Commander's Guide to Combat Health Support
US Army PAM-40-19
Commander's Guide to Combat Health Support
Army Pamphlet 40-19
24 March 1995
Unclassified
PIN: 073466-000
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Commander's Guide to Combat Health Support
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Change Summary
This new pamphlet contains information on the combat health support system. It is intended to
be a guide for commanders of nonmedical units.
Title Page
PICTURE 1
History.
This UPDATE printing publishes a new informational pamphlet.
Summary.
This new informational pamphlet is published for commanders of nonmedical units. The
information presented in this publication describes the combat health support system and how it
interfaces with and provides support to the organization in wartime and peacetime.
Applicability.
This pamphlet is published for use by commanders of nonmedical units in the Active Army, the
Army National Guard, and the U.S. Army Reserve. This publication is not applicable during
mobilization.
Proponent and exception authority.
The proponent of this regulation is The Surgeon General. The proponent has the authority to
approve exceptions to this regulation that are consistent with controlling law and regulation.
Proponents may delegate the approval authority, in writing, to a division chief under their
supervision within the proponent agency who holds the grade of colonel or the civilian equivalent.
Supplementation.
Supplementation of this pamphlet is prohibited without prior approval from Headquarters,
Department of the Army (DASG-HCD), 5109 Leesburg Pike, Falls Church, VA 22041-3258.
Interim changes.
Interim changes to this pamphlet are not official unless they are authenticated by the
dministrative Assistant to the Secretary of the Army. Users will destroy interim changes on their
expiration dates unless sooner superseded or rescinded.
Suggested improvements.
The proponent agency of this pamphlet is the U.S. Army Medical Department Center and
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School. Users are invited to send comments and suggested improvements on DA Form 2028
(Recommended Changes to Publications and Blank Forms) directly to the Commander, U.S. Army
Medical Department Center and School, ATTN: MCCS-FCD-L, Fort Sam Houston, TX
78234-6100.
Distribution.
Distribution of this publication is made in accordance with DA Form 12-09-E, block number
5377, intended for command levels C, D, and E for Active Army, Army National Guard, and U.S.
Army Reserve.
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Table of Contents
COVER
CHANGES
TITLE-PAGE
CONTENTS
FIGURES
1.0
1.1
1.2
Book Cover
Change Summary
Title Page
Table of Contents
Figures
Introduction
Purpose
References
1.3
1.4
1.5
Explanation of abbreviations and terms
History of the Army Medical Department
Mission
1.6
1.7
2.0
2.1
2.2
2.3
2.4
Personnel
Quality assurance
Combat Health Support Within a Theater of Operations
Combat health support system
Modular medical support system
Echelons of combat health support
Theater hospital system
2.5
2.6
2.7
2.8
2.9
2.10
3.0
3.1
3.2
Hospital support requirements
Dental support in a theater of operations
Veterinary support in a theater of operations
Area medical laboratory
Theater evacuation policy
Intratheater evacuation policy
Combat Health Support Logistics
Combat Health Logistics System
Division Combat Health Logistics System
3.3
3.4
3.5
3.6
3.7
4.0
4.1
4.2
Corps Combat Health Logistics System
Echelons Above Corps Combat Health Logistics System
Medical equipment maintenance support
Optical Combat Health Logistics System
Blood management
Medical Intelligence
What is medical intelligence?
Health service intelligence resources
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4.3
Combat health support planning in historical examples
4.4
5.0
5.1
5.2
6.0
6.1
6.2
6.3
6.4
6.5
Criticality of medical intelligence
Law of Land Warfare Provisions Affecting Medical Operations
Law of land warfare
Medical implications of Geneva Conventions
Personnel
Personnel Reliability Program
Physical profiling
Physical Performance Evaluation System
Medical Evaluation Board
Physical Evaluation Board
6.6
7.0
7.1
Professional Filler System
Training
Expert Field Medical Badge
7.2
7.3
7.4
7.5
7.6
7.7
Initial unit training and sustainment training
Combat lifesaver
Field sanitation team training
Medical proficiency training
The Joint Medical Readiness Training Center and the Combat Casualty
Care Course
U.S. Army physician assistant
8.0
8.1
8.2
8.3
8.4
8.5
8.6
8.7
8.8
Soldier Health Maintenance/Current Health Problems
Soldier health maintenance elements
Sleep
Stress
Alcohol/drug abuse
Suicide prevention
Immunizations/prophylaxes
The Oral Health Fitness Program
Sexually transmitted diseases
8.9
8.10
8.11
8.12
8.13
8.14
9.0
9.1
Acquired immunodeficiency syndrome
Occupational safety and health
Field sanitation team
Army Aviation Medicine Program (flight surgeon)
Veterinary services
Nutrition
The Military Family
TRICARE
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9.2
Civilian Health and Medical Program of the Uniformed Services
9.3
9.4
9.5
9.6
9.7
A.0
GLOSSARY
USAPPC-INDEX
Primary Health Care for the Uniformed Services
Uniformed Services Dependents Dental Insurance Plan
Family Advocacy Program
Exceptional Family Member Program
Veterinary treatment facilities
Appendix A. References
Glossary
Index
Figures
2-1. Echelons of combat health support
2-2. Component hospital system
2.10
2.10
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1.0 Introduction
1.0 Introduction
Subtopics
1.1 Purpose
1.2 References
1.3 Explanation of abbreviations and terms
1.4 History of the Army Medical Department
1.5 Mission
1.6 Personnel
1.7 Quality assurance
1.1 Purpose
The purpose of this pamphlet is to provide commanders of nonmedical units with information
on the combat health support (CHS) system. It is not intended to be all-inclusive but to provide a
summary for the target audience. The information presented in this pamphlet is based on doctrine,
policy, and procedures published in Army Medical Department (AMEDD) manuals.
1.2 References
Required and related publications and referenced forms are listed in appendix A.
1.3 Explanation of abbreviations and terms
Abbreviations and special terms used in this pamphlet are explained in the glossary.
1.4 History of the Army Medical Department
a. Today's medics trace their history back to the siege of Boston in 1775 under the leadership
of George Washington. At Washington's request, the Continental Congress established the
"hospital," which was the forerunner to the AMEDD. The AMEDD was not permanently
established under that name until 1818. The physicians of the AMEDD did not receive the status of
commissioned officers until 1847, but they had gained a reputation for efficient service and high
professional standards well before then. As early as 1827, the Inspector General of the U.S. Army
noted that the service "is truly fortunate in having such a medical corps . . . how could it be that the
government was able to employ such professional worth at so paltry a price?"
b. The AMEDD lacked a supporting staff of specially trained enlisted men to aid the surgeons
in preserving the health of the troops. Although in 1838 Congress had authorized the enlistment of
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men for exclusive duty as hospital stewards, it reversed this policy in 1842. To meet the needs of
the AMEDD, Surgeon General Thomas Lawson had established a training school for hospital
stewards in 1840. In 1844 Lieutenant General Winfield Scott, Commanding General of the Army,
ordered that all soldiers detailed temporarily from their units for service as hospital stewards
should remain officially attached to the hospitals throughout their service. Lieutenant General
Scott's order forced the training school for hospital stewards to close for lack of eligible students.
In 1887 a hospital corps was established to provide a standing body of educated, permanently
assigned, enlisted personnel for service with the AMEDD.
c. During the late nineteenth and early twentieth centuries, the AMEDD also provided officers
who made major contributions to the other branches of the Service. While stationed at Fort Davis,
Texas, during the 1850's, Surgeon Albert J. Myer became interested in the problems of field
communications using flags and torches. He presented his study on the subject to
War Department, and in 1863 became the first chief of the newly created Signal Corps.
the
Organizational skill and a passion for systematic procedures won Surgeon Fred C.
Ainsworth appointment first as acting Secretary of War and later as Adjutant General of the Army
in 1907. During the same period Surgeon Leonard Wood, a Medal of Honor recipient for
earlier service in the Indian Wars, shattered all precedent by becoming Chief of Staff
of the Army.
d. The drive for professional excellence through education continued
in the AMEDD. On
28 April 1920, Surgeon General Merritte W. Ireland addressed a letter to the Adjutant General
requesting permanent authority to use the U.S. Military Reservation at Carlisle Barracks,
Pennsylvania, as a field school. In June 1920, the Medical Field Service School
(MFSS) was officially established at that post.
e. The school at Carlisle Barracks consisted of five departments: military art,
enlisted training, hygiene, administration, and equipment and transportation. The school
started with a basic course for medical, dental, and veterinary officers of the Regular Army. It soon
added courses for Reserve and National Guard officers and noncommissioned officers
(NCOs). It also added summer training for officers of the Reserve and the Reserve Officers
Training Corps.
f. Some notable activities other than training were carried on at Carlisle. One
was the equipment laboratory, which experimented with new equipment used in the treatment
and evacuation of casualties.
The first-aid dressing carried today by every
soldier, once called the Carlisle dressing, was developed in that laboratory. Tentage for
field hospitals (FHs), electrical equipment, improved litters, field dental dispensaries, new
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ambulances, field x-ray equipment, and many other items of medical equipment used by the
Army were developed there.
g. The helicopter's potential for rapid evacuation of casualties from battlefields to
hospitals, where prompt and definitive surgical care is available, was demonstrated first at
Carlisle Barracks in 1935.
h. In 1940, as the nation mobilized for World War II, the AMEDD expanded and the school
geared its activities to new requirements. Facilities and space at Carlisle Barracks were
lacking to support expansion, large-scale field exercises, and demonstrations.
The end of
World War II saw selection of a larger site for the school--Fort Sam Houston, Texas.
In 1946, the school moved from Carlisle Barracks to the new site where it became an
organizational element of Brooke Army Medical Center (BAMC).
i. In training medical department personnel for their mission, the school enlarged its facilities
and expanded and adapted courses of instruction to support changing requirements for field
medical service. The U.S. Army Health Services Command (HSC) was established on 1
April 1973; this command consolidated many elements (including 36 post hospitals
and 7 medical centers) of the continental United States (CONUS) AMEDD under a single
major Army command. Concurrently, BAMC was reorganized as two commands under
HSC: a medical center (designated BAMC), and several education/training elements
(including the discontinued MFSS) consolidated under an Academy of Health Sciences
(AHS), U.S. Army. Major new AHS facilities were completed; and, nearly 20 years later, on 1
July 1991, the AHS was redesignated as the AMEDD Center and School (AMEDDC&S).
As a reaction to increasing medical centralization as well as post-Cold War developments,
realignments accelerated; and, on 1 October 1994, HSC was redesignated and expanded
as the U.S. Army Medical Command (MEDCOM)--a worldwide major command led by The
Surgeon General.
j. The basic objectives of the first
school
were to
train
medical personnel
to
recover wounded from the battlefield and to treat them rapidly and effectively. These
two elements of military medicine are studied as exhaustively today as they were in that
first class at Carlisle Barracks.
1.5 Mission
a. The mission of the AMEDD mirrors the medical mission of the Department of Defense
(DOD):
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(1) To provide
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and maintain readiness to provide medical services and support to the
armed forces during military operations.
(2) To provide services and support to members of the armed forces, their dependents, and
others entitled to DOD medical care.
b. The AMEDD has responsibility for all medical services provided within the Department of
the Army (DA). These services include-(1) Patient evacuation and medical regulation.
(2) Hospitalization.
(3) Combat health logistics/blood management.
(4) Dental services.
(5) Veterinary services.
(6) Preventive medicine (PVNTMED) services.
(7) Combat stress control (CSC) services.
(8) Area medical support.
(9) Command, control, communications, computers, and intelligence.
(10) Medical laboratory services.
(11) Garrison outpatient services.
(12) Coordination of complementary health services among other Federal and civilian
agencies.
1.6 Personnel
The AMEDDC&S trains both officer and enlisted personnel in a variety of medical
functional areas and medical military occupational specialties (MOSs). Some of these
medically trained officer and enlisted personnel may be assigned to a medical platoon organic to
your battalion.
a. Officer personnel.
Officers
normally assigned to a medical platoon include Medical
Corps (MC) officers (physicians), Medical Service Corps (MS) officers, and Army Medical
Specialist Corps (SP) physician assistants (PAs).
(1) The MC officer has three major areas of responsibility. The first responsibility is to
serve as platoon leader of the medical element of the battalion (medical platoon leader). The second
responsibility is to serve as the medical advisor and special staff officer to the
battalion commander. The third responsibility is to treat patients. Other
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(a) Planning and directing unit-level CHS of the battalion.
(b) Assisting the Operations and Training Officer (S3) in planning and supervising
individual and collective training of
the medical platoon/section and in training
nonmedical personnel within the battalion.
(c) Advising the battalion commander and staff on the current health of the command.
(d) Supervising the administration, discipline, equipment maintenance, supply functions,
organizational training, and employment of the assigned medical element.
(e) Treating casualties.
Note.
In the absence of the physician or when there is none assigned, the physician's duties
and responsibilities, except the treatment of patients, will be assumed by the senior commissioned
officer.
The treatment of patients will remain with the patient treatment protocol.
(2) The MS officer (field medical assistant) serves as the medical operations officer and is
responsible for the operational readiness of the medical platoon. The responsibilities and functions
include but are not limited to-(a) Coordinating CHS operations with the battalion S3.
(b) Coordinating nonmedical supplies with the headquarters and headquarters company supply
personnel.
(c) Coordinating patient
medical company.
evacuation and
medical
resupply with
the supporting
(3) The PA, while not a physician, is a skilled clinician who, by formal training and
experience, is qualified to perform medical tasks formerly undertaken only by a physician.
This individual functions in the battalion medical platoon under the direction and
technical supervision of the medical platoon leader. The PA, in conjunction with the platoon leader,
is responsible for-(a) Conducting and/or supervising training of all battalion personnel in first aid, field
sanitation, personal hygiene, medical evaluation procedures, and medical aspects of injury
prevention.
(b) Arranging for the conduct of the battalion CSC program, with technical
assistance from the psychiatrist and other officers and NCOs of the division mental health section
or its equivalent.
This program includes training battalion troop leaders in methods of
controlling stress and preventing stress casualties, especially battle fatigue (BF) and
misconduct stress behaviors.
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(c) Establishing and operating the battalion aid station (BAS).
(d) Treating, within the individual's medical capability, those patients reporting for sick call
or those evacuated from the maneuver companies.
(e) Providing emergency medical care to the wounded and injured to include-1.
2.
3.
4.
5.
6.
Establishing and maintaining a patient's airway.
Controlling bleeding.
Preventing and treating shock.
Dressing wounds.
Immobilizing fractures.
Relieving pain and undue suffering.
b. Enlisted personnel. Enlisted personnel who assist in the operation of the medical platoon
include but are not limited to the medical specialist (MOS 91B10/20) and the medical NCO (MOS
91B30).
(1) A medical specialist, trained and certified per civilian standards, is referred to as an
Emergency Medical Technician (EMT). This specialist assists the medical NCO in accomplishing
assigned duties and also performs triage and emergency medical treatment for
battlefield casualties.
Specific duties of the medical specialist include-(a) Assisting with outpatient care and treatment.
(b) Assisting with care and treatment under the supervision of a physician, PA,
or medical NCO.
(c) Erecting and breaking down field medical shelter systems, to include chemical protective
shelters.
(d) Initiating patient records (DD Form 1380 (U.S. Field Medical Card)).
(e) Logging patients seen or treated in the medical treatment facility (MTF).
(f) Operating and maintaining assigned vehicle, tactical radio, and power generation
equipment.
(2) A medical NCO is qualified as a medical specialist and completes either the
C-8-C40 (91B) and/or the AMEDD NCO basic (NCO Education System) course. Just like the
medical specialist, the medical NCO, with additional civilian training and certification, may
be classified as an EMT or a paramedic.
This NCO assists the physician and the
PA in the accomplishment of their clinical duties. This NCO performs triage and
emergency medical treatment procedures in the care and management of the trauma
(including chemically contaminated) patient, assists in the care and management of the BF
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patient,
performs routine patient
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care, and performs nuclear, biological,
and
chemical (NBC) detection procedures.
This NCO is also trained to-(a) Supervise and train medical specialists.
(b) Supervise field and clinical medical facilities.
(c) Assist with technical and administrative management of MTFs under the supervision of a
physician or PA.
(d) Administer emergency and routine outpatient medical treatment to battle and
nonbattle casualties.
(e) Assist with outpatient care and treatment.
(f) Assist in the establishment and operation of a unit-level field MTF.
(g) Maintain the patient accountability/casualty reporting system.
(h) Maintain medical equipment sets.
(i) Conduct training in first aid and emergency medical procedures for assigned personnel and
combat lifesavers.
(j) Conduct sanitation inspections of troop living areas, field food service
preparation areas, waste disposal areas, and potable water distribution points and
equipment.
1.7 Quality assurance
a. The AMEDD has established a formal Quality Assurance Program to-(1) Provide quality care and treatment to all beneficiaries in their need for health services,
subject to the availability of space and facilities and the capabilities of the health care staff.
(2) Make improvements resulting in higher quality health care.
(3) Promote the professional development and enhance the capabilities of the military and
civilian members of the AMEDD. The scope of the program is broad, encompassing health care
services provided in all table of distribution and allowances and table of organization
and equipment (TOE) treatment facilities.
b. The objectives of the Quality Assurance Program are to-(1) Assure that health care personnel deliver quality patient care.
(2) Reduce risk-creating incidents and adverse effects to patients.
(3) Improve provider-patient communication and patient satisfaction.
(4) Enhance coordination and communication among health care providers and clinical
and ancillary services.
(5) Improve the health care provider screening, selection, and accession process.
(6) Objectively evaluate performance through performance-based criteria and other quality
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assurance information.
(7) Educate health care personnel on quality assurance requirements.
(8) Enhance the skills and knowledge of practitioners.
(9) Consolidate quality assurance efforts into one comprehensive program.
(10) Reduce medical malpractice and claims to the maximum
extent possible.
c. The Quality Assurance Program involves an ongoing process to monitor and evaluate
objectively and systematically the access to and quality and appropriateness of patient care, pursue
opportunities to improve patient care and clinical performance, and resolve identified problems
in care and performance. Quality is the degree of adherence to generally recognized standards
of good practice and achievement of anticipated outcomes for a particular service,
procedure, diagnosis,
or clinical problem. Appropriateness is the extent to which a
particular procedure, treatment, test, or service is efficacious and clearly indicated for the
patient. The components of the Quality Assurance Program are: patient care
evaluation, credentials review and privileging, utilization management to include access to patient
care, and risk management.
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2.0 Combat Health Support Within a Theater of Operations
Subtopics
2.1 Combat health support system
2.2 Modular medical support system
2.3 Echelons of combat health support
2.4 Theater hospital system
2.5 Hospital support requirements
2.6 Dental support in a theater of operations
2.7 Veterinary support in a theater of operations
2.8 Area medical laboratory
2.9 Theater evacuation policy
2.10 Intratheater evacuation policy
2.1 Combat health support system
a. CHS plays a vital role as a force multiplier. Sustaining the health of the fighting forces is a
critical factor in the success or failure of the combat mission. The number and type of CHS
organizations will be based on the-(1) Mission, enemy, terrain, troops, and time available.
(2) Size of force being supported.
(3) Projected patient work loads.
(4) Availability of evacuation assets.
(5) Evacuation policy.
b. The CHS mission--to conserve the fighting strength-- dictates that patients be
collected, triaged, treated, evacuated, and/or returned to duty as far forward as possible.
c. The multifunctional
CHS
system is a single, integrated system that extends from the
forward line of own troops (FLOT) back through the communications zone
(COMMZ) and ends in CONUS. This system is dependent upon effective medical regulating and
the evacuation of sick, injured, and wounded soldiers in the shortest possible time. Patients who are
expected to return to duty (RTD) within the theater evacuation policy are evacuated to a corps
and/or a COMMZ hospital. Those patients classified as nonreturn to duty within the theater
evacuation policy are treated and stabilized for evacuation out of theater.
2.2 Modular medical support system
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a. CHS
in
the division
is
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provided by a modular support system that standardizes
all medical subelements. The CHS modular design enables the medical resources manager
to rapidly tailor, augment, reinforce, or reconstitute the CHS units as needed. This system
is designed to acquire, receive, and triage patients, and to provide emergency medical treatment
and advanced trauma management (ATM). CHS originates in the forward areas of the division,
separate brigade, and armored cavalry regiment (ACR) with the combat medic supporting each
platoon or company/troop team. From this point, the patient is evacuated to the
battalion/squadron medical platoon treatment squad (battalion/squadron aid station) and then to
the medical company/troop treatment platoon (clearing station).
b. The modular medical support system is built around six modules organic to division
and
nondivisional CHS units. These modules are oriented to casualty collection, treatment, and RTD
or evacuation.
(1) Combat medic module. The combat medic module consists of one combat medical
specialist and the prescribed load of medical supplies and equipment. Combat medics
are organic to the medical platoons or sections of combat support (CS) and combat
service support (CSS) battalions and squadrons.
(2) Ambulance squad module. An ambulance squad module is comprised of four
medical specialists and two ambulances. This squad provides patient evacuation throughout the
division, corps, and COMMZ and provides en route care. Ambulance squads are organic to the
medical platoons or sections in maneuver battalions and squadrons, some CS
battalions, and medical companies of divisional and nondivisional support
battalions/squadrons. These squads are also organic to medical companies of area support
medical battalions (ASMBs) in the corps and COMMZ. Medical company ambulance
squads are employed in the brigade support area (BSA), division support area (DSA),
corps support area (CSA), and in all areas of the COMMZ. The medical platoon's ambulance
squads may be collocated with the companies of the maneuver battalions.
(3) Treatment squad module. This squad consists of a primary care physician,
a PA, and six medical specialists. The squad is trained and equipped to provide ATM to the
battlefield casualty. ATM is physician- or PA-directed emergency medical care designed to
resuscitate and stabilize the patient for evacuation to the next echelon of medical care, or
to treat and RTD. ATM provides maximum benefit if received within 60 minutes of injury. To
maintain contact with the combat maneuver elements, each squad has two emergency
treatment vehicles. Each squad can split into two treatment teams. These squads are organic to
medical platoons or sections in maneuver battalions/squadrons and designated CS units, as well
as being the basic building block of the medical companies.
(4) Area support squad. This squad is comprised of one dentist trained in ATM, a dental
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specialist, an x-ray specialist, and a medical laboratory specialist.
The squad is organic to the
medical companies within the BSA, DSA, CSA, and COMMZ.
(5) Patient-holding squad. This squad consists of two practical nurses and two
medical specialists.
It is capable of holding and providing minimal care for up to 40 RTD
patients for a maximum of 72 hours. This squad is organic to the medical companies
within the BSA, DSA, CSA, and COMMZ.
Note. When a treatment squad, an area support squad, and a patient-holding squad are
collocated, they form an area support section.
This section provides CHS on an area basis
to all forces within a geographical area of responsibility (clearing station). The area support
section normally operates in the BSA, DSA, CSA, and COMMZ. The area
support and patient-holding squads are incapable of independent operations.
