Army health system memorandum

ARMY HEALTH SYSTEM MEMORANDUM
 

Purpose

To demonstrate an understanding of the Army Health System.

Topic

The transition to Large Scale Combat Operations (LSCO) brings with it a
multitude of challenges to the Army Health System (AHS). Awareness of
and attention to medical considerations related to LSCO is critical.

Identify your medical function and define which of the two warfighting
functions you support. Describe how your role in either Force Health
Protection or Health Service Support is preparing or is prepared to transition
to LSCO. Provide an example supporting your argument.

Resource
Requirements

AHS Lesson
AHS Smart Book

Expectations

1. Utilizing the DA Letterhead template provided in blackboard, write a
MEMORANDUM FOR RECORD for the topic above. Your memorandum
must:
-follow the guidelines in AR 25-50 (do not sign the document)
-be a minimum of 2 body paragraphs
-be a maximum of 1 page
-include a Point of Contact line
-use NCOA-DL for the office symbol

Use your home station address for the letterhead. Do not include a
reference paragraph, suspense date, or ARIMS record number.

2. Upload and submit your memo as a MS Word document for grading in
blackboard. Verify that you have uploaded the correct document before
clicking submit. Only one attempt is authorized for this assignment.

*Your memo will be evaluated on the expectations listed above and the
assignment rubric*

1

Army Health System

Doctrine Smart Book

1 JUNE 2020

DISTRIBUTION RESTRICTION:

Approved for public release; distribution is unlimited.

HEADQUARTERS, DEPARTMENT OF THE ARMY

Foreword

As the Army transitions from counterinsurgency operations to large-scale combat operations (LSCO),
the United States Army Medical Center of Excellence must redefine its culture. Training, education,
and force modernization must focus on operational medicine in support of LSCO instead of hospital-
based health care delivery and limited contingency missions. The foundation of Army operations has
always been Army doctrine and it is important for this cultural evolution to reinvigorate our use and
understanding of doctrine. The Doctrine Smart Book is an effort to consolidate important doctrinal
references in one place and make it easier to find the most significant doctrinal concepts.

This document captures all of the Army medical doctrine in one abbreviated publication. Leaders have
a responsibility to seek self-development and to develop their subordinates; this Doctrine Smart Book
is a useful tool to energize Soldiers to seek more detailed information on how we employ medical
capabilities in support of Army, joint, and multinational operations.

The Army Health System Doctrine Smart Book will be updated frequently when Army Health System
doctrine, as well as Army doctrine, is updated and published to the fielded force. The lead agent for
this publication is the United States Army Medical Center of Excellence’s Doctrine Division. It invites
input and feedback on improvements to this tool. As we are often reminded, doctrine communicates
the units and capabilities that currently exist. Doctrine outlines how capabilities can be employed if
they were required now or in the near future.

Today, Army Medicine is entering not only a period of transition, but also an era of great opportunity.
The strategic environment has grown increasingly complex, demanding a more agile force that must
adapt in order to operate in a multi-domain operations (MDO) environment. Technological advances
have created new ways to communicate, to understand, and to influence others. At the same time,
almost two decades of war has reinforced timeless lessons about the centrality of human beings in all
aspects of military operations. We must build on these insights to change how we think about, plan for,
and conduct all of our operations. Doctrine will be in a relentless state of revision over the next several
years as doctrine developers endeavor to keep up with evolving capability developments related to
LSCO and MDO.

While we cannot predict the future, we can be certain that the Chief of Staff of the Army will continue
to call on Army Medicine to preserve Soldier lethality and survivability. Going forward, Army Medicine
will continue to transition in support of MDO and in LSCO. Army Medicine will apply the lessons learned
from recent combat to peacetime as we prepare for evolving threats. Our doctrine will keep pace in
order to provide the framework by which we provide medical support; it is incumbent upon leaders to
ensure our doctrine is inculcated into the training, education, and professional development of our units
and Soldiers.

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

DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited.

1 June 2020 Army Health System Doctrine Smart Book i

1 June 2020

Army Health System
Doctrine Smart Book

Contents

Page

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

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

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

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

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ii Army Health System Doctrine Smart Book 1 June 2020

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

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

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

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

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

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

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

Figures

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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1 June 2020 Army Health System Doctrine Smart Book iii

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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iv Army Health System Doctrine Smart Book 1 June 2020

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tables

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1 June 2020 Army Health System Doctrine Smart Book v

Preface

The Army Health System Doctrine Smart Book is a concise collection of Army Health System
summaries that reflects current approved doctrine.

Part One provides a summary of the Army Health System and its ten medical functions.

Part Two provides a visual representation of the Army Health System’s doctrinal hierarchy and its
corresponding Army and joint doctrine. It illustrates the hierarchy as it applies to the Joint Publication
4-02, Joint Health Services; Field Manual 4-02, Army Health System; and Army Health System Army
techniques publications. It follows on with one-page synopses of each current approved Army Health
System doctrinal publication. Each synopsis contains the characteristics, fundamentals, terms, and
ideas as they are discussed in each publication.

Part Three consists of doctrinal synopses of each Army Health System unit. Each synopsis contains
the table of organization and equipment, task organization, personnel breakdown, and doctrinal
employment as they are discussed in various Army Health System doctrinal publications.

Part Four discusses the Army Health System by Army strategic role (shape, prevent, large scale ground
combat operations, and consolidate gains).

The principal audience for this publication is all readers of Army Health System doctrine—military,
civilian, and contractor.

This publication uses Department of Defense terms where applicable.

The proponent and preparing agency of the Army Health System Doctrine Smart Book is the United
States Army Medical Center of Excellence (MEDCoE), Doctrine Literature Division. Send questions,
comments, and recommendations to Commander, MEDCoE, ATTN: MCCS-FD (Army Health System
Doctrine Smart Book), 2377 Greeley Road, Joint Base San Antonio, Fort Sam Houston, Texas 78234-
7731 or by e-mail to [email protected]

1 June 2020 Army Health System Doctrine Smart Book 1

PART ONE

ARMY HEALTH SYSTEM

INTRODUCTION

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

ARMY HEALTH SYSTEM OPERATIONAL FRAMEWORK

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

Figure 1-1. Army Health System Operational Framework

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2 Army Health System Doctrine Smart Book 1 June 2020

OPERATIONAL ENVIRONMENT

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

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

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1 June 2020 Army Health System Doctrine Smart Book 3

Figure 1-2. Army Health System Logic Chart

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4 Army Health System Doctrine Smart Book 1 June 2020

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

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

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

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

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

Nonmedical Personnel

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

Self-Aid and Buddy Aid

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

Combat Lifesaver

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

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1 June 2020 Army Health System Doctrine Smart Book 5

Role 1

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

 Immediate lifesaving measures.

 Disease and nonbattle injury (DNBI) prevention.

 Combat and operational stress preventive measures.

 Patient location and acquisition (collection).

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

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

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

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

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

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

Role 2

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

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6 Army Health System Doctrine Smart Book 1 June 2020

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

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

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

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

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

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

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

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

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

Role 3

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

 Coordination of patient evacuation through medical regulating.

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

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

Role 4

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

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ARMY HEALTH SYSTEM PRINCIPLES (FM 4-02)

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

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

Conformity

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

Proximity

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

Flexibility

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

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

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8 Army Health System Doctrine Smart Book 1 June 2020

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

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

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

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

Mobility

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

Continuity

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

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Control

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

MEDICAL FUNCTIONS (FM 4-02)

1-31. The AHS is a complex system of systems (see figure below). The systems which comprise
the AHS are divided into medical functions which align with medical disciplines and scientific
knowledge. These systems are interrelated and interdependent and must be meticulously and
continuously synchronized to reduce morbidity and mortality and to maximize patient outcome. The
ten medical functions are—

 Medical command and control.

 Medical treatment (organic and area support).

 Hospitalization.

 Medical Evacuation (to include medical regulating).

 Dental services.

 Preventive medicine services.

 Combat and operational stress control (COSC).

 Veterinary services.

 Medical logistics (to include blood management).

 Medical laboratory services (to include both clinical laboratories and environmental
laboratories).

The AHS supports and is in consonance with joint doctrine, as described in JP 4-02.

Figure 1-3. Ten Army Health System Medical Functions

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10 Army Health System Doctrine Smart Book 1 June 2020

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

Primary Task Purpose

Medical command

Commander tasks:

– Drive the operations process through the activities of understand,
visualize, describe, direct, lead, and assess.

– Develop teams, both within their own organizations and with unified
action partners.

– Inform and influence audiences, inside and outside their organizations.

Staff tasks:

– Conduct the operations process (plan, prepare, execute, and assess).

– Conduct knowledge management and information management.

– Synchronize information-related capabilities.

– Conduct cyber electromagnetic activities.

Communications and computers

– Maintain situational understanding of Army mission command systems
and the common operational picture.

– Facilitate the transfer of medical information, to enhance the
documentation of medical encounters and exposures to health hazards,
and to ensure the compatibility and interoperability of medical
communications for combat casualty care.

Task-organization

– Provide a scalable and tailorable medical infrastructure which ensures
the right mix of medical capabilities is available to execute the Army
Health System mission. This capability is further enhanced through the
modular design of Army Health System units.

Medical intelligence
– Facilitate the identification, evaluation, and assessment of health

hazards to the deployed force.

Technical supervision

– Ensure medical standards are established, implemented, and monitored
throughout the operational area.

– Provide consultation and support to subordinate Army Health System
units or elements.

– Provide reach back capability to the continental United States-support
base in the areas of various medical disciplines and specialties.

Regional focus
– Support and facilitate the execution of the combatant commander’s

theater engagement strategy during the execution of stability tasks.

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

Primary task Purpose

First aid
– Decrease died of wounds rate. This task is performed by nonmedical

Soldiers performing self-aid, buddy aid, and/or combat lifesaver support
prior to arrival of the combat medic and/or other health care personnel.

Tactical combat casualty care

– Provide lifesaving intervention at the point of injury or wounding. This
task is performed by the combat medic who locates, acquires, stabilizes,
and evacuates patients with combat trauma. At echelons above brigade,
this task is referred to as emergency medical treatment in noncombat
operations.

Forward resuscitative surgery
– Provide a damage control surgery capability close to the point of injury

or wounding. This care is provided by a forward surgical team collocated
with a Role 2 medical treatment facility.

Routine sick call – Provide primary care services as close to patient’s unit as possible.

Patient holding
– Provide a short-term holding capability (not to exceed 72 hours) for

patients requiring minimal care prior to returning to duty.

Casualty prevention measures

– Promote wellness and enhance Soldier medical readiness to decrease
morbidity and mortality. There are no preventive medicine or combat
and operational stress control assets at Role 1; however, they are
available at Role 2.

Medical evacuation
– Provide medical evacuation by ground ambulance on an area support

basis and to provide en route medical treatment during transport.

Physical therapy

– Role 2 medical treatment facilities may be augmented with a physical
therapy team to provide assistance in strengthening the Soldier’s
physical resiliency, assistance in the prevention of neuromusculoskeletal
injuries, and treatment of Soldiers with neuromusculoskeletal injuries
allowing them to return to duty as soon as possible.

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12 Army Health System Doctrine Smart Book 1 June 2020

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

Primary task Purpose

Essential care

– Includes first responder care, initial resuscitation and stabilization as well as
treatment and hospitalization in order to either return the patient to duty
within the theater evacuation policy, or to begin initial treatment required for
optimization of outcome.

Triage and emergency care

– Provides for the receiving of incoming patients to assess their medical
condition, provide emergency medical treatment, and transfer them to the
appropriate functional area within the hospital.

Outpatient services

– Provides patient care and family medicine consultation services, evaluation
and treatment of dermatological and gynecological diseases, injuries,
disorders, orthopedic and physical therapy services; sick call operations
and comprehensive routine medical care to include electrocardiographs in
the medical services clinic.

Inpatient care

– Provides nursing and medical services in intermediate and intensive care
wards in order to prepare patients for surgery, manage postoperative
recovery, monitor patients, and prepare them for further evacuation.

Clinical Laboratory and
blood banking

– Performs analytical procedures in hematology, urinalysis, chemistry, blood
banking, and microbiology screening. Includes all routine blood grouping
and typing, abbreviated cross-matching procedures, emergency blood
collection, and storage/issuing liquid blood components and fresh frozen
plasma.

Radiology

– Provides radiological services to all areas of the hospital and operates on a
24-hour basis to include computed tomography in the newly designed field
hospitals.

Physical therapy

– Provides a physical-occupational clinic to evaluate and treat
neuromusculoskeletal injuries, minor soft tissue wounds to include burn
wound treatment, behavioral health, injury prevention, and human
performance optimization.

Medical logistics

– Provides Class VIII management, requisitioning, and resupply as well as
maintenance on medical equipment. Coordinates with supporting medical
logistics company and medical detachment (blood support) for required
external medical logistics support.

Emergency and essential
dental care

– Provides emergency and essential dental services and consultation for
patients and staff in order treat urgent dental cases or prevent dental
emergencies.

General and specialty
surgery

– Perform initial surgery for battle and nonbattle injuries and follow-on surgery
for patients received from other medical treatment facilities to include
general, orthopedic, and obstetrics-gynecological surgical services in order
to return patients to duty or stabilize them for further evacuation.

Anesthesia service

– Provides anesthesia and respiratory services for the hospital that includes
respiratory therapy by specifically trained technicians and the ability to
provide mechanical respiratory assistance in intensive care units and the
operating rooms.

Pharmacy

– Operates a fully functioning pharmacy and exercises appropriate control,
accountability, and distribution of medications and controlled substances to
both inpatients and outpatients as prescribed by medical staff.

Nutrition care

– Provides food service management, meal preparation, modified diet food
preparation, and distribution of foods to patients and staff.

Behavioral health

– Provides outpatient psychiatry and inpatient neuropsychiatric consultation
and education services.

Patient administration
services

– Admission and disposition of patients, maintaining patient records, security
of patient valuables, statistical reporting, patient privacy policies, and
coordination for patient evacuation out of theater.

Consultation

– Provide specialty medical consultation to Role 1 and 2 medical providers to
enhance the care given in forward areas, potentially eliminating the need to
evacuate some patients rearward.

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

Primary task Purpose

Acquire and locate

– Provide a rapid response to acquire wounded, injured, and ill personnel.
Clear the battlefield of casualties and facilitate and enhance the tactical
commander’s freedom of movement and maneuver. This task is performed
by the medical evacuation crew of the evacuation platform.

Treat and Stabilize
– Maintain or improve the patient’s medical condition during transport and
provide en route care as required. This task is performed by medical
evacuation crewmembers and providers when necessary.

Intra-Theater Medical Evacuation

– Provide rapid evacuation utilizing dedicated assets to the most
appropriate role of care. Provide a capability to cross-level patients within
the theater hospitals and to transport patients being evacuated out of
theater to staging facility prior to departure. This task is performed by the
evacuation platforms in the medical company (ground ambulance) and
medical company (air ambulance).

Emergency movement of
medical personnel, equipment,
and supplies

– Provide a rapid response for the emergency movement of scarce
medical resources throughout an operational environment.

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

Primary task Purpose

Medical materiel procurement

– Program funding, develop, acquire, and field the most cost-effective and
efficient medical materiel support to satisfy materiel requirements
generated by doctrinal and organizational revisions to tables of
organization and equipment, as well as user-generated requirements,
state-of-the-art advancements, and initiatives to enhance materiel
readiness.

