
care wards with a capacity to hold 180 patients. Augmentation includes pharmacy,
clinical laboratory, radiology, physical therapy , and occupational therapy.
5-5. HOSPITAL UNIT, HOLDING
The HUH is associated with the FH. It can provide convalescent care to 280
patients. Other services are physical therapy and occupational therapy.
5-6. FORWARD SURGICAL TEAMS
a. Forward Surgical Team Organization. Forward surgical teams (FSTs) are
clinically standardized modules regardless of their assignments. These 20-person units
are organized into four functional areas: triage-trauma management (TTM), surgery,
recovery, and administration/operations.
b. Mission. The mission of the FST is to provide a rapidly deployable immediate
surgery capability, enabling patients to withstand further evacuation. It provides
surgical support forward in the division, separate brigade, and armored cavalry regiment
(ACR) operational areas. The requirement to project surgery forward increases as a
result of the extended battlefield. This small, lightweight surgical team is designed to
complement and augment emergency treatment capabilities for the-sized task force.
c. Assignment. The FST is assigned to the corps medical brigade or medical
group, the airborne/assault division, and the ACR (light).
d. Capabilities.
(1) At Echelon I (Level I), the FST is capable of continuous operations with a
divisional or nondivisional medical company/troop for up to 72 hours; the ability to
continue operations is limited by personnel fatigue/exhaustion and available supplies.
The FST provides urgent, initial surgery for otherwise nontransportable patients. The
nonforward deployed corps FST will constitute, replace, and reinforce the FST of the
airborne/air assault division, the ACR, and any other forward deployed brigade combat
team, as required.
(2) The FST's surgical capability is based on 2 OR tables with a surgical
capacity of 24 OR table hours, total, per day. Other capabilities include the following:
(a) Emergency medical treatment. Assets to receive, triage, and prepare
incoming patients for surgery.
(b) Surgery. Initial emergency and continued postoperative care for up to
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30 critically wounded or injured patients over a period of 72 hours with the FST's
organic medical equipment sets (MESs) prior to resupply.
(c) Nursing care. Postoperative acute nursing care for up to eight patients,
simultaneously, prior to further MEDEVAC.
(d) Rapid strategic deployability. The team's personnel and equipment
(less vehicles) are capable of deploying in one C-130 aircraft for initial entry missions
when required. The FST is capable of subsequent movement by helicopter sling-load
operations.
(e) Tactical mobility. The team is 100 percent mobile with organic vehicles
(six HMMWVs).
5-7. THE COMBAT SUPPORT HOSPITAL
a. Combat Support Hospital Organization. The CSH is located in the corps
area. This hospital provides Levels 1 and 2 care for organic personnel only.
(1) Personnel: 606.
(2) Mobility: 35 percent.
(3) Basis of allocation: 100 percent of projected beds in CZ.
(4) Components: one HUB plus one HUS.
b. Mission of the Combat Support Hospital. The CSH provides:
(1) Resuscitation.
(2) Initial wound surgery.
(3) Postoperative treatment.
(4) Stabilization for further evacuation and RTD for patients who fall within the
corps evacuation policy.
c. Types of Patients and Location. The CSH is capable of handling all types of
patients and will normally be employed in the corps area.
d. Capabilities of the Combat Support Hospital.
(1) Capacity: 296 patients.
(2) Eight intensive nursing care wards: 96 patients, total.
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(3) Seven intermediate nursing care wards: 140 patients, total.
(4) One neuropsychiatric ward: 20 patients, total.
(5) One minimal care ward: 40 patients, total.
(6) Surgical capacity: eight OR tables (four from HUB, four from HUS), 144
OR table hours, total, per day
(7) Additional services of the CSH include:
(a) Pharmacy.
(b) Laboratory.
(c) Blood banking.
(d) Radiology.
(e) Nutrition care services.
(f) Physical therapy.
(g) Dental treatment to staff and patients.
(h) Oral surgery support (on area basis).