(6) Surgical squad/detachment.This module is comprised of two surgeons, two
nurse
anesthetists,
two operating room specialists, one medical/surgical nurse, and two
practical nurses. It is organized to provide early resuscitative surgery for
seriously wounded or injured patients, to save life, and to preserve physical function. Early
surgery is performed whenever a likely delay in the evacuation of a patient threatens
life or the quality of recovery. Postsurgical patients awaiting evacuation are held by the
patient-holding squad. This squad collocates with the surgical modules. The surgical squad
provides the required nursing care. Surgical squads are organic to the medical battalions of the
airborne and air assault divisions. All other surgical modules are called detachments. These
detachments are not organic to divisions. They normally are employed in the DSA but may be
employed in the BSA during brigade task force operations.
(7) Forward surgical team. A forward surgical team (FST) will replace the two surgical squads
in each of the following: the Airborne Division; the Air Assault Division; and the 2d
ACR. The FSTs will also replace the medical detachment (surgical) and the 30-bed mobile Army
surgical hospital (MASH). This team will be a corps augmentation for divisional
and nondivisional medical companies. It will provide emergency/urgent initial surgery and
nursing care after surgery for the critically wounded/injured patient until sufficiently stable
for evacuation to a theater hospital. The FSTs not organic to divisions and the 2nd ACR will be
assigned to a medical brigade or group and normally attached to a corps hospital when not
operationally employed and further attached for support to a divisional or nondivisional medical
company.
2.3 Echelons of combat health support
There are four echelons of CHS in a theater of operations (TO) that have a direct impact on
patients as they are treated and evacuated from the FLOT to the CONUS base. (See fig 2-1.)
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a. Echelon I. This echelon is also known as unit level. Care is provided by designated
individuals or elements organic to combat and CS units and elements of the ASMB.
Major
emphasis is placed on those measures necessary to stabilize the patient (maintain
airway, stop bleeding, prevent shock) and allow for evacuation to the next echelon of care.
(1) Combat medic. This is the first individual in the CHS chain who makes
medically-substantiated decisions based on medical MOS-specific training. The combat
medic is supported by first-aid providers in the form of self-aid and buddy aid and the
combat lifesaver.
(a) Self-aid and buddy aid. The individual
soldier is
trained to
be proficient
in
a
variety of specific first-aid procedures with particular emphasis on lifesaving tasks. This training
enables the soldier, or a buddy, to apply immediate first aid to alleviate a
life-threatening situation.
(b) Combat lifesaver. Enhanced first-aid training is provided to selected individuals who are
called combat lifesavers. These individuals are nonmedical unit members selected
by their commander for additional training to become proficient in a variety of first-aid
procedures.
A minimum of one individual per squad, crew, team, or
equivalent-sized element is trained. All combat units and some CS and CSS units have combat
lifesavers. The primary duty of these individuals does not change. The additional duties
of combat lifesavers are performed when the tactical situation permits.
These individuals
provide enhanced first aid for injuries prior to treatment by the combat medic. The
training is normally provided by medical personnel assigned or attached to the unit.
The training program is managed by a senior medical person designated by the commander.
(2) Treatment squad (BAS).Personnel are trained and equipped to provide ATM to the
battlefield casualty.
Like elements provide this echelon of care in the division, corps, and
COMMZ. Echelon I care for units not having an organic capability is provided
on an area basis by the organization responsible in the sector.
b. Echelon II. This echelon may also be known as division level. Care at this echelon is
rendered at the clearing station (division, corps, or COMMZ). Here the casualty is examined
and his or her wounds and general status are evaluated to determine the treatment and
evacuation precedence, as a single casualty among other casualties. Emergency medical
treatment (including beginning resuscitation) is continued and, if necessary, additional
emergency measures are instituted; however, they do not go beyond the measures dictated
by the immediate necessities. The division clearing station has limited blood replacement
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capability, limited x-ray and laboratory services, patient-holding capability, and emergency dental
care. An FST will augment the divisional/nondivisional medical companies to provide
emergency/urgent initial surgery.
(See para 2-2b(7).) Division-level CHS also
includes PVNTMED activities and CSC. Those patients who can RTD within 1 to 3 days
are held for treatment. These functions are performed typically by company-sized
medical units organic to brigades, divisions, and ASMBs.
c. Echelon III. The first hospital facilities are located at this echelon. Within
the combat zone (CZ), the MASH and the combat support hospital (CSH) are staffed and
equipped to provide resuscitation, initial wound surgery, and postoperative treatment.
Although the MASH is an Echelon III facility, it is designed to be employed within the
division area. At the CSH, patients are stabilized for continued evacuation or returned to
duty. Those patients who are expected to RTD within the theater evacuation policy
are regulated to a facility that has the capability for reconditioning and rehabilitation.
d. Echelon IV. At this echelon, the patient may be treated at the general hospital (GH) or the
FH. The GHs are staffed and equipped for general and specialized medical and surgical care.
Those patients not expected to RTD within the theater evacuation policy are stabilized and
evacuated to CONUS. At the FH, reconditioning and rehabilitation services are provided for
those patients who will be RTD within the theater evacuation policy.
e. Echelon V. This echelon of care is provided by the CONUS base.
Hospitalization is provided by DOD hospitals (military hospitals of the triservices) and
Department of Veterans Affairs (DVA) hospitals. Under the National Disaster Medical System,
patients overflowing DOD and DVA hospitals will be cared for in designated civilian
hospitals.
2.4 Theater hospital system
a. Medical Force 2000 is the modernization effort to restructure the hospitalization
system in support of a TO. This system consists of four hospitals, a medical company
(holding), and six medical/surgical teams. The hospitals normally located in the corps are the
MASH and the CSH. The hospitals normally located in the COMMZ are the GH and the FH. In
addition to these hospitals, the medical company (holding) provides a 1200-cot
convalescent capability. For a detailed discussion on the Medical Force 2000 Hospital System,
refer to FM 8-10.
(1) MASH. This hospital is a 30-bed facility with the primary mission of providing
lifesaving surgical intervention to stabilize patients for further evacuation to either the
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CSH or COMMZ hospitals. Patients are held approximately 24 to 36 hours until considered stable
enough to tolerate a bed-to-bed transfer without incurring further risk to their condition. The
MASH is normally employed near a divisional rear boundary to support a two divisional force.
However, an element of the MASH, the hospital unit surgical-forward (HUSF) may be
employed within a particular division. The HUSF may be employed within the DSA or BSA and
collocated with a support battalion medical company. The MASH is 100 percent mobile
with organic vehicles.
(2) CSH. This organization is a 296-bed facility with the mission of stabilizing
patients for further evacuation and RTD of those who fall within the corps evacuation policy.
It is capable of handling all types of patients and will be employed in the corps area. The CSH
is
35 percent mobile with organic vehicles.
(3) FH.
This
organization is
a 504-bed facility with the mission of providing
hospitalization for patients and for reconditioning and rehabilitating those patients
who can RTD within the theater evacuation policy. The majority of patients within this facility
will be in the convalescent care category. The FH is normally located in the COMMZ, but
could be used in the corps rear when geographical and tactical operational constraints dictate.
Its mobility with organic vehicles is 20 percent.
(4) GH. This organization is a 476-bed facility with
the mission of providing
stabilization and hospitalization for patients who require either further evacuation out of
the TO, or who can RTD within the theater evacuation policy. The GH is normally located in the
COMMZ. Its mobility is 10 percent with organic vehicles.
(5) Medical company (holding).This unit provides for reconditioning and rehabilitation of
convalescent care patients who are expected to RTD. It consist of 1200 cots and is minimally
staffed and equipped. This facility has the capability to task organize by separating the company
into five holding platoons, each capable of operating 240 cots. These elements can be
attached to augment hospitals and mobile aeromedical staging facilities.
Additionally, the medical company (holding) can be used in the combat stress reconditioning
programs.
(6) Medical/surgical teams. These teams provide specialized medical and surgical
augmentation to CZ and COMMZ hospitals. These teams provide the following services:
(a) Renal hemodialysis.
(b) Infectious disease treatment.
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(c) Pathology services.
(d) Head and neck surgery.
(e) Neurosurgery.
(f) Eye surgery.
b. All of the hospitals, except the MASH, are configured using various combinations of a
four-module concept. The four modules include-(1) Hospital unit, base (HUB).
(2) Hospital unit, surgical (HUS).
(3) Hospital unit, medical (HUM).
(4) Hospital unit, holding (HUH).
c. The CSH, FH, and GH consist of a base component and one or more
mission-adaptive components. The base can operate independently and is clinically similar
in each hospital. The other three mission-adaptive modules (HUS, HUM, and HUH)
are dependent upon the base. (See fig 2-2.) The hospital's capability can be further enhanced by
the attachment of medical or surgical teams.
2.5 Hospital support requirements
a. In deployment and sustainment of operations, the theater hospitals are dependent upon
appropriate elements of the corps and COMMZ for-(1) Personnel and administrative services.
(2) Finance.
(3) Mortuary affairs.
(4) Legal services.
(5) Transportation services.
(6) Laundry and bath services for other than patient-related support.
(7) Security (to include enemy prisoners of war (EPW) security during processing and
evacuation).
(8) Transportation and reequipping (to include the balance of their individual
Class II clothing and equipment and weapon and ammunition) for discharged patients. The hospital
will provide the minimal basic uniform items and, if required, mission-oriented protective
posture gear, to RTD soldiers to protect them during transit to replacement companies.
b. During deployment and sustainment of operations, engineer support is required for site
preparation, waste disposal, and minor construction.
2.6 Dental support in a theater of operations
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Dental service support is an integral part of the theater CHS system and shares in the overall
responsibility of conserving the fighting force. As part of the mission, the responsibility of the
field dental care system is to prevent and treat dental disease and injury. Dental support in the
TO is organized into a modular and flexible system which can respond to rapidly
changing conditions across the continuum of dental operations. Dental assets in the TO are
found at Echelons II, III, and IV. Most dental assets in the theater are organized into dental
units whose primary mission is to provide dental service. However, a significant number
of dental resources are organic to medical companies and hospitals. During periods of
increased combat activity, dental soldiers augment the medical capability of medical units by
performing alternate wartime roles such as triage and ATM.
a. Categories of dental care.Dental treatment is classified into four categories:
emergency, sustaining, maintaining, and comprehensive. These categories are not absolute in
their limits; however, they are the general basis for the definition of capability at the various
echelons of CHS. Each category is successively greater in service provided
and corresponding resources required to provide that service. Sustaining care is capable of
less definitive treatment than maintaining care, but requires less equipment and is
more suited to use further forward on the battlefield where weight and mobility are greater
concerns. Conversely, maintaining care provides a much wider spectrum of services, but is
far more resource-dependent and less suited for use in a rapidly moving scenario. Of
the four categories of care, only the first three, emergency, sustaining, and maintaining are available
in the TO. Comprehensive care is normally provided in fixed facilities in CONUS.
b. Types of dental support. There are three types of dental support in the TO: unit,
hospital, and area (the largest category). They are defined primarily by the relationship
the dental assets with the supported patient population.
of
(1) Unit. Unit dental support is provided by dental personnel organic to Echelon II
medical units. Dental modules are part of the area support squads in the medical companies of
divisions, separate brigades, and ACRs and the medical element of the special forces group.
Dental modules are also found in the area support squads of the area support
medical companies located throughout the CZ and COMMZ. The dental module consists of a
dental officer, a dental assistant, and compact high technology dental equipment. Their
primary objective is to return the soldier to duty as rapidly as possible consistent with the tactical
situation.
(2) Hospital.
CSH, FH, and GH.
Hospital dental support is provided by dental personnel organic to the
The MASH has no capability for dental support. The primary
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mission of hospital dental sections is to minimize loss of life and disability resulting from severe
oral and maxillofacial injury, whether battle or nonbattle. When casualty care work load permits,
dental resources provide dental treatment to hospital patients and staff. In addition, treatment is
provided to patients referred by other dental and medical facilities when oral and
maxillofacial care is beyond the capability of the referring facility. The maxillofacial surgery
capability in these hospitals can be augmented by attaching a medical team, head and neck
surgery.
(3) Area. Area dental support is provided by dental personnel and equipment
organized into dental service units capable of providing all categories of dental care
up to and including maintaining care. These units are the medical company (dental service),
medical detachment (dental service), and medical team (prosthodontics). They are usually
organized under the command of a medical battalion (dental service) which is
assigned to a corps or COMMZ medical brigade. Dental units may also be attached to a
medical group. As the name suggests, area dental support is provided within a designated
geographic area of responsibility.
Within this area of responsibility, area dental support
units may be tasked to provide direct support to unit or hospital dental support elements. They
may also be tasked to reconstitute unit dental support modules from like modules within their
own unit. Area dental support represents a major share of the dental capability within the
TO.
2.7 Veterinary support in a theater of operations
As an integral part of the theater CHS system, the primary responsibility
of field veterinary service detachments is to ensure the wholesomeness and
food safety of all Class A and operational rations consumed and to provide
veterinary health care to all military working dogs, military mascots, and
indigenous animals in the TO. Veterinary support in the TO is organized
into a mobile, modular, and flexible system capable of split base
operations. Veterinary support is capable of responding to rapidly
changing mission requirements in the TO. Veterinary units are found at
Echelons II, III, and IV. Veterinary support is provided on an area basis.
There are no organic veterinary units in the division. Veterinary units
will be assigned to a medical group or medical brigade in the TO. These
units may be attached in direct support of division Class 1 supply points
to ensure the food safety of all subsistence or to military police
military working dog units to provide on-site veterinary health care.
a. Categories of veterinary food safety support. This support is divided
into four categories: surveillance inspections of subsistence at Class 1
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supply points, in-country commercial sanitary inspections for procurement
of Class A rations, receipt inspections of all subsistence entering the
TO, and food microbiology laboratory support. These categories are not
absolute; however, they are the general basis for determining the
veterinary support required in the TO. Veterinary detachments do possess a
significant nuclear and chemical agent surveillance monitoring capability.
This ensures timely information to the Class 1 officer on the disposition
and suitability for human consumption of possible NBC contaminated
subsistence.
b. Categories of veterinary health care support. This support is divided
into three categories that will be available in the TO. Level 1 will be
limited to sick call and emergency first aid for Government animals. This
support is located in the division rear area. Level II will involve
complete health care (to include emergency surgery under gas anesthesia)
for Government animals. The emphasis will be on health care for military
working dogs. This support will be located near a major air base to
facilitate air evacuation. Additionally, veterinary units have the
capability to investigate zoonotic disease outbreaks (e.g., rabies), or
unexplained deaths in the indigenous animal population.
2.8 Area medical laboratory
a. The area medical laboratory (AML) provides the theater commander the
analytical and scientific capabilities to assess chemical, biological
warfare and endemic disease agents. This unit is a high-technology,
hospital-independent laboratory with a
degree of complexity and
sophistication exceeding that present in hospital-based medical
laboratories.
b. Unlike conventional
medical
laboratories,
the
AML
performs
investigative
protocols
and analytical procedures to evaluate
environmental health issues with the potential to affect
military
operations in the TO. The focus is on a broader scope related to the
health of theater armed forces as a whole as opposed to direct support of
individual patient care.
c. The AML may task-organize its resources to provide laboratory support
for military contingency operations, civic action programs, humanitarian
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support missions, or to
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deploy an investigative team forward into the
corps area once the base laboratory is established in the theater.
2.9 Theater evacuation policy
a. This policy is established by the Secretary of Defense, with the
advice of the Joint Chiefs of Staff, and upon the recommendation of the
theater commander. 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 will be held in the theater for the entire period
of noneffectiveness.
A patient who is not expected to be ready for RTD
within the number of days established in the theater evacuation policy is
evacuated to CONUS or some other safe haven. This is done providing that
the treating physicians determine that such evacuation will not aggravate
the patient's disabilities or medical condition. For example, a theater
evacuation policy of 60 days does not mean that a patient is held in the
theater for 59 days and then evacuated. Instead, it means that a patient
will be evacuated as soon as possible after a determination is made that
the patient cannot be returned to duty within 60 days following admission.
b. When unforeseen increases in the number of patients occur (due perhaps
to an epidemic or heavy combat casualties), a temporary reduction in the
policy may be necessary to adjust the volume of patients in the theater
hospital system. A reduction in the evacuation policy increases the number
of patients requiring evacuation out of theater, increases the requirement
for
evacuation
assets,
and
increases the requirement
replacement/filler personnel. This action is necessary to relieve the
congestion caused by the increased number of patients.
c. The time period established in the theater evacuation policy starts on
the date the patient is admitted to the first hospital (CZ or COMMZ). The
total time a patient is hospitalized in the theater, including transit
time between MTFs, for a single uninterrupted episode of illness or injury
should not exceed the number of days stated in the theater evacuation
policy. Although the medical company (holding) is not a hospital, the time
a patient spends in one is included in the calculation of the duration of
the hospital stay. Though guided by the evacuation policy, the actual
selection of a patient for evacuation will be based on clinical judgment
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the patient's ability to tolerate and survive the movement to the
next level of hospitalization.
2.10 Intratheater evacuation policy
a. Subordinate commands may establish intratheater patient evacuation
policies within the limits of the theater patient evacuation policy and
subject to approval by the theater commander. For example, a short
evacuation policy may be established for corps hospitals to maintain their
mobility and their capability to accommodate surges of patients. The
intratheater evacuation policy, usually stated in days at the corps level,
represents the maximum period of allowable hospitalization in corps
hospitals. Any patient who can be expected to RTD within the stated
policy is retained by a CSH for definitive care and subsequent RTD. Any
patient who cannot be expected to RTD within the stated policy is
evacuated to the COMMZ as soon as the patient's condition
transportation resources permit. Intratheater patient evacuation policies
must be flexible and changed as dictated by the tactical situation. (These
policies may be adjusted in the early days of a contingency operation as
the availability of treatment facilities and evacuation means permit.)
Intratheater evacuation policies may differ among hospitals depending on
their location, facilities, staff, and the numbers and types of patients
received.
b. When patients are received at a constant rate, the evacuation policy
at a specific echelon may be adjusted to retain and subsequently RTD those
patients who do not require specialized treatment in COMMZ GHs. However,
when increased patient loads are anticipated, the intratheater evacuation
policy must be adjusted downward to make additional beds available for
current and anticipated needs. As a result, a larger proportion of
patients admitted to hospitals in the CZ are evacuated to the COMMZ.
PICTURE 2
Figure 2-1. Echelons of combat health support
PICTURE 3
Figure 2-2. Component hospital system
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3.0 Combat Health Support Logistics
Subtopics
3.1 Combat Health Logistics System
3.2 Division Combat Health Logistics System
3.3 Corps Combat Health Logistics System
3.4 Echelons Above Corps Combat Health Logistics System
3.5 Medical equipment maintenance support
3.6 Optical Combat Health Logistics System
3.7 Blood management
3.1 Combat Health Logistics System
a. The Combat Health Logistics System (CHLS) encompasses the activities
of medical supply (Class VIII), medical equipment maintenance, optical
fabrication, contracting services, single integrated medical logistical
manager (SIMLM) for joint operations, and blood management for Army,
joint, or combined operations. The CHLS is modular in design to provide
the flexibility, mobility, and capability to support war and operations
other than war. The system is anticipatory and projects its support based
on operational objectives.
b. The organizational structure for CHLS in a TO consists of four types
of units: medical logistics (MEDLOG) battalion (forward), MEDLOG battalion
(rear), theater medical materiel management center (TMMMC), and MEDLOG
support detachment.
(1) The MEDLOG battalion (forward) provides Class VIII supplies,
single-vision optical lens fabrication, medical equipment maintenance
support, and blood processing, storage, and distribution to divisional and
nondivisional units operating in the corps area. This organization will
function, if required, as the SIMLM for the task force/theater.
(2) The MEDLOG battalion (rear) provides Class VIII logistical support to
echelons above corps (EAC) and the MEDLOG battalion (forward). This
organization has the capability for single-vision and multivision optical
lens fabrication. This organization will function, if required, as the
SIMLM for a joint task force/theater.
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(3) The TMMMC has primary responsibility for providing centralized
theater-level inventory management of Class VIII logistical support to the
theater. It may also serve as executive agent (SIMLM) for Class VIII
supply and materiel for other services in the theater.
(4) The MEDLOG support detachment provides Class VIII supply,
single-vision optical lens fabrication, and medical equipment maintenance
augmentation capability to MEDLOG battalions where work load or special
operations require an increment of less than a battalion-sized unit.
c. Medical logistics support is normally a Service responsibility.
However, in joint operations, a SIMLM may be designated to provide central
logistical support to all participating Services in the combatant CINCs
area of responsibility. As the dominant user, the U.S. Army has been
formally tasked by DOD to perform the peacetime SIMLM mission in the
European and Korean theaters. Under wartime or crisis conditions, the
U.S. Army, in all probability, will be the dominant Class VIII user and
must plan for the SIMLM mission.
d. The Theater
Army Medical
Management
Information System provides
state-of-the-art automation systems to facilitate supply management.
Electronic data communications to include satellite links will
be
established between MEDLOG battalions, their MEDLOG forward support
platoons (FSPs), theater MEDLOG organizations, and MTFs. Other
enhancements to MEDLOG organizations include: global positioning systems,
advanced cargo handling systems, and the application of standard bar code
reading systems (in-transit visibility).
3.2 Division Combat Health Logistics System
a. The MEDLOG battalion (forward) is responsible for Class VIII supply
support to divisional and nondivisional medical units.
The MEDLOG
battalion coordinates with the corps movement control center or movement
control team for movement of bulk medical materiel to supported customers.
It also coordinates with the medical evacuation battalion for air movement
of emergency resupply of blood products and other items of critical need
to support customers. Ambulance backhaul is used to supplement divisional
or corps transportation assets on an as required basis.
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b. Requests for Class VIII resupply in the division are supplied via push
packages using unit distribution (UD). This UD is from the MEDLOG
battalion (forward) through the division/brigade/regimental medical supply
office, forward support battalions (FSBs), forward support medical company
(FSMC), and down to the BASs.
c. An FSP of the MEDLOG battalion (forward) establishes a MEDLOG base to
receive and distribute Class VIII push packages and blood to medical
elements deployed in the divisional area of operations. The MEDLOG FSP has
the capability of handling emergency line item requests from supported
customers. The MEDLOG FSP will push Class VIII preconfigured packages to
the division medical supply office (DMSO).
d. In the division, brigade, and regimental support areas, Class VIII
resupply is performed by the division/brigade/regimental medical supply
offices. These elements coordinate with the division medical operations
center (DMOC), division support command (DISCOM), for transportation of
Class VIII to the forward areas. As a secondary means of transportation,
ground ambulances are utilized to backhaul Class VIII supplies.
e. Each FSMC operates a secondary Class VIII supply point in the BSA for
the emergency resupply of maneuver battalions and other medical elements
on an area basis. Emergency requests are forwarded to the FSMC by any
available means. If the request cannot be filled from stock on hand, it is
passed to the supporting DMSO.