Class VIII management and
distribution

– Provide intensive management and coordinated distribution of
specialized medical products and services required to operate an
integrated Army Health System anywhere in the world throughout the
range of military operations.

Medical equipment
maintenance and repair

– Perform appropriate maintenance checks, services, repairs, and tests on
medical equipment set component equipment items as specified in
applicable technical manuals or manufacturer operating instructions.

Optical fabrication and repair

– Fabricate and repair prescription eyewear that includes spectacles,
protective mask inserts, and similar ocular devices for eligible personnel
in accordance with applicable Army policies and regulations.

Blood management
(distribution)

– Provide collection, manufacturing, storage, and distribution of blood and
blood products to echelons above brigade Army Health System units.
Provide distribution of blood and blood products to Role 2 medical
treatment facilities and forward surgical teams.

Centralized management of
patient movement items

– Support in-transit patients, exchange in-kind patient movement items
without degrading medical capabilities, and provide prompt recycling of
patient movement items from initial movement to the patient’s final
destination.

Health facilities planning and
management

– Provide a reliable inventory of facilities that meet specific codes and
standards, maintains accreditation, and affords the best possible health
care environment for the Soldiers, Family members, and retired
beneficiaries.

Medical contracting support
– Ensure the establishment and monitoring of contracts for critical medical

items and services.

Hazardous medical waste
management and disposal

– Ensure the proper collection, control, transportation, and disposal of
regulated medical waste in accordance with applicable Army and host-
nation policies and regulations.

Production and distribution of
medical gases

– Ensure the production, receipt, storage, use, inspection, transportation,
and handling of medical gases and their cylinders in accordance with all
applicable regulations.

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14 Army Health System Doctrine Smart Book 1 June 2020

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

Primary task Purpose

Conduct periodic examination
of Soldiers’ teeth, gums, and
jaw

– Identify dental deficiencies and recommend follow-up courses of action.

Classify Soldiers’ dental
conditions in the dental
classification system and
determine Soldiers’ dental
readiness status

– Determine Soldiers dental classification and dental readiness status.

Provide training to Soldiers and
units on measures to take to
mitigate the adverse impact of
dental threats

– Provide training/education to Soldiers and unit leaders on identifying
dental threats, taking preventive measures to mitigate or eliminate the
dental threat, and ensuring Soldiers are practicing good oral hygiene.

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

Primary task Purpose

Comprehensive dental care
– Restore an individual to optimal oral health, function, and aesthetics.

Normally provided in continental United States-support base.

Operational dental care
– Provide treatment in austere environments for Soldiers engaged in

operations. Operational care is provided in the area of operations and
consists of emergency dental care and essential dental care.

Emergency dental care
– Relieve oral pain, eliminate acute infection, control life-threatening oral

conditions (hemorrhage, cellulitis, or respiratory difficulty) and treat
trauma to teeth, jaws, and associated facial structures.

Essential dental care
– Prevent potential dental emergencies and maintain the overall oral

fitness of Soldiers at levels consistent with combat readiness.

Oral maxillofacial surgery
– Provide oral maxillofacial surgery capability to minimize loss of life and

disability resulting from oral and maxillofacial injuries and wounds within
the area of operations.

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

Primary task Purpose

Disease prevention and control

– Prevent and control communicable diseases and provide travel
medicine, population health management, and hospital-acquired
infection control.

Field preventive medicine

– Provide field sanitation team, preventive medicine measures, individual
Soldier personal protective measures, inspection of potable water and
field feeding facilities, and ice and bottled/packaged water in an
operational environment.

Environmental health

– Provide the monitoring of environmental health-related data for the
health of, or potential health hazard impact on, a population and on
individual personnel; pest and disease vector prevention and control;
health threat controls for waste disposal; identification of environmental
health hazards and endemic diseases; incident-specific environmental
monitoring; and climatic injury prevention and control.

Occupational health

– Provide medical surveillance examinations and screenings; health
hazard education; surety programs; hearing and vision conservation and
readiness; workplace epidemiological investigations; ergonomics;
radiation protection; industrial hygiene; work-related immunizations;
Army aviation medicine; health hazard assessment of Army materiel and
equipment; medical facility safety; and workplace violence prevention.

Health surveillance and
epidemiology

– Provide for the deployment of occupational and environmental health
surveillance, Defense Occupational and Environmental Health
Readiness System, medical surveillance, Medical Protection System,
and epidemiology.

Soldier, Family, community
(public) health, and health
promotion

– Provide Soldier health (to include Soldier medical and dental readiness),
Family and community (public) health (to include childhood lead
poisoning prevention and Family safety), and health promotion programs
and services (to include tobacco use cessation, substance abuse
prevention, and suicide prevention).

Preventive medicine toxicology

– Provide toxicological assessments of potentially hazardous materials,
toxicity clearances for Army chemicals and materiel, and toxicologically-
based assessments of health risks.

Preventive medicine laboratory
services

– Provide laboratory certification and accreditation, quality control and
quality management, and the Department of Defense Cholinesterase
Monitoring Program.

Health risk assessment

– Provide capabilities and activities necessary to identify and evaluate a
health hazard and to determine the associated health risk (probability of
occurrence and resulting outcome and severity) from potential exposure
to the hazard.

Health risk communication

– Provide capabilities and activities necessary to identify the personnel
affected by potential or actual health and safety threats, to determine the
interests and concerns that those personnel have about the threats, and
to develop strategies for effectively communicating the complexities and
uncertainties associated with their health risk.

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16 Army Health System Doctrine Smart Book 1 June 2020

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

Primary task Purpose

Implement combat and
operational stress control
plan/program

– Prevent combat and operational stress reaction.

Perform combat and
operational stress control unit
needs assessment

– Provide command with global assessment of the unit, with considerations
of multiple variables that may affect leadership, performance, morale,
and operational effectiveness of the organization.

Conduct traumatic event
management for potentially
traumatic event

– Assist in the transition of units and Soldiers who are exposed to
potentially traumatic events by building resilience, promoting
posttraumatic growth, and/or increasing functioning and positive changes
in the unit.

Screen and evaluate Soldiers
with maladaptive behaviors to
rule out neuropsychiatric/
behavioral health conditions

– Provide diagnosis, treatment, and disposition for Soldiers with
neuropsychiatric/behavioral problems.

Conduct combat and
operational stress restoration
and reconditioning programs to
include warrior resiliency
training

– Provide Soldiers rest/restoration within or near their unit area for rapid
return to duty and to prevent posttraumatic stress disorder.

Perform command-directed
evaluation for Soldier’s
behavioral health status

– Determine if a Soldier’s mental state renders him at risk to himself or
others or may affect his ability to carry out his mission.

Screen patients with potential
behavioral health issues for
signs/symptoms of mild
traumatic brain injury

– Rule out mild traumatic brain injury for Soldiers seeking assistance with
behavioral health issues. If appropriate, refer individuals for follow-up
medical examination.

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

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

Primary task Purpose

Animal medical care
– Provide medical care for military working dogs and other government

owned animals.

Food protection
– Ensure quality, food safety, and food defense of food sources for

deployed forces.

Veterinary public health – Reduce transmission of zoonotic diseases transmissible to man.

Primary task Purpose

Identify and diagnose be-
havioral health/neuropsychiatric
disorder/disease

– Identify and initiate treatment for patients with behavioral health/
neuropsychiatric disease processes.

Stabilize patient
– Stabilize behavioral health/neuropsychiatric patients for evacuation from

the theater for treatment of disease process in the continental United
States-support base.

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

Primary task Purpose

Preventive care
– Maintenance of health to optimize working dog detection and patrol

capability to detect threats to Service members.

Sick call
– Treatment of routine disease and nonbattle injuries and noncombat

related emergencies as close to the working dog’s unit as possible to
minimize lost working days.

Combat casualty care
– Provision of lifesaving stabilization and care as close to the working

dog’s point of injury as possible to maximize survival rates.

Military and contract working
dogs hospitalization

– Provision of short-term hospitalization capability (not to exceed 72 hours)
for military and contract working dogs requiring direct veterinary care to
reduce medical evacuation and maximize return to duty rates.

Medical evacuation
– Medical evacuation between veterinary roles of care for both the working

dog and his handler. When necessary, provision of en route care will be
provided by accompanying veterinary personnel.

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

Primary task Purpose

Analytical, investigational, and
consultative capabilities

– Identify chemical, biological, radiological, and nuclear threat agents in
biomedical specimens and other samples from the area of operations.

– Assist in the identification of occupational and environmental health
hazards and endemic diseases.

Special environmental control
and containment

– Evaluate biomedical specimens for the presence of highly infectious or
hazardous agents of operational concern.

Data and data analysis – Support medical analyses and operational decisions.

Medical laboratory analysis
– Support the diagnosis of zoonotic and significant animal diseases that

impact on military operations.

Deploy modular sections or
sectional teams

– Interface with preventive medicine teams, veterinary teams, forward-
deployed Army Health System units, biological integrated detection
system teams, and chemical company elements operating in the area of
operations.

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

Primary task Purpose

Analysis of medical specimens

– Provide for the identification, diagnosis, and treatment of diseases and
pathogens.

– Provide blood-banking services to include capability to type and cross-
match blood samples and perform limited testing of whole blood.

Blood-banking services

– Provide laboratory support to type and cross-match blood specimens for
transfusion services.

– Provide limited testing of blood products.

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PART TWO

Army Health System Doctrine
Hierarchy and Summaries

INTRODUCTION

The United States Army Medical Center of Excellence, is the proponent for
Army medical doctrine. Field Manual 4-02, is the capstone doctrinal
publication within the Army medical doctrine hierarchy. The remaining ATPs
are subordinate publications to FM 4-02 and therefore support and expand, in
greater detail, the concepts contained in FM 4-02.

There are 28 doctrinal publications under the Army Medicine doctrinal
publication library that are either currently published or in development. As
requirements change or concepts become capabilities, publications get
revised, new publications are created, or publications are rescinded. In
accordance with Training and Doctrine Command policies and regulations, it
takes 18 to 24 months to revise or create a doctrinal publication, not accounting
for the extensive research required prior to starting the formal development
process.

Part Two contains a brief summary of each of the Army medical doctrine
publications. While some publications contain the same or very similar content
as other medical doctrine, the Training and Doctrine Command guidance is to
not repeat significant amounts of content between publications and that
references to other publications should be provided so the reader can seek
additional information on a specific topic.

Note. These summaries are of Army Medicine’s current/proposed
publications. They do not reflect scheduled and periodic updates.

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20 Army Health System Doctrine Smart Book 1 June 2020

*ATP 4-02.1

Army Medical

Logistics

ATP 4-02.2

Medical

Evacuation

ATP 4-02.3

AHS Support
to Maneuver

Forces

ATP 4-02.5

Casualty Care

*ATP 4-02.7

MTTP for HSS
in a CBRN

Environment

ATP 4-25.12

Unit Field

Sanitation Teams

*TC 4-02.1

First Aid

*ATP 4-02.8

Force Health

Protection

*ATP 4-02.43

AHS Support

to Army SOF

ST 4-02.25

Employment

of the FRST

TC 4-02.3

Field Hygiene

and Sanitation

ATP 4-02.42

AHS Support
to Stability and

DSCA Tasks

ATP 4-02.82

Occupational
and

Environmental
Health Site

Assessment

ATP 4-02.84

MTTP for the
Treatment of

Biological
Warfare Agent

Casualties

ATP 4-25.13

Casualty

Evacuation

*ATP 4-02.85

MTTP for the
Treatment of

Chemical Warfare
Agent Casualties
and Conventional
Military Chemical

Injuries

*ATP 6-22.5

A Leader’s
Guide to

Soldier Health

and Fitness

ST 4-02.10

Field Hospital

Operations

Not Yet
Published

AHS Mission
Command

ATP 4-02.12

ATP 4-02.51

Combat and
Operational

Stress Control

Not Yet
Published

ATP 4-02.18

Veterinary

Services

Not Yet
Published

ATP 4-02.19

Dental

Services

Not Yet
Published

ATP 4-02.17

Preventive

Medicine

Not Yet
Published

ATP 4-02.46

AHS Support to
Detainee

Operations

ATP 4-02.10

THEATER

HOSPITALIZATION

Not Yet
Published

ATP 4-02.55

AHS Support

Planning

Navy is
proponent.

ATP 4-02.83

MTTP for the
Treatment of
Nuclear and
Radiological
Casualties

Not Yet
Published

Medical Platoon

ATP 4-02.4

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ARMY HEALTH SYSTEM PUBLICATIONS

ARMY HEALTH SYSTEM SUPPORT

 ATP 4-02.3, Army Health System Support to Maneuver Forces

 ATP 4-02.4, Medical Platoon (Not Yet Published)

 ATP 4-02.7, MTTP for Health Service Support in a CBRN Environment

 ATP 4-02.12, Army Health System Mission Command (Not Yet Published)

 ATP 4.02.42, Army Health System Support to Stability and Defense Support of Civil Authorities
Tasks

 ATP 4.02.43, Army Health System Support to Special Operations Forces

 ATP 4.02.46, Army Health System Support to Detainee Operations

 ATP 4-02.55, Army Health System Support Planning

MEDICAL TREATMENT (ORGANIC AND AREA SUPPORT)

 ATP 4-02.5, Casualty Care (Being Rescinded)

 TC 4-02.1, First Aid

 ST 4-02.25, Employment of the FRSD

 ATP 4-02.83, MTTP for the Treatment of Nuclear and Radiological Casualties

 ATP 4-02.84, MTTP for the Treatment of Biological Warfare Agent Casualties

 ATP 4-02.85, MTTP for Chemical Warfare Agent Casualties and Conventional Military Chemical
Injuries

HOSPITALIZATION

 ST 4-02.10, Field Hospital Operations

 ATP 4-02.10, Theater Hospitalization (Not Yet Published)

MEDICAL EVACUATION (INCLUDING MEDICAL REGULATING)

 ATP 4-02.2, Medical Evacuation

 ATP 4-25.13, Casualty Evacuation

DENTAL SERVICES

 ATP 4-02.19, Dental Services (Not Yet Published)

PREVENTIVE MEDICINE SERVICES

 TC 4-02.3, Field Hygiene and Sanitation

 ATP 4-25.12, Unit Field Sanitation Teams

 ATP 4-02.17, Preventive Medicine (Not Yet Published)

 ATP 4-02.82, Occupational and Environmental Health Site Assessment (Navy is the proponent for
this publication.)

COMBAT AND OPERATIONAL STRESS CONTROL

 ATP 4-02.51, Combat and Operational Stress Control (Not Yet Published)

 ATP 6-22.5, A Leader’s Guide to Soldier Health and Fitness

VETERINARY SERVICES

 ATP 4-02.18, Veterinary Services (Not Yet Published)

MEDICAL LOGISTICS (INCLUDING BLOOD MANAGEMENT)

 ATP 4-02.1, Army Medical Logistics

MEDICAL LABORATORY SERVICES (INCLUDING CLINICAL AND ENVIRONMENTAL LABORATORIES)

 ATP 4-02.8, Forced Health Protection (Being Rescinded)

Note. The following Army Medicine doctrinal publications (TC 4-02.1, TC 4-02.3, ATP

4-02.10, ATP 4-02.12, ATP 4-02.17, ATP 4-02.18, ATP 4-02.19, ST 4-02.25, ATP 4-02.51, and ATP
4-25.12) are new publications or are currently being updated and/or revised. Throughout part 2, any
proposed chapters will be listed from the program directive and are subject to change.