5-8. HOSPITALIZATION UNITS AT ECHELON IV
The hospitalization units found at Echelon IV are the FH and the GH. Echelon IV
combat health support is found whenever there is a protracted conflict. It should be
noted that while the FH can be placed in the corps area if need be, it remains
essentially an Echelon IV asset.
5-9. THE FIELD HOSPITAL
a. Field Hospital Organization. There is one FH allocated per corps.
(1) Personnel: 448.
(2) Basis of allocation: 70 percent of projected beds in EAC.
(3) Components: one HUB plus one HUH.
b. Field Hospital Mission. The FH provides hospitalization for patients within the
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theater that:
(1) Require further stabilization prior to evacuation.
(2) Will return to duty within the theater evacuation policy.
c. Types of Patients. The majority of patients brought to the FH are in the
reconditioning and rehabilitating category. The FH is normally located in the EAC, but
circumstances may require that it be employed in the corps.
d. Field Hospital Capabilities.
(1) Hospitalization capacity: 504 patients.
(a) Two intensive nursing care wards: 24 patients total.
(b) Seven interned nursing care wards: 140 patients total.
(c) One neuropsychiatric care ward: 20 patients.
(d) Two minimal care wards: 40 patients total.
(e) Seven convalescent care wards: 280 patients total.
(2) Field hospital surgical capacity: The FH has two OR tables with a surgical
capacity of 24 OR hours, total, per day.
(3) Additional services. The FH provides almost the identical services as the
CSH, except that the FH also provides occupational therapy support to its patients.
(a) Pharmacy.
(b) Laboratory.
(c) Blood banking.
(d) Radiology.
(e) Nutrition care services.
(f) Physical therapy
(g) Occupational therapy.
(h) Dental treatment to staff and patients.
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(i) Oral surgery support (on an area basis).
5-10. THE GENERAL HOSPITAL
a. Organization of the General Hospital. The GH provides the most definitive
level of care that can be deployed in the Army.
(1) Personnel: 771.
(2) Basis of allocation: 30 percent of projected beds in EAC.
(3) Movement requirements: responsibility of theater transportation units.
(4) Components: one HUB plus one HUS plus one HUM.
b. Mission and Location.
(1) Provides hospitalization and stabilization for general classes of patients.
(2) Serves as primary conduit for the evacuation of patients to CONUS.
(3) Located in the EAC.
(4) Assigned to Medical Command (MEDCOM); may be further attached to a
medical brigade.
c. General Hospital Capabilities.
(1) Hospitalization capacity: 476 patients.
(a) Eight intensive nursing care wards: 96 patients, total.
(b) Sixteen intermediate nursing care wards: 320 patients, total.
(c) One neuropsychiatric care ward: 20 patients.
(d) Two minimal care wards: 40 patients, total.
(2) Surgical capabilities: eight OR tables, 144 hours, total, per day.
(3) Additional services.
(a) Pharmacy.
(b) Laboratory.
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(c) Blood banking.
(d) Radiology.
(e) Nutrition care services.
(f) Physical therapy.
(g) Occupational therapy.
(h) Dental treatment to staff and patients.
(i) Oral surgery support (on an area-wide basis).
5-11. THE MEDICAL COMPANY, HOLDING (ECHELONS lll and IV)
a. Organization of the Medical Company, Holding.
(1) Personnel: 47.
(2) Basis of allocation: one per corps.
(3) Mobility: 60 percent mobile.
b. Mission of the Medical Company, Holding.
(1) Provides holding capability within the CZ for up to 1200 minimal care
patients.
(2) Provides minor medical treatment and physical rehabilitation for patients
being held.
c. Capabilities of the Medical Company, Holding. There are no registered
nurses in the medical company. The nurse care provider-to-patient ratio in an intensive
care unit is one nurse care provider (MOS 91C, practical nurse) for every two patients.
The nurse care provider-to-patient ratio in a minimum care facility is one 91C for every
three patients. The medical company has five holding platoons; each platoon can
handle 240 patients.
d. Composition of the Medical Holding Platoon.
(1) Capacity: 240 cots.