3.3 Corps Combat Health Logistics System
a. The MEDLOG battalion (forward) is the Class VIII manager in the corps
area. This unit provides Class VIII support to corps and division units
using forward positioned elements. The MEDLOG battalion (forward) provides
medical supply support to division medical units through the DMSO and to
the DMSO by UD of preconfigured resupply (push) packages.
b. Medical supply support to the ASMB and hospitals in the corps area is
accomplished primarily by line item requisition and UD from the MEDLOG
battalion (forward). In the ASMBs area of responsibility, medical resupply
support to other medical elements and nonmedical units is accomplished on
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an area support basis.
c. The authorized stockage list (ASL) for the MEDLOG battalion (forward)
is established based on the programmed force structure and equipment
densities consistent with theater policy. A Medical Standby Equipment
Program (MEDSTEP) is maintained at the MEDLOG battalion (forward) to
support medical equipment maintenance repair programs.
d. The corps MEDLOG battalion (forward) is supported by line item
requisition from the theater MEDLOG battalion (rear), local procurement,
and contracting and throughput from the wholesale medical supply system.
e. In a single corps theater, the MEDLOG battalion (forward) must be
prepared to perform the Class VIII management functions of the TMMMC; the
MEDLOG battalion may also assume the role of SIMLM for the joint theater.
3.4 Echelons Above Corps Combat Health Logistics System
a. The MEDLOG battalion (rear) provides Class VIII supplies and blood
support to EAC and MEDLOG battalions (forward). The MEDLOG battalion
(rear) will use forward positioned elements (MEDLOG area support platoon)
to accomplish its mission. The MEDLOG battalion (rear) uses line item
requisition to supply the MEDLOG battalion (forward) and other major
customers. The MEDLOG battalion (rear) maintains preconfigured push
packages in support of the MEDLOG battalion (forward). Medical supply
support for other EAC medical/nonmedical units is provided on an area
basis by the ASMB.
b. The ASL for the MEDLOG battalion (rear) is established based on
programmed force structure and equipment densities. The ASL at the MEDLOG
battalion (rear) will be consistent with TO policy. A MEDSTEP is
maintained at the MEDLOG battalion (rear) to support medical equipment
maintenance programs for corps and EAC units.
c. The MEDLOG battalion (rear), in support of joint and/or combined
operations, performs the SIMLM in conjunction with the TMMMC.
d. The TMMMC is the Class VIII supply, medical maintenance, blood, and
contracting manager for the theater. It provides the link between the
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wholesale system and the theater for Class VIII supplies. Using automated
systems, the TMMMC manages Class VIII materiel, contracting services, and
end items. The TMMMC maintains in-transit visibility, redirects shipments,
and directs theaterwide cross-leveling of Class VIII assets in joint
and/or combined operations.
e. The MEDLOG support detachment is modular in design and capable of
augmenting the CHLS structure at any echelon in the theater. The MEDLOG
support detachment provides organizational and operational flexibility
through its modular design to meet peak logistical work loads. The
detachment augments the MEDLOG battalions (forward and rear) as an
additional FSP or an area support platoon. Additionally, individual
sections of the detachment are used to tailor specific functional missions
such as reconstitution or temporary increases in medical equipment
maintenance or optical fabrication requirements.
3.5 Medical equipment maintenance support
a. Medical equipment maintenance capability in the division consists of
operator- and unit-level maintenance at the FSMC and the main support
medical company (MSMC). The FSMC has a medical equipment repairman who
performs unit-level medical equipment maintenance on the FSMCs medical
equipment and unit-level equipment maintenance to units without organic
maintenance support on an area basis. The MSMC has two medical equipment
repairmen assigned to the DMSO. The DMSO provides unit-level equipment
maintenance to the MSMC and direct support medical equipment maintenance
to the FSMC; it provides unit-level/direct support medical equipment
maintenance to units without organic maintenance support on an area basis.
These repairmen are responsible for scheduled services, equipment repair,
documentation, maintenance of the medical prescribed load list and ASL,
and equipment publications, and for coordination for evacuation of
unserviceable
capabilities.
equipment
or
equipment
whose
repair exceed their
b. At corps level, the MEDLOG battalion (forward) provides direct support
maintenance to the DMSO and to corps-level medical units through their
FSPs. It provides unit-level/direct support maintenance to units without
organic maintenance support on an area basis. The DMSO coordinates with
the MEDLOG FSP for the evacuation/repair of medical equipment which exceed
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their capabilities. The MEDLOG battalion (forward) receives direct support
and general support from the MEDLOG battalion (rear).
c. In the COMMZ, the MEDLOG battalion (rear) provides general support
maintenance on medical equipment for the MEDLOG battalion (forward). It
provides direct and unit-level maintenance, on an area basis, for medical
units in the COMMZ. The MEDLOG battalion (rear) coordinates with the TMMMC
for the evacuation of medical equipment which exceed their capabilities to
CONUS (U.S. Army Medical Materiel Agency).
3.6 Optical Combat Health Logistics System
a. Division.
(1) The optometry section of the
MSMC
is responsible for providing
single-vision fabrication and limited eyewear repair to Echelons I and II
units in the supported division.
If appropriate materials are not
available at the MSMC or the prescription exceeds the MSMC fabrication
capability, it is passed to the MEDLOG battalion (forward) for fabrication
with return of the prescription to the originator.
(2) The FSMC will request replacement of corrective eyewear from the MSMC
via the best communications available with delivery back to the request
originator. Prescriptions which cannot be filled from on-hand stock or
which exceed the MSMC capability are passed to the MEDLOG battalion
(forward).
(3) Separate brigades and ACRs have optometric support with limited
eyewear repair capabilities but no optical fabrication capabilities. All
requests for prescription eyewear are forwarded via data link to the
MEDLOG battalion (forward) for fabrication and return to the originator.
b. Corps.
(1) The optometry section of the ASMB is responsible for providing
single-vision fabrication and repair of corrective eyewear for units on an
area basis. Medical treatment elements supported by the ASMB will request
replacement corrective eyewear via electronic data links to the ASMBs
optometry section. Prescriptions which exceed its capabilities are passed
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battalion (forward) for fabrication with delivery back to
the ASMB.
(2) The MEDLOG battalion (forward) provides single-vision optical lens
fabrication to divisional and nondivisional units operating in the corps
area. All prescriptions requested from the MEDLOG battalion (forward)
optical section that cannot be filled are passed to the MEDLOG battalion
(rear) with delivery of the request to the originating medical activity.
Medical logistics support detachment optical fabrication modules provide
additional temporary capabilities when required.
c. EAC. The MEDLOG battalion (rear) provides single-vision and
multivision support to EAC and general support (backup) to the corps. The
MEDLOG battalion (rear) modular design allows its optical section to
relocate as necessary to support the TO.
3.7 Blood management
a. Blood support is a combination of four systems (medical, technical,
operational, and logistical) and should be considered separately from
clinical laboratory support. The
management and distribution of
resuscitative fluids in the TO, including blood and blood products, are
functions of combat health logistics. The management of blood and blood
products incorporates storage and distribution plans that encompass rigid
time-sensitive specifications. In the mature theater, blood management is
based on resupply of needs from the CONUS donor base. In a developing
theater, during the buildup period, blood requirements may include the use
of pre-positioned frozen blood stockpiles. These stocks are designed to
meet initial blood requirements until the logistical system can deliver
liquid blood to the TO. When supply channels open, frozen blood
utilization normally will no longer be required.
b. Blood and blood products enter the theater through the U.S. Air Force
(USAF) Blood Transshipment Centers (BTCs) for further distribution to the
Army blood bank platoons located in the MEDLOG battalions (forward or
rear). Army MTFs are supplied required blood products from the blood bank
platoons. MASHs operating in divisional areas and Echelon II medical
treatment elements are supplied by the FSP of the MEDLOG battalion
(forward). Liquid blood, limited to Group O red blood cells, is issued as
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required down to divisional medical companies.
c. Blood
follows:
and blood product support to the TO is provided by echelon as
(1) Echelon I. No blood product support is provided at this echelon.
(2) Echelon II. Blood storage and transportation refrigerators are used
by the FSP to provide Group O red blood cells to divisional units. The FSP
is supplied by the blood bank platoon assigned to the corps MEDLOG
battalion (forward).
(3) Echelon III.
(a) Each MASH is limited to Group O red blood cells only.
Each CSH
stores red blood cells of various groups and types; additionally, limited
quantities of other blood products are available. Each Echelon III
hospital has an emergency blood collection capability but does not have
the capability to perform serological testing of the donor units (i.e.,
hepatitis, human immunodeficiency virus (HIV), and syphilis testing). All
Echelon III hospitals are routinely supplied with blood and blood products
by a blood bank platoon assigned to the MEDLOG battalion.
(b) The blood bank platoon is resupplied from a supporting USAF BTC. The
blood bank platoon leader serves as the Corps Blood Program Officer. He or
she manages blood and blood products through a system of specific blood
report formats.
(4) Echelon IV. Each FH and GH stores liquid blood products of various
groups and types. Blood distribution and reporting is similar to that for
Echelon III hospitals. The blood bank platoon assigned to the MEDLOG
battalion (rear) is resupplied from a supporting USAF BTC. The platoon
leader may also serve as the theater Army blood manager until the TMMMC is
operational.
(5) Echelon V. The Army blood support system is an integral part of the
Armed Services Blood Program. Upon mobilization, donor centers and CONUS
MTFs increase their blood drawing capabilities as directed by the Army
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Blood
Program
US Army PAM-40-19
Officer. Additional donor centers are opened as required.
All of these facilities draw, process, and prepare blood and blood
products for shipment to the Armed Services Whole Blood Processing
Laboratory who sends the blood to the TO.
d. Blood collection in the theater is governed by theater policy, but
normally is done to provide platelets for emergency situations. Testing of
blood drawn in the theater is not currently available.
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4.0 Medical Intelligence
Subtopics
4.1 What is medical intelligence?
4.2 Health service intelligence resources
4.3 Combat health support planning in historical examples
4.4 Criticality of medical intelligence
4.1 What is medical intelligence?
Medical intelligence is that product
resulting from
the collection,
evaluation, analysis,
and interpretation of
foreign
medical,
biotechnological, and environmental information. It includes intelligence
on-a. Endemic and epidemic diseases,
public health
capabilities, and the quality and availability of health services.
standards
and
b. Medical supplies, medical services, health service facilities, and the
number of trained CHS personnel.
c. Environmental conditions.
d. Foreign
animal
transmissible to humans.
and plant diseases, especially those
diseases
e. Health problems relating to the use of local food supplies.
f. Medical effects of and prophylaxis for chemical and biological
and radiation.
agents
g. The impact of newly developed foreign weapons systems as they relate
to casualty production.
4.2 Health service intelligence resources
a. In the normal course of duty, medical personnel at all echelons may
gain information of medical intelligence value.
Medical personnel are
responsible for reporting information gained through casual observation of
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activities in
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plain view during the discharge of their duties. This does
not violate the law of war obligation of the U.S. nor constitute grounds
for denial of protected status to medical personnel. For additional
information on medical intelligence, see FM 8-10-8.
b. Requests for medical intelligence and requirements for military
intelligence of medical interest should be accomplished through the
command's supporting intelligence staff element, or the
military
intelligence analytical elements. (Some of these elements are the echelon
above corps intelligence center (EACIC) and the tactical operations center
support element.)
c. There is no medical intelligence or health service intelligence
analytical and production capability within the theater. There is a
military intelligence officer that performs medical intelligence functions
located in detachment O of military intelligence units at EAC. However,
the primary focus of this officer is the exploitation of weapons,
equipment, and other material found, captured, or acquired within the
theater. Medical intelligence officers and NCOs at medical command,
medical brigade, and medical group level will be required to fill the void
in the absence of additional health service intelligence analytical
resources. A special health service intelligence analytical cell may be
established within the theater at medical command, medical brigade, and/or
EACIC. Other possible health service intelligence resources include:
(1) DMOC.
(2) ASMB.
(3) Medical battalion (evacuation).
(4) MEDLOG battalion (forward).
(5) MEDLOG battalion (rear).
(6) AML.
(7) PVNTMED elements.
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4.3 Combat health support planning in historical examples
Studying the medical threat of past battles or military experiences
provides us with information concerning the type and quality of water
supply, endemic/epidemic diseases, effects of heat and cold, flora and
fauna, operational and combat stressors, chemical agents, and terrain.
Some historical examples of military experiences attributed to proper or
improper planning are-a. French wars. Some of the greatest fiascoes in military history
resulted from a breakdown in sanitation and disease control. Even though
history holds Napoleon as a military genius, he often failed to
preventive measures to protect the health of his troops.
take
(1) For example, in 1803 when Napoleon sent a force of 22,000 men to
suppress a rebellion in the French Colony of Haiti, 20,000 men died from
yellow fever. As a result, Haiti achieved independence with little French
opposition and from Napoleon's lack of good judgment in sending a force
into an area where yellow fever was epidemic. There was no vaccine against
yellow fever or any other prophylactic measure to control the disease.
(2) Another example of Napoleon's lack of good judgment occurred in 1813
when he invaded Russia with a force of 480,000 men. Although he succeeded
in taking Moscow, the guerrillas, a lack of provisions, disease
(particularly typhus), and cold injuries decimated his troops and forced
his retreat. As a result, only 10,000 men returned to France. Of the
470,000 men lost in battle, only 60,000 men were killed in action; the
remainder either abandoned Napoleon's army or died of disease and cold
injuries.
b. World War I.
(1) As an example of the benefits accrued from heeding the lessons of
past military experiences, consider the disease of tetanus. During World
War I, the soil in France was particularly rich in bacteria that caused
tetanus which was a constant danger to those wounded in action. The
British occupational troops, for example, had a tetanus rate of 52 per
1,000 wounded. Of these casualties, 90 percent died. Although the tetanus
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antitoxin had been developed before the war, British medical
authorities
did not immunize their troops because of the uncomfortable side
effects--chills, fever, and injection pain caused by the antitoxin. The
U.S. Army recognized this medical threat and immunized its troops with the
tetanus antitoxin prior to deploying to France. Consequently, the U.S.
Army had negligible tetanus rates, saving many soldiers' lives.
(2) Chemical agents were used extensively throughout the war. Countless
chemical agents were experimented with; however, the chemical agents that
were most effective and thus most often used were phosgene and mustard.
Numerous medical personnel suffered from cross contamination with mustard
during patient treatment. This put tremendous burden on health care
capabilities. It is unfair to judge the errors committed in the past based
on the knowledge subsequently gained from the experience. This experience,
however, taught the AMEDD that CHS personnel must protect themselves first
from the effects of these chemical agents. Since warfare has become
increasingly sophisticated, this caution also applies to self-protection
from the effects of NBC weapons.
(3) Prior to deploying the American Expeditionary Force to Europe, the
Surgeon General sent a medical team to collect lessons learned from our
new British and French allies. The psychiatrist on that team reported the
major problems the allies had were with"psychiatric casualties" (called
"shell shock" or "war neurosis" at that time). The U.S. Army adopted the
same techniques and organization which the allies had found effective in
preventing overevacuation, maximizing RTD, and minimizing chronic
disability. A psychiatrist was allocated to each division. Special medical
units behind the division had the sole function of providing brief
treatment for evacuated cases. A special base hospital provided longer
treatment for required cases.
c. World War II.
(1) Combat psychiatry. The system for preventing and treating stress
casualties which had worked in World War I was forgotten. It had to be
rediscovered and recreated in World War II after an epidemic of stress
casualties had been overevacuated from the North African and Pacific
Theaters. Those incidents proved again that stress casualties who are
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overevacuated seldom
RTD and are
US Army PAM-40-19
very likely to
develop permanent
disability. Cases that are treated immediately, close to their units,
with positive expectation of rapid recovery have good RTD rates.
(2) Togatabu Island. The 134th Artillery and the 404th Engineer
Battalions were part of a task force preparing to attack Guadalcanal in
1942. Fifty-five percent of the engineers and 65 percent of the
artillerymen contracted a disease called filariasis which is transmitted
by mosquitoes. Both units were medically evacuated without seeing any
enemy action. The use of an insect repellent would have prevented this.
(3) Merrill's Marauders.Merrill's Marauders, officially known as the
5307th Composite Unit (Provisional), served in Burma during World War II
from January through June 1944. It was an all-volunteer force of 3,000 men
who pioneered long-range penetration tactics in jungle and mountain
terrain behind enemy lines. Despite an extensive training program and the
soldiers' combat experience, most fell prey to a variety of diseases
including malaria, dysentery, exhaustion, and respiratory infections.
Soldiers with high fever were evacuated and medical officers were ordered
to treat most soldiers in the field. One entire platoon cut the seats from
their pants because severe diarrhea had to be relieved on the move. After
an initial successful attack on Myitkyina Airfield on 17 May, the majority
of Merrill's Marauders were forced to be evacuated to a base for treatment
and rest.
d. The French Campaign in Indochina, the British experience in Malaya,
and World War II experiences in relation to the U.S. experience in
Vietnam. In Vietnam, official and professional attitudes toward skin
diseases were much the same as they were in previous wars--essentially
benign neglect until experience revealed that these apparently trivial
conditions could cause an enormous
substantial drain on medical resources.
amount
of disability and create a
(1) During the French Campaign in Indochina (1945 to 1954), skin diseases
created an enormous drain on manpower and caused a great deal of
suffering. Fungal infections were most frequent and were followed in
precedence by staphylococcal infections. Streptococcal infections were rarer. There were
no effective means of preventing any of these infections.
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(2) In the late 1940's and well into the 1950's, British forces were
actively engaged in counterinsurgency operations in the Malayan jungles.
They suffered a great deal from skin diseases. This experience afforded a
chance to observe militarily important skin diseases under circumstances
similar to those that would prevail in Vietnam. However, as we note from
the U.S.
experience in Vietnam, the U.S. Army missed the lessons of
history.
(3) In Vietnam, the U.S. suffered an enormous drain on manpower and a
great deal of suffering because of skin diseases just as did the French in
1945 to 1954 and the British in the Malayan jungles in the 1940's and
1950's. The U.S. Army could have diminished suffering and temporary
disability resulting from skin diseases among infantrymen if they had
learned the lessons of history from French and British experiences.
Likewise, many of the same problems faced by the U.S. Army and its allies
in World War II reappeared in Vietnam. The most important of these were
that-(a) The medical statistical
cutaneous disease problem.
system failed to reveal the size of the
(b) Well-trained and highly motivated physicians often were unable to
properly diagnose and treat the most common skin disorders.
(c) Educational programs and materials concerning militarily important
skin diseases were grossly inadequate.
(d) Research and development programs were not appropriately focused and
supported until after skin disease became a serious problem.
(e) A system for provision of consultant coverage was not devised at the
start of the war as it had been for other classes of disease, but was
instituted only after the situation had reached epidemic proportions.
e. Vietnam. The U.S. Army leaders thought they had solved the problem of
stress casualties with the policy of setting a fixed (365 day) combat tour
with permissive rest and recreation leave. Those measures, coupled with
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other operational
US Army PAM-40-19
procedures, made traditional "combat exhaustion " rare
in relation to wound casualties. What we did not realize was that our
individual
rotation plans and other leadership policies seriously
undermined unit cohesion. Furthermore, the guerrilla/terrorist tactics of
the enemy deliberately sought to create ambiguity, frustration, boredom,
and tension. Their intention was to provoke misconduct combat stress
behaviors which would turn the local and U.S. population and world opinion
against the U.S. And indeed, frustration and rage over the inability to
distinguish friend from foe among the Vietnamese led to the commission of
criminal atrocities. The breakdown in unit cohesion resulted in incidents
of threatening and even killing unpopular unit members and leaders. By
late 1972, 60 percent of all medical evacuations from Vietnam were "
neuropsychiatric cases," mostly related to substance abuse. The failure to
correctly identify and counteract the special stressors of the conflict
contributed to the ultimate failure of U.S. policy objectives in Vietnam,
even though our combat forces were not defeated in the field.
f. Operation "Urgent Fury" in Grenada. As recently as 1983, in their
rush to plan and conduct this contingency operation, military planners
overlooked the significance of the medical threat in the area of
operations. As a result, U.S. forces suffered from preventable injuries,
incapacitation, and degradation of performance. Because the medical threat
was not examined or analyzed prior to the operation, proper preventive
measures were not taken. Had this obvious oversight not been made-(1) The lightweight jungle fatigue uniforms would have been issued to
U.S. forces. (The troops deployed wearing the battle dress uniform which
proved to be much too heavy and hot. The lightweight jungle fatigue
uniforms were subsequently sent from Fort Bragg, North Carolina, but not
before U.S. forces suffered numerous heat casualties.)
(2) Provisions for sufficient amounts of insect repellent, aerosol
insecticide, and bed nets would have been made. (The troops quickly used
the small quantities of insect repellent with which they deployed in an
effort to combat the swarms of mosquitoes and other jungle insects that
feasted on their bodies.)
(3) The U.S.
forces would have been cautioned to protect themselves
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against a species of extremely aggressive fire ants.
(Some troops were
not careful around this dangerous insect which claimed many victims.)
(4) The U.S. forces would have been warned to stay away from indigenous
poisonous vegetation such as the manchineel tree.
(Some soldiers
developed large blisters on their bodies after sweeps through the jungle
and underbrush. Early reports of this alarmed the task force leadership.
They thought that a chemical agent that burns and blisters the skin and
damages the respiratory tract had been employed by enemy forces. Just as
the leadership was prepared to order mission-oriented protective posture
level 4, the local inhabitants and a PVNTMED officer with tropical plant
background confirmed the problem--the manchineel tree. Inhabitants in the
Caribbean avoid this tree and its fruit because the caustic sap can
greatly irritate one's skin and eyes.)
(5) Water discipline would have been emphasized throughout
deployment. The incorrect assumption that potable water would be readily
available led to--
the
(a) Inadequate resources to supply water.
(b) Insufficient command emphasis
sufficient amounts of safe water.
on ensuring that
troops
4.4 Criticality of medical intelligence
Medical intelligence is critical to strategic and tactical planning and
operations to conserve the fighting strength and return injured soldiers
to duty. See FM 8-10-8 for a complete discussion to include the requesting
and reporting channels of medical intelligence. It is a highly technical
area which must retain its integrity so that the end product
technically accurate and contains all required information.
a. At the strategic level, medical intelligence contributes significantly
to the formulation of national and international policy predicated in part
on foreign military and civilian capabilities of the medical/biological
scientific community.
b. At the tactical level, the objectives of medical intelligence
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provide technical
US Army PAM-40-19
intelligence evaluation and analyses of the following
factors in the theater:
(1) Conditions concerning people or animals.
(2) Epidemiological information, flora, fauna, and sanitary conditions.
(3) The enemy's field medical delivery system.
(4) New weapons systems
planning factors.
(5) Medical aspects
from NBC weapons.
or employment
methods that could
alter CHS
of the employment, weapon fills, and contamination
(6) The enemy's state of health.
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5.0 Law of Land Warfare Provisions Affecting Medical Operations
Subtopics
5.1 Law of land warfare
5.2 Medical implications of Geneva Conventions
5.1 Law of land warfare
a. Sources of the law of land warfare.
(1) The law of land warfare is drawn from two sources:
(a) The first is treaty law. Treaties are formally enacted under
procedures set out in the U.S. Constitution. They are laws of the highest
order and statutes and regulations must comply with them. They govern all
U.S. soldiers and civilians.