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November 2019 https://armypubs.army.mil
Army Medicine is the lead service and proponent for this publication. Other Service’s designations are

MCRP 4-11.1C / NTRP 4-02.23 / AFMAN 44-156_!P

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1 June 2020 Army Health System Doctrine Smart Book 53

PART THREE

Army Health System Unit Synopsis

INTRODUCTION

Part Three provides a brief summary of the medical units employed to provide
FHP and HSS. Each summary contains a brief description of the mission,
capabilities, basis of allocation, dependencies, and employment of the unit.
Where appropriate, additional considerations and graphical aids are provided
in an effort to simplify the understanding of some of the medical units. At the
top of each of the summaries is the doctrinal correct symbol that represents
the medical unit discussed below it. In many cases, the summaries started
with the unit’s Section 1 of its table of organization and equipment (TOE).
Section 1’s provide a basic description of a unit and is always a good place to
begin when learning what unit was designed and resourced to accomplish.

Note. Efforts are being made to revise symbology depicting medical units. Where there
is RED depicted on unit symbols in this part, those are recommended changes that the
HRCoE recommended to the Army Symbologist. As of the writing of this publication,
decisions have not been finalized on those symbols.

ARMY COMMAND AND SUPPORT RELATIONSHIPS

ORGANIC

3-1. Organic forces are those assigned to and forming an essential part of a military organization.
Organic parts of a unit are those listed in its table of organization for the United States Army, United
States Air Force (USAF), and United States Marine Corps (USMC), and are assigned to the
administrative organizations of the operating forces for the United States Navy (USN). Joint
command relationships do not include the term organic because a joint forces command is not
responsible for the organizational structure of units. The organic command relationship is unique
in that the relationship is inherent in unit force structure; units that have an organic command
relationship with a parent unit are an integral part of the parent unit TOE. As a result, the organic
command relationship cannot be further delegated. Commanders with organic subordinate units
may designate any of the other four command relationships to the subordinate unit. Commanders
with organic subordinate units have administrative control (ADCON) authority and responsibility for
the subordinate units.

ASSIGNED AND ATTACHED

3-2. Commanders establish the assigned and attached command relationships by placing a
subordinate unit under the command of another organization for a specified period of time. An
assigned command relationship is relatively permanent. The gaining organization controls and
administers the units or personnel for the primary function, or greater portion of the functions, of
the unit or personnel. An attached command relationship is relatively temporary. The attachment
may be for a specific mission or phase of an operation. The commander establishes these
command relationships in an operation order issued to the subordinate commander and specifies

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54 Army Health System Doctrine Smart Book 1 June 2020

the duration of the relationship in the order. Unless specifically stated in the OPORD, these
command relationships includes ADCON authority and responsibility for the gaining command.
Once the assignment or attachment duration has lapsed, the unit returns to its parent unit.

OPERATIONAL CONTROL AND TACTICAL CONTROL

3-3. Commanders establish the operational control (OPCON) and tactical control (TACON)
command relationships by placing a subordinate unit under the command of another organization
for a specified period of time. The OPCON is the authority to perform those functions of command
over subordinate forces involving organizing and employing commands and forces, assigning
tasks, designating objectives, and giving authoritative direction necessary to accomplish the
mission. The TACON is a command authority over units made available for tasking that is limited
to the detailed direction and control of movements or maneuvers within the operational area
necessary to accomplish missions or tasks assigned. The commander establishes these command
relationships in an OPORD issued to the subordinate commander and specifies the duration of the
relationship in the order. Unless specifically stated in the OPORD, these command relationships
do not include ADCON authority and responsibility for the gaining command. Once the duration of
the relationship has lapsed, the unit returns to its parent unit.

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 55

Table 3-1. Army command and support relationships

If relation-
ship is:

Then inherent responsibilities:

Have
command
relation-

ship with:

May be
task-

organized
by:1

Unless
modified,
ADCON

Are
assigned
position

or AO by:

Provide
liaison

to:

Establish/
maintain

communication
’s with:

Have
priorities

established
by:

Can impose
on gained

unit further
command or

support
relationship

of:

Organic

All
organic
forces
organized
with the
HQ

Organic
HQ

Army HQ
specified
in
organizing
document

Organic
HQ

N/A N/A Organic HQ

Attached;
OPCON;
TACON; GS;
GSR; R; DS

Assigned
Gaining
unit

Gaining
HQ

Gaining
Army HQ

OPCON

As
required
by
OPCON

As required by
OPCON

ASCC or
Service-
assigned HQ

As required
by OPCON
HQ

Attached
Gaining
unit

Gaining
unit

Gaining
Army HQ

Gaining
unit

As
required
by
gaining
unit

Unit to which
attached

Gaining unit

Attached;
OPCON;
TACON; GS;
GSR; R; DS

OPCON
Gaining
unit

Parent unit
and
gaining
unit;
gaining
unit may
pass
OPCON to
lower HQ1

Parent
unit

Gaining
unit

As
required
by
gaining
unit

As required by
gaining unit
and parent unit

Gaining unit
OPCON;
TACON; GS;
GSR; R; DS

TACON
Gaining
unit

Parent unit
Parent
unit

Gaining
unit

As
required
by
gaining
unit

As required by
gaining unit
and parent unit

Gaining unit
TACON;GS
GSR; R; DS

Note: 1 In NATO, the gaining unit may not task-organize a multinational force. (See TACON.)

ADCON administrative control HQ headquarters

AO area of operations N/A not applicable

ASCC Army Service component command NATO North Atlantic Treaty Organization

DS direct support OPCON operational control

GS general support R reinforcing

GSR general support-reinforcing TACON tactical control

ARMY SUPPORT RELATIONSHIPS

3-4. Army support relationships are direct support, general support, reinforcing, and general
support-reinforcing. Army support relationships are not command authorities and are more specific
than joint support relationships.

3-5. In order for unit commanders to be able to plan and develop viable support concepts, they
must know the type and quantity of units supported and for how long. The commander’s higher
headquarters provides this information by task-organizing subordinate units and designating clear
support relationships between each subordinate unit and supported units. This information is
communicated via an OPORD.

3-6. Direct support is a support relationship requiring a force to support another specific force
and authorizing it to answer directly to the supported force’s request for assistance (joint doctrine
considers direct support as a mission rather than a support relationship). A unit assigned a direct
support relationship retains its command relationship with its parent unit but is positioned by and
has priorities of support established by the supported unit.

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3-7. Reinforcing support is a support relationship requiring a force to support another supporting
unit. Only like units can be given a reinforcing mission. A unit assigned a reinforcing support
relationship retains its command relationship with its parent unit, but is positioned by the reinforced
unit. A unit that is reinforcing has priorities of support established by the reinforced unit first, and
then by the parent unit.

3-8. General support-reinforcing is a support relationship assigned to a unit to support the force
as a whole and to reinforce another similar-type unit. A unit assigned a general support-reinforcing
support relationship is positioned and has priorities established by its parent unit and secondly by
the reinforced unit.

3-9. General support is that support which is given to the supported force as a whole and not to
any particular subdivision thereof. Units assigned a general support relationship are positioned
and have priorities established by their parent unit.

AREA SUPPORT

3-10. Area support is NOT a support relationship and is a task given to sustainment units that
directs them to support units transiting or operating within a specified geographic boundary and for
which a support relationship has not been established. This is normally for units that are in
immediate need of support and are not near their organic or designated supporting unit. Area
support is not a support relationship and is not synonymous with general support.

Table 3-2. Army support relationships

If
relation-
ship is:

Then inherent responsibilities:

Have
command
relation-

ship with:

May be
task

organized
by:

Receives
sustain-

ment
from:

Are
assigned

position or
an area of
operations

by:

Provide
liaison to:

Establish/
maintain

communi-
cations

with:

Have
priorities

established
by:

Can
impose on

gaining
unit

further
command
or support
relation-
ship by:

Direct

support
1

Parent
unit

Parent
unit

Parent
unit

Supported
unit

Supported
unit

Parent
unit;

supported
unit

Supported
unit See note

1

Reinforc-
ing Parent

unit
Parent

unit
Parent

unit
Reinforced

unit
Reinforced

unit

Parent
unit;

reinforced
unit

Reinforced
unit; then

parent unit

Not
applicable

General
support–
reinforc-
ing

Parent
unit

Parent
unit

Parent
unit

Parent unit

Reinforced
unit and as

required
by parent

unit

Reinforced
unit and as
required by
parent unit

Parent unit;
then

reinforced
unit

Not
applicable

General
support

Parent
unit

Parent
unit

Parent
unit

Parent unit

As
required
by parent

unit

As
required by
parent unit

Parent unit
Not

applicable

Note:
1

Commanders of units in direct support may further assign support relationships between their subordinate
units and elements of the supported unit after coordination with the supported commander.

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1 June 2020 Army Health System Doctrine Smart Book 57

MEDICAL COMMAND (DEPLOYMENT SUPPORT)

MISSION

Core Mission. Command and control of EAB medical units providing AHS support in theater. It is
the theater enabling command responsible for C2, integration, synchronization, and execution of
all AHS support operations within the AOR.

Doctrinal Mission. Serves as the theater medical command responsible for providing C2 for AHS
support (which includes HSS and FHP), administrative assistance, and staff and technical
assistance for assigned and attached medical units.

GENERAL MISSION ESSENTIAL TASKS

Conduct C2 including planning, preparing, executing, and assessing theater medical operation.

Protect the force which includes conducting local security, employing survivability measures,
employing chemical, biological, radiological, and nuclear (CBRN) protection, and conducting
personnel recovery operations.

CORE CAPABILITIES MISSION ESSENTIAL TASKS

Manage AHS for the HSS and FHP missions. Plan AHS support.

Direct HSS which includes providing medical C2, supervision of medical treatment and combat
casualty care, MEDEVAC and medical regulating, hospitalization, clinical laboratory services,
behavioral health/neuropsychiatric treatment, medical logistics (MEDLOG) and blood manage-
ment, treatment of CBRN patients, as well as the treatment aspects of preventive medicine and
veterinary services.

Direct FHP to include medical C2, veterinary services for food inspection and animal care missions,
medical surveillance and occupational and environmental health surveillance, COSC, preventive
dentistry, and laboratory services.

ASSIGNMENT

Army service component command (ASCC) as a theater enabling command.

DEPENDENCIES

This unit is dependent on the following: Army service component command for religious, legal,
FHP, finance, and personnel and administrative services. This organization requires field feeding
company, for field feeding support.

EMPLOYMENT

The MEDCOM [DS] provides appropriate staff sections for command, control, and support to
assigned or attached units in the theater.

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08640K000 MEDCOM [DS] 79 8 92 0 179

08641KA00
MEDCOM [DS] OPERATIONAL
COMMAND POST (OCP)

37 3 48 0 88

08641KB00
MEDCOM [DS] MAIN COMMAND POST
(MCP)

42 5 44 0 91

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BASIS OF ALLOCATION

One per theater.

CAPABILITIES

This unit provides—

 Command and control of EAB medical units providing FHS and HSS in the theater AO.

 Subordinate medical organizations to provide medical capabilities to the BCT, BSMCs,
and at EAB.

 Advice to the ASCC commander, surgeon, and other senior level commanders on the
medical aspects of their operations.

 Staff planning, supervision of operations, and administration of assigned and attached
medical units.

 Coordination and integration of strategic capabilities from the sustaining base to units in
the theater AO.

 Advice and assistance in facility selection and preparation.

 Army support to other services and Title 10 responsibilities of the commander.

 Coordination with the USAF theater patient movement requirements center (TPMRC) for
medical regulating and movement of patients from MTF.

 Consultation services and technical advice in all aspects of medical and surgical services.

 Functional staff to coordinate medical plans and operations, hospitalization, preventive
medicine (PVNTMED), tactical and strategic MEDEVAC, MEDLOG, blood management,
dental service, veterinary services, nutrition care, COSC, medical laboratory services,
and area medical support to support units.

 Coordination and orchestration of MEDLOG operations to include Class VIII supply,
distribution, medical maintenance and repair support, optical fabrication, and blood
management.

 Planning and support for single integrated medical logistics manager (SIMLM), when
designated.

 Veterinary support for zoonotic disease control and investigation and inspection of
subsistence.

 Preventive medical support for medical, occupational and environmental health (OEH)
surveillance, potable water inspection, pest management, food facility inspection, and
control of medical and nonmedical waste.

 Legal advice to the commander, staff, subordinate commanders, service members, and
other authorized persons.

 Monitoring of health threats within the AOR and ensures required capabilities are
identified to mitigate the threats.

 The unit ministry team (UMT) which will provide religious support to the command. They
will coordinate with the HQ UMT for required religious support throughout the AOR and
provide consultation capability to subordinate MEDCOM [DS] UMTs.

 The maintenance personnel will augment the maintenance capability of the unit that
performs field maintenance on the unit’s organic vehicles and power equipment.

FUNCTIONS

Command Section

This section provides C2 and management of all Medical Command services. Personnel of this
section supervise and coordinate the operations and administrative services of the Command
Section.

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1 June 2020 Army Health System Doctrine Smart Book 59

Chief of Staff Section

This sections plans, directs, and coordinates the execution of the staff functions. Reviews
organization activities and recommends changes, as necessary, to the Commander.

Deputy Chief of Staff, Personnel

Serves as advisor to the Commander on personnel issues and provides administrative services for
the command.

Personnel Management/Actions

Provides overall administrative services for the command to include personnel management and
personnel actions, awards, decorations, and leaves.

Current Operations Branch

Provides security, plans and operations, deployment, relocation, and redeployment of the
Command.

Plans Branch

Provides security, plans and operations, deployment, relocation, and redeployment of the
Command.

Intelligence/Operations Branch, G2/3

Provides security, plans and operations, deployment, relocation, and redeployment of the medical
command (deployment support).

Theater Patient Movement Center

This center is responsible for medical regulation of all patients in the Theater and preparation of
patient statistical reports. Coordinates with TPRMC/joint patient movement requirements center
for all patients leaving the Theater. Works with the USAF for all strategic patient movement.
Maintains 24 hours continuous operations.

Deputy Chief of Staff, Logistics

Serves as advisor to the commander and provides supervision and coordination of logistics, food
service, supply, transportation, and maintenance support for the subordinate units.

Medical Logistics Support Section

This section provides planning, policies, and programs for medical logistics operations.
Coordinates and synchronizes the execution of the medical logistics mission in the Theater. This
includes Class VIII supply operations, medical maintenance support, optical fabrication, and blood
management.

Civil Affairs Section

This section facilitates and develops assessments of host nation country’s medical infrastructure
to assist the Theater Commander in planning and executing FHP in the TO. Assist the Commander
in preparing medical functional studies and assessments and estimates of how displaced persons
affect U.S. MTFs.

Deputy Chief of Staff, Information Management

Provides for all aspects of automation and communications-electronics for the Command. Assists
the Commander and Staff on C2 signal requirements, capabilities, and operations.

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60 Army Health System Doctrine Smart Book 1 June 2020

Deputy Chief of Staff, Comptroller

Directs and monitors all finance and accounting functions for the Command, to include budget
planning, contract payments, and internal review.

Clinical Services

Serves as the Commander’s principle consultants and the Command’s technical advisers in
pharmacy, optometry, and COSC.

Veterinary Services

Serves as the Commander’s principle consultant and the Commands technical advisor. Assumes
the Tri-Service Executive Agent responsibilities for veterinary support within the Theater.