(2) Type of service: minimal care patients.
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(3) Components: Six holding squads (40 patients per squad) and one
treatment squad.
e. Uses of the Medical Company, Holding. The medical company holding
may be used by platoon to:
(1) Expand hospital minimal care wards.
(2) Augment USAF mobile aeromedical staging facility (MASF).
(3) Hold combat fatigue casualties for combat stress control (CSC).
(4) Provide limited area CHS.
f. Augmenting Minimal Care Capacity.
(1) Most casualties in conflict are disease and nonbattle injury (DNBI) cases
that will be returned to duty (RTD). As a result, the number of casualties in the minimal
care class could easily exceed the beds available. In an attempt to deal with the
overflow, there is a certain temptation to place minimum care patients in intermediate
care beds.
(2) If this is done, however, it causes a snowball effect whereby intermediate
care patients end up in intensive care unit beds.
(3) This is where the medical company, holding comes into play. By using
the medical company, holding, a medical unit can increase its minimal care capacity
and keep its intensive and intermediate care beds for the patients that need them.
5-12. SURGICAL SERVICE TEAMS (ECHELONS lll and lV)
a. Mission of the Surgical Service Team. The surgical service teams, which
may be found at Echelons III and IV, may be of three types: head and neck surgery,
neurosurgery, and eye surgery. They provide surgical augmentation to CZ and EAC
hospitals. They are assigned/attached to a medical brigade or medical group and may
be further attached to subordinate hospitals, as required.
b. Medical Team, Head and Neck Surgery.
(1) Personnel: six.
(2) Mobility: 100 percent.
(3) Basis of allocation: 0.25 per CSH, FH, and GH.
(4) Types of surgery: initial and secondary maxillofacial surgery and ears,
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nose, and throat (ENT) surgery.
c. Medical Team, Neurosurgery.
(1) Personnel: 8.
(2) Mobility: 100 percent.
(3) Basis of allocation: 0.37 per CSH, FH, and GH.
(4) Type of surgery: initial and secondary neurosurgery.
d. Medical Team, Eye Surgery.
(1) Personnel: 7.
(2) Mobility: 100 percent
(3) Basis of allocation: 0.25 per CSH, FH, and GH.
(4) Type of surgery: ophthalmologic.
(5) Consultative services provided.
5-13. MEDICAL SERVICE TEAMS
There are three types of medical service teams: medical team, pathology;
medical team, renal dialysis; and medical team, infectious disease. They provide
medical augmentation to CZ and EAC hospitals. They are assigned to a medical
brigade or medical group, but may be further attached to subordinate hospitals, as
required.
5-14. MEDICAL DETACHMENT, SURGICAL
a. Organization and Capabilities.
(1) Personnel: 9.
(2) Basis of allocation: one per corps.
(3) Mobility: 100 percent mobile.
(4) Capabilities:
(a) Initial surgery to save life or limb.
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(b) Up to 40 critically wounded patients.
(c) Up to 48 hours.
(d) Normally in support of Echelon ll, but can augment Echelon III
hospitals.
(e) One of every four surgical detachments in a corps area will be
airborne qualified.
b. Assignment. The unit may be assigned to a medical brigade or medical
group and attached to subordinate AMEDD C2 units as required by the tactical situation.
c. Support Requirements. The medical detachment, surgical, requires food
services, administrative services, unit maintenance, and security.
d. Mission. The mission of the medical detachment, surgical, is to provide a
rapidly deployable initial surgical service forward in a division's area of operations (AO).
5-15. HOSPITALIZATION AT ECHELON V
a. Echelon V Facilities. Echelon V facilities consists of:
(1) Medical department activities (MEDDAC).
(2) Medical centers (MEDCEN).
(3) Veterans Administration (VA) hospitals.
(4) Civilian national disaster medical systems (NDMS) hospitals.
b. Patient Destination. Normally, the type of care needed and the patient's
home of record determine the patient destination. The global patient movement
requirements center (GPMRC) regulates patients to CONUS MTFs to recuperate as
close to their family as possible.
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