(b) The second source of the law of war is customary international law.
Once a practice is internationally accepted, either by widespread treaty
enactment or other agreement, it becomes customary international law. Once
this occurs, it regulates even countries which do not agree with the
concept concerned.
(2) In the area of CHS, the principal treaties are the Geneva Convention
for the Amelioration of the Condition of the Wounded and Sick in Armed
Forces in the Field, 12 August 1949, and the Hague Resolutions. These are
found in DA Pam 27-1. FM 27-10 is a handbook reference which will provide
answers to commanders' questions concerning the law of war.
b. Geneva Convention for the Amelioration of the Condition of the Wounded
and Sick in Armed Forces in the Field (GWS). The GWS provides for
protection of armed forces members and other persons who are wounded and
sick on the battlefield. It directs members of the conflict to take all
possible measures to search for and collect the wounded and sick; to
protect them against pillage and ill treatment; to ensure their adequate
care; and to search for the dead and prevent their being despoiled.
It
further provides for the protections afforded AMEDD personnel.
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5.2 Medical implications of Geneva Conventions
a. Provisions for collection of wounded and sick.Provisions must be made
for the collection and treatment of wounded and sick personnel, whether
friend or foe, military or civilian, regardless of legal status. Only
urgent medical reasons will determine priority in the order of treatment
to be administered. This means that wounded enemy soldiers may be treated
before wounded Americans or allies. For enemy personnel wounded as a
result of military operations, dual responsibilities must be carried
out--custodial and medical. The custodial activity of guarding the wounded
prisoner of war (PW) should be carried out by assets other than AMEDD
personnel. Medical personnel should devote their time to the special
medical tasks for which they are trained. The echelon commander will
designate nonmedical units to act as guards when EPW are in medical
channels.
b. Accountability and custody of enemy prisoners of war (Geneva
Convention Relative to the Treatment of Prisoners of War, 12 August 1949)
(GPW). EPW evacuated through medical channels must be identified and their
accountability established prior to evacuation per appropriate tactical
standing operating procedure (TSOP). Sick, injured, and wounded prisoners
may be evacuated through normal medical channels, but they are segregated
from U.S. and allied personnel. They may also be evacuated through
dedicated or task-organized evacuation assets, particularly in rear areas
where they are likely to be moved in a group.
c. Responsibility and handling of PWs. The U.S. Army is responsible for
the care and treatment of EPW from the moment of capture. Below brigade
level, these prisoners are handled by combat troops who bring them to the
designated EPW collecting points. EPW patients are evacuated from the CZ
as soon as possible. Only those sick or wounded prisoners who would run a
greater health risk by being immediately evacuated may be temporarily kept
in the CZ. When intelligence sources indicate that large numbers of EPW
may result from an operation, medical units may require reinforcement to
support the additional EPW patient work load. In this case, the care of
the EPW wounded becomes a joint matter between the ground combat commander
and the medical commander. Procedures for estimating the medical work load
involved in the treatment and care of EPW are described in FM 8-55. For a
more detailed discussion on the administration, handling, treatment, and
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identification of EPW, see AR 190-8, FM 8-10, and FM 19-40.
d. Identification and protection of medical personnel.
(1) Personnel exclusively engaged in the performance of medical duties in
connection with the sick or wounded in medical units or establishments
shall wear, affixed to the left arm, a water-resistant brassard/arm band
bearing the distinctive emblem (the red cross on a white background)
prescribed by the Geneva Convention. The wearing of brassards/arm bands
will be at the discretion of the tactical commander in far forward areas.
(2) Medical personnel are to carry a special identity card, DD Form 1934
(Geneva Conventions Identity Card for Medical and Religious Personnel Who
Serve in or Accompany the Armed Forces), issued to all persons qualifying
as protected medical personnel. (See AR 640-3.) It is carried in addition
to their regular identification card.
(3) Enemy military medical personnel who are captured are considered retained
personnel and not PWs. They will receive the benefits and
protection of the Geneva Conventions and may be required to treat PWs.
Medical personnel or medical units that are captured would do likewise,
continuing to provide medical support behind enemy lines. In such a
situation, this would probably be a primary source of treatment for U.S.
PWs, although enemy wounded could also be treated.
(4) Enemy civilian medical personnel who are physicians, surgeons,
dentists, nurses, or medical orderlies may be asked, but not forced to use
their medical knowledge in the interest of PWs. These medical personnel
are protected persons under the Geneva Conventions, as are persons
regularly and solely engaged in the operation and administration of
civilian hospitals.
(5) Personnel protected as medical personnel under the GWS must be
exclusively engaged in medical duties or administration of medical units.
This covers all members of a medical unit to include cooks, mechanics,
drivers, or administration personnel. However, this protection is given
only if the soldier is exclusively engaged in medical duties. Performance
of any nonmedical duty removes the protection and the DD Form 1934 must be
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withdrawn. For example, if an ambulance driver is tasked with
driving an
unmarked vehicle forward with ammunition prior to evacuating casualties
rearward, the driver would not be exclusively engaged in medical duties
and could not be considered or credentialed as "medical personnel."
e. Self-defense.
(1) Medical personnel may carry arms for defense of themselves and their
patients. This does not mean that they may resist capture or fire on an
advancing enemy. It means that, if the enemy is attacking and ignoring the
distinctive emblem displayed by the medic or the medical unit, the medic
may provide self-protection. Of course, it is preferable
attempt to avoid capture by withdrawal.
and proper
(2) The arms that medics may use are only defensive arms.
regulation, these are defined as service rifles (M-16 series) and pistols.
Other U.S. Services restrict arms to pistols alone.
to
By Army
(3) An overall defense plan does not require medical units to take
offensive action against enemy troops at any time. If a medical force is
part of a defensive area containing nonmedical units, the medical unit's
personnel (that is, all personnel assigned or attached to that unit) will
not routinely be responsible for manning part of the overall perimeter. If
located in isolation, the medical unit may provide its own security if
other support is not available. A medical unit should not be defended from
capture even if military police or other soldiers are manning the
defensive perimeters.
(4) If medical personnel fire on enemy troops (other than as described in
(1) above) or otherwise abuse their protected status, they may lose their
special status under the law of war.
It is also possible that such a
violation could result in a war crimes trial by a capturing force. For
instance, if an enemy force was advancing on a marked medical facility but
was not firing on it and medical personnel then took advantage of the
situation and fired on the enemy, this would be an offense. Under the law
of war, this action would constitute an act of perfidy or treason. It would be akin to
firing on soldiers exposed under a flag of truce.
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f. Marking of medical units/facilities and ambulances.
(1) Medical units and facilities.
(a) The distinctive flag (red cross on a white background) of the
conventions shall be hoisted only over such field medical units and
facilities (except veterinary) as are entitled to be respected under the
convention, and only with the consent of the tactical commander of a
brigade-size or larger unit. The marking of facilities and the use of
camouflage are incompatible and should not be attempted concurrently. Use
of the red cross is authorized. The camouflage of medical units is
regulated by Army regulations and also, in the European theater, by North
Atlantic Treaty Organization Standardization Agreement (NATO STANAG) 2931.
It is not envisioned that fixed, large medical facilities would be
camouflaged. The commander must be aware of who has the authority to order
camouflage and for what period it may last. The camouflaging of medical
facilities, to include ground ambulances and air ambulances while on the
ground, is more difficult to reconcile with operational necessities. The
problem has been present in past wars, but is now more critical because of
the ability of intelligence assets to see deep into the rear area of
operations. If the failure to camouflage endangers or compromises the
tactical operations, the camouflage of medical facilities may be ordered
by a NATO commander of at least brigade level or equivalent. Such an order
is to be temporary and local in nature and is countermanded as soon as
circumstances permit.
(b) The camouflage of a medical unit does not deprive it of protection.
However, the enemy is not required to respect a camouflaged facility until
he recognizes it as such, so the protection is illusory to a point,
especially where indirect fire weapons are involved. The use of defensive
arms by medical personnel at a camouflaged site attacked by ground
maneuver forces poses a dilemma. The medics should attempt to make the
attackers aware of their status rather than fighting back. However, that
may be difficult to do on the modern battlefield.
(c) If medical facilities are used to commit acts harmful to the enemy,
the protection of those facilities may be withdrawn if the acts are not
stopped after warning. This might be the case where a facility is used as
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an observation post,
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or if combat information was reported or relayed
through the facility.
(2) Ambulances.
(a) Air and ground ambulances will be marked with the distinctive red
cross emblem. While there is no legal reason why the ambulances could not
have the red cross removed and then be used for nonmedical roles, two
points must be remembered. First, as stated above, the aviators and
drivers may not do nonmedical tasks without losing their medical status
under the Geneva Conventions. Second, some of our ambulances have a
distinctive silhouette used by no other vehicle. In many cases, the red
crosses may not be visible in low light, over long distance, or through
certain sighting devices while the vehicle is nonetheless recognizable as
an ambulance.
As such, the policy that benefits the mission to the
greatest degree is to use ambulances exclusively for medical tasks.
(b) It is the Surgeon General's policy that crew-served weapons not be
mounted on ground ambulances or air ambulances, even if mounting brackets
are present.
(c) Vehicles other than ambulances may be used in dual roles, moving
wounded to the rear under removable red crosses. However, the red crosses
must be removed before nonmedical tasks are attempted, and care must be
taken that the protection provided by the red cross is not abused.
g. Civilians--wounded and sick (Geneva Convention Relative to the
Protection of Civilian Persons in Time of War, 12 August
1949)
(GC).Civilians who are wounded or become sick as a result of military
operations will be collected and provided initial medical treatment in
accordance with theater policies and transferred to appropriate civil
authorities as soon as possible. All those wounded and sick as a result of
an armed conflict will be collected and cared for. All medical treatment
should be documented and appropriate witness signatures obtained.
Department of Labor (DOL) Form CA 1 (Federal Employee's Notice of
Traumatic Injury and Claim for Continuation of Pay/Compensation) and DOL
Form CA 2 (Notice of Occupational Disease and Claim for Compensation)
should be provided to any civilian injured or ill as a result of military
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operations. The echelon commander
US Army PAM-40-19
and medical
unit
commanders jointly
exercise responsibilities for the custody and treatment of the sick,
injured, or wounded enemy personnel and detained civilian personnel.
h. Captured medical supplies and equipment. Because medical supplies and
equipment captured from the enemy are considered neutral and protected,
they are not to be intentionally destroyed. If these items are considered
unfit for use, or if they are not needed for U.S. and allied forces,
noncombatants, or EPW patients, they may be abandoned for enemy use. Since
captured medical personnel are familiar with their own medical supplies
and equipment, the captured items are especially valuable in the treatment
of EPW. Use of these captured items for EPW and the indigenous population
helps to conserve other medical supplies and equipment. When the capture
of U.S. medical supplies and equipment by enemy forces is imminent, these
items are not to be purposely destroyed. Every attempt must be made to
evacuate them. Those items which cannot be evacuated are abandoned;
however, such abandonment is a command decision.
i. Compliance with the Geneva Conventions.
(1) As the U.S. is a signatory to the Geneva Conventions, all medical
personnel should thoroughly understand the provisions that apply to CHS
activities. Violation of these Conventions can result in the loss of the
protection afforded by them. Medical personnel should inform the tactical
commander of the consequences of violating the provisions of these
Conventions.
(2) Outright violations of the Geneva Conventions result when-(a) Medical personnel are used to
man any offensive-type weapons or
weapons systems.
(b) Medical personnel are ordered to engage enemy forces other than in
self-defense or in the defense of patients and MTFs.
(c) Crew-served weapons are mounted on a medical vehicle.
(d) Mines or booby traps are placed in
and
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facilities.
(e) Hand grenades, light antitank weapons, grenade launchers, or any
weapons other than rifles and pistols are issued to a medical unit or its
personnel.
(f) The site of a medical unit is used as an observation post, a fuel
dump, or an ammunition storage site.
(3) Possible consequences of violations described in (2) above are-(a) Loss of protected status for the medical unit and personnel.
(b) Medical facilities attacked and destroyed by the enemy.
(c) Medical personnel being considered PWs rather than
when captured.
retained persons
(d) CHS capabilities are decremented.
(4) Other examples of violations of the Geneva Conventions include-(a) Making medical treatment decisions for the wounded and sick on any
basis other than medical priority, urgency, or severity of wounds.
(b) Allowing the interrogation of
medically contraindicated.
enemy wounded or sick even though
(c) Allowing anyone to kill,
wounded or sick enemy soldier.
torture, mistreat, or in any way harm a
(d) Marking nonmedical unit facilities and vehicles with the distinctive
emblem or making any other unlawful use of this emblem.
(e) Using medical vehicles marked with the distinctive Geneva Emblem for
transporting nonmedical troops, equipment, and supplies.
(f) Using a medical vehicle as a tactical operations center.
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(5) Possible consequences of violations described in (4) above are-(a) Criminal prosecution for war crimes.
(b) Reprisals taken against our wounded in the hands of the enemy.
(c) Medical facilities attacked and destroyed by the enemy.
(d) Medical personnel being considered PWs rather than
when captured.
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6.0 Personnel
Subtopics
6.1 Personnel Reliability Program
6.2 Physical profiling
6.3 Physical Performance Evaluation System
6.4 Medical Evaluation Board
6.5 Physical Evaluation Board
6.6 Professional Filler System
6.1 Personnel Reliability Program
a. On a tactical battlefield, the possibility of nuclear and chemical
weapons employment can be planned for
and defended
against
knowledgeable, well-trained personnel. In peacetime, however, worldwide
terrorism presents the possibility of unplanned weapons use or threat of
such use by groups determined to disrupt governments and blackmail
nations. Minimizing this possibility, as well as protecting these devices
from accident, becomes the primary objective of the nuclear and chemical
surety programs. Support of these programs by the AMEDD falls principally
in the area of personnel reliability.
b. The Personnel Reliability Program (PRP) identifies nuclear and
chemical duty positions and provides a means to assess the reliability of
individuals being considered for (and during) their assignments to these
positions. A nuclear surety program (see AR 50-5) includes those controls,
procedures, and actions which contribute to the safety, security, and
reliability of nuclear weapons without degrading operational performance.
The program must also contribute to the assurance that there will be no
nuclear weapons accidents, incidents, unauthorized detonations, or
degradation's of weapon performance at the target. A chemical surety
program (see AR 50-6) includes those controls, procedures, and actions
which contribute to the safety, security, and reliability of chemical
agents and their associated weapon systems throughout their life cycle
without degrading operational performance.
c. A nuclear/chemical surety officer is designated by the commander of a
medical department activity, a medical center, and all dental activities.
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The nuclear/chemical surety officer manages the PRP. This officer acts as
the liaison and/or point of contact for PRP units and serves as a member
of the Nuclear Surety Board.
d. Requirements of the PRP include identifying nuclear/chemical duty
positions by checking the nuclear/chemical duty position roster which is
updated annually or upon changes and furnished to the supporting personnel
office, medical activity or contract physician, dental facility, and
alcohol and drug control officer.
A preassignment screening of an
individual's medical and dental records is performed by the losing unit
prior to that individual's departure. These positions are under continual
evaluation and when the following disqualification's are observed, they
are immediately reported to the individual's commander:
(1) Alcohol abuse or dependence.
(2) Drug abuse or dependence. (Personnel who have used a hallucinogenic
drug with a potential for "flashback " --lysergic acid diethylamide (LSD),
phencyclidine (PCP), or other substances with similar properties--will
neither be selected nor retained in the PRP under any circumstances.)
(3) Negligence or delinquency in duty performance.
(4) Nonjudicial punishment.
(5) Conviction(s) by a military or civil court of a serious offense.
(6) A pattern of behavior or actions that is reasonably indicative of a
contemptuous attitude toward the law or other duly constituted authority.
(7) Any significant physical or mental condition, as substantiated by
competent medical authority, or any characteristic or aberrant behavior
that, in the judgment of the certifying official, is prejudicial to
reliable performance of the duties of a particular chemical PRP position.
(8) Poor attitude or lack of motivation.
(9) Inability to wear protective clothing and equipment required by the
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assigned position (only in a chemical duty position).
e. Individuals are medically evaluated to determine physical and mental
condition and qualifications under the standards of the PRP. The
evaluation will be based on medical history and health records (if current
and comprehensive) for this purpose. Dental records need not be evaluated
as part of the initial screening process. Medical records are personally
screened by a U.S. military medical officer, a U.S. civilian physician
under DOD contract or employed by the U.S. Government, or other qualified
medical personnel. If insufficient or questionable information is found,
the individual's medical record is referred to a military medical officer
or civilian physician for evaluation. The certifying official or the
reviewing authority will
be advised of potentially disqualifying
information. If disqualifying information is found, Part II of DA Form
3180-R (Personnel Screening and Evaluation) (see AR 50-5 and AR 50-6) is
prepared and signed by the screening facility officer in charge or an
officially designated representative. When information is attached that
may preclude assignment of the individual, the attachment must be signed
by the evaluating physician or military PA. The DA Form 3180-R and its
attachments will be returned in a sealed envelope marked " EXCLUSIVE FOR"
the certifying official. The medical officer or civilian physician will
not decide the suitability of a candidate. The certifying official will
make the decision. The final decision will be based on a thorough review
of pertinent information provided and consultation with appropriate
medical personnel. An individual may be temporarily disqualified
(temporary prescription for controlled drug) or permanently disqualified
(alcohol or drug abuse or dependence).
f. After the personnel and medical records have been screened, the
certifying official will review the DA Form 3180-R and any attached
information furnished by personnel or medical officers. The certifying
official will ensure that a valid personnel security investigation has
been completed or initiated and determine if the candidate is acceptable
for the PRP. A determination of unsuitability may be made at any time
during the screening process.
(1) The certifying official will complete DA Form 3180-R, Part III, for
an individual found acceptable.
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(2) The certifying official will brief the individual on the importance
of nuclear weapons duties in general, rather than the details of a
specific assignment, if the individual is scheduled for school training or
for a nuclear duty assignment in another unit.
(3) The certifying official will brief an individual
unit nuclear/chemical duties.
being
assigned
to
(4) An individual will be permanently disqualified if the certifying
official makes a determination of unsuitability. The certifying official
will complete Part V of DA Form 3180-R after final action by the reviewing
authority.
g. Upon receipt of a completed copy of DA Form 3180-R showing an
individual is qualified for the PRP, the individual's health record,
outpatient record, and dental record will be identified in accordance with
AR 40-66. If records are maintained in an Army MTF, the DA Form 4515
(Personnel Reliability Program Record Identifier) will be inserted in the
Military Personnel Records Jacket. The following records, when present and
maintained apart from the health record, must also be identified:
(1) Inpatient treatment records.
(2) Clinical Psychology Individual Case Files.
(3) Social Work Individual Case Files.
(4) Alcohol and Drug Abuse Rehabilitation Files.
h. Continuing evaluation of personnel is absolutely essential to the PRP.
Personnel in nuclear/chemical duty positions and those who function in
support of the program must observe and report immediately to the
certifying official any incident or condition that might result in
restriction from PRP duties or disqualification in the program. This
includes prompt notification of any prescribed medication that may tend to
detract from the ability of an individual to perform assigned
nuclear/chemical duties. Oral or telephonic notification will be confirmed
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in writing.
i. Nuclear and chemical surety programs must rely heavily on AMEDD
support in the area of personnel screening for the PRP. It is essential,
therefore, that AMEDD personnel receive proper training for duty execution
and maximum program support.
6.2 Physical profiling
a. The physical profile system is a standardized medical rating system.
It is based upon the function of body systems and their relation to
military duties. Since the analysis of the individual's medical, physical,
and mental status plays an important role in assignment and welfare, not
only must the functional grading be executed with great care, but also the
descriptions of medical, physical, and mental deviations from normal must
be clear and accurate. This information will assist you and your personnel
officer in the determination of individual assignments or reclassification
actions.
b. In developing the system, the functions are categorized under six
factors.
(1) Physical capacity or stamina (P).
(2) Upper extremities (U).
(3) Lower extremities (L).
(4) Hearing and ears (H).
(5) Eyes (E).
(6) Psychiatric (S).
c. Four numerical designations are assigned
for
individual's functional capacity in each of the six factors.
evaluating
the
(1) An individual having a numerical designation of "1 " under all
factors is considered to possess a high level of medical fitness.
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(2) A physical profile "2" under any or all factors indicates that an
individual possesses a medical condition or physical defect which may
require some action.
(3) A profile containing one or more numerical designators of"3"
signifies that the individual has one or more medical conditions or
physical defects which may require significant limitations. The soldier
should receive
assignments commensurate with his or her physical
capability for military duty.
(4) A profile serial containing one or more numerical designators of "4"
indicates that the individual has one or more medical conditions or
physical defects of such severity that performance of military duty must
be drastically limited. The numerical designator "4" does not necessarily
mean that the soldier is unfit because of physical disability as defined
in AR 635-40. When a numerical designator "4 " is used, there are
significant assignment limitations which must be fully described if such
an individual is returned to duty.
d. An individual who is
issued a permanent
physical
profile
with
a
numerical factor of "3" in one or more of the physical profile serial
factors will be mandatorily referred for evaluation to an MOS Medical
Retention Board (MMRB) through the Physical Performance Evaluation System
(PPES). However, if the soldier does not meet the retention standards of AR 40-501,
chapter 3, the soldier will be referred directly to a Medical Evaluation Board (MEBD) and will not
be reviewed by an MMRB.
6.3 Physical Performance Evaluation System
The PPES establishes operating procedures that will upgrade the physical
quality of the force and ensure that each individual is physically
qualified to perform in his or her primary MOS or specialty code in a
worldwide field environment. The system provides for an MMRB to serve as
an administrative screening board to determine if an individual with a
numerical designator of "3" under the physical profile can perform
satisfactorily in his or her primary MOS. Based on the recommendations of
the MMRB, an individual may be--
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a. Retained in his or her primary MOS or specialty code.
b. Reclassified by Headquarters, Department of the Army (HQDA).
c. Placed on probationary status for 6 months so a commander can evaluate
the soldier's ability to perform in his or her primary MOS.
d. Referred to the Army's physical disability system, beginning with
MEBD.
the
6.4 Medical Evaluation Board
The MEBDs purpose is to determine the physical and mental fitness of
military patients. The MEBD will refer soldiers to the Physical Evaluation
Board (PEB). The PEB determines if a soldier is fit or unfit for duty. If
a soldier is determined to be unfit, the PEB will make recommendations for
disability discharge or retirement. Cases that require evaluation by the
MEBD involve-a. Patients who are referred to the PEB for medical disability.
b. Patients whose fitness or unfitness for duty is controversial.
c. Patients who have a progressive disease or condition in which a claim
may be made against the Government.
d. Reservists
is questionable.
whose fitness for duty upon completion of hospitalization
e. Patients whose mental competency is questionable.
6.5 Physical Evaluation Board
a. The purpose of the PEB is to investigate all disability cases referred
to the board and to provide a full and fair hearing for the individual.
After examining line of duty findings, the PEB determines eligibility
benefits. A line of duty "no " determination may result in discharge of
the individual without disability benefits. The board will recommend
appropriate disposition of the individual or determine percentage of
disability, if appropriate.