Preventive Medicine Section

This section serves as the Commander’s principle consultant and the Commands preventive
medicine and environmental science advisors.

Inspector General Section

This section conducts command inspections and investigations and provides Inspector General
assistance as required.

Public Affairs Section

This section serves as the Commands focal point for Command information, public information,
and community relations matters.

Staff Judge Advocate

Supervises the administration of military justice and other legal matters for Medical Command
Soldiers. Advises the commander, staff, and subordinate commanders on legal matters. Provides
legal services on military law, administrative and contract law, claims, criminal law, legal assistance,
operational law, and other related legal matters.

Company Headquarters

Provides company level command, supply management, local security, unit level maintenance, and
all other life support requirements.

Unit Ministry Team

Serves as advisor to the Commander and provides religious support and pastoral care ministry for
assigned staff and subordinate organizations.

MOBILITY

This unit is 100 percent mobile and is able to transport all of its TOE equipment in a single lift using
organic vehicles.

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1 June 2020 Army Health System Doctrine Smart Book 61

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

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

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62 Army Health System Doctrine Smart Book 1 June 2020

MEDICAL BRIGADE (SUPPORT)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08420K000 HHC, MEDICAL BRIGADE 35 5 59 0 99

08422KA00
MEDICAL BRIGADE, EARLY ENTRY
MODULE

15 3 22 0 40

08422KB00 MEDICAL BRIGADE, EXPANSION MODULE 8 0 16 0 24

08422KC00 MEDICAL BRIGADE, CAMPAIGN MODULE 12 2 21 0 35

MISSION

Core mission. Medical C2 of theater medical units providing AHS support for BCTs/division/corps,
joint and multinational forces.

Doctrinal mission: Provide scalable C2 for assigned or attached medical functional modules task-
organized in support of a deployed division/corps.

GENERAL MISSION ESSENTIAL TASKS

Conduct C2 including planning an operation, preparing for an operation, executing an operation,
and assessing an operation.

Protect the force which includes conducting local security operations, employing survivability
measures, employing CBRN protective measures, and conducting personnel recovery operations.

Provide sustainment which includes conducting logistics support, conducting human resources
support, and providing HSS.

CORE CAPABILITIES MISSION ESSENTIAL TASKS

Manage AHS support for the HSS and FHP missions to include planning AHS support.

Direct HSS which includes providing medical C2, supervising the following: medical treatment and
combat casualty care, MEDEVAC and medical regulating, hospitalization, clinical laboratory
services, behavioral health and neuropsychiatric treatment, MEDLOG and blood management,
treatment of CBRN patients, preventive medicine services, and veterinary services.

Direct FHP which includes providing medical C2, and supervising the following: veterinary service
for food inspection and animal care missions, medical surveillance and occupational and
environment health surveillance, combat and operation stress control, preventive dentistry, and
laboratory services.

ASSIGNMENT

Assigned to the MEDCOM (DS).

DEPENDENCIES

This unit is dependent upon the following:

 Appropriate elements within the theater for religious, legal, FHP, finance, and personnel
and administrative services.

 The quartermaster supply company, or equivalent for Class I rations.

 The engineer company, or equivalent, for site selection, waste disposal, and minor
construction.

 The headquarters and headquarters detachment (HHD) movement control battalion, for
supplemental transportation requirements.

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1 June 2020 Army Health System Doctrine Smart Book 63

 The medical detachment (veterinary service support) (MDVSS), for zoonotic disease
control and investigation and the inspection of medical and nonmedical rations to include
suspected contaminated rations and disposition recommendations.

 The medical detachment, PVNTMED, for food facility inspection, vector control, and
control of medical and nonmedical waste.

 Field feeding company, for field feeding support.

EMPLOYMENT

The headquarters and headquarters company (HHC), MEDBDE [SPT], is employed throughout the
division/corps AO, and provides reinforcement/reconstitution support to BCT medical companies in
each of the maneuver BCTs. The MEDBDE [SPT] may be employed as a whole, early entry module
(EEM), expansion module (EM), and campaign module, (CM), or it may incrementally deploy
modules as required by METT-TC factors. It is designed to employ the EEM initially, followed by
the EM, and then by the CM as the theater matures. At a minimum, this organization requires the
capabilities of the EEM and EM module.

BASIS OF ALLOCATION

One per two to six subordinate battalions or like units such as the CSH. The first MEDBDE [SPT]
deploys with the first two subordinate battalions sized units.

CAPABILITIES

This organization provides—

 A rapidly responsive early entry Army medical C2 module that can quickly integrate into
the early entry deployment sequence for crisis management.

 Full spectrum continuous Army medical C2 in support of all Army BCT, division/corps,
joint, and multinational forces.

 Operational medical plugs augmentation to Role 2 BCT medical companies.

 Advice to division/corps and BCT commanders on the medical aspects of their
operations.

 Medical staff planning, operational and technical supervision, and administrative
assistance for medical battalions (multifunctional) (MMBs) and hospitals operating in the
division/corps AO.

 Coordination with the supporting TPMRC for medical regulating and MEDEVAC from
MMBs and hospitals to supporting Role 4 MTFs and CONUS.

 Medical consultation services and technical advice in the following areas:

 PVNTMED (medical surveillance, environmental health, sanitary engineering, and
medical entomology).

 Nursing services.

 Dental services.

 COSC and neuropsychiatric care.

 Veterinary services (including food safety and inspection, animal medicine, and
veterinary preventive medical services).

 Nutrition care.

 Laboratory support services.

 Advise and provide recommendations for the conduct of civil-military operations.

 Control and supervision of Class VIII supply and re-supply movement to include blood
management. When designated by the combatant commander, serves as the SIMLM.

 A joint-capable Army medical C2 capability when augmented with appropriate joint
assets.

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64 Army Health System Doctrine Smart Book 1 June 2020

 Coordination of Army support to other Services for the ship-to-shore/shore-to-ship
MEDEVAC mission.

FUNCTIONS

S1 Section

This section provides overall administrative services for the command, to include personnel
administration, and coordinates with elements of supporting agencies for finance personnel, legal,
and administrative services.

S2 Section

This section performs all-source intelligence assessments and estimates for the command.
Advises the commander and staff on nuclear/chemical surety and CBRN operations.

S3 Section

This section is responsible for plans and operations, deployment, relocation and redeployment of
the Brigade and supervising medical evacuation operations for both air and ground.

S3 Operations Branch

This branch is responsible for authenticating and publishing plans and orders. Exercises staff
supervision over AHS support activities, advises the commander and staff on nuclear/chemical
surety and CBRN operations.

S3 Plans Branch

This branch is responsible for current planning in the MEDBDE [SPT] AO, to include deliberate and
crisis planning. Additionally, it plans for future operations in excess of 72 hours and prepares major
regional contingency plans for the MEDBDE [SPT]. Further, it prepares, authenticates, and
publishes AHS support plans and OPLANs to include the integration of annexes and appendixes
prepared by other staff sections.

S3 Patient Movement Branch

This branch is responsible for maintaining 24 hour coordination and oversight responsibility for
patient regulating and administration within the Brigade AO.

S4 Logistics Operations Branch

This branch monitors, coordinates, and facilitates medical logistics operations within the command.
This includes Class VIII supply and re-supply, blood management and distribution, medical
equipment maintenance and repair, medical gases, and optical lens fabrication and repair.

S9 Section

This section is responsible for the integration of civil-military operations planning within the
MEDBDE [SPT]. Conducts area assessments and estimates on the impact of the local populace
on U.S. MTFs to include the assessment of the host/foreign nation medical infrastructure in
planning for and executing health care delivery.

S6 Section

This section provides for all aspects of automation and CE for the command. Determines C2 signal
requirements, capabilities, and operations. Also, provides advice and consultation on medical
automated systems in use within the Brigade.

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Clinical Operations Section

This section serves as the commander’s principal consultants and technical advisors for the
command in general medicine, PVNTMED to include Neuropsychiatric Care, COSC and behavioral
health. The behavioral health team provides advice and assistance in the areas of behavioral
health and COSC.

Company Headquarters,Provides C2 of the company. Develops the occupation plan,
training and morale, welfare, and recreation activities, life support activities, field
sanitation, and supply for headquarters personnel. Provides unit vehicle maintenance
organic to or allocated for use by the headquarters.

MOBILITY

Early Entry Module. This unit is 100 percent mobile and is able to transport all of its TOE equipment
in a single lift using organic vehicles. The expansion and campaign modules will use organic
vehicles to transport their TOE equipment into an AOR.

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

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66 Army Health System Doctrine Smart Book 1 June 2020

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

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

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MEDICAL BATTALION (MULTIFUNCTIONAL)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08485K000
MEDICAL BATTALION
(MULTIFUNCTIONAL)

16 2 54 0 72

08486KA00 EARLY ENTRY ELEMENT, MED BN (MMB) 11 1 32 0 44

08486KB00
CAMPAIGN SUPPORT ELEMENT, MED BN
(MMB)

5 1 22 0 28

MISSION

To provide a scalable, flexible and modular medical C2, administrative assistance, logistical
support, and technical supervision capability for assigned and attached medical organizations
(companies and detachments) task-organized for support of deployed forces.

ASSIGNMENT

To a MEDCOM [DS], or a MEDBDE [SPT].

DEPENDENCIES

This unit is dependent upon appropriate elements of the theater for religious, legal, FHP, finance,
and personnel and administrative services.

Field feeding company, for field feeding support.

EMPLOYMENT

Normally employed in a MEDCOM [DS], or MED BDE (SPT), AO.

BASIS OF ALLOCATION

One per three to six subordinate company/detachment size units.

CAPABILITIES

This organization provides the following as shown in their respective TOEs.

EARLY ENTRY ELEMENT

HQs detachment, MMB provides medical C2, staff planning, supervision of operations, medical and
general logistics support as required, and administration of the assigned and attached units
conducting FHP operations in its supported AO.

 Task organization of medical assets.

 Advice to senior commanders in the AO on the medical aspects of their
operations.

 Coordination of medical regulating and patient movement within the AO.

 Monitoring, planning, and coordinating ground and air evacuation within the
battalion AO. Coordinating air evacuation support requirements with the
supporting aviation unit, and synchronizing the air evacuation plan into the
overall MEDEVAC plan.

 Consultation and technical advice on preventive medicine (medical entomology,
medical and OEH surveillance, and sanitary engineering), COSC, medical

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68 Army Health System Doctrine Smart Book 1 June 2020

records administration, veterinary services, nursing practices and procedures,
dental services, and automated medical information systems to supported units.

 Guidance for facility site selection and area preparation.

 Monitoring and supervising MEDLOG operations, to include Class VIII supply/re-
supply.

 Consolidated property book support.

 Unit level maintenance for wheeled vehicles and power generation equipment
and wheeled vehicle recovery operations support to assigned or attached units.

 Organizational communications equipment maintenance support for the battalion.

 Food service support for staff and assigned/attached medical units.

 Consolidated maintenance support for assigned/attached medical units. MCAS,
medical company (ground ambulance) (MCGA), medical detachment (blood
support), medical detachment (COSC), MDVSS.

CAMPAIGN SUPPORT ELEMENT

HQs detachment, MMB provides augmentation of medical C2 in, personnel, logistics, AHS support,
medical operations, preventive medicine, behavioral health, automation, maintenance, and food
service to the MMB (early entry element).

Individuals of this organization can assist in the coordinated defense of the unit’s area or
installation.

This unit does perform field maintenance on all organic equipment except communications security
(COMSEC) equipment.

FUNCTIONS

Command Section

This section provides medical C2 of assigned and attached medical companies and detachments.

S1 Section

This section provides overall administrative services for the command, to include personnel
administration, and coordinates with elements of supporting agencies for finance, personnel, legal,
and administrative services.

S2/S3 Section

This section is responsible for security, plans and operations, deployment, relocation, and
redeployment of the battalion and its assigned and attached units. The battalion’s primary net
control station is in this section.

S4 Section

This section is responsible for coordination, control, and management of logistics for assigned and
attached units.

FHP Operations
Is responsible for the planning, coordination, and execution of the FHP and HSS mission within the
battalion’s AOR. Supervises the operations of the medical logistics, operations, preventive

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1 June 2020 Army Health System Doctrine Smart Book 69

medicine, and mental health sections.

Medical Logistics Section

This section is responsible for the planning, coordination, and execution of the Class VIII mission
within the battalion’s AOR. This includes blood and medical maintenance management.

Medical Operations Section

This section is responsible for the planning, coordination, and execution of the FHP area support
mission within the battalion’s AOR. This includes management of area medical support (Role 1
and 2), evacuation, and area dental support.

Preventive Medicine Section

This section is responsible for the planning, coordination, and execution of the preventive medicine
mission within the battalion’s AOR. This includes management of preventive medicine and
veterinary assets.

Mental Health Section

This section is responsible for the planning, coordination, and execution of the COSC mission within
the battalion’s AOR. Collects and records social and psychological data.

S6 Section

This section is responsible for all aspects of information management, automation, and C-E support
to assigned and attached units. The battalion’s alternate net control station is in this section.

Detachment Headquarters

Headquarters provides for billeting, discipline, security, training, and administration for personnel
assigned to the HHD.

Battalion Maintenance Section

Under the staff supervision of the battalion S4, this section provides unit level maintenance for
wheeled vehicles assigned to the HHD and assigned or attached units without unit level
maintenance capability.

MOBILITY

Early Entry Module. This unit is 100 percent mobile and is able to transport all of its TOE equipment
in a single lift using organic vehicles. The campaign modules will use organic vehicles to transport
their TOE equipment into an AOR.

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

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

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COMBAT SUPPORT HOSPITAL (248-BED)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08945K000 COMBAT SUPPORT HOSPITAL (248 BED) 156 2 336 0 494

08950K000 HHD, COMBAT SUPPORT HOSPITAL (248
BED)

11 2 42 0 55

08960K000 HOSPITAL COMPANY (84 BED) 61 0 122 0 183

08948K000 HOSPITAL COMPANY (164 BED) 84 0 172 0 256

MISSION

To provide hospitalization and outpatient services for all classes of patients within the theater.

ASSIGNMENT

To a MEDBDE (SPT), MEDCOM (DS), or a joint/combined task force.

DEPENDENCIES

This unit is dependent upon the following:

 Appropriate elements within theater for religion, legal, FHP, finance, and personnel and
administrative services.

 Quartermaster supply company, for Class I rations to include medical B rations required
for patient feeding.

 Engineer battalion, for site preparation and minor construction.

 Military police company, combat support, for security of enemy prisoners of war (EPW)
patients and U.S. prisoner patients.

 Mortuary affairs team, for mortuary affairs support.

EMPLOYMENT

The CSH is employed in the combat zone.

BASIS OF ALLOCATION

3.78/1000 conventional, 3.957/1000 blister, and 1.315/1000 nerve hospital patients in the corps.

CAPABILITIES

This unit provides—

 Hospitalization for up to 248 patients. The hospital includes a HHD and two completely
functional hospital companies, one 84-bed and one 164-bed. Collectively, this hospital
has four wards providing intensive nursing care for up to 48 patients, and ten wards
providing intermediate nursing care for up to 200 patients.

 HHD, 248-bed CSH provides C2 of all organic/attached units, to include medical
planning, policies, support operations, personnel section, logistical, communications
support information management, and laundry operations.

 HQs section, early entry hospitalization element (44-Bed), and early entry hospitalization
element (44-Bed), hospital company (84-bed) forms a stand-alone hospitalization
element for up to 72 hours without further logistical support. C2 of all organic/attached
units, to include medical planning, policies, and support operations.

 HQs section, hospital augmentation element (40-Bed), provides augmentation for the
early entry hospitalization element (44-Bed), augmentation support for C2, operations,

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72 Army Health System Doctrine Smart Book 1 June 2020

personnel section, logistical, communications support, information management, and
laundry operations.

 HQs section, hospital company (164-bed), augments C2 to the hospital company (84-
bed), and hospital company (164-bed), and is employed in the corps area. Augmentation
for all C2 organic/ attached units to include medical planning policies, support operations,
operational, administrative, logistical, communication support, information management,
and laundry operations within the AO.

 Hospital company, provides up to 30 days stand-alone operations without further
augmentation from the hospital except logistical support.

 Early entry hospitalization element (44-Bed) hospital company A (84-bed), provides up
to 72 hours stand along operations with augmentation from HQs section early entry
hospitalization element (44-Bed), without resupply. Hospitalization for up to 44 patients
consisting of two wards providing intensive care nursing for up to 24 patients, and one
ward providing intermediate care nursing for up to 20 patients.

 Hospitalization augmentation element (40-Bed), hospital company (84-bed), augments
the early entry hospitalization element (44-Bed). Provides outpatient specialty clinic
services, intermediate care hospital beds (40), and augmentation to the company HQs
and supply and service section.

 Transportation element, hospital company (84-bed), provides 100% mobility for the early
entry hospitalization element, hospital company (84-bed), and hospitalization
augmentation element (40-Bed), if deployed/employed.

 Hospital company (164-bed), provides hospitalization for up to 164 patients consisting of
two wards providing intensive care nursing for up to 24 patients, and seven wards
providing intermediate care nursing for up to 140 patients.

 Emergency treatment to receive, triage, and prepare incoming patients for surgery.

 Surgical capability, including general, orthopedic, thoracic, urological, gynecological, and
oral maxillofacial, based on 6 operating room (OR) tables staffed for 96 operating table
hours per day.

 Consultation services for inpatients and outpatients to include area support for units
without organic FHP services.

 Pharmacy, psychiatry, community health nursing, physical therapy, clinical laboratory,
blood banking, radiology, and nutrition care services.

 Routine and emergency dental treatment to staff and patients.

 Medical administrative and logistical services.

 Information to higher HQs on patient’s status within the AO.

 Laundry for patient related linens.

FUNCTIONS

See 84-bed and 164-bed hospital companies.

MOBILITY

See 84-bed and 164-bed hospital companies.

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HOSPITAL COMPANY (84-BED)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08960K000 HOSPITAL COMPANY (84 BED) 61 0 122 0 183

08546KA00
HQ SECTION, EARLY ENTRY
HOSPITALIZATION ELEMENT (44 BED)

3 0 7 0 10

08546KB00
HQ SECTION, HOSPITALIZATION
AUGMENTATION ELEMENT (40 BED)

3 2 20 0 25

08547KC00
TRANSPORTATION ELEMENT, HOSPITAL
COMPANY (84 BED)

0 0 0 0 0

MISSION

Provide hospitalization and outpatient services for all classes of patients within the Corps.

ASSIGNMENT

To a CSH (248-bed).

DEPENDENCIES

This unit is dependent upon the following:

 Appropriate elements within theater for religion, legal, FHP, finance, personnel and
administrative services.

 Quartermaster supply company, for Class I rations to include medical B rations required
for patient feeding.

 Engineer battalion, for site preparation and minor construction.

 Military police company, combat support, for security of EPW patients and U.S. prisoner
patients.

 Quartermaster graves registration team, for mortuary affairs support.

EMPLOYMENT

Hospital company (84-bed), is modularly designed to provide split-base operations and enhances
the ability to tailor HSS to adapt to mission requirements of a smaller magnitude. The 84-bed
hospital company consists of three separate organizations: early entry hospitalization element (44
bed), hospitalization augmentation element (40-Bed), and transportation element, hospital
company (84-bed).

BASIS OF ALLOCATION

One per CSH (248-bed).

CAPABILITIES

This unit provides—

 Up to 30 day stand-alone operations without further augmentation from the hospital
except logistical support.

 Split-based operations capability with strategic deployment of an early entry
hospitalization element, (44-Bed) hospital company (84-bed).

 Early entry hospitalization element, hospital company (84-bed), provides up to 72 hours
stand along operations with augmentation from the HQs section, early entry
hospitalization element, hospital company (84-bed), without resupply. Hospitalization for
up to 44 patients consisting of two wards providing intensive care nursing for up to 24
patients, and one ward providing intermediate care nursing for up to 20 patients.

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 Hospitalization augmentation element, hospital company (84-bed), augments the early
entry hospitalization element (44-Bed), hospital company. Provides outpatient specialty
clinic services, intermediate care hospital beds (40), and augmentation to the company
HQs and supply and service section.

 Transportation element, hospital company (84-bed), provides organic transportation for
the hospital company (84-bed), if deployed/employed.

 Emergency treatment to receive, triage and prepare incoming patients for surgery.

 Surgical capability consisting of general and orthopedic surgery based on 2 OR tables
staffed for 36 operating table hours per day. This unit also provides OR space and time
for the operating table hours required by the hospital augmentation surgical teams.

 Consultation and outpatients referred from other medical treatment facilities.

 Hospitalization for up to 84 patients consisting of two wards providing intensive care
nursing for up to 24 patients, and three wards providing intermediate care nursing for up
to 60 patients.

 Unit level FHP for organic personnel.

 Pharmacy and clinical laboratory services to include limited basic microbiology screening,
blood banking and radiology services.

 Administrative, patient administration, logistical and nutritional care services.

All work areas and assemblages deploy with three days of supply on hand within identified medical
set(s) and with seven days of supplies maintained in the medical materiel set (MMS) medical supply
CSH 84-bed.

When additional capabilities are required, the following hospital augmentation teams may be
attached/assigned: hospital augmentation team, head and neck; medical detachment, minimal
care; hospital augmentation team, pathology; medical team, hemodialysis; medical team, infectious
disease; and hospital augmentation team, special care.

FUNCTIONS

Company Headquarters

Headquarters is responsible for C2, administration, and logistical support required conducting unit
operations. Net control station is located in this element.

S1 Section

This section provides overall administrative services for the hospital, to include personnel
administration, mail distribution, and awards and decorations.

S2/S3 Section

This section is responsible for plans, intelligence, operations, security, deployment,
communications and relocation of the hospital.

S4 Section

This section is responsible for the planning, programming, coordinating, and supervision of all
activities concerning the internal logistical operations of the hospital. Maintains and manages the
hospital’s property book. Responsible for establishing a temporary morgue for handling remains
until remains are transported to the supporting mortuary affairs organization.

S6 Section

This section is responsible for the installation, operation, management and maintenance of the
information management system and internal and external communication links for the company
and attached units.

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1 June 2020 Army Health System Doctrine Smart Book 75

Automation Support Section

This section is responsible for the planning and operation of the units’ information management
systems. Maintains CD-ROM libraries of medical and operational information required for the HHD
and hospital operations. Coordinates with organic and attached units to ensure integration of
information management systems and telemedicine services

Patient Administration Section

This section is responsible for the admission and disposition of patients, maintenance of patient
records, security of patient valuables, coordinates patient evacuations and preparation of patient
statistical reports.

Nutrition Care Section

This section provides hospital nutrition services, meal preparation and distribution to patients and
staff, dietetic planning, patient education, supervision and control of overall operations and
command advisor on health and nutrition.

Supply and Services Sec/Div

This section provides logistics functions throughout the company and attached units, to include
general and medical supplies; medical maintenance; blood management; utilities as well as water
distribution; waste disposal; and environmental control of patient treatment areas; power and
vehicle maintenance, and fuel distribution.

Triage/PRE-OP/EMT Section

This section provides for the receiving, triage, and stabilization of incoming patients. The staff will
receive patients, assess their medical condition, provide EMT and transfer them to the appropriate
areas of the hospital. Alternate net control station is located in this element.

Operating Room/CMS Section

This section provides general, orthopedic, and gynecological surgical services. Provides
scheduling of nursing staff, prepares and maintains OR and CMS. Also, provides sterilization and
operator maintenance of equipment.

Anesthesia Service Section,

This section provides and manages the anesthesia program and respiratory services for the
hospital. Provides supervision and administration of anesthetics to patients undergoing surgery.

Nursing Service Section,

This section provides supervision for all nursing service personnel; forwards daily patient reports
to the chief nurse located at the HHD, CSH and the Patient Administration Section; and is
responsible for standards of nursing practice and nursing care throughout the facility. This section
plans, coordinated and supervises the layout and design of the hospital physical facilities.

Intensive Care Unit (2)

This section provides for critically injured or ill patients. Nursing care is performed for those patients
who require close observation and vital sign monitoring, complex nursing care, and mechanical
respiratory assistance. This section also serves as preoperative stabilization and postanesthesia
recovery area.

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Hospital Ministry Team

This team provides religious support and pastoral care ministry for assigned staff and patients.

Intermediate Care Ward

Provides care for patients whose conditions require observation for real or potential life-threatening
disease/injury.

Pharmacy Section

This section is responsible for quality control of pharmaceuticals, distribution of bulk drugs,
maintenance and publication of the hospital formulary, and the intravenous additive program. It
also provides outpatient medications and provides a five day supply of medications for air
evacuation patients out of the Corps or Theater.

Lab Services/Blood Bank Section

This section performs analytical procedures in hematology, urinalysis, chemistry, blood banking
and limited basic microbiology screening.

Radiology Section

This section provides radiological services to all areas of the hospital.

Laundry Section

This section provides laundry services for patient related linens and coordinates with the Corps
supporting element for all other laundry support.

MOBILITY

This unit requires 100 percent mobility of its TOE equipment to be transported in a single lift;
augmented by the transportation element, hospital company.

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HOSPITAL COMPANY (164-BED)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08546KC00
HQ SECTION, HOSPITAL COMPANY (164
BED)

5 1 15 0 21

08948K000 HOSPITAL COMPANY (164 BED) 84 0 172 0 256

MISSION

To provide hospitalization and outpatient services for all classes of patients within the Corps.

ASSIGNMENT

To a CSH, (248-bed).

DEPENDENCIES

This unit is dependent upon the following:

 Appropriate elements within theater for religion, legal, FHP, finance, personnel and
administrative services.

 Quartermaster supply company, for Class I rations to include medical B rations required
for patient feeding.

 Engineer battalion, for site preparation and minor construction.

 Military police company, combat support, for security of EPW patients and U.S. prisoner
patients.

 Mortuary affairs team, for mortuary affairs support.

 HHD, CSH (248-bed), corps, for battalion level C2 of organic and attached elements
during split-based operations. Also logistical support during stand-alone operations.

 The following hospital augmentation teams when increased combat health support
capabilities are required: hospital augmentation team, head and neck; medical
detachment, minimal care; and FST.

EMPLOYMENT

This unit is employed with the CSH, 84-bed hospital company to make up a complete 248-bed
CSH.

BASIS OF ALLOCATION

One per CSH, (248-bed).

CAPABILITIES

This unit provides—

 Emergency treatment; to receive, triage, and resuscitate casualties.

 Surgical capability, including general, orthopedic, thoracic, urological, gynecological, and
oral maxillofacial, based on 4 OR tables staffed for 60 operating table hours per day.

 Hospitalization for up to 164 patients consisting of two wards providing intensive care
nursing for up to 24 patients, and seven wards providing intermediate care nursing for up
to 140 patients.

 Consultation and outpatient clinic services for patients referred from other medical
treatment facilities.

 Pharmacy, psychiatry, community health nursing, physical therapy, clinical laboratory,
blood banking, radiology and nutrition care services.

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78 Army Health System Doctrine Smart Book 1 June 2020

 Operational dental care that consists of emergency dental care and essential dental care
designed to circumvent potential dental emergencies.

 Augments the hospital Company A (248-bed), CSH, as required by mission.

 Provides power for all nondedicated generator requirements; and field feeding support to
the HHD, CSH.

 All work areas and assemblages deploy with three days of supply on hand within
identified medical sets and with seven days of supplies maintained in the MMS medical
supply CSH.

 Unit level FHP for organic personnel.

 Medical, administrative, and logistical services.

 Individuals of this organization, except the chaplain, can assist in the coordinated defense
of the units’ area or installation.

 In conjunction with maintenance personnel assigned, this unit does perform field
maintenance on all organic equipment, except communications-electronics (CE) and
COMSEC equipment.

FUNCTIONS

Company Headquarters

Headquarters is responsible for C2, administration, and logistical support required to conduct unit
operations.

Patient administration section

This section is responsible for the admission and disposition of patients, maintenance of patient
records, security of patient valuables, coordination of patient evacuations, and preparation of
patient statistical reports for the company.

Nutrition care section

This section is responsible for providing hospital unit nutrition services, meal preparation and
service to patients and staff, dietetic planning, patient education, and advises the command on
health and nutrition, theater dietetic/nutritional health promotion.

Supply and service division

This division is responsible for the logistics functions of the hospital company and attached units,
to include general and medical supplies, medical maintenance, blood management, water
distribution, waste disposal, and environmental control of patient treatment areas, power and
vehicle maintenance, and fuel distribution.

Triage/preoperation (PREOP)/(EMT) section

This section provides for the receiving, triage, and stabilizing of incoming patients. The staff will
receive patients, assess their medical condition, provide EMT and transfer them to the appropriate
areas of the hospital.

Operating room/central materiel services (CMS) section

This section provides general, orthopedic, thoracic, urological, and maxillofacial surgical. It
performs scheduling of nursing staff, prepares and maintains OR and CMS. It provides sterilization
and operator maintenance of surgical equipment.

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Anesthesia service section

This section provides and manages the anesthesia program and respiratory services for the
hospital. Provides supervision and administration of anesthetics to patients undergoing surgery.

Specialty clinic

This clinic provides patient care services including sick call for staff and attached units, primary
care and internal medicine consultation services, evaluation and treatment dermatological and
gynecological diseases, injuries, disorders, and orthopedic and physical therapy services. Also,
provides outpatient psychiatry and inpatient neuropsychiatric consultation services.

Dental section

This section provides dental services and consultation for patients and staff. The dentist will
augment the hospital with additional combat casualty capability.

Nursing service section

This section provides supervision for all nursing service personnel; forwards daily patient reports
to the chief nurse located at the HHD, CSH and the Patient Administration Section; and is
responsible for standards of nursing practice and nursing care throughout the facility. This section
plans, coordinates and supervises the layout and design of the hospital physical facilities.

Intensive care unit (ICU) (x2)

This unit provide for critically injured or ill patients. Nursing care is performed for those patients
who require close observation and vital sign monitoring, complex nursing care, and mechanical
respiratory assistance. This section also serves as the preoperative stabilization and
postanesthesia recovery area.

Intermediate care ward (ICW) (x7)

This ward provides care for patients whose conditions require observation for real or potential life
threatening disease/injury.

Pharmacy section

This section is responsible for quality control of pharmaceuticals, distribution of bulk drugs; provides
a supply of medications for air evacuation patients out of Corps or Theater; maintenance and
publication of the hospital formulary; and the intravenous additive program.

Lab services/blood bank section

This section performs analytical procedures in hematology, urinalysis, chemistry, limited basic
microbiology screening, and blood banking.