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b. Based on the findings of the PEB, an individual is returned to duty if
physically fit with or without a profile. The MEBD only makes a
recommendation on fitness; the PEB is the decision-making authority. An
individual found unfit by the PEB can be placed on the Temporary
Disability Retired List or on the Permanent Disability Retired List. The
individual receives a lump sum of money for a less than 30 percent
disability if not retirement eligible.
Note. Administrative, not medical, channels are the most expedient means
of removing an individual from your unit and the Army.
It can take as
long as a year or more to remove an individual through medical channels.
Check with your patient administrator if you have any questions.
6.6 Professional Filler System
a.
In April 1980, The Surgeon General approved the concept of
establishing a predesignated AMEDD Professional Filler System (PROFIS) to
augment personnel staffing of units in Europe and Korea and CONUS units
deploying during the deployment to deployment plus 40 days time frame. The
primary feature of the predesignation system is the distribution of
requirements, which remains relatively constant. The designation of unit
commanders, chief nurses, and other key personnel is accomplished by the
Office of The Surgeon General. The designation of MEDCOM units to provide
filler personnel is accomplished by the MEDCOM. In conjunction with AR
220-1, commanders who provide designated filler personnel for the PROFIS
will send feeder information to the gaining unit commander, including-(1) Preparation of replacements for overseas movement.
(2) Area of concentration (AOC) qualification of designees.
b. Although it is not mentioned in AR 220-1, some units request that sex
gender also be included. These rules also apply for those MEDCOM units
which are providing personnel for the Korean Augmentation Package.
Specific guidance concerning these requirements has been published by the
MEDCOM.
c. Although the filler system involves all six
AMEDD corps, the
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impact
on MEDCOM officer assets
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will
be on medical and nurse corps
staffing. It is obvious that a personnel drawdown of the magnitude
necessary to support a European scenario would have a severe impact on the
command's ability to receive and treat casualties returning from the TO.
Therefore, significant backfill from Reserve Component
units and
individuals, as well as preassigned retirees, is of the utmost necessity.
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7.0 Training
Subtopics
7.1 Expert Field Medical Badge
7.2 Initial unit training and sustainment training
7.3 Combat lifesaver
7.4 Field sanitation team training
7.5 Medical proficiency training
7.6 The Joint Medical Readiness Training Center and the Combat Casualty Care Course
7.7 U.S. Army physician assistant
7.1 Expert Field Medical Badge
a. The Expert Field Medical Badge (EFMB) is intended to recognize medical
personnel who attain high degrees of professional skill and proficiency as
field medics. It rewards medical personnel who can expertly perform common
soldier tasks and apply the principles of basic medical care in a field
environment. This badge also promotes esprit de corps and provides an
incentive for greater effort as well as quality training for AMEDD
personnel.
b. The badge may be awarded to individuals who meet the following
eligibility requirements and pass all test components.
Individuals
classified as conscientious objectors are exempt from weapon requirements.
(1) Officers must be assigned to one of the six AMEDD corps.
This
includes Army officers in training at the Uniformed Services University of
the Health Sciences (USUHS). It also includes Army officers enrolled in
the Health Professions Scholarship Program.
(2) Warrant officers must have an AMEDD primary MOS. Warrant officer
pilots are also eligible if they have a "D " special qualifications
identifier (aeromedical evacuation pilot) and are assigned to an air
ambulance unit.
(3) Enlisted personnel must also have an AMEDD primary MOS. This includes
all MOSs in the 91 career management field and the 18D Special Operations
Medical NCO from the 18 career management field. (See AR 611-201 for a
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complete list of the 91 career management field.)
c. As prerequisites, candidates must-(1) Volunteer for the EFMB test.
(2) Be recommended by their unit commander.
(3) Qualify with their assigned weapon or their M16-series rifle.
(4) Have a passing Army physical readiness test score in accordance with
AR 350-15.
(5) Meet height and weight standards under provisions of AR 600-9.
d. Those authorized to administer the EFMB test and award the badge are-(1) Commanders of Active Army, U.S. Army Reserve, and Army National Guard
TOE medical units in the rank of lieutenant colonel or above.
(2) Commanders in DISCOMs without medical battalions.
(3) Regiment and separate brigade commanders who have the resources and
facilities to conduct all test phases prescribed by TC 8-100.
(4) Surgeons at corps level and above, lieutenant colonel and above.
e. In order to be awarded the badge, candidates must successfully
complete the required number of tasks in each of the following 11 critical
performance areas:
(1) Comprehensive written test.Each candidate must correctly answer 75 of
100 performance-oriented multiple choice questions.
(2) Army physical readiness test.Each candidate must achieve a composite
score of 180 points or higher with a minimum of 60 points in each of the
following three events: push-ups, sit-ups, and a 2-mile run. Alternate
events are not authorized.
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(3) Land navigation. Each candidate must successfully complete a day and
a night land navigation course.
(4) Weapons qualification. Each candidate must qualify with his
assigned weapon or the M16-series rifle within the previous year.
or her
(5) Communications. Each candidate must successfully demonstrate
comprehensive knowledge of field radios and radio techniques.
(6) Survival. Using the M16-series rifle, each candidate must demonstrate
knowledge of survival skills in an NBC environment and a combat situation.
(7) Forced road march. Each candidate must complete a 12-mile road
march
within 3 consecutive hours.
(8) Emergency medical treatment.Each candidate must demonstrate skills in
the treatment of various wounds under simulated combat conditions in a
battlefield scenario.
(9) Evacuation of sick and wounded. Utilizing a variety of vehicles
and
manual carries, each candidate must demonstrate evacuation techniques
under simulated combat conditions in a battlefield scenario.
(10) Litter obstacle course.Candidates will be formed into four-person
litter teams. Each team, while being tested under simulated combat
conditions in a battlefield scenario, must correctly negotiate three out
of four obstacles on a litter obstacle course.
(11) Cardiopulmonary resuscitation. Using the one-soldier method, each
candidate must demonstrate proficiency in cardiopulmonary resuscitation.
7.2 Initial unit training and sustainment training
a. The 91B10 Initial Unit Training Package contains instructional
materials to train 91B10 critical and mission-essential tasks. All medical
specialists (MOS 91B10) are required to complete this new training.
Request
training materials from the Commander, U.S. Army Medical
Department Center and School, ATTN: MCCS-HSN, Fort Sam Houston, TX
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78234-6100.
b. Maintenance of soldiers' skills within their MOS is mission essential.
Many soldiers, particularly medical soldiers, perform duties outside their
MOS. To maintain MOS proficiency, sustainment training materials are
available. The unit furnishes time, equipment, and instructors to provide
unit
training programs.
Exportable sustainment packages for
Self-Aid/Buddy Aid, 91B10, 91B30, and Area Support Cross Training, 91C,
are available from the Commander, U.S. Army Medical Department Center and
School, ATTN: MCCS-HSN, Fort Sam Houston, TX 78234-6100.
c. Correspondence courses are available from Commander, U.S. Army Medical
Department Center and School, ATTN: MCCS-HSN, Fort Sam Houston, TX
78234-6100. Correspondence courses are
generally programmed for
individual, self-paced study, but they may be used in the group study
mode. (See DA Pam 351-20 for a complete listing of correspondence
courses.)
7.3 Combat lifesaver
a. The concept for the combat lifesaver was developed as part of the CHS
portion of AirLand Battle doctrine. The combat lifesaver is a nonmedical
soldier trained to provide enhanced first aid as a secondary mission. The
primary mission of this soldier does not change. All combat units employ
the combat lifesaver concept. Normally, one member of each squad, crew,
team, or equivalent-sized element is a combat lifesaver. CS and CSS units
may also train personnel to serve as combat lifesavers in their units. The
combat lifesaver provides an intermediate level of first aid between the
self-aid/buddy aid skills taught during basic training and the combat
medic.
b. The combat lifesaver course (listed in DA Pam 351-20) is offered only
in the group study mode and is conducted at the unit level. The training
program is managed by a senior medical person designated by the unit
commander. The course involves prestudy of self-aid/buddy aid tasks and 3
days of classroom instruction/testing. Days 2 and 3 consist of additional
training in selected medical tasks such as initiating intravenous
infusions and providing initial care to soldiers with BF. Students must
pass written and performance examinations in order to become combat
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lifesavers. Qualified combat lifesavers require annual recertification.
Unit commanders wishing to enroll students in the combat lifesaver course
must apply to the Army Institute of Professional Development, U.S. Army
Training Support Center, ATTN: ATIC-IPS, Newport News, VA 23628-0001.
7.4 Field sanitation team training
a. The standard Field Sanitation Team Training Module was developed by
the PVNTMED Division, AMEDDC&S, after numerous requests from the field and
with extensive support from field units. The module consists of 13 lessons
which provide the field sanitation team with the information to contribute
to maximizing the fighting strength of their unit.
b. This course is designed for 40 hours of hands-on and classroom
instruction. AR 40-5 requires that at least two people be on a unit field
sanitation team and that one of those individuals be an NCO. If organic
medical personnel (91B) are available, these personnel should be appointed
as the field sanitation team. Successful completion of the 40-hour field
sanitation team certification training course will earn soldiers (private
through sergeant) two promotion points. This course appears in DA Pam
351-20 and is usually offered by local PVNTMED assets, such as those
organic to divisions and separate brigades, by separate TOE PVNTMED
detachments, or by host installation medical department
services.
activity PVNTMED
7.5 Medical proficiency training
a. The purpose of medical proficiency training is to help soldiers
possessing a medical MOS and assigned to a TOE unit to train and sustain
the proficiency of those tasks which are not routinely performed in a TOE
environment. However, current medical proficiency training programs are
decentralized and vary widely among the installations conducting the
training program. To eliminate this problem, HSC (now the MEDCOM) and the
U.S. Army Forces Command signed a Memorandum of Understanding (MOU)
authorizing the development and implementation of the Army Medical
Department Systematic Modular Approach to Realistic Training, a
standardized tool for use in the medical proficiency training program.
This standardized training tool is a means to provide hands-on, documented
training by using MOS-specific modules/tasks which contain individual,
nonfield (clinical) tasks. These modules/tasks assist the MTF trainers in
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providing standardized sustainment training to TOE soldiers during their
90-day rotation at the MTF. Tasks are listed according to training days;
similar or related tasks are placed together as they would be performed or
trained. Tasks to be trained are a combination of soldier's training
publication tasks, Army Training and Evaluation Program tasks, and other
tasks referred to as " clinical" --that is, medical tasks performed in an
MTF.
b. The TOE commander provides soldiers to be trained. The commander also
provides the MTF with mission-essential tasks. This item is just one of
many details which must be agreed upon in advance by the TOE and MTF
commanders as they develop, sign, and implement a local MOU. The
establishment of training requirements and responsibilities and negotiated
terms of the agreement are essential for providing the best possible
training to the soldier.
7.6 The Joint Medical Readiness Training Center and the Combat Casualty Care Course
The Joint Medical Readiness Training Center (JMRTC) is a triservice
organization providing (under the auspices of the AMEDDC&S) medical
readiness training for officers and selected enlisted personnel from all
Active and Reserve Components. The Combat Casualty Care Course (C( 4) )
is the primary course presented by the JMRTC.
a. The C( 4) is controlled by the Joint Medical Readiness Education
Council (JMREC), which is chaired by the Deputy Assistant Secretary of
Defense for Medical Readiness. The membership in the JMREC consists of a
flag rank representative from The Surgeon General's office of the
Departments of the Army, Navy, and Air Force; flag rank or colonel
representatives from the Services' Reserve Component medical departments;
and a member appointed by the President, USUHS. The AMEDDC&S, the U.S.
Marine Corps, and the U.S. Public Health Service also participate as
observers.
b. The purpose of C( 4) is to prepare medical department officers to
function on an integrated battlefield at the forward points of the
casualty care system. The practical goal is to develop skills to the level
where casualties can be successfully assessed and treated to RTD in the
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shortest possible time, or be evacuated to the rear as conditions
of the
individual and the environment dictate. Practical exercises are also used
to introduce and develop skills required of medical staff officers.
c. Some of the specific areas of emphasis are as follows:
(1) Advanced trauma life support (ATLS). This is the standard ATLS course
(from the American College of Surgeons) teaching initial assessment and
management of the trauma victim through large group lectures and small
group, practical, hands-on training.
(2) Field exercises stressing participative training in NBC warfare
defense and the identification of medical limitations in NBC environment.
(3) Participation in day and night tactical maneuvers giving the student
the opportunity to practice the applications of medical concepts and
skills in a field environment.
(4) Medical officer responsibilities to the commander regarding the
assessment of the medical threat to combat forces, combat stress, and the
prevention of diseases and nonbattle injuries.
d. The C( 4) is conducted in residence as a 9-day consecutive course. It
is also presented as a nonresident course in phases, so that personnel
from the Reserve Components can complete the course during either weekend
drills or annual training.
(1) The resident course is conducted at Camp Bullis, Texas, and the
AMEDDC&S, Fort Sam Houston, Texas. The students are divided into 12-person
squads and live in tents and hutments under field conditions. All
equipment required is issued at Camp Bullis.
courses annually with 144 officers per class.
There are presently 17
(2) With one exception, the nonresident course content is the same as
that of the resident course. In the nonresident course, a variety of academic
medical education courses may be substituted for ATLS. Examples are advanced burn life support,
medical management of chemical casualties, combat anesthesia, and deployment medicine. The
course is broken into three phases which can be taken in any order. The course can be
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completed on weekends over a 1- to 3-year period or during one period of annual training.
e. The JMRTC also conducts the Combat Casualty Management Course. This is
an 8-day course for senior medical department officers and is offered
twice yearly in residence. Some of the major areas emphasized are an
in-depth review of war wound management; how medical regulating and the
evacuation policy affect critical resources; medical logistics; medical
intelligence; and refugee medical problems.
7.7 U.S. Army physician assistant
a. The U.S. Army PA course is
conducted by the AMEDDC&S, Fort Sam
Houston, Texas. The PA course trains Active Component and National Guard
personnel who meet the criteria delineated in DA Cir 601-94-3. Applicants
are selected by a DA selection board.
b. The PA course is a 2-year, multiphased baccalaureate program through
affiliation with the University of Texas Health Sciences Center, San
Antonio, accredited by the Committee for Allied Health Education Agencies.
Phase I is a didactic phase taught at the AMEDDC&S; Phase II is a 1-year
clinical practicum taught at various AMEDD activities. A baccalaureate
degree is granted by the University of Texas upon completion of the
course. Certification by the National Commission for Certification of
Physician Assistants is required to be commissioned into the Army SP (AOC
65D). Following completion of the PA course, graduates are required to
attend the AMEDD officer basic course.
c. The purpose of the PA course is to prepare candidates to-(1) Serve as primary care providers (under the direct supervision of a
physician) for combat and CS battalions, troop medical clinics, outpatient
clinics, emergency rooms, and other primary care facilities.
(2) Provide ATM and care for nonbattle injuries for soldiers during
peacetime and times of hostility.
(3) Function as special staff officers to commanders of combat and CS
battalions and frequently as medical platoon leaders of those battalions.
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d. The PA is an appointed primary medical care expert who manages the
following battalion medical activities:
(1) Training.
(2) Sick call.
(3) Medical support.
(4) Tactics.
(5) Logistics.
(6) Special staff support.
(7) Emergencies.
(8) Deployment.
(9) Medical planning.
(10) PVNTMED.
(11) Occupational health.
(12) Wellness.
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8.0 Soldier Health Maintenance/Current Health Problems
Subtopics
8.1 Soldier health maintenance elements
8.2 Sleep
8.3 Stress
8.4 Alcohol/drug abuse
8.5 Suicide prevention
8.6 Immunizations/prophylaxes
8.7 The Oral Health Fitness Program
8.8 Sexually transmitted diseases
8.9 Acquired immunodeficiency syndrome
8.10 Occupational safety and health
8.11 Field sanitation team
8.12 Army Aviation Medicine Program (flight surgeon)
8.13 Veterinary services
8.14 Nutrition
8.1 Soldier health maintenance elements
Physically and mentally fit soldiers are a vital element of your unit's
operation. If the soldiers are physically and mentally fit, they are less
likely to be a combat loss from disease or injury. To ensure the fitness
of your personnel, you should employ the unit's field sanitation team and
your supporting surgeon, flight surgeon, PA, CSC personnel, and dental,
PVNTMED, and veterinary services in monitoring-a. Sleep.
b. Stress.
c. Alcohol/drug abuse.
d. Suicide prevention.
e. Immunizations/prophylaxes.
f. The Oral Health Fitness Program.
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g. Sexually transmitted diseases (STDs).
h. Acquired immunodeficiency syndrome (AIDS).
i. Occupational safety and health.
j. Food wholesomeness.
k. Nutrition.
8.2 Sleep
a. Sleep is not a luxury, but a necessity for adequate mission
performance. While you and your unit can go for 2 or 3 days without sleep
to accomplish urgent mission objectives and counter enemy threats,
considerable risk is involved. Care must be taken to protect critical task
performance with "counterdegradation " or "counterfatigue" measures. With
increasing sleep
loss, physical strength remains unimpaired, but
coordination, alertness, mental ability, and motivation deteriorate. Tasks
take longer to perform. The likelihood of serious errors increases as-(1) Signals are missed.
(2) Communications become garbled.
(3) Judgment falters.
(4) Important task steps are neglected.
b. Sleep-deprived individuals fall asleep when they should not.
Their
attention wanders and they are prone to accidental injury and death. If
kept awake, they begin to have visual hallucinations and see, very
vividly, things which are not there--often what they wish or fear to see.
They may also suffer temporary delusions. This is not a sign of mental
illness but of insufficient sleep. However, it can endanger you, other
unit personnel, and the mission.
c. Not every individual needs to
be
evacuated
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because of visual hallucinations or mirages. What the individual needs is
a good 6 to 8 hours of sleep, although even 4 hours will be surprisingly
restorative. It is your job to see that neither you nor your unit comes to
this state. To maintain continuous operations beyond a few days, you must
provide guidance and a command climate for a sleep plan which gives all
individuals (especially those with critical thinking, decision making, and
vigilance tasks) sufficient sleep. The NCOs must assure execution of the
plan's details. "Sleep discipline" does not mean prohibiting sleep any
more than water discipline means restricting water. Rather, it means
assuring that everyone sleeps at times and in places which are safe for
the individual, the unit, and the mission. The following are guidelines
for your unit's sleep plan. They must, of course, be flexible to adapt to
fit your resources and mission. The plan must assure short-term mission
accomplishment and unit survival while enabling the unit and its members
to function over a longer term.
d. Do not allow sleep in unsafe places. The TSOP must specify the
designated sleeping areas. When appropriate, the TSOP will outline
requirements for perimeter guards and ground guides, day as well as night,
for all vehicles to assure personnel safety and security. Depending on the
type of threat, this may range from simple dispersion and concealment
through sentries, foxholes, and slit trenches, to well dug-in bunkers with
three or more layers of sandbags. Have the right TSOP for your situation.
Do not relax it just because everyone is tired.
e. Provide dry and comfortable sleeping areas as practical. Four hours
of sleep stretched out in a sleeping bag or hammock is worth 8 hours
wedged in a cramped vehicle or wet hole in the ground.
f. Set
shifts
which give everyone 6 to 10 hours of sleep in 24 hours,
when feasible. Ideally, this sleep should be uninterrupted. However, even
two or three blocks of 2, 3, or 4 hours which add up to 6 to 8 hours are
sufficient for continuous operations which may extend for months.
g. Try to give individuals a minimum of 4 hours of uninterrupted sleep
per 24 hours when 6 hours of sleep a day is impossible. If possible, give
6 hours of uninterrupted sleep to individuals who are responsible for key
tasks and who are more or most susceptible to the effects of sleep loss.
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h. Allow individuals to get as much sleep as possible before going into
sustained operations. Individuals cannot really"stockpile " sleep, but it
pays to be well rested before starting a period of sleep deprivation. Even
taking an afternoon nap before the night operation can significantly
improve performance and delay the onset of deterioration.
i. In sustained operations, when shifts are impossible, allow individuals
to nap whenever they can do so safely. Never waste a chance for an
individual to catch safe sleep. The longer the nap the better, but even
15- to 30-minute catnaps help over the longer term. However, in the
short-term, be aware that most sleep-deprived individuals awaken slowly
from naps. It may take them several minutes to "warm up their brains"
before their alertness and mental ability are as good as they were before
they went to sleep. This is especially true if the nap comes at a time
when they are accustomed to going into a long sleep period such as from
2400 to 0600 hours. There are big differences in an individual's ability
to awaken quickly. Know your unit and yourself and take this into account
when allowing naps.
j. Allow individuals to catch up on sleep after going without it. Six
to
10 hours is best, but even 4 hours is surprisingly restorative, even after
96 hours of no sleep.
k. Learn, practice, and teach rapid relaxation techniques such as-(1) Breathing meditation.
(2) Progressive muscle relaxation.
(3) Imagination of a relaxing situation.
l. Skill at these techniques will be useful for taking quick restorative
naps in noisy, uncomfortable, and anxiety-filled situations. The
techniques also help to get back to sleep after the frightening dreams
which are a normal and common reaction to combat experiences. However,
individuals should not put themselves into a too relaxed state at those
times when vigilance and urgent action are required.
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m. Conduct cross training in advance so that individuals with critical
skills and duties can be relieved in order to sleep. Junior leaders must
be trained and kept fully informed so that they can keep watch while the
senior leader sleeps. After all, they may have to take over suddenly if
the senior leader becomes a casualty, which is inevitable if the leader
tries to go too long without sleep.
n. Allow individuals who need sleep to rest in their units or in the
unit's CSS trains. However, if individuals are so"keyed up" or "spaced
out" that they could do harm to themselves or others (such as around
weapons, dangerous equipment, or possible enemy action), allow them to use
the supporting medical unit's cots.
8.3 Stress
Fear and physical signs or symptoms of stress are normal reactions before,
during, and after combat or other dangerous and/or life-threatening
situations. Stress symptoms are also normal, although usually less
obvious, in peacetime field training and garrison. Military life involves
many "stressors " such as long working hours, periods of separation from
family, changing job responsibilities and coworkers, and moves to faraway
duty stations. Even when such events are positive, they involve
uncertainty and possible cost. Other life events such as marriage, birth
of children, spouse's job, and children's progress through school also
create stressors, even when positive. They can interact with the military
life stressors to cause distressing problems.
When negative stressors
such as illness or disability in the family, financial problems, or
interpersonal discord are added, the normal stress process is overworked.
Too much stress impairs mission performance. It can even lead to physical
illness such as heart disease or ulcers and can be associated with alcohol
and other drug abuse, overeating, depression,
problems.
or other psychological
a. Stress management. Stress management is one aspect of the Army's
Wellness and Fitness Program. The objective of Army stress management is
not to eliminate stress but to help soldiers and their families use stress
adaptively and improve their coping abilities. The peacetime mission of
the Army is to prepare for combat, and combat is the most stressful of all
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human activities.
b. Combat stress casualties. In heavy conventional battle, one soldier
usually becomes a temporary"BF casualty" for every two to five soldiers
wounded in action.