Radiology section

This section provides radiological services to all areas of the hospital.

Hospital ministry team

This team provides religious support and pastoral care ministry for assigned staff and patients.

MOBILITY

This unit requires 0 percent mobility of its TOE equipment to be transported by its organic vehicles.

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HOSPITAL CENTER (240-BED)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08976K000 HHD HOSPITAL CENTER 10 0 17 0 27

08988K000 FIELD HOSPITAL (32 BED) 49 3 114 0 166

08977K000
HOSPITAL AUGMENTATION DETACHMENT
(SURGICAL 24 BED) 33 0 33 0 66

08978K000
HOSPITAL AUGMENTATION DETACHMENT
(MEDICAL 32 BED) 19 0 27 0 46

08979K000
HOSPITAL AUGMENTATION DETACHMENT
(ICW 60 BED) 10 0 23 0 33

INTRODUCTION

The HHD, hospital center and field hospital (32-bed) comprise the core and lowest denominator of
the hospital center. The field hospital (32-bed) is the only unit that provides complete clinical
capabilities/staffing required to be designated as a Role 3 MTF. This hospital is deliberately
designed to be self-supporting while remaining light, transportable, and expandable. The HHD,
hospital center and field hospital (32-bed) are designed as the first increments to be deployed in
support of an expeditionary force and can be expanded incrementally to a maximum of a 240-bed
hospital. The HHD, hospital center can command one to two field hospitals (32-bed), with requisite
augmentation detachments and teams, in one or separate locations (dual-based operations)
without staff augmentation.

There are five distinct elements, with associated TOEs, that make up the hospital center: 1) HHD,
hospital center; 2) the field hospital (32-bed); 3) hospital augmentation detachment (medical 32-
bed); 4) hospital augmentation detachment (surgical 24-bed); and 5) hospital augmentation
detachment (ICW 60-bed). When referring to the organization as a whole (or at least the HHD and
one or more of the subordinate units), it is generally called the hospital center (not field hospital).
The field hospital is the 32-bed subordinate unit that is one component within the hospital center.

MISSION

The HHD, hospital center provides mission command for up to two field hospitals (32-bed) and
requisite augmentation detachments all in one location or dual based.

ASSIGNMENT

Assigned to the (MEDBDE [SPT].

DEPENDENCIES

This unit is dependent upon, but not necessarily limited to, the following:

 Appropriate elements of the theater for religious, legal, AHS support, finance, and
personnel and administrative services, mortuary affairs, security of
EPW/retained/detained patients and U.S. prisoner patients, transportation services when
single lift requirements exceed unit capability, vehicle recovery operations, transportation
and equipping for return to duty (RTD) personnel, to include individual clothing and
equipment, seasonal outer garments, chemical protection garments, and shower and
laundry services not related to patient care.

 Quartermaster supply company for Class I, II, III and VII supplies and to provide potable
water and unclassified map support.

 Medical logistics company (MLC) for Class VIII support. Augmentation of personnel for
medical equipment maintenance and repair, as required.

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 Field hospital (32-bed), nutritional care section for feeding of HQs staff.

 Horizontal construction company to construct field hospital platforms.

 Prime power battalion, to generate long term hard-stand electrical power and provide
advice and technical assistance for electrical power and distribution, and for relief of
tactical generators as required for the hospital.

 MDVSS support for zoonotic disease control and investigation, food safety and defense
inspections of medical and nonmedical rations to include suspected CBRN contaminated
rations (as directed), and provision of disposition instructions for contaminated rations.

 Expeditionary signal company to provide automatic switching services for both analog
and digital voice and data traffic, tactical multichannel high capacity transmission
systems, and multichannel satellite ground terminals.

 Casualty liaison team for accurate and timely casualty information, facilitates real-time
casualty information for commanders, and assists in the management of casualty
operations as needed.

 The medical company (air ambulance) (MCAA) to provide Intratheater aeromedical
evacuation support to and between roles of care within the AO, transportation of
emergency Class VIII resupply, and movement of medical personnel.

 The USAF aeromedical evacuation liaison team for coordinating intertheater patient
evacuations.

 In addition to the augmentation detachments routinely associated with the hospital center,
the following specialty augmentation teams/detachment can be attached to increase
medical specialty and support capabilities as needed: hospital augmentation team, head
and neck; medical team, forward surgical; medical detachment, minimal care

EMPLOYMENT

Deploys into a joint operations area (JOA) providing mission command to assigned and attached
units providing hospitalization and outpatient services for all classes of patients within the theater.
It is important to note that the HHD, hospital center is designed to be able to provide mission
command of two field hospitals (32-bed) in two separate locations, not one field hospital (32-bed)
split in two locations. The field hospital (32-bed) is not designed to be split.

RULE OF ALLOCATION

One per a maximum of two field hospitals (32-bed), and hospital augmentation detachments, up to
a total of 240-beds. If medical planners determine that one HHD, hospital center cannot adequately
provide mission command of two separated field hospitals (32-bed) due to distance and insufficient
communications, a second HHD, hospital center should be requested. Attaching a minimal care
detachment (120 cots) does not count against the 240-bed maximum the HHD can C2.

CAPABILITIES

This unit provides—

 Mission command of organic and attached elements, to include AHS support planning,
policies, and support operations within the hospital’s AO.

 Provide information to commanders and staff on the health of the command and on health
aspects affecting the unit’s mission(s) or AHS support.

 Indefinite dual-base capability as required; it can provide C2 of two field hospitals (32-
beds) and associated augmentation detachments collocated as one hospital or in two
separate locations.

 Augmentation to the field hospital (32-bed), motor maintenance section.

 Individuals of this organization are provided weapons for personal defense and protection
of the patients under their care.

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82 Army Health System Doctrine Smart Book 1 June 2020

 This unit does not perform field maintenance on all organic equipment to include
COMSEC equipment.

FUNCTIONS

Command section

This section provides mission command for elements of the hospital and coordination for
hospitalization support within the hospital’s AO. The command section provides advice to
supported tactical commanders on the health of the command and provides medical surveillance
activities within the AO. Command and staff personnel provide supervision and coordination of
administrative, logistics, operations, medical, surgical, nursing, and hospital ministry services. The
commander should consider combining the HHD staff with that of the field hospital (32-bed) it is
collocated with. Neither staff is extremely robust; this technique allows for a more capable 24 hour
staffing. In order to separate functions of the two staffs, another technique is for the HHD staff to
focus “up and out” while the field hospital (32-bed) staff focuses “down and in.”

Clinical operations section

This section consists of the principal consultants and technical advisors for the command in
medical, surgical, and nursing care and manages health care provider credentialing and
administration, as well as clinical care quality assurance, treatment protocol management, and AHS
support and training; establishes patient management policies, and ensures facilities and resources
are adequate to treat all types of disease and injury, to include CBRN casualties; provides staff
supervision of clinical activities throughout the hospital to include proper staffing of the subordinate
hospital elements; plans and coordinates health services clinical resources within the hospital;
plans and coordinates clinical medical resources to provide effective and consistent treatment of
wounded, injured, or sick personnel so as to return to duty or evacuate from the AO; monitors
clinical policies, protocols, and procedures pertaining to the medical and surgical treatment of sick,
injured, and wounded personnel; plans and monitors the provision of combat casualty care within
assigned or attached hospital elements; monitors the management of clinical specialties including
Professional Filler System (PROFIS) and rotation policy.

S1 section

This section provides human resources services for the hospital center and subordinate elements
attached and assigned, to include personnel administration, mail distribution, and awards and
decorations; maintains leave and rest and recuperation schedules; coordinates for morale, welfare,
and recreation support; prepares and manages correspondence for the command; maintains unit
personnel readiness status; ensures personnel and deployment manifests are maintained and
manages the personnel replacement program; coordinates with the senior medical unit’s public
affairs officer for protocol and public affairs support.

S2/S3 section

This section plans and coordinates medical resources to provide effective and consistent treatment
of wounded, injured, or sick personnel so as to return to full duty or evacuate from the AO; plans
and coordinates health services resources within the hospital; assists in maintaining situational
understanding by coordinating for current medical intelligence and the common operating picture
with the MEDBDE [SPT] and MEDCOM [DS] counterintelligence and human intelligence staff
officer/operations staff officer/assistant chief of staff, operations; maintains tactical situational
understanding through coordination with supported units; assists in coordinating AHS training
requirements and execution in the hospital; develops mass casualty (MASCAL) plans and
determines the medical workload requirements based upon the casualty estimate within the
hospital’s AO; develops, synchronizes, and coordinates hospitalization support within the AO to
support the commander’s decisions, planning guidance, and intent; evaluates and interprets
medical statistical data; provides support to the commander for plans, intelligence, operations,

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security, deployment, redeployment, and relocation of the hospital center and subordinate
elements.

S4 section

This section monitors MEDLOG services within the hospital and supported units; monitors health
services and FHP resources within the hospital; determines MEDLOG requirements and priorities;
adapts medical equipment sets (MES) for a specific scenario to include adding items based on
forecasted types of injuries; monitors the requisition, procurement, storage, maintenance,
distribution, management, and documentation of Class VIII materiel, and special hospital items of
subsistence required for patient care; provides planning, programming, coordinating, and
supervision of all activities concerning the internal logistical operations of the hospital center and
subordinate elements; maintains and manages the hospital’s property book; coordinates for
external logistical support requirements such as (nonorganic) equipment transportation support,
inbound resupply tracking and contracts; coordinates for resupply of all classes of supply; monitors
equipment (medical and nonmedical) status, reporting, and repair programs.

S6 section

This section provides for all aspects of automation and CE for the command; determines signal
requirements, capabilities, and operations; provides advice and consultation on medical automated
systems used within the hospital center and subordinate elements; ensures internal and external
communication connectivity within the hospital and subordinate elements; establishes and
maintains internal data and patient digital records.

Transportation section

This section provides organic transportation required for mission accomplishment of the field
hospital (32-bed); provides transportation for the HHD, hospital center; coordinates for external
transport support when the mission demands exceed organic transportation assets. The HHD owns
the majority of the vehicles for the entire hospital while the field hospital (32-bed) provides the
majority of the drivers and motor maintenance. The two elements, as well as the other
augmentation detachments, are very dependent on one another for prioritizing and moving critical
medical capabilities.

MOBILITY

The unit’s organic vehicles are capable of transporting 100 percent of its TOE equipment and
provide transportation for the field hospital (32-bed). The unit’s organic vehicles can transport 35
percent of the field hospital’s (32-bed) TOE equipment in a single lift with personnel augmentation
from the field hospital (32-bed) to assist in driving the vehicles.

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

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

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

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

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

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FIELD HOSPITAL (32-BED)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08988K000 FIELD HOSPITAL (32 BED) 49 3 114 0 166

MISSION

Provide hospitalization and outpatient services for all classes of patients within the theater.

ASSIGNMENT

Assigned to the HHD, hospital center.

DEPENDENCIES

This unit is dependent upon the following:

 Appropriate external elements for religious, legal, AHS support, finance, personnel and
administrative, and logistical services, mortuary affairs, security of EPW patients and U.S.
prisoner patients, transportation support when single lift requirements exceed unit
capability, vehicle recovery operations, transportation and equipping for RTD personnel,
to include individual clothing and equipment, seasonal outer garments, chemical
protection garments, and shower and laundry services not related to patient care.

 Quartermaster supply company for Class I, II, III and VII supplies and to provide potable
water and unclassified map support.

 Medical logistics company for Class VIII support. Augmentation of personnel for medical
equipment maintenance and repair, as required.

 Horizontal construction company to construct field hospital platforms.

 Prime power battalion to generate electrical power and to provide advice and technical
assistance for electrical power and distribution.

 Medical detachment (veterinary service support) for zoonotic disease control and
investigation, food safety and defense inspections of medical and nonmedical rations to
include suspected CBRN-contaminated rations (as directed), and provision of disposition
instructions for contaminated rations.

 Expeditionary signal company to provide automatic switching services for both analog
and digital voice and data traffic, tactical multichannel high capacity transmission
systems, and multichannel satellite ground terminals.

 Casualty liaison team for accurate and timely casualty information, facilitates real-time
casualty information for commanders, and assists in the management of casualty
operations as needed.

 The MCAA to provide Intratheater aeromedical evacuation support to and between roles
of care within the AO, transportation of emergency Class VIII resupply, and movement of
medical personnel.

 The USAF aeromedical evacuation liaison team for coordinating intertheater patient
evacuations.

In addition to the augmentation detachments routinely associated with the field hospital (32-bed),
the following specialty augmentation teams/detachment can be attached to increase medical
specialty and support capabilities as needed: hospital augmentation team, head and neck; FRSD;
medical detachment, minimal care.

EMPLOYMENT

The field hospital (32-bed) is designed to be employed with the HHD, hospital center, and will

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provide mission command, Role 3 hospitalization, and outpatient services in an AO. It is important
to note that providing Role 3 medical capabilities in two locations, controlled by one HHD, hospital
center is performed by two field hospitals (32-bed) in two separate locations, not one field hospital
(32-bed) split in two locations. An individual field hospital (32-bed) is not designed to be split.

With the hospital being a newly designed and fielded unit, very little data exists on the length of
time it takes to establish operations. However, based on comparisons with the CSH and a small
number of field training exercises, it will take approximately 72 hours for the field hospital to
establish limited Role 3 capabilities (EMT, surgery, ICU beds, CMS, and ancillary services required
to support surgery). It will also take another 48-72 hours to establish the entire field hospital (32-
bed) with the full complement of its capabilities.

BASIS OF ALLOCATION

Large-scale combat operations for brigade and EAB hospital direct admissions per 100 occupied
beds: 1.11 field hospitals/100 wounded in action (WIA); 0.66 field hospitals/100 DNBI; 0.39 field
hospitals/100 nerve & 0.82 field hospitals/100 blister. For Theater direct admissions per 100
occupied beds: 0.82 field hospitals/100 WIA; 0.45 field hospitals/100 DNBI; 0.48 field hospitals/100
nerve & 0.47 field hospitals/100 blister. For theater hospital transfer admissions per 100 occupied
beds: 0.77 field hospitals/100 WIA; 0.31 field hospitals/100.

DNBI; 0.93 field hospitals/100 nerve; & 0.13 field hospitals/100 blister. For theater hospital transfer
admissions with skip: 0.69 field hospitals/100 WIA; 0.21 field hospitals/100 DNBI; 0.92 field
hospitals/100 nerve; & 0.92 field hospitals/100 blister.

The MEDCoE, Computational Sciences Division, developed an Excel spreadsheet modeling tool
to assist planners in determining the requisite hospital elements to provide Role 3 medical care in
an AO. The tool is currently named ST 4_02_FH_Solver_Production_with NEO and is located in
the AKO files at AKO Home > Files > Organizations > DOD Organizations > Army > Army Direct
Reporting Unit > MEDCOM > AMEDD Pubs, Policies & FMs > ATPs, FM, STs, and TCs > Special
Text > ST 4_02_10>ST 4_02_FH_Solver_Production_with NEO
(https://www.ako1.us.army.mil/suite/files/4565668).

Note. When the tool is opened, enable editing, enable content, and select one of the
populations at risk categories in the drop-down listings. The medical planner will enter
the correct population at risk (PAR) and estimated beds occupied by four different
categories of patients. The spreadsheet will then calculate the beds and units required
to support the estimation of occupied beds. The medical planner can enter information
in column J and review the results of beds required versus beds allocated by various
hospital unit compositions or configurations.