More soldiers may suffer wounds, injuries, or
preventable diseases because stress has impaired their ability to perform
their duties and protect themselves and their buddies. BF and misconduct
combat stress behaviors are not unique to combat soldiers. They also occur
in CSS unit and headquarters personnel, even in those who are not directly
under fire. The division mental health section (or equivalent supporting
mental health team) can assist you in the prevention, treatment, and RTD
or disposition of BF casualties and other harmful combat stress behaviors.
Other soldiers may show misconduct stress behaviors which require
disciplinary action, such as-(1) Commitment of criminal acts such as atrocities.
(2) Self-inflicted wounds.
(3) Desertion.
c. Combat stress defense. You can promote the defenses against stress in
combat through unit cohesion and tough, realistic training. Ideally, these
defenses need to be developed before mobilization; but when necessary,
they may be developed during deployment and even in combat. Other
important stress management techniques which are part of basic good
leadership include-(1) Assuring physical fitness and taking care
needs.
of the troops' physical
(2) Keeping soldiers informed while focusing their perspective on how the unit will overcome
difficulties to succeed with the mission.
(3) Reassuring soldiers that home front
positively.
(a) Unit
cohesion
problems
means two things. Cohesion
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will
is
be resolved
the
personal,
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face-to-face loyalty shared by people
who work with and depend on one
another. It becomes strongest when these individuals have shared and
overcome difficulty, hardship, or danger. Ideally, cohesion matures over
months or years, but it can develop over hours and days under intense
pressure. Unit refers to a sense of shared identity in the unit and its
mission. It defines not only who we are, but also what we do and how and
why we do it. Cohesion alone is very strong but flexible--easy to bend but
hard to break or pull apart. Unit identity is firm but brittle. Putting
the two together creates a result that is much stronger than either alone.
To promote unit cohesion, keep the same team members (soldiers, NCOs, and
officers) working together as long as possible. Do not move them from one
team to another unless absolutely necessary. Assign work details to intact
teams. Encourage friendly competition in mission-oriented tasks and in
sports events to emphasize the teams, not the individuals. Use awards,
ceremonies, and unit-sponsored social activities to promote unit cohesion
and to allow individual acquaintances. Include soldiers' families in these
activities and encourage a social support network. The family support
group will help these families rely on one another if the unit deploys.
Intervene, when necessary, to assure that the official social support
agencies work smoothly to assist your unit and their families. Using the
Army Community Service, the Army Emergency Relief, the Alcohol and Drug
Abuse Prevention and Control Program, and the Exceptional Family Member
Program (EFMP) can be beneficial. The unit or local chaplains and the
mental health personnel of the division mental health section or community
mental health activity can assist with individual or marital counseling
and/or referral. There must be no stigma or negative career implications
attached to those who responsibly use these resources to improve the
quality of their lives and their stress tolerance.
(b) Unit
cohesion alone is
not
enough. Tough, realistic training is
essential. This training contributes to unit cohesion by encouraging joint
working efforts for overcoming difficulty and hardship and for
accomplishing the unit's mission. Suffering hardship and discomfort and
successfully accomplishing the unit's mission are necessary. Tough,
realistic training builds the individuals' confidence in themselves, their
comrades, and their equipment. It also builds confidence in the leader's
competence, candor, courage, commitment to the mission, and concern
(caring) for the soldier. Training prepares the soldiers to face and
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overcome the rigors, discomforts,
US Army PAM-40-19
fears, and horrors of the combat
mission.
This is especially important for CSS units. Another important
aspect of tough training is a routine, progressive program of physical
exercise. Physical exercise develops endurance, strength, agility, and
calluses in all parts of the body subjected to the demands of the mission.
Master physical fitness coordinators in your unit or at the installation
or garrison can advise on the most appropriate activities. Implementation
of the program promotes unit cohesion and mutual confidence.
d. BF. Even with all these preventive measures, soldiers will show
symptoms of BF in combat or during highly stressful missions. Your unit's
NCOs, medics, and combat lifesavers (if your unit has them), and officers
can provide temporarily overstressed soldiers the calm reassurance and the
positive expectation that they can continue their duties and are needed by
their buddies. Encourage these soldiers to talk about what has happened
that bothers them and to express their feelings without fear of being
judged or disputed. A good listener helps them to put things back in a
perspective which enables them to refocus on the unit and its mission.
8.4 Alcohol/drug abuse
a. Alcohol and drug abuse remains
a serious problem in the military
Services. It affects combat readiness, job performance, and the health of
military personnel and their families. It also costs millions of dollars
in lost time and productivity and short and long term medical costs; more
specifically, it affects the individual. The reasons for alcohol and drug
abuse are as varied as the individuals who use them. Individuals abuse
these substances to change the way they feel. They may want to feel better
and happier or escape from stress, pain, or frustration. Some may want to
forget, others may want to be accepted or be sociable. Other individuals
abuse alcohol and/or drugs to escape boredom or to satisfy their
curiosity. Peer pressure can also be a very strong motivating factor in
their abuse. Individuals often feel better about themselves when they use
alcohol and/or drugs, but these effects do not last. Alcohol and/or drugs
never solve problems--they merely postpone and complicate them.
Individuals who abuse alcohol and/or drugs to solve one problem run the
risk of continued usage, which creates new problems and makes old problems
worse.
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b. You are
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responsible for ensuring that the heavy use or abuse of
alcohol and/or the abuse of other drugs is not condoned in the unit. You
should not promote any official or unofficial function which glamorizes
the use of alcohol through drinking contests, games, or initiations or the
awarding of alcoholic beverages as prizes for contests. Nonalcoholic
beverages should be readily available at military functions to provide
alternatives for those who prefer not to drink alcohol. You also should
promote and encourage off-duty sports, educational, cultural, religious,
or spiritual pursuits as alternatives to use of alcohol and/or drugs.
c. Potential alcohol and/or drug abuses in your unit are brought to
your
attention either by self-disclosure or by evidence provided by biochemical
testing, law enforcement apprehension, command investigation, medical
identification, inadequate performance attributable to intoxication or
withdrawal, witness reports, or other sources. Any soldier who self-refers
or who you believe may have an alcohol or drug problem must be referred
immediately to the Alcohol and Drug Abuse Prevention and Control Program
for assessment and treatment planning, regardless of your administrative
intentions. The soldier's problem will be assessed and treatment conducted
until it is no longer necessary or until the soldier is deemed unfit for
duty and is subsequently separated.
8.5 Suicide prevention
a. Suicide is the third leading cause of death of active duty soldiers in
peacetime. Many cases of suicide may go unreported, as they can masquerade
as accidents. In combat, the suicide rate tends to decrease. Aggressive
drives can be channeled toward the enemy. However, some deaths due to
inappropriate behavior in combat may, in reality, be suicides. Suicide
among family members, including elderly parents, spouses, teenagers, and
even children, is also a serious problem which impacts on the entire Army.
b. Suicide turns a temporary depression (or a brief loss of self-control
due to frustration, anger, or substance abuse) into a fatal illness. Even
unsuccessful suicidal attempts can lead to permanent disability. The
effectiveness of the entire unit suffers when one soldier or family member
attempts suicide. While there is no certain way to predict and prevent
all suicides, the risk can and must be kept to a minimum. Soldiers and
their families may lessen the risk of suicide by using the emotional
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support and cohesion
US Army PAM-40-19
of friends and leaders. This must be directed by a
caring chain of command and supported by medical
personnel, chaplains, and the helping agencies.
and mental health
c. You are responsible for assuring that your subordinate officers and
NCOs know and are alert to the warning signs of depression
self-destructive thinking. They should know the kinds of stressors and
situations that are often found behind cases of successful or attempted
suicide. These include-(1) Loss or breakup of a love relationship.
(2) Sexual problems.
(3) Trouble with authority.
(4) Failure.
(5) Other blows to self-esteem.
(6) Unwanted retirement.
(7) The prospect of a chronic, painful, or disabling disease.
d. Alcohol and/or drug abuse greatly increases the danger of suicide. Key
emotional factors are-(1) Loneliness.
(2) Lack of self-worth.
(3) Strong guilt feelings.
(4) The sense
better.
of hopelessness--the
belief that things can never get
(5) Anger turned inward--the urge to hurt others or to
guilty by hurting oneself.
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make them
feel
and
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e. Suicide gestures or other unspoken "cries for help" should not be
discounted or ignored. Most of those who have succeeded at suicide have
made previous attempts or shown other signs that they have crossed that
important line between thinking about it and starting to take action.
Ignoring the gesture simply confirms their belief that they are alone and
no one cares, while discounting its seriousness is, in effect, daring them
to prove their desperation by trying something more dangerous. Anyone who
makes a gesture should be evaluated by medical/psychiatric personnel.
Those who are judged to be seriously suicidal must be escorted to
care--they should not be left alone.
f. The DA has directed commanders to educate all junior leaders and
supervisors in suicide prevention. A videotape and supporting pamphlet are
available at most training and audiovisual support centers. These training
aids are not intended to stand by themselves, but rather to be lead-ins to
an active discussion led by qualified experts such as the mental health
personnel of the division mental health section or post medical activity.
g. Note that suicide prevention training should be focused at the junior
leaders. Caution is necessary when publicizing the topic among the junior
troops since this can unintentionally"glamorize " suicide, especially in
the minds of unhappy young people. Suicide is sometimes "epidemic" ; one
suicide at a post or in the community may be followed by others. If a
suicide or suicide attempt occurs in or near your unit, it is important
for the leaders to redouble their vigilance and to actively help the
troops work through their reactions. Mental health personnel and chaplains
can be helpful.
8.6 Immunizations/prophylaxes
a. Immunizations/prophylaxes are major components of the overall Army effort to counter
the infectious disease threat. As battalion commander, you are responsible for assuring
that all individuals assigned to your unit receive required immunizations/prophylaxes and
that appropriate records of such immunizations/prophylaxes are maintained. You are also
responsible for assuring that individuals transferred from your unit receive the
immunizations/prophylaxes required in the area to which they are ordered.
b. The specifics of
the Army Immunization/Prophylaxis
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Program
are established in
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AR 40-562/NAVMEDCOMINST 6230.3/AFR
161-13/CG COMDTINST M6230.4.
This
regulation discusses requirements for specific immunizations/prophylaxes related to-(1) Mission.
(2) Geographic location.
(3) Categories of persons such as-(a) Active duty.
(b) Basic trainees.
(c) Reserve Components.
(d) Military dependents.
(e) Personnel granted-1. Waivers.
2. Exemptions.
c. All requirements are subject to change
and amendment based upon current situations and
needs. Questions regarding current specific requirements or recent changes should be directed to
the local PVNTMED service at your MTF.
8.7 The Oral Health Fitness Program
a. Dental maladies account for a significant amount of lost duty time.
The rate of dental emergencies varies with the-(1) Amount of predeployment preparation of troops.
(2) Length of deployment.
(3) Intensity of conflict.
(4) Amount of in-theater dental care.
b. The rate of dental emergencies from Vietnam and large field training exercises ranges from 142
to 234 dental emergencies per 1,000 troops per year.
c. Commanders, the dental care system, and the soldier share the responsibility for
dental fitness. The primary focus of this program is to ensure that soldiers do not become
"noncombat dental casualties." Within this program, the dental care system has responsibility for-(1) Fitness classification.
(2) A yearly 100 percent audit of records to ensure accuracy of classification.
(3) Dental treatment of soldiers to achieve a satisfactory dental fitness level. The
responsibility for personnel accountability rests with installation personnel support
activities and unit commanders.
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d. The Oral Health
program
to
Fitness
Program
US Army PAM-40-19
provides
a structured preventive dentistry
maximize dental readiness. The four dental fitness classes are--
(1) Dental Fitness Class 1--Includes soldiers who require no dental treatment. (On
examination, no further dental appointments are given or recommended; for example, if
there are missing teeth and no replacement is recommended, the patient is in Class 1.)
(2) Dental Fitness Class 2--Includes soldiers whose existing dental condition is unlikely to
result in a dental emergency within 12 months.
(3) Dental Fitness Class 3--Includes soldiers who require dental treatment to correct
a dental condition that could cause a dental emergency within 12 months.
(4) Dental Fitness Class 4--Includes soldiers who require a dental examination.
This includes soldiers who require annual or other required dental examinations and
soldiers whose dental classifications are unknown.
e. A commander should strive to maintain all of his or her troops in Dental Fitness Class 1 or 2.
f. Full procedures and responsibilities of the Oral Health Fitness Program are described in AR
40-35.
8.8 Sexually transmitted diseases
a. STDs comprise another disease
category which can have a negative impact on
soldiers and their effectiveness. The increase in sexual promiscuity in our society,
coupled with young soldiers out of their home environment, make STDs a common military
problem.
Chlamydia and other forms of nongonococcal urethritis are the most common
STDs followed by the familiar diseases, gonorrhea and syphilis, and a variety of others.
b. STDs are generally contracted through sexual contact. Many STDs can be treated and
cured with proper medical care but the risk of complications and the
existence of incurable STDs such as herpes, hepatitis B, and AIDS make prevention the
obvious preference.
c. Punishing soldiers who acquire an STD is not only forbidden by regulation
is counterproductive to the overall prevention and control effort.
but
d. When a soldier in your unit suspects he or she may have a problem they should-(1) Report for sick call immediately. (The longer they have the disease, the more serious it
may become.)
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(2) Tell their sexual partner(s) to seek treatment.
(3) Abstain from all sexual activity until the problem is resolved.
(4) Follow medical instructions exactly and completely.
(5) Cooperate with the STD interviewer.
e. Assistance in diagnosing and treating STD can be obtained from-(1) Military MTFs.
(2) Civilian health care facilities.
(3) Municipal public health departments.
f. Information about STDs may be obtained from the above sources and from the national hot line
(1-800-227-8922).
g. An effective program for controlling STDs depends on the cooperation you have from
soldiers assigned to your unit. Place particular emphasis on-(1) Commanders. Commanders are responsible for initiating and maintaining an effective STD
control program in their units.
(2) Education of soldiers.
(3) Safe sex practices.
(4) Tracing of contacts.
h. PVNTMED activities serve as a resource in helping you design an STD control program
and may be able to provide personnel to help in the education effort.
8.9 Acquired immunodeficiency syndrome
a. HIV has been identified as the etiologic agent of AIDS. The HIV infection covers a
spectrum of illness from an absence of physical signs and symptoms to the most severe
presentation of immunodeficiency, AIDS. The HIV antibody positive individual is considered to
be infectious to other people for the rest of his/her life.
b. AIDS is the condition resulting from the natural progression of infection by the
virus. The body's immune system is destroyed, causing otherwise controllable infections
to invade the body and cause additional diseases. These opportunistic diseases may eventually
cause death. AIDS is commonly identified because of the presence of an opportunistic disease, a
positive Western Blot laboratory test, and a decrease in T-lymphocytes with a profound
compromise of the immune system.
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c. The last few years have seen a change in the perceived spectrum of HIV disease from that of a
uniform, rapidly fatal process to more of a chronic disease, with a poor outcome, but with
increasing life span and quality of life.
d. Due to
because--
the Army's unique mission, soldiers who have HIV must be identified
(1) Soldiers who have the HIV antibody may have a deficient immune system and easily
become ill from different diseases and are not deployable worldwide.
(2) Soldiers are required to donate blood for direct transfusion on the battlefield and
transmission of the AIDS virus could occur. Soldiers are screened for antibodies to HIV
at least every 2 years. All new recruits are screened before entry into the military.
Those who are screened positive are not allowed to enter the military.
e. Any soldier assigned to your unit with a positive HIV test has the potential for a serious
health problem. The HIV/AIDS is an infectious disease which not only has potentially
catastrophic medical implications, but also has a potential for devastating psychological
consequences. An individual with HIV/AIDS infection typically requires many
forms of assistance in addition to routine medical care. The military community has a
multidisciplinary support system to help the HIV/AIDS soldier. Some of these services includes
pastoral counseling, mental health, PVNTMED (to include PVNTMED officers and community
health nurses), and social services. The objective in using community resources is to assist the
soldier in maintaining psychological and social well-being.
f. Although there is no cure for AIDS, it can be prevented. The HIV/AIDS virus is contracted
through contaminated blood or needles or through sexual contact with an
individual who harbors the HIV infection. The following recommendations will help prevent
the spread of AIDS:
(1) Abstain from sex.
(2) Do not use illegal injectable drugs.
(3) Minimize the number of sexual contacts.
(4) Practice safer sex. Safer sex practices means using
barrier precautions
such as condoms while having sex. This will help prevent the exchange of blood, vaginal
secretions, or semen, the"bodily fluids" in which HIV is easily transmitted.
(5) Do not donate blood if you are a potential carrier of the virus.
(6) Avoid sexual contact with high risk groups--prostitutes, homosexuals, bisexuals,
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individuals with many sexual contacts, and drug abusers.
g. Information, resources, and publications (in English and Spanish) about HIV/AIDS
may be obtained from the National AIDS Clearing House via hot line 1-800-458-5231.
8.10 Occupational safety and health
a. Congress passed the Occupational Safety and Health Act in 1970. Subsequent to the
passage of the act, executive orders directed DOD to apply guidelines of the
Occupational Safety and Health Act to military personnel while in garrison-type workplaces and
operations--workplaces and operations comparable to those of business and industry in the
private sector. Soldiers who use the correct protective procedures and equipment while in
garrison-type workplace settings can continue their success
related illness and injury during field training and operations.
in preventing occupationally
b. As a battalion commander, how does this impact upon your unit? At a recent brigade
commander's staff meeting, the annual occupational safety and health injury and illness
statistics were published for the division. The results indicated that over 89,000 training man-hours
were lost during the past year because of occupational eye injuries alone. The cost, based on
average salary per hour at the rank of corporal, was well over $200,000.
c. About half of the actual man-hours lost and the associated cost
could have been prevented
by simply providing and requiring the use of safety eyewear. Can you afford similar losses of
manpower and funds in your unit?
d. A recent hearing loss survey performed by PAs of a large mechanized infantry division
revealed that 30 percent of the senior tankers had suffered sufficient hearing loss
and impairment to warrant reclassification to another MOS. Hearing loss is a totally
preventable occupational injury/illness. What would be the impact on readiness if 30 percent
of your unit suffered from hearing losses and hearing impairments and were reclassified?
e. Prevention of occupational injuries and illnesses is a command program. (AR
40-5 and AR 385-10 identify some of the commander's responsibilities in these
areas.) The soldier must be protected while performing his/her duties. Without
protection, the effects of hazardous workplace exposures can and will prove detrimental to the
combat readiness of the individual soldier and the unit. Command emphasis is imperative for the
program to succeed. Command emphasis also extends to the appointment and support of
unit safety officers. Instead of overwhelming junior officers with another additional duty,
consider appointing more senior personnel (officers or NCOs), providing adequate training
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and delegating them
the authority to
make the
program effective.
f. Occupational injuries and illnesses can deprive you and your unit of valuable training hours
and training assets. There are assets within your unit that are available to you to prevent
these injuries and illnesses. The PVNTMED service of the installation MTF has occupational
health assets to assist you in managing an effective program. Organic or supporting
AMEDD personnel trained in occupational healthcare or industrial hygiene can identify,
evaluate, and recommend corrective action for potential occupational health hazards.
At the installation/division level, the safety manager can assist in the recognition and
evaluation of workplace exposures. Incorporation of occupational safety and health principles
into your operations produces a true "combat multiplier," reducing loss of training hours
and assets by preventing occupational injuries and illnesses.
8.11 Field sanitation team
Make your field sanitation team an asset you can use. It can assist you in carrying out all
field sanitation tasks for protecting the health of your unit. This invaluable team is
responsible for those PVNTMED measures that affect your unit as a whole or are beyond
the resources of the individual soldier. This is a most important responsibility because
your unit's effectiveness is greatly dependent upon its members' health. Military
units are unable to carry out their missions when unit personnel are weakened by disease. The
success or failure of an army, the outcome of a war, and the fate of a nation may, therefore,
rest upon how well diseases and nonbattle injuries are prevented through effective
PVNTMED measures in the units. The field sanitation team plays a major role in reducing
diseases and nonbattle injuries. When you encounter problems beyond the capabilities of
the field sanitation team, request assistance from supporting PVNTMED elements. The duties
of the field sanitation team may be categorized as both basic sanitation and insect and rodent
control.
a. Basic sanitation. The duties of the field sanitation team include-(1) Supervising the disinfection of
unit
water supplies
inspecting/maintaining unit water containers and the unit water trailer.
and
(2) Advising the unit food service personnel in the prevention and
elimination of deficiencies in food service sanitation. The team instructs
unit personnel, as necessary, in methods of washing individual eating
utensils.
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(3) Supervising the construction of garbage and soakage
assisting in inspections for proper disposal of garbage.
pits and
(4) Supervising the construction of field latrines and urinals
assisting in the inspection for proper sanitation.
and
Note. A unit detail is responsible for the actual construction of field
waste disposal facilities.
(5) Assisting in the guidance and inspection of personnel and facilities
to ensure a high level of personal hygiene.
(6) Providing guidance as needed in the use of protective measures to
prevent heat and cold injuries.
(7) Reporting any sanitation inadequacies to you.
b. Insect and rodent control.The duties of
include--
the field
sanitation team
(1) Ensuring the practice of proper waste disposal which is essential for
insect and rodent control.
(2) Explaining to unit personnel the ways in which insects and rodents
may affect their health and instructing them in the use of individual
protective measures against insects and rodents.
(3) Instructing how to properly wear the uniform to avoid insect-borne
diseases.
(4) Procuring and distributing components of the DOD insect repellent
system (specifically, topical diethyltouluamide (DEET) formulations and
permanone formulations for impregnating clothing and tentage).
(5) Supervising the proper use of the DOD insect repellent system, battle
dress uniform, and bed nets to prevent bites by disease vectors.
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(6) Supervising the application of authorized
"General
Use" pesticides
for insect pests and disease vectors.
(7) Inspecting to ensure the elimination of food and shelter (harborage)
for insects and rodents.
(8) Performing limited insect and rodent management.
(9) Supervising the use of traps and authorized rodenticides as required
in the control of rodents.
(10) Reporting any other inadequacies.
8.12 Army Aviation Medicine Program (flight surgeon)
a. The role of the Army Aviation Medicine Program is to support the Army
aviation mission. The Army Aviation Medicine Program accomplishes this
role by providing medical support, both clinical and nonclinical, to the
aviation population to ensure individual health, flying safety, and
successful mission completion. The Army flight surgeon is the program
manager.
b. The Army flight surgeon is a physician who is specially trained in
aviation medicine. This special training ensures that medical problems and
their treatment do not compromise the health and safety of personnel in
the aviation environment. Underlying the need for this special training is
the fact that diseases and medications which are routine on the ground may
become very significant in the air, often requiring a temporary or
permanent restriction from flying. The focus of aviation medicine is to
apply the concepts of PVNTMED and occupational medicine (OCCMED) so that
disease is detected and managed at the earliest possible stage, the
aeromedical hazards of flying are minimized, and a healthy combat ready
aviation force is maintained. This ensures retaining the aircrew member on
flying status for the duration of a military career. As a result, the
flight surgeon is trained to be uniquely qualified in aeromedical decision
making and problem solving. This qualification underlies the flight
surgeon's role as a combat multiplier for Army aviation.
c. The clinical responsibilities of the flight surgeon can be subdivided
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into two areas of responsibility.
(1) Primary care responsibilities include-(a) Providing clinical care for aviation unit personnel.
(b) Providing clinical care for dependents of
possible.
aviation
personnel,
when
(c) Providing a 24-hour on-call service for aeromedical emergencies and
consultation for aeromedical evacuation missions.
(d) Coordinating specialty evaluations to determine fitness
aircrew with disqualifying medical conditions.
to
fly for
(2) PVNTMED responsibilities include-(a) Performing periodic flying duty medical examinations and other
periodic health assessments as prescribed in AR 40-501, to include
aeromedical summaries and in-flight evaluations.
(b) Disease surveillance in coordination with PVNTMED activity.
(c) Health promotion through health risk appraisals, health education
(lectures) on life-style modification, and conducting the unit health
promotion programs.
d. The nonclinical responsibilities of the flight surgeon encompass those
aviation medicine duties which occur outside of the clinic, but in direct
support of the Army aviation mission. These nonclinical duties include-(1) Unit staff officer functions.As a unit
surgeon-(a) Keeps the
command.
aviation
unit
staff officer, the flight
commander informed of the health of the
(b) Provides advice on medical matters to commanders.
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(c) Participates in medical staff planning activities associated
tactical aviation operations.
with
(d) Ensures that aviation unit personnel are familiar with
physiological limitations of flying by conducting an aeromedical training
program for the unit.
the
(e) Advises the commander on crew endurance limitations.
(f) Serves as a member of flight evaluation boards which are convened to
assess whether an officer should continue an aviation career.
(2) Safety program responsibilities. Involvement in the aviation
safety
program means the flight surgeon-(a) Makes recommendations to improve human factors
crashworthiness, and survival features of aircraft.
compatibility,
(b) Serves as a member of aircraft accident investigations.
(c) Ensures that the medical portion of the preaccident plan is adequate
and participates in accident plan exercises.
(d) Takes part in aviation safety meetings to educate aviation crew
members on such topics as the aeromedical aspects of flight, personal
health care, and PVNTMED and OCCMED issues as they relate to the flight
safety environment.
(3) Aviation life support duties.Aviation life support duties require the
flight surgeon to-(a) Monitor the fitting, use, and serviceability of aviation life support
equipment.
(b) Provide advice and training on the
training for aircrew personnel.
medical
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(4) OCCMED responsibilities.OCCMED responsibilities require the flight
surgeon to-(a) Provide environmental surveillance which evaluates toxic hazards
(aerial/ground), and involves monitoring the mess, latrine, alert and
maintenance facilities, the flight line, and all aircraft.
(b) Provide training and surveillance for a multitude of environment
risks--that is, noise and vibration, stress and fatigue, heat and cold
injuries, hypoxia, barotrauma, and the psychological aspects of flying.
(c) Conduct frequent flight line inspections, to include inspections of
air traffic control and crash rescue facilities.
(d) Advise and
program.
assist
on the unit hearing and eyesight conservation
(5) Flight requirements as an aircrew
requirements as an aircrew member includes-(a) Taking part
in
and observing flight
member.Fulfilling
flight
operations to monitor the
interactions of crew members, aircraft, and environment in all Army
aircraft as allowed by regulation during all aviation duty hours, to
include nap-of-the-earth missions, night vision goggle operations,
aeromedical evacuations, and field exercises.
(b) Meeting annual flying requirements, in accordance with AR 600-105.
e. Two additional clinical missions (location-dependent) which the Army
Aviation Medicine Program has responsibility for are-(1) Supporting a local aeromedical (air ambulance) evacuation unit.
Support for an aeromedical evacuation unit entails-(a) Acting as the primary advisor to the local MTF commander on matters
pertaining to aeromedical evacuation.
(b) Participating in the care of patients during aeromedical evacuation.
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(c) Assisting in the review of
personnel.
all
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care
delivered by air ambulance
(d) Participating in the development and training of local flight medical
aidmen.
(2) Supporting a
includes--
local
diving mission.
(a) Clinical support providing primary care
Support for a diving mission
and PVNTMED coverage for
diving personnel. See paragraph c above.
(b) Screening for decompression sickness
(that
is,
the bends) and
referring to the nearest recompression chamber.
8.13 Veterinary services
a. Veterinary services can assist you in maintaining the health of your
unit, both in garrison and in the field. The Army Veterinary Service is
the DOD executive agent for veterinary support to all of the U.S. armed
services and, when requested, to other selected Federal agencies.
Doctrinally, veterinary units provide their triservice support mission on
an area basis.
b. Veterinary services inspect all food procured by the military,
including operational rations (meals, ready-to-eat, T-rations, and so
forth), to ensure wholesomeness and safety. Procured subsistence is also
inspected to ensure contractual compliance and to protect the financial
interests of the U.S. Government. Veterinary services initially approve
the sanitation (facilities and procedures) of commercial establishments,
maintain an approved list, and conduct periodic sanitary inspections and
compliance procedures for sources of military subsistence to include ice
and bottled water. Military funds may be used to purchase subsistence from
approved sources only. This includes the expenditure of unit fund monies
for food. Veterinary personnel perform sanitary inspections of approved
sources to ensure food for the military is produced and stored under
sanitary conditions. Military food establishments, such as commissaries,
Army and Air Force Exchange Service retail outlets,
troop issue
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subsistence activities, and nonappropriated fund subsistence warehouses
are also inspected by veterinary personnel to ensure the proper receipt,
storage, and issue of food for military personnel.
c. Complete veterinary medical care is provided to all Government-owned
animals. Of particular importance to most military commanders is the care
given to military working dogs. Army veterinarians also provide as much
care as possible to other Government-owned animals such as working and
ceremonial horses, nonappropriated recreational horses, and unit mascots.
Unit mascots are provided care only if the animals are appointed on unit
orders. Commanders should check local regulations to determine the exact
requirements for unit mascots. Veterinary personnel inspect all Government
animal facilities and make recommendations concerning the
feeding,
housing, training, utilization, and evaluation of the animals. Veterinary
services operate the veterinary treatment facilities located on military
installations. Pets are authorized limited veterinary care on a time
available basis. Fees charged for privately-owned animal care are under
the fiscal management of nonappropriated fund instrumentalities. (See AR
40-905/SECNAVINST 6401.1A/AFI 48-131.)
d. The Army Veterinary Service plays an essential role in the prevention
of zoonotic diseases in the military environment worldwide. Several
diseases transmitted from animals to man (for example, rabies, plague,
equine encephalitis, and numerous parasitic diseases) are of significant
military importance. Vaccination and other measures are provided for
Government-owned animals, and a nominal charge is made for animals
belonging to soldiers and their families to control zoonotic diseases in
animals. Veterinary personnel make recommendations to commanders on
establishing policies concerning the control of animals and the prevention
and control of zoonotic diseases (diseases transmissible from animals to
humans).
e. In a TO, veterinary personnel can be found throughout the COMMZ and CZ
where food is received, stored, and/or issued.
Local sources of fresh
food are also inspected. Veterinary personnel do not normally go into
divisional areas. Exceptions include Troop Issue Support Activities,
ration break points, and animal care in the divisional areas. Veterinary
personnel inspect NBC-contaminated rations to determine which rations can
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be salvaged and to recommend decontamination procedures. Veterinary units
are located throughout a TO to provide care to Government-owned animals
and to assist in civic action projects.
f. In all areas of operation involving operations other than war,
veterinary personnel are extremely valuable health care assets. The
agricultural base of other countries provides vast opportunity for the
utilization of veterinary service personnel in supporting the interests of
the U.S. Government in nation assistance and low intensity conflict.
Veterinarians as well as veterinary animal technicians are utilized from
the care and treatment of animals to development of alternate forms of
agriculture and development of American "goodwill." As the utilization of
DOD personnel evolves in the disaster assistance arena, Army veterinary
personnel will be key in the functional areas of animal medicine and food
safety and quality assurance.
g. A paramount role of the Army Veterinary Service is the provision of
specialty trained veterinarians in the areas of pathology, laboratory
animal medicine, microbiology, physiology, pharmacology, toxicology, and
surgery for Army, Navy, and Air Force biomedical research and development
laboratories. Also, one-fourth of the Army Veterinary Service's animal
care specialists support the DOD biomedical research laboratories. These
specialty personnel conduct and support research to develop drugs and
vaccines, biological and chemical defense measures, and
protective
measures for weapon systems hazards.
h. Currently, a major component of the Army Veterinary Service CHS is
from the Reserve Component. AS DOD restructures, the total number of
veterinary Reserve units will decrease, and the Active Component is
restructuring to provide a larger share of the support for the
war-fighting commanders. Individual Mobilization Augmentees are important
components of numerous veterinary units which provide professional
backfill during Active Component mobilization, and supplement and conduct
special projects which benefit unit
commanders, and consequently
installations during and as a result of periodic active duty for training.
8.14 Nutrition
a. Importance of nutrition.Nutrition may be thought of as an enhancement
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to military operations. Properly planned
and executed,
good feeding
practices in the field and in garrison maintain and enhance physical
performance and morale and significantly contribute to mission
accomplishment. Military personnel who establish a strong nutritional
status will better endure the harsh environments encountered in today's
battlefield.
b. Garrison environment.
(1) The nutritional goal in garrison is to optimize nutritional status so
the soldier will be in the best shape possible to meet the physical and
mental demands of training. Keeping a soldier"fit to win"
providing sound nutrition information and healthy food alternatives.
involves
(2) The following Dietary Guidelines for Americans, published by the U.S.
Department of Health and Human Services, provide guidance on what to eat
to stay healthy. The dietitian at the installation hospital can provide
detailed descriptions and information on implementing these guidelines.
(a) Eat a variety of foods.
(b) Maintain a healthy weight.
(c) Choose a diet low in fat, saturated fat, and cholesterol.
(d) Choose a diet with plenty of vegetables, fruits, and grain products.
(e) Use sugars only in moderation.
(f) Use salt and sodium only in moderation.
(g) If you drink alcoholic beverages, do so in moderation.
c. Nutrition advice for field feeding.
Food plays a major role in
sustaining performance and morale in the field. Commanders must assure
their soldiers are provided an adequate quantity of high quality food with
ample time to eat. Commanders and food service officers should work
together to tailor food supplies and food management to the tactical
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situation and unit mission.
(1) Inadequate ration consumption. Weight loss, both voluntary and
involuntary, is quite common in the field. Soldiers often eat 20 to 40
percent less in the field due to the change from their normal routine,
becoming bored with field rations after a few days, not having enough time
to eat, etc. If this low food intake is not prevented, body weight loss
can quickly reach a level where physical and mental performance is
impaired. Weight losses of as little as 2 percent of pre-field body weight
may negatively influence performance. Even if soldiers are overweight, the
lower food intake may have a negative impact on performance.
(a) Soldiers must be taught that adequate consumption of food and water
are tactical weapons and how eating and drinking can affect their health
and performance.
(b) Unit leaders should watch to see what their personnel are eating or
failing to eat.
(c) Do not permit troops to use field deployments as a convenient way of
dieting.
(d) Control the use of food brought from home, "junk food," and other
non-issue food. Do not allow these foods to be used as substitutes for
more nutritious meals or rations.
(e) Encourage soldiers to eat at least part of all the ration items
served. Various components of operational rations are fortified to provide
all the nutrients essential for health and fitness.
(f) Establish regularly scheduled meal times if possible. Soldiers tend
to eat more when they are in social groups for meals.
(2) Dehydration. Soldiers who do not consume enough fluids to replace
those lost from sweating and urination become dehydrated and constipated.
Even mild dehydration affects performance, reduces the desire to eat, and
cause lethargy. Moderate dehydration leads to diminished work capacity,
and more severe dehydration may result in severe disability or even death.
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(a) Leaders should establish a program of regularly scheduled, enforced
drinking in order to prevent dehydration. In general, most soldiers need
to drink at least four canteens of water per day and considerably more
when working in the heat.
(b) Provide plenty of fluids at meal times, preferably flavored and
served at appropriate temperatures for the environment.
(c) Eating too much salt (sodium) may lead to dehydration. Excess salt
intake increases the body's water requirement since a person must drink
more water to excrete the extra salt.
(d) Monitoring the color of one's urine
helps
determine who
may be
getting dehydrated. Dark yellow urine indicates inadequate fluid intake;
fluid consumption should be increased until urine turns pale yellow.
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9.0 The Military Family
Subtopics
9.1 TRICARE
9.2 Civilian Health and Medical Program of the Uniformed Services
9.3 Primary Health Care for the Uniformed Services
9.4 Uniformed Services Dependents Dental Insurance Plan
9.5 Family Advocacy Program
9.6 Exceptional Family Member Program
9.7 Veterinary treatment facilities
9.1 TRICARE
a. Managed care is being implemented in DOD under its overriding managed care program called
TRICARE. The coordinating, networking, contracting, and business improvement activities of the
Army and the other Services optimize the use of all our health care resources. The objectives are
improved access to health care, maintenance of the high quality care we provide, control over the
costs of health care for the Government and our beneficiaries, and enhanced readiness. These
objectives are particularly important during the time of defense downsizing and declining resources.
We must ensure that we meet the medical mission for our forces despite the reduction of our
medical force, the closing of facilities, and the dispersion of units into remote locations.
b. TRICARE introduces changes into the traditional Army health care system and is the foundation
upon which access, quality, cost, and readiness objectives will be met. TRICARE is the clinically
directed business approach to health care. Its essential elements include division of the continental
United States and Hawaii into 12 DOD Coordinated Health Care Regions and supplementing
military MTF capacity with regional managed care contracts. A business plan approach contribute
to efficient management of the Army and DOD medical resources and incorporate appropriate use
of technology. Some of the changes visible to commanders, soldiers, and their families will include
assignment of soldiers to primary care managers (PCMs), administration of Health Risk Appraisals
with directed follow-up, use of telephone health care advisors and increased use of automation to
process telephone calls, patient clinical records and reports and other soldier information.
c. Implementation of TRICARE is an incremental process with health care delivery centered
upon the local MTF supported by the contractor's network of civilian providers. Most health care is
expected to be provided in the MTF. When the necessary care cannot be provided in the MTF, the
providers in the local civilian and regional Federal facilities may provide the necessary
care. Upon completion of full implementation of TRICARE, three options for access to health
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care will be available:
(1) Health Maintenance Organization (HMO) TRICARE Prime.
(a) Enrollment into the HMO-like option is conducted through the MTF. All active duty
personnel are first priority and automatically enrolled in this option for care when it
becomes available.
(b) Soldiers and families will be administered a Health Risk Appraisal and assigned to a
PCM. PCMs are either clinics (e.g., Troop Medical Clinic or Primary Health Care for the
Uniformed Services (PRIMUS) clinic (para 9-3)) or individual providers who take care of the
patient's first and routine needs for health care. The PCM is the designated source of care the
soldier will go to first when health care is needed. Primary care providers may include physicians
in Family Practice, Internal Medicine, General Medicine and Pediatrics, PAs, and nurse
practitioners. The PCM will be responsible for coordinating the beneficiaries total care. PCMs
operate as members of a complementary medical team which includes nurses, PAs, physical
therapists, dietitians, etc. The value of assignment to a PCM is the systematic coordination and
follow-up of routine care and referrals to specialists. Referrals to specialists will be facilitated by
Health Care Finders who are the knowledgeable link to specialists in the TRICARE network which
complements the MTF. Health promotion and disease prevention through the development of
healthy and safe lifestyles receive greater emphasis, instruction, and follow-up through primary
care management. The results of these activities contribute to the medical readiness of our
soldiers and their families. Family members may enroll in the HMO option as primary care
panels expand.
(c) Beneficiary costs for enrollment in the HMO option are significantly less than standard
CHAMPUS. Care received in the MTF will continue to be provided at no cost to the patient.
Any costs which are incurred by beneficiaries, such as for specialist care in the network,
are expected to be nominal as a benefit to enrollment in the HMO. Beneficiaries will
always have the freedom of choice for care, including their referral care. However, if the choice is
in conflict with the PCM recommendations or the appeals
process, the beneficiary may
be refused a nonavailability statement and subject to full costs for that care.
(2) Preferred Provider Organization (PPO) (TRICARE EXTRA).This option allows the
beneficiary more freedom of choice for the site of health care. Nonenrollees in the HMO, will
continue to have access to health care in the MTF. If care is not available in the MTF,
beneficiaries may use providers in the"network." These are Civilian Health and Medical
Program of the Uniformed Services (CHAMPUS) (para 9-2) and MEDICARE providers who
have agreed to participate within the local network. Costs to the beneficiaries who
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use the PPO are lower than standard CHAMPUS
and the provider typically completes the
CHAMPUS paperwork.
(3) Standard TRICARE. The Standard CHAMPUS option with the deductibles and
copayments directed by law is always available for eligible beneficiaries.
d. In some instances, care outside the MTF must be provided by non-network providers and
beneficiaries thus may not receive the discounts or administrative services described above.
Health Care Finders and Health Benefits Advisors at the MTF will still be available to assist with
the coordination of appointments and claims filing.
e. The AMEDD recommends that unit commanders and their soldiers become acquainted with the
local TRICARE Service Centers. Current information on implementation status of TRICARE and
costs for care to soldiers and their families is available through this office. Soldier and Army health
is a team effort of individuals, units, the AMEDD, and many other activities. Understanding how to
get one's health care needs taken care of before the need arises should be a part of every soldier's
personal and family readiness objectives and responsibilities.
9.2 Civilian Health and Medical Program of the Uniformed Services
a. CHAMPUS is a health care entitlement program under chapter 55, title 10, United States Code,
and is administered by DOD under DOD 6010.8-R. The program serves all seven uniformed
Services:
(1) Army.
(2) Navy.
(3) Marine Corps.
(4) Air Force.
(5) Coast Guard.
(6) Public Health Service.
(7) National Oceanic and Atmospheric Administration.
b. The following groups are eligible for benefits:
(1) Dependents of active duty personnel.
(2) Retirees and their dependents.
(3) Surviving spouses and children of soldiers who died while on active duty if they were
under 65 years of age. Spouses who remarry are not eligible.
(4) Reservists and Guardsmen between 60 and 65 years of age who are qualified to receive
retired pay.
(5) Surviving spouses and children of retirees. Again, spouses who remarry are ineligible.
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(6) Divorced spouses of military personnel who served at least 20 years on active duty
and whose marriages covered at least 20 years of active duty and who are not enrolled in an
employer-sponsored health insurance program.
(7) Divorced spouses of military personnel who served at least 20 years on active duty and
whose marriages covered at least 15 of those years. Individuals divorced after 1 April 1985
are limited to 2 years of DOD Health Insurance Program benefits.
c. This program supplements the military's hospitals and clinics and provides medical
care for retirees and their families who do not live close to a military installation. The
program was never intended to duplicate medical care available at these military
installations.
d. Because of recent changes in legislation, CHAMPUS-(1) Protects military families from catastrophic medical expenses.
(2) Provides help for psychotherapy patients.
(3) Requires certification for the necessity of abortions.
e. Under the catastrophic protection provision, the cost of deductibles and cost-shares in any
fiscal year (FY) for family members of active duty soldiers is capped at $1,000. For retirees
and their families and other CHAMPUS beneficiaries, the cap is $7,500 per FY. Charges
above the "allowable " and charges for treatment not covered by CHAMPUS are not
capped. The cap is not automatic; families must
processor.
request
it
from
their CHAMPUS claims
f. On each Army installation at the installation medical activity, a CHAMPUS advisor is
available to answer questions about-(1) Eligibility.
(2) Benefits.
(3) Administrative procedures that must be followed before benefits can be obtained.
9.3 Primary Health Care for the Uniformed Services
a. The PRIMUS Program supplements the primary health care services available at
select DOD MTFs through contractor-owned and operated satellite clinics. The
Navy calls these clinics"Navy Care" (NAVCARE). PRIMUS clinics also serve a key role as
PCMs, thereby complementing the DODs managed care programs. The primary objective of
these Congressionally-directed clinics is to increase patient access to quality primary health
care while containing costs. PRIMUS clinics fulfill this objective by-(1) Providing accessible and convenient primary health care.
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(2) Reducing patient overcrowding in the MTFs primary care clinics,
and, more importantly,
the MTFs emergency room.
(3) Improving patient satisfaction through improved access and continuity of care.
(4) Reducing costs by bringing previous CHAMPUS users into the PRIMUS clinic.
b. As PCMs, PRIMUS clinics provide the beneficiary a vital link to the local MTF.
Beneficiaries who enroll in the HMO option are assigned a PCM. PCM assignment is normally
determined by location to the beneficiary and when PCM capability exists. If a PRIMUS
clinic is locally available, it may serve as the beneficiary's PCM. In this role, the clinic staff
ensure continuity of care for the enrolled beneficiary. More importantly, the PRIMUS clinic
is responsible for all of the beneficiary's health care needs. This responsibility can be
fulfilled either by directly providing the required health care services, or if
the clinic, through coordination with the local MTF.
not
available in
c. Competitive bidding has demonstrated that these clinics can provide primary care visits at a
considerably lower cost than a standard CHAMPUS outpatient visit. Such arrangements
allow the Government to maximize the utilization of scarce resources in providing needed health
care services. More importantly, the soldier and other eligible beneficiaries do not
incur any cost-share by using these health care clinics as they are considered part of
the direct care system.
d. Not every MTF needs a PRIMUS clinic. Some MTFs already have ample primary care staff to
meet their beneficiaries demands for health care services. The decision to pursue a PRIMUS
clinic rests with the local MTF commander. If the MTF commander determines a valid need for a
PRIMUS clinic, that commander must demonstrate the cost effectiveness of his/her decision. The
commander's cost effectiveness study must be approved by the Medical Command before a
PRIMUS clinic can be contracted. Funding for the operation of the clinic remains the sole
responsibility of the local MTF.
9.4 Uniformed Services Dependents Dental Insurance Plan
The Uniformed Services Dependents Dental Insurance Plan is a DOD dental program
designed for families of active duty soldiers. This plan pays for basic dental services
provided by participating civilian dental care providers. This is a cost-sharing
insurance program in which the Government pays for part of the premium and the
active duty soldier pays the remainder of the premium through a monthly payroll deduction.
Contact your health benefits advisor or the dental plan insurer for information concerning the
benefits of this insurance program.
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9.5 Family Advocacy Program
a. The Family Advocacy Program is a program developed by the Army to—
(1) Prevent spouse and child abuse.
(2) Protect victims of abuse.
(3) Treat families affected by abuse.
(4) Assure that there are personnel who are professionally trained to intervene in abuse cases.
Since many incidents of abuse constitute violations of the law, the program recognizes the
commander's authority to take disciplinary or administrative action when necessary.
b.
The purpose of this program is to promote public awareness within the military community and
to coordinate professional intervention at all levels within the civilian and military
communities, including—
(1) Law enforcement.
(2) Social services.
(3) Health services.
(4) Legal services.
c. The program is designed to-(1) Break the cycle of abuse.