CAPABILITIES

This unit provides—

 Company level mission command of organic elements to include AHS support, planning,
policies, and support operations within the hospital’s AO and is capable of operating up
to 72 hours with its initial basic load of supply.

 Information to commanders and their staff on the health of their command and on health
aspects affecting the unit’s mission(s) or AHS.

 Indefinite dual-base capability when attached to the hospital center.

 Hospitalization for up to 32 patients consisting of one (1) ward providing intensive nursing
care for up to twelve (12) patients and one (1) ward providing intermediate nursing care
for up to twenty (20) patients.

 Surgical capability, including general, orthopedic, and obstetrics-gynecological based on
two OR tables capable of providing 36 OR hours per day.

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 Emergency treatment to receive, triage, and resuscitate casualties to include not only
military personnel, but Department of Defense (DOD) civilian employees and contractors,
local nationals, detainees, EPWs/retained/detained personnel as required.

 Pharmacy, clinical laboratory, blood banking, radiology/computed tomography and
nutrition care service for patients and organic staff.

 Personnel administration, patient administration, unit maintenance, medical and
nonmedical logistics, laundry services for direct patient-related linen and shower facilities
for ambulatory patients and direct patient care providers.

 Coordination with the USAF TPMRC for medical regulating and movement of patients
from the theater.

 Technical advice and consultation on medical automated information systems and
programs such as the theater medical information program and medical communications
for combat casualty care (MC4).

 All work areas and assemblages deploy with three days of supply on hand within
identified MMSs.

 Provides hospital nutrition services.

 Field maintenance support to all elements of the hospital, and all attached and assigned
units.

 Individuals of this organization (except the chaplains) are provided weapons for personal
defense and protection of the patients under their care.

FUNCTIONS

Command section

This section provides internal mission command and management of the hospital. It provides
administrative support, prepares unit plans for movement, routine and medical support operations,
and mission-related task organization. The commander may consider combining the HHD staff
with that of the field hospital (32-bed). Neither staff is extremely robust; this technique allows for a
more capable 24 hour staffing. In order to separate functions of the two staffs, another technique
is for the HHD staff to focus “up and out” while the field hospital (32-bed) staff focuses “down and
in.”

Company headquarters

This headquarters provides mission command of the field hospital (32-bed). Personnel of this
section supervise and coordinate the operations and administrative services. Provides logistical
functions for the hospital element and attached units, to include general and medical supplies;
environmental control of patient treatment areas; power and vehicle maintenance; fuel distribution;
and equipment records and repair parts management. Provides laundry services for direct patient
care providers and patients and coordinates with appropriate elements within the theater for all
other laundry support. Provides shower services for patients and health care providers.

Operations section

This section plans and coordinates medical resources to provide treatment of wounded, injured, or
sick personnel involving return to duty or evacuation from the hospital’s AO. Plans and coordinates
AHS resources within the hospital’s AO. Assists in maintaining situational awareness by
coordinating for current AHS support information with operations sections at the next higher,
adjacent, and subordinate HQs. Assist in coordinating AHS training requirements and execution
in the hospital. Develops mass casualty plans, and determines the medical workload requirements
based upon the casualty estimate within the hospital’s AO. Develops, synchronizes, and
coordinates AHS within the hospital’s AO to support the commander’s decisions, planning
guidance, and intent. Coordinates AHS training requirements and execution. Provides support to
the commander for plans, intelligence, operations, security, deployment, redeployment and

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relocation of the field hospital and subordinate elements. Responsible for the installation,
operation, management and maintenance of the information management systems. Establishes
and maintains secure and nonsecure local area network, MC4, theater medical information
program, and automated logistics in all sections of the hospital and attached units.

Patient administration section

This section secures and accounts for patients’ valuables. Prepares patient-statistical reports for
the hospital and coordinates reporting to the appropriate mission command structure. Coordinates
requests for patient evacuation and provides reports to higher HQs. Coordinates with patient’s unit
and mortuary affairs for prompt removal of remains and personal effects.

Nutrition care section

This section provides food service management, meal preparation, modified diet preparation,
distribution of foods to patients and staff, and medical nutrition therapy to include: dietetic planning,
patient education, supervision and control of overall nutritional care operations. Provides nutrition
care services for patients, EPW/retained/detained patients while ensuring culturally appropriate
foods are provided according to command guidance. Serves as the command advisor on health
and nutrition.

Supply and services section

This section provides logistical functions for the hospital and attached units, to include medical
supplies; medical maintenance management; blood management; water distribution, waste
disposal, environmental control of patient treatment areas, and temporary hospital morgue.

Motor maintenance section

This section performs field maintenance functions on organic wheeled vehicles, power generation,
quartermaster-chemical equipment and environmental control units.

Laundry/shower section

This section provides laundry services for direct patient care providers and patients; coordinates
with supporting element for all other laundry support not directly related to patient care. Provides
shower services for patients and health care providers.

Triage/Pre-Op/EMT section

This section provides for the receiving, triaging, and stabilizing of incoming patients. The staff will
receive patients, assess their medical condition, provide EMT, and transfer them to the appropriate
areas within the field hospital. The staff will be trained in advanced trauma management, and EMT,
as appropriate. The staff monitors patient conditions and prepares those requiring immediate
surgery for the OR. The litter bearers are responsible for the transportation of patients within the
hospital unit. The EMT personnel read from and input to the automated clinical record, using
available information systems for both inpatient and outpatients. They use automated tools for
access to medical and essential operational information. The section communicates directly with
incoming evacuation platforms (ground and air) to provide en route consultation and to ensure
readiness to receive incoming patients. The section also provides on-site and remote consultation
services via digital means when available.

Operating room/Central materiel services section

This section provides supervision of the OR and CMS. It schedules nursing staff, prepares and
maintains the OR and CMS, and maintains surgical and nursing standards within these areas. It
functions with the anesthesia section to perform initial surgery for battle and nonbattle injuries and
follow-on surgery for patients received from other medical treatment facilities. It provides general,

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orthopedic, obstetrics-gynecological surgical services with two (2) OR tables for a total of 36 hours
of table time per day. It uses automated tools to maintain projected OR schedules and determine
OR surgical backlog in terms of projected hours to complete each surgery and numbers of patients.
It provides records and reports to the commander. The staff reads from and inputs to the automated
clinical record using available information systems. It accesses digital x-ray files for patient care
during surgery. The section functions with the hospital augmentation detachment (surgical 24-bed)
as one surgical service, when consolidated.

Anesthesia service section

This section provides anesthesia and respiratory services for the hospital. It provides supervision
and administration of anesthetics to patients undergoing surgery. The section coordinates with and
assists the EMT section in trauma care services. When consolidated, it functions with the hospital
augmentation detachment (surgical 24-bed) anesthesia and respiratory services as one service.

Nursing service section

This section is responsible for the management of daily operations of nursing services throughout
the hospital, to include scheduling and supervision of nursing staff: preparation and coordination
of duty rosters; emergency mass casualty plans and contingency staffing. It plans, organizes,
executes, and directs nursing care practices and activities of the hospital. This section ensures
clinical training and readiness of medical personnel. It also ensures the clinical validation of
medical equipment sets and the readiness of clinical standing operating procedures. The section
plans, coordinates, and supervises the layout and design of the clinical aspects of the physical
facilities.

ICU

This section provides one (1) 12-bed ICU for critically injured or ill patients and are responsible to
the Nursing Service Section. The ICU provides intensive care for up to twelve (12) patients
requiring the most intensive monitoring/care. The ICUs manage surgical and/or medical patients,
adult and/or pediatric, whose physiological status is so disrupted that they require immediate and
continuous medical and nursing care. The staff is specially trained with the clinical and managerial
skills necessary to deliver safe nursing care to patients with complex nursing and medical problems.
The ICU is also used as a preoperative stabilization area and postanesthesia recovery area for
patients either awaiting surgery or recovering from surgery.

Note. Of the 12-Beds, only 10 are resourced with all of the requisite capabilities of a fully
functioning ICU bed (nursing staff, intravenous pumps, and ventilators). These 2 beds
can be and are typically used as transition beds for patients awaiting evacuation, for
patients that are too complex for the ICW, or simply as overflow beds.

ICW

This section provides one (1) ICW that manages surgical or medical patients whose conditions
require observation for real or potential life-threatening disease/injury. The acuity of care may
range from those requiring constant observation to those patients able to ambulate and begin to
assume responsibility for their care. Although not routine, ICW patients may require monitoring
devices and ventilator support. The ICW consists of 20 beds.

Pharmacy section

This section is responsible for developing, coordinating, and executing programs and policies
ensuring safe and appropriate medication use within the field hospital. The following are key
functions performed by the pharmacy section personnel. Develop, maintain, and publish the
approved hospital formulary; screen all medication orders for drug-drug, drug-nutrient interactions,

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or medication allergies; monitor individual medication therapies for safe and appropriate disease
state management; recommend alternative drug regimens to meet situational requirements;
monitor and report on all medication-related patient safety problems; provide consultation services
to medical and logistical staff; monitor and enforce hospital-wide quality control of pharmaceuticals;
provide outpatient pharmacy services; provide inpatient pharmacy services, including sterile
products preparation services; provide drug/medication information services; provide bulk drug and
controlled substance distribution support for patient care areas; provide direct patient care services,
and provide pharmacy supply and support services. The pharmacy section exercises appropriate
control and accountability for all controlled substances and rosters with signature documentation
for all individuals approved by the field hospital commander to prescribe, receive, order, or
distribute controlled drugs. The pharmacy section provides outpatient medications for the required
number of days to complete therapy and/or the supply of medications required for aeromedical
evacuation out of theater. It uses automated systems for requisition of pharmacy supplies and
interfaces with other unit sections for bulk pharmacy orders and with the supply and services
section for re-supply.

Laboratory services/blood bank section

This section performs analytical procedures in hematology, urinalysis, chemistry, blood banking,
and limited basic microbiology screening. Attachment of the hospital augmentation detachment
(surgical 24-bed) and/or the hospital augmentation detachment, (medical 32-bed) is required if
analytical microbiology capability is required. The section provides blood banking services,
including all routine blood grouping and typing, abbreviated cross-matching procedures,
emergency blood collection, and blood inventory management. This section provides storage and
issues liquid blood components and fresh frozen plasma. It coordinates with the supply and
services section and directly with the medical detachment (blood support) and blood program office
for blood supply and re-supply requirements. It provides automated records and reports of current
and projected blood status to the commander and higher HQs.

Radiology section

This section provides radiological services to all areas of the field hospital and operates on a 24-
hour basis. The radiologist is responsible for the clinical standard operating procedures and
policies.

Computed tomography (CT)

This section provides specialized radiological services to all areas of the hospital. The section
provides diagnostic data concerning foreign bodies in the orbit and eyeball, mediastinum, near the
diaphragm and in other borderline locations in the chest. This section provides essential
information for orthopedic injuries guiding surgical repair.

Hospital ministry team

This section provides religious support and pastoral care ministry for patients, assigned staff, and
subordinate organizations.

MOBILITY

Dependent upon the HHD, hospital center, the field hospital is approximately 35% mobile using
organic and HHD transportation assets.

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

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

Not including living areas, the field hospital (32-bed) requires approximately 6.78 acres.

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

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HOSPITAL AUGMENTATION DETACHMENT
(SURGICAL 24-BED)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08977K000
HOSPITAL AUGMENTATION DETACHMENT
(SURGICAL 24 BED)

33 0 33 0 66

MISSION

Augments the capabilities of the field hospital (32-bed) with thoracic, urology, oral maxillofacial
surgical capabilities, 24 additional ICU beds, outpatient services, and microbiology.

ASSIGNMENT

Assigned to the HHD, hospital center and further attached to the field hospital (32-bed)

DEPENDENCIES

This unit is dependent upon the following:

 Appropriate external elements for religious, legal, AHS support, finance, personnel and
administrative, and logistical services, mortuary affairs, security of
EPW/retained/detained patients and U.S. prisoner patients, transportation services when
single lift requirements exceed unit capability, vehicle recovery operations, transportation
and equipping for RTD personnel, to include individual clothing and equipment, seasonal
outer garments, chemical protection garments, and shower and laundry services not
related to patient care.

 Quartermaster supply company for Class I, II, III and VII supplies and to provide potable
water and unclassified map support.

 Medical logistics company for Class VIII support. Augmentation of personnel for medical
equipment maintenance and repair, as required.

 Field hospital (32-bed), nutritional care section for feeding of hospital staff and patients.

 Horizontal construction company to construct field hospital platforms.

 Prime power battalion to generate electrical power and to provide advice and technical
assistance for electrical power and distribution.

 Medical detachment (veterinary service support) for zoonotic disease control and
investigation, food safety and defense inspections of medical and nonmedical rations to
include suspected CBRN-contaminated rations (as directed), and provision of disposition
instruction for contaminated rations.

 Expeditionary signal company to provide automatic switching services for both analog
and digital voice and data traffic, tactical multichannel high capacity transmission
systems, and multichannel satellite ground terminals.

 Casualty liaison team for accurate and timely casualty information, facilitates real-time
casualty information for commanders, and assists in the management of casualty
operations as needed.

In addition to the augmentation detachments routinely associated with the field hospital (32-bed),
the following specialty augmentation teams/detachment can be attached to increase medical
specialty and support capabilities as needed: hospital augmentation team, head and neck; FRSD;
medical detachment, minimal care.

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EMPLOYMENT

Deploys to a theater or JOA providing additional surgical, capabilities, 24 ICU beds, outpatient
clinic, and microbiology to the field hospital (32-bed). Once attached to the field hospital (32-bed),
this unit loses much of its own autonomy and identity. It is intended to augment a hospital that
already possesses much of its capabilities and therefore, gets absorbed into the field hospital (32-
bed) surgical configuration.

BASIS OF ALLOCATION

Large-scale combat operations for brigade and echelon above brigade direct admissions per 100
occupied beds: 1.11 surgical detachments/100 wounded in action (WIA); 0.00 surgical
detachments/100 DNBI; 0.20 surgical detachments/100 nerve & 0.00 surgical detachments/100
blister. For theater hospital direct admissions per 100 occupied beds: 0.75 surgical
detachments/100 WIA; 0.00 surgical detachments/100 DNBI; 0.00 surgical detachments/100 nerve
& 0.00 surgical detachments/100 blister. For theater hospital transfer admissions per 100 occupied
beds: 0.57 surgical detachments/100 WIA; 0.00 surgical detachments/100 DNBI; 0.00 surgical
detachments/100 nerve; & 0.00 surgical detachments/100 blister occupied beds. For theater
hospital transfer admissions with skip: 0.38 surgical detachments/100 WIA; 0.00 surgical
detachments/100 DNBI; 0.00 surgical detachments/100 nerve; & 0.00 surgical detachments/100
blister occupied beds.

The MEDCoE, Computational Sciences Division, developed an Excel spreadsheet modeling tool
to assist planners in determining the requisite hospital elements to provide Role 3 medical care in
an AO. The tool is currently named ST 4_02_FH_Solver_Production_with NEO and is located in
the AKO files at AKO Home > Files > Organizations > DOD Organizations > Army > Army Direct
Reporting Unit > MEDCOM > AMEDD Pubs, Policies & FMs > ATPs, FM, STs, and TCs > Special
Text > ST 4_02_10>ST 4_02_FH_Solver_Production_with NEO
(https://www.ako1.us.army.mil/suite/files/4565668).