(2) Identify abuse as early as possible.
(3) Provide treatment for affected family members.
d.
The Family Advocacy Program is a commander's program located within the Army
Community Service. As a battalion commander, you should—
(1) Attend spouse and child abuse command education programs designed for commanders.
(2) Schedule time for soldiers to attend troop awareness briefings.
(3) Be familiar with rehabilitative, administrative, and disciplinary procedures relating to
spouse and child abuse.
(4) Report suspected spouse and child abuse to the designated point of contact and provide all
pertinent information to those investigating the report.
(5) Consider all recommendations made by the family advocacy case management team.
(6) Notify the chairperson of the family advocacy case management team when orders are
issued reassigning soldiers or when moving family members who are involved in treatment
for spouse or child abuse.
(7) Encourage civilian family members to participate in treatment programs.
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e. To prevent spouse and child abuse, military and civilian agencies can provide services which-(1) Improve family functioning.
(2) Ease types of stress that can aggravate or trigger patterns of abusive behavior.
(3) Create a community that is supportive of families.
f. These services are available to-(1) Young and inexperienced families.
(2) Families with closely spaced children.
(3) Single-parent families.
(4) Lower income families.
(5) Families with parents who are soon to deploy.
g. Prevention programs provided by military and civilian agencies can also-(1) Create community and command awareness of abuse.
(2) Provide information of existing services.
(3) Provide specific educational programs:
(a) Community Education Program.
(b) Commander Education Program.
(c) Troop Education Program.
(d) Education for Professionals Program.
(e) Safety education for children's programs.
9.6 Exceptional Family Member Program
a. The EFMP is an Army personnel readiness support program in which the AMEDD is
responsible for assessing, documenting, and coding the medical, physical, emotional,
developmental, and special educational needs of family members for consideration in the
personnel assignment process. Enrollment in the EFMP is mandatory. In locations outside
CONUS, the EFMP is also responsible for providing support to students in the Department of
Defense Dependents Schools who require special education evaluations and medically related
services, i.e., occupational and physical therapy, psychological and social work services.
b. An exceptional family member (EFM) is a patient with a serious or chronic medical problem,
physical disability, or mental health disorder. Any child with a development disability or
special education requirement should be enrolled. For the program to be fully effective in
meeting the needs of a soldier's family, it is imperative that identification of potential EFMs be
accomplished early. In doing so, the best care for the patient with a serious or chronic medical
problem or a need for special education can be planned or programmed as the soldier continues
his or her career.
c. For a successful program, installation and activity commanders are responsible for ensuring
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that soldiers with EFMs are informed that—
(1) They are responsible for the care and welfare of their dependents.
(2) Their participation in the program does not adversely affect their selection for promotions,
schooling, or assignments.
(3) Enrollment in the EFMP is continuous. Changes in condition status and/or care
requirements are the basis for updating enrollment data. Procedures for disenrollment are
outlined in AR 608-75.
(4) Assignment managers at HQDA will consider the documented special education and
medical needs of family members in permanent change of station moves.
d. Soldiers with EFMs should become familiar with AR 608-75 and its provisions.
9.7 Veterinary treatment facilities
Veterinary treatment facilities are located on most military installations and are operated by
Army Veterinary Service personnel. These facilities are used to provide veterinary care to
Government-owned animals and to privately-owned animals of eligible DOD beneficiaries. In
CONUS, privately-owned animal care is limited to measures that control diseases that are
transmissible from animal to animal, and from animal to man, and emergency services to save the
life or limb of animals. In CONUS, DOD regulations require additional definitive
privately-owned animal care be referred to civilian veterinarians. In most locations outside
CONUS, complete veterinary care for privately-owned animals is provided as time, space, and
facility capabilities permit. Fees charged for privately-owned animal services are under the fiscal
management of nonappropriated fund instrumentalities.
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A.0 Appendix A.
References
Section I
Required Publications
AR 40-5 Preventive Medicine. (Cited in paras 7-4 b and 8-10e.)
AR 40-35 Preventive Dentistry. (Cited in para 8-7 e.)
AR 40-66 Medical Record Administration. (Cited in para 6-1 g.)
AR 40-501 Standards of Medical Fitness. (Cited in paras 6-2 d and 8-12c(2)(a).)
AR 40-562/NAVMEDCOMINST 6230.3/AFR 161-13/CG COMDTINST M6230.4
Immunizations and Chemoprophylaxis. (Cited in para 8-6 b and table 8-1.)
AR 40-905/SECNAVINST 6401.1A/AFI 48-131 Veterinary Health Services. (Cited in para
8-13 c.)
AR 50-5 Nuclear and Chemical Weapons and Materiel--Nuclear Surety. (Cited in paras
6-1 b and 6-1e.)
AR 50-6 Nuclear and Chemical Weapons and Materiel--Chemical Surety. (Cited in paras 6-1
b and 6-1e.)
AR 190-8 Enemy Prisoners of War--Administration, Employment and Compensation. (Cited
in para 5-2 c.)
AR 220-1 Unit Status Reporting. (Cited in para 6-6 a.)
AR 350-15 The Army Physical Fitness Program. (Cited in para 7-1 c(4).)
AR 600-9 The Army Weight Control Program. (Cited in para 7-1 c(5).)
AR 608-75 Exceptional Family Member Program. (Cited in paras 9-6 c(3) and 9-6d.)
AR 600-105 Aviation Service of Rated Army Officers. (Cited in para 8-12 d(5)(b).)
AR 611-201 Enlisted Career Management Fields and Military Occupational Specialties.
(Cited in para 7-1 b(3).)
AR 640-3
Identification Cards, Tags, and Badges. (Cited in para 5-2 d(2).)
DA Cir 601-94-3 Military Physician Assistant Procurement Program, Fiscal Years
1995-1997. (Cited in para 7-7 a.)
DA Pam 351-20 Army Correspondence Course Program Catalog. (Cited in paras 7-2 c, 7-3b,
and 7-4b.)
FM 8-10 Health Service Support in a Theater of Operations. (Cited in paras 2-4 a and 5-2c.)
FM 8-10-8
Medical Intelligence in a Theater of Operations. (Cited in paras 4-2 a and 4-4.)
FM 8-55 Planning for Health Service Support. (Cited in para 5-2 c.)
FM 19-40 Enemy Prisoners of War, Civilian Internees and Detained Persons. (Cited in para
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5-2 c.)
FM 27-10
TC 8-100
The Law of Land Warfare. (Cited in para 5-1 a(2).)
Expert Field Medical Badge Test. (Cited in para 7-1 d(3).)
Section II
Referenced Publications
AR 10-5 Department of the Army
AR 40-3 Medical, Dental, and Veterinary Care
AR 40-25/NAVMEDCOMINST 10110.1/AFR 160-95
Education
Nutrition Allowances, Standards, and
AR 40-60 Policies and Procedures for the Acquisition of Medical Materiel
AR 40-216 Neuropsychiatry and Mental Health
AR 40-657/NAVSUPINST 4355.4/MCO P10110.31 Veterinary/Medical Food Inspection
and Laboratory Service
AR 381-26 Army Foreign Materiel Exploitation Program
AR 385-10 The Army Safety Program
AR 385-95 Army Aviation Accident Prevention
AR 600-85 Alcohol and Drug Abuse Prevention and Control Program
AR 600-110
Identification, Surveillance, and Administration of Personnel Infected with
Human Immunodeficiency Virus (HIV)
AR 601-142 Army Medical Department Professional Officer Filler System
AR 608-18 The Army Family Advocacy Program
AR 611-101 Officer Classification and Management System
AR 635-40 Physical Evaluation for Retention, Retirement, or Separation
AR 672-5-1 Military Awards
DA Pam 25-51 The Army Privacy Program--System Notices and Exemption Rules
DA Pam 27-1 Treaties Governing Land Warfare
DA Pam 40-12 Who Needs It--Venereal Diseases
DOD 6010.8-R Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS)
FM 8-10-5
Brigade and Division Surgeon's Handbook for Tactics, Techniques, and
Procedures
FM 27-1
Legal Guide for Commanders
FM 27-2 Your Conduct in Combat Under the Law of War
FM 27-14
Legal Guide for Soldiers
GTA 21-3-4 Battle Fatigue, Normal Common Signs, What to do for Self and Buddy
GTA 21-3-5 Battle Fatigue, " More Serious" Signs: Leader Actions
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Battle Fatigue, Company Leader Actions and Prevention
STANAG 2931 Camouflage of the Geneva Emblem on Medical Facilities on Land
TB 38-750-2 Maintenance Management Procedures for Medical Equipment
Section III
Prescribed Forms
This section contains no entries.
Section IV
Referenced Forms
DA Form 3180-R
Personnel Screening and Evaluation
DA Form 4515 Personnel Reliability Program Record Identifier
DD Form 1380 US Field Medical Card
DD Form 1934 Geneva Conventions Identity Card for Medical and Religious Personnel
Who Serve In or Accompany the Armed Forces
DOL Form CA 1 Federal Employee's Notice of Traumatic Injury and Claim for
Continuation of Pay/Compensation
DOL Form CA 2 Notice of Occupational Disease and Claim for Compensation
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GLOSSARY
Section I
Abbreviations
ACR
armored cavalry regiment
AHS
Academy of Health Sciences, U.S. Army
AIDS acquired immunodeficiency syndrome
AMEDD U.S. Army Medical Department
AMEDDC&S
U.S. Army Medical Department Center and School
AML area medical laboratory
AOC area of concentration
AR Army regulation
ASL authorized stockage list
ASMB area support medical battalion
ATLS
advanced trauma life support
ATM advanced trauma management
BAMC Brooke Army Medical Center
BAS battalion aid station
BF battle fatigue
BSA
BTC
brigade support area
Blood Transshipment Center
C(4) Combat Casualty Care Course
CHAMPUS Civilian Health and Medical Program of the Uniformed Services
CHS combat health support
CHLS
Combat Health Logistics System
COMMZ communications zone
CONUS continental United States
CS
combat support
CSA corps support area
CSC combat stress control
CSH combat support hospital
CSS
combat service support
CZ combat zone
DA
Department of the Army
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DA Cir
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Department of the Army circular
DA Pam Department of the Army pamphlet
DD Form Department of Defense form
DISCOM division support command
DMOC division medical operations center
DMSO division medical supply office
DOD Department of Defense
DOL Department of Labor
DSA division support area
DVA Department of Veterans Affairs
EAC echelons above corps
EACIC echelon above corps intelligence center
EFM exceptional family member
EFMB Expert Field Medical Badge
EFMP Exceptional Family Member Program
EMT emergency medical technician
EPW enemy prisoner(s) of war
FH field hospital
FLOT forward line of own troops
FM field manual
FSB forward support battalion
FSMC
forward support medical company
FSP forward support platoon
FST forward surgical team
FY fiscal year
GC Geneva Convention Relative to the Protection of Civilian Persons in Time of War, 12
August 1949
GH general hospital
GPW Geneva Convention Relative to the Treatment of Prisoners of War, 12 August 1949
GTA graphic training aid
GWS
Geneva Convention for the Amelioration of the Wounded and Sick in Armed Forces in
the Field, 12 August 1949
HIV human immunodeficiency virus
HMO Health Maintenance Organization
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HQDA
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Headquarters, Department of the Army
HSC
U.S. Army Health Services Command
HUB hospital unit, base
HUH hospital unit, holding
HUM hospital unit, medical
HUS
hospital unit, surgical
HUSF hospital unit surgical-forward
JMREC
JMRTC
Joint Medical Readiness Education Council
Joint Medical Readiness Training Center
MASH mobile Army surgical hospital
MC
Medical Corps
MEBD Medical Evaluation Board
MEDCOM U.S. Army Medical Command
MEDLOG medical logistics (battalion)
MFSS
Medical Field Service School
MMRB MOS Medical Retention Board
MOS
military occupational specialty
MOU memorandum of understanding
MS
Medical Service Corps
MSB main support battalion
MSMC
main support medical company
MTF medical treatment facility
NATO North Atlantic Treaty Organization
NBC nuclear, biological, and chemical
NCO noncommissioned officer
OCCMED
occupational medicine
PA physician assistant
PCM primary care manager
PEB Physical Evaluation Board
PPES Physical Performance Evaluation System
PPO Preferred Provider Organization
PRIMUS
Primary Health Care for the Uniformed Services
PROFIS
Professional Filler System
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PRP
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Personnel Reliability Program
PVNTMED preventive medicine
PW prisoner(s) of war
RTD
return to duty
S3 Operations and Training Officer
SIMLM single integrated medical logistical manager
SP Army Medical Specialist Corps
SPD supply point distribution
STANAG standardization agreement
STD
TB
sexually transmitted disease
technical bulletin
TC training circular
TMMMC
theater medical materiel management center
TO theater of operations
TOE table(s) of organization and equipment
TSA tactical support area
TSOP tactical standing operating procedure
UD unit distribution
USAF U.S. Air Force
USUHS Uniformed Services University of the Health Sciences
Section II
Terms
Beneficiary
Members and certain former members of the uniformed Services and their dependents entitled
to care as described in section 1072 (b), 1076 (a) or (b), chapter 55, title 10, United States Code.
Credentials review
The review of the documents which constitute evidence of training, licensure, experience, and
expertise of a practitioner.
Echelon of combat health support/care
A North Atlantic Treaty Organization term that can be used interchangeably with the term
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"level" of combat health support/care.
Information
The raw material from which intelligence is produced. It becomes available usually in bits
and pieces and may take many forms such as facts, statistics, observations, reports, trends, opinions,
rumors, documents, photographs, diagrams, maps, and other items. Information may be true or
false, positive or negative, organized or unorganized, related or unrelated.
Intelligence
The product obtained when raw information is collected, collated, and analyzed with other
information already on hand to determine its significance in terms of a given mission. Intelligence
is sequential, timely, and event-oriented. In a tactical situation, you need intelligence upon which to
base your decisions or plans and to concentrate combat power at critical places and times. The
degree of success achieved by your unit in accomplishing its mission will be directly affected by
the intelligence it develops and uses.
a. Strategic Intelligence. Strategic intelligence is that intelligence which is required for the
formation of policy and military plans at national and international levels.
Directed on national
objectives, it assists in determining feasible national policies and in furnishing a basis for planning.
Factors which influence the military capabilities, vulnerabilities, and probable courses of action of
nations are considered components of strategic intelligence.
b. Tactical Intelligence. Tactical intelligence is that knowledge of the enemy, weather, and
terrain which you need to plan and conduct combat operations. It may be obtained
from within the command or from higher, lower, or adjacent headquarters.
c. Technical Intelligence. Technical intelligence is that intelligence concerning foreign
technological developments and performance and operational capabilities of foreign
materiel which currently has or eventually may have a practical military application.
Before and during the AirLand Battle, technical intelligence may contribute significantly to
fulfilling the mission of tactical units. There are communications-electronics intelligence;
weapons and munitions intelligence; logistics and NBC intelligence; medical intelligence; and
mobility intelligence.
d. Medical Intelligence. Medical intelligence is a product resulting from the collection,
evaluation, analysis, and interpretation of information concerning the medical aspects of foreign
countries that has immediate or potential impact on policies, plans, and operations.
The key word is "foreign " because this information is only developed on foreign
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countries.
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It includes--
(1) Intelligence on foreign epidemiology, public health standards and capabilities, and
the number of trained military and civilian combat health support personnel.
(2)
Intelligence
on medical
supplies, health service facilities, and medical services.
(3) Intelligence on-(a) Foreign animal diseases (especially those diseases transmissible to humans).
(b) Health problems relating to the use of local food supplies.
(c) Medical effects of prophylaxis against chemical and biological agents.
(4) Intelligence concerning the impact of newly developed foreign weapons systems as related
to casualties.
(5) Intelligence concerning an enemy force or an area of operations that in some way may
affect the health of the command or combat health support operations.
Medical Force 2000
The development and marked improvement in the ability of the AMEDD to support
the AirLand Battle which focuses on a complete medical force package. This force
package can more efficiently and effectively support the combat force through enhanced
medical care and patients early return to duty while reducing the"confusion " and the support
requirements in the corps.
Patient care evaluation
A process, performed either concurrently or retrospectively,
which assesses in
depth the quality and/or nature of the utilization of an aspect of health or dental care
services. This often is accomplished by observation or medical record audit.
Corrective action is taken where indicated and a subsequent analysis (follow-up) is made of the
effect of the corrective action.
Privileging
The processing through credentials committee channels of those individuals given the authority
and responsibility for making independent decisions to diagnose, initiate, alter, or terminate
a regimen of medical or dental care.
Provider (health care provider)
Military (Active or Reserve Component) and civilian personnel (civil service and providers
working under contractual or similar arrangements) granted privileges to diagnose, initiate, alter, or
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terminate health care treatment regimens within the scope of his or her license, certification, or
registration. This category includes physicians, dentists, nurse practitioners, nurse anesthetists,
nurse midwives, podiatrists, optometrists, clinical psychologists, occupational therapists,
audiologists, speech pathologists, physician assistants or any others providing direct patient care.
Risk management
Clinical and administrative activities that hospitals undertake to identify, evaluate, and reduce
the risk of injury and financial loss to patients, personnel, visitors, and the institution itself.
Standards are applied to evaluate a hospital's performance in conducting risk management activities
designed to identify, evaluate, and reduce the risk of patient injury associated with care and
services.
Utilization management
The planning, organization, directing, and controlling of medical or dental services in a
cost-effective manner while maintaining acceptable standards.
Section III
Special abbreviations and terms
This section contains no entries.
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USAPPC-INDEX
This index is organized alphabetically by topic and by subtopic within topic.
are identified by paragraph number.
Acquired immunodeficiency syndrome, 8-9
Advanced trauma life support, 7-6
Advanced trauma management, 2-2
Alcohol and drug abuse, 8-4
Ambulance squad, 2-2
Area support squad, 2-2
Army Medical Department
History, 1-4
Mission, 1-5
Services, 1-5
Army medical laboratory, 2-8
Aviation medicine program
Army flight surgeon, 8-12
Clinical responsibilities, 8-12
Nonclinical responsibilities, 8-12
Role of Army aviation medicine, 8-12
Basic sanitation, 8-11
Battle fatigue, 8-3
Blood management, 3-1, 3-3, 3-4, and 3-7
Buddy aid, 2-3
Civilian Health and Medical Program of the Uniformed Services, 9-1
Combat Casualty Care Course, 7-6
Combat Health Logistics System
Blood management, 3-1
Corps Combat Health Logistics System
Medical equipment maintenance, 3-3
Medical logistics battalion (forward), 3-3
Medical logistics battalion (rear), 3-3
Medical supply and blood support, 3-3
Definition, 3-1
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Division Combat Health Logistics System
DMSO, 3-2 and 3-3
Medical equipment maintenance, 3-2
Medical logistics battalion (forward), 3-2. See also Echelons III and IV
Medical Standby Equipment Program, 3-2
Echelons I and II, 3-1
Echelons III and IV, 3-1
Echelons above corps
Medical logistics battalion (forward), 3-4
Medical logistics battalion (rear), 3-4
Medical logistics support detachment, 3-4
Joint/combined operations, 3-4
Theater medical materiel management center, 3-4
Medical equipment maintenance, 3-1
Optical fabrication, 3-1
Optical combat health logistics system
Echelons I and II, 3-5
Echelons III and IV, 3-5
Organizational structure
Medical logistics battalion (forward), 3-1
Medical logistics battalion (rear), 3-1
Medical logistics support detachments, 3-1
Theater medical materiel management center, 3-1
U.S. Air Force Blood Transshipment Center, 3-1 and 3-7
Combat health support mission, 2-1
Combat health support system, 2-1
Combat lifesaver, 2-3
Combat medic, 2-2 and 2-3
Combat support hospital, 2-3 and 2-4. See also Echelons of combat health support
Dental support in a theater of operations
Categories of dental care, 2-6
Dental support in a theater of operations, 2-6
Types of dental support, 2-6
Echelons of combat health support
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Echelon I, 2-3 and 3-1
Echelon II, 2-3 and 3-1
Echelon III, 2-3 and 3-1
Echelon IV, 2-3 and 3-1
Echelon V, 2-3
Emergency medical treatment, 2-2 and 2-3
Exceptional Family Members Program, 9-5
Expert Field Medical Badge, 7-1
Family Advocacy Program, 9-4
Field hospital, 2-4. See also Echelons of combat health support
Field sanitation team, 8-11
Field sanitation team training, 7-4
General hospital, 2-4.
See also Echelons of combat health support
Health Maintenance Organization, 9-1
Hospital modules, 2-4
Hospital support requirements, 2-5
Immunizations/prophylaxes, 8-6
Initial unit training and sustainment training, 7-2
Insect and rodent control, 8-11
Intratheater evacuation policy, 2-10
Joint Medical Readiness Training Center, 7-6
Law of land warfare
Accountability and custody of enemy prisoners of war, 5-2
Captured medical supplies and equipment, 5-2
Civilians--wounded and sick, 5-2
Geneva Convention, 5-1, 5-2
Identification and protection of medical personnel, 5-2
Marking of ambulances, 5-2
Marking of medical units/facilities, 5-2
Provisions for collection of wounded and sick, 5-2
Responsibility and handling of prisoners of war, 5-2
Self-defense, 5-2
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Sources of the law of land warfare, 5-1
Medical company, holding, 2-4
Medical Evaluation Board, 6-4
Medical Force 2000, 2-4
Medical intelligence
Definition, 4-1
Historical data, 4-3
Resources, 4-2
Strategic level, 4-4
Tactical level, 4-4
Medical proficiency training, 7-5
Medical/surgical teams, 2-4
Mobile army surgical hospital,2-4 and 2-6. See also Echelons of combat health support
Modular medical support, 2-2
Nutrition, 8-14
Occupational safety and health, 8-10
Oral Health Fitness Program, 8-7
Patient holding squad, 2-2
Personnel
Enlisted personnel, 1-6
MC officer, 1-6
Medical NCO, 1-6
Medical specialist, 1-6
MS officer, 1-6
Officer personnel, 1-6
PA, 1-6
Personnel Reliability Program, 6-1
Physical Evaluation Board, 6-5
Physical Performance Evaluation System, 6-3
Physical profiling, 6-2
Preferred Provider Organization, 9-1
Preventive medicine, 2-3
Primary care managers, 9-1
Primary Health Care for the Uniformed Services, 9-2 and 9-3
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Professional Filler System, 6-6
Quality assurance, 1-7
Self-aid, 2-3
Sexually transmitted diseases, 8-8
Sleep, 8-2
Soldier health maintenance elements, 8-1
Stress
Battle fatigue, 8-3
Combat stress casualties, 8-3
Combat stress defense, 8-3
Stress management, 8-3
Suicide prevention, 8-5
Surgical squad/detachment, 2-2
Theater evacuation policy, 2-9
Theater hospital support system, 2-4
Treatment squad, 2-2 and 2-3
Treatment squad (battalion aid station) 2-3
TRICARE, 9-1 and 9-2
Uniformed Services Dependents Dental Insurance Plan, 9-3
Veterinary services, 8-13
Veterinary support in a theater of operations, 2-7
Veterinary treatment facilities, 9-6
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