Note. When the tool is opened, enable editing, enable content, and select one of the
populations at risk categories in the drop-down listings. The medical planner will enter
the correct PAR and estimated beds occupied by four different categories of patients.
The spreadsheet will then calculate the beds and units required to support the estimation
of occupied beds. The medical planner can enter information in column J and review the
results of beds required versus beds allocated by various hospital unit compositions or
configurations.

CAPABILITIES

This unit provides—

 Augmentation of surgical capability for thoracic, orthopedic, and oral maxillofacial surgery
based on two (2) OR tables for a total of thirty-six (36) operating table hours per day.

 Augmentation of hospitalization with up to 24 patients consisting of two (2) wards
providing intensive care nursing.

 Consultation and outpatient clinic services for patients referred from other medical
treatment facilities.

 Psychiatry, public health nursing, and physical therapy services.

 Three days’ supply of basic load within identified MMSs in all work areas and deployed
assemblages.

 Individuals of this organization are provided weapons for personal defense and protection
of the patients under their care.

 This unit supplements the medical maintenance capabilities of the field hospital, (32-bed).

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 97

FUNCTIONS

Supply and services section

This section augments the supply and services functions within the field hospital (32-bed) to
increase logistics capabilities (medical, utilities, and generator maintenance, and MEDLOG.

Operating room/Central materiel services section

This section incrementally expands the operative capabilities of the hospital with two OR tables
and staffed for 36 operating hours per day. Provides sterilization and operator maintenance of
equipment.

Anesthesia service section

This section incrementally expands the anesthesia and respiratory service capacities of the
hospital. Provides supervision and administration of anesthetics to patients undergoing surgery.

ICUs

This section incrementally expands the capacity of the hospital to care for critically injured or ill
patients. Nursing care is performed for those patients who require close observation and vital sign
monitoring, complex nursing care, and mechanical respiratory assistance. This section also serves
as preoperative stabilization and postanesthesia recovery area.

Specialty clinics section

This section provides ambulatory care expansion capabilities of the field hospital (32-bed) to
primary care, family practice, and psychiatry. Provides patient care and family medicine
consultation services, evaluation and treatment of dermatological and gynecological diseases,
injuries, disorders, orthopedic and physical therapy services. Provides outpatient psychiatry and
inpatient neuropsychiatric consultation and education services. Provides an obstetrics-gynecology
clinic with the basic medical supplies and equipment necessary to evaluate, diagnose, and clinically
manage routine patient complaints related to the female reproductive system. Provides an
orthopedic clinic with the basic medical supplies and equipment necessary to evaluate, diagnose
and clinically manage musculoskeletal conditions, to include mobile cast capability. Provides the
supplies and equipment to conduct sick call operations and comprehensive routine medical care to
include electrocardiographs in the medical services clinic. Provides a physical-occupational clinic
to evaluate and treat neuromusculoskeletal injuries, minor soft tissue wounds to include burn
wound treatment, behavioral health, injury prevention, and human performance optimization.

Microbiology section

This section provides additional capability to the field hospital (32-bed) to accomplish aerobic and
anaerobic cultures, limited parasitology and antibiotic susceptibility testing.

MOBILITY

This unit has no organic vehicles and relies on the HHD, hospital center and theater assets for
mobility.

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98 Army Health System Doctrine Smart Book 1 June 2020

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

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

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 99

HOSPITAL AUGMENTATION DETACHMENT
(MEDICAL 32-BED)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08978K000
HOSPITAL AUGMENTATION DETACHMENT
(MEDICAL 32 BED)

19 0 27 0 46

MISSION

Augments the field hospital (32-bed) with operational dental care, one additional ICU ward (12-
Beds), one ICW ward (20-Beds), additional microbiology capabilities and outpatient services for all
classes of patients.

ASSIGNMENT

To the HHD, hospital center (further attached to the field hospital [32-bed]).

DEPENDENCIES

This unit is dependent upon the following:

 Appropriate external elements for religious, legal, AHS support, finance, personnel and
administrative, and logistical services, mortuary affairs, security of
EPW/retained/detained patients and U.S. prisoner patients, transportation services when
single lift requirements exceed unit capability, vehicle recovery operations, transportation
and equipping for RTD personnel, to include individual clothing and equipment, seasonal
outer garments, chemical protection garments, and shower and laundry services not
related to patient care.

 Quartermaster supply company for Class I, II, III and VII supplies and to provide potable
water and unclassified map support.

 Medical logistics company for Class VIII support. Augmentation of personnel for medical
equipment maintenance and repair, as required.

 Field hospital (32-bed), nutritional care section for feeding of hospital staff and patients.

 Horizontal construction company to construct field hospital platforms.

 Prime power battalion to generate electrical power and to provide advice and technical
assistance for electrical power and distribution.

 Medical detachment (veterinary service support) for zoonotic disease control and
investigation, food safety and defense inspections of medical and nonmedical rations to
include suspected CBRN-contaminated rations (as directed), and provision of disposition
instruction for contaminated rations.

 Expeditionary signal company to provide automatic switching services for both analog
and digital voice and data traffic, tactical multichannel high capacity transmission
systems, and multichannel satellite ground terminals.

 Casualty liaison team for accurate and timely casualty information, facilitates real-time
casualty information for commanders, and assists in the management of casualty
operations as needed.

In addition to the augmentation detachments routinely associated with the field hospital (32-bed),
the following specialty augmentation teams/detachment can be attached to increase medical
specialty and support capabilities as needed: hospital augmentation team, head and neck; FRSD;
medical detachment, minimal care.

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100 Army Health System Doctrine Smart Book 1 June 2020

EMPLOYMENT

Deploys to a theater providing augmentation of additional intensive and intermediate medical care,
additional microbiology capabilities and outpatient services to the field hospital (32-bed). Once
attached to the field hospital (32-bed), this unit loses much of its own autonomy and identity. It is
intended to augment a hospital that already possesses much of its capabilities and therefore, gets
absorbed into the field hospital (32-bed) operations.

BASIS OF ALLOCATION

LSCO for brigade/and EAB hospital direct admissions per 100 occupied beds: 0.50 medical
detachments/100 wounded in action (WIA); 0.58 medical detachments/100 DNBI; 0.20 medical
detachments/100 nerve and 0.72 medical detachments/100 blister. For theater hospital direct
admissions per

100 occupied beds: 0.07 medical detachments/100 WIA; 0.40 medical detachments/100 DNBI;
0.42 medical detachments/100 nerve & 0.41 medical detachments/100 blister. For theater hospital
transfer admissions from the theater per 100 occupied beds: 0.20 medical detachments/100 WIA;
0.27 medical detachments/100 DNBI; 0.81 medical detachments/100 nerve; & 0.12 medical
detachments/100 blister. For theater hospital transfer admissions with skip per 100 occupied beds:
0.31 medical detachments/100 WIA; 0.18 medical detachments/100 DNBI; 0.81 medical
detachments/100 nerve; & 0.81 medical detachments/100 blister.

The MEDCoE, Computational Sciences Division, developed an Excel spreadsheet modeling tool
to assist planners in determining the requisite hospital elements to provide Role 3 medical care in
an AO. The tool is currently named ST 4_02_FH_Solver_Production_with NEO and is located in
the AKO files at AKO Home > Files > Organizations > DOD Organizations > Army > Army Direct
Reporting Unit > MEDCOM > AMEDD Pubs, Policies & FMs > ATPs, FM, STs, and TCs > Special
Text > ST 4_02_10>ST 4_02_FH_Solver_Production_with NEO
(https://www.ako1.us.army.mil/suite/files/4565668).

Note. When the tool is opened, enable editing, enable content, and select one of the
populations at risk categories in the drop-down listings. The medical planner will enter
the correct PAR and estimated beds occupied by four different categories of patients.
The spreadsheet will then calculate the beds and units required to support the estimation
of occupied beds. The medical planner can enter information in column J and review the
results of beds required versus beds allocated by various hospital unit compositions or
configurations.

CAPABILITIES

This unit provides—

 Augmentation to the field hospital (32-bed) with hospitalization for up to 32 patients
consisting of one (1) ward providing intensive care nursing for up to 12 patients, requiring
the most intensive monitoring/care, and one (1) ward providing intermediate care nursing
for up to twenty (20) patients.

 Augmentation to the specialty clinic with consultation and outpatient clinic services for
patients referred from other medical treatment facilities, as well as additional psychiatry,
community health nursing, and physical therapy capabilities.

 Operational dental care consisting of emergency dental care and essential dental care
designed to circumvent potential dental emergencies.

 Augmentation to the hospital with additional personnel for patient administration,
logistical and nutritional care services.

 Three days of supply within all sections and MMSs.

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 101

 Individuals of this organization are provided weapons for personal defense and protection
of the patients under their care.

 Supplements the supply and services section within the hospital (medical, utilities, and
generator maintenance and MEDLOG).

FUNCTIONS

Detachment Headquarters

Once attached to a field hospital (32-bed), has little ability to do extensive C2 functions. The
commander functions as the clinical head nurse in the ICW and the detachment senior NCO is a
wardmaster.

Nutrition care section

This section augments the hospital with additional personnel for the nutrition care section providing
nutrition services.

Supply and services section

This section augments the supply and services section of the hospital with additional personnel to
increase the logistical functions (medical, utilities, and generator maintenance and MEDLOG).

Anesthesia service section

This augments the hospital with additional personnel to incrementally expand the anesthesia and
respiratory service capacities of the hospital.

ICU

This section augments the hospital with one 12-bed ICU providing for critically injured or ill patients.
The ICU manages surgical and/or medical patients, adult and/or pediatric patients whose
physiological state is so disrupted that they require immediate and continuous medical and nursing
care.

ICW

This section augments the hospital with one ICW managing surgical or medical patients whose
conditions require observation for real or potential life-threatening disease/injury. The acuity of
care may range from those requiring constant observation to those patients able to ambulate and
begin to assume responsibility for their care. The ICW ward consists of 20-Beds.

Specialty clinics section

This section augments the hospital’s specialty clinics section, providing additional outpatient
capabilities. Provides limited inpatient neuropsychiatric services and preventive medicine
surveillance of disease and nonbattle injuries. In addition, provides inpatient and outpatient on-site
consultations and provides public health nursing support in the identification and treatment of
illnesses resulting from the health threat in the AO.

Dental section

This section provides dental services and consultation for patients and staff. Dentist will augment
the hospital with additional combat casualty care capabilities during mass casualty situations.

Microbiology section

This section augments the hospital with additional microbiology capabilities.

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102 Army Health System Doctrine Smart Book 1 June 2020

MOBILITY

This unit has no organic vehicles and relies on the HHD hospital center’s transportation section for
mobility.

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

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

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 103

HOSPITAL AUGMENTATION DETACHMENT
(INTERMEDIATE CARE WARD 60-BED)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08979K000
HOSPITAL AUGMENTATION DETACHMENT
(ICW 60 BED)

10 0 23 0 33

MISSION

The hospital augmentation detachment (ICW 60 bed) augments the capabilities of the field hospital
(32 bed) with three additional ICWs providing intermediate nursing care and additional personnel
to support nutrition and patient administration capabilities.

ASSIGNMENT

Assigned to the HHD, hospital center and usually further attached to a field hospital (32 bed).

DEPENDENCIES

This unit is dependent upon the following:

 Appropriate external elements for religious, legal, AHS support, finance, personnel and
administrative, and logistical services, mortuary affairs, security of EPW patients and U.S.
prisoner patients, transportation services when single lift requirements exceed unit
capability, vehicle recovery operations, transportation and equipping for RTD personnel
(to include individual clothing and equipment, seasonal outer garments, chemical
protection garments, and shower and laundry services not related to patient care).

 Quartermaster supply company for Class I, II, III and VII supplies and to provide potable
water and unclassified map support.

 Medical logistics company for Class VIII support. Augmentation of personnel for medical
equipment maintenance and repair, as required.

 Horizontal construction company to construct field hospital platforms.

 Prime power battalion to generate electrical power and to provide advice and technical
assistance for electrical power and distribution.

 MDVSS support for zoonotic disease control and investigation, food safety and defense
inspections of medical and nonmedical rations to include suspected CBRN-contaminated
rations (as directed), and provision of disposition instruction for contaminated rations.

 Expeditionary signal company to provide automatic switching services for both analog
and digital voice and data traffic, tactical multichannel high capacity transmission
systems, and multichannel satellite ground terminals.

 Casualty liaison team for accurate and timely casualty information, facilities real-time
casualty information for commanders, and assists in the management of casualty
operations as needed.

 USAF Aeromedical evacuation liaison team for coordinating patient evacuations.

EMPLOYMENT

Deploys into an AO to augment the field hospital (32-bed), engaged in the operational support of
hospitalization and outpatient services for all classes of patients within the theater.

BASIS OF ALLOCATION

LSCO, for brigade/and EAB hospital direct admissions per 100 occupied beds: 0.61 ICW
detachments/100 wounded in action (WIA); 0.66 ICW detachments/100 DNBI; 0.39 ICW
detachments/100 nerve and 0.82 ICW detachments/100 blister. For theater hospital direct

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104 Army Health System Doctrine Smart Book 1 June 2020

admissions per 100 occupied beds: 0.82 ICW detachments/100 WIA; 0.45 ICW detachments/100
DNBI; 0.48 ICW detachments/100 nerve & 0.47 ICW detachments/100 blister. For theater hospital
transfer admissions per 100 occupied beds: 0.77 ICW detachments/100 WIA; 0.31 ICW
detachments/100 DNBI; 0.93 ICW detachments/100 nerve; & 0.13 ICW detachments/100 blister.
For theater hospital transfer admissions with skip per 100 occupied beds: 0.69 ICW
detachments/100 WIA; 0.21 ICW detachments/100 DNBI; 0.92 ICW detachments/100 nerve; &
0.92 ICW detachments/100 blister.

Stabilize, apply major combat operations rule for US supported forces and add for directed support
for host nation PAR at one (1) medical detachment (60-bed hospital augmentation, ICW) per
50,000.

Enable Civil Authority, rules of allocation adjustments will be based on roles of care directed and
PAR supported.

The MEDCoE, Computational Sciences Division, developed an Excel spreadsheet modeling tool
to assist planners in determining the requisite hospital elements to provide Role 3 medical care in
an AO. The tool is currently named ST 4_02_FH_Solver_Production_with NEO and is located in
the AKO files at AKO Home > Files > Organizations > DoD Organizations > Army > Army Direct
Reporting Unit > MEDCOM > AMEDD Pubs, Policies & FMs > ATPs, FM, STs, and TCs > Special
Text > ST 4_02_10>ST 4_02_FH_Solver_Production_with NEO
(https://www.ako1.us.army.mil/suite/files/4565668).

Note. When the tool is opened, enable editing, enable content, and select one of the
populations at risk categories in the drop-down listings. The medical planner will enter
the correct PAR and estimated beds occupied by four different categories of patients.
The spreadsheet will then calculate the beds and units required to support the estimation
of occupied beds. The medical planner can enter information in column J and review the
results of beds required versus beds allocated by various hospital unit compositions or
configurations.

CAPABILITIES

This unit provides—

 Hospitalization for up to 60 patients consisting of three (3) wards providing intermediate
nursing care.

 Augmentation to the patient administration and nutrition care sections.

 Individuals of this organization are provided weapons for personal defense and protection
of the patients under their care.

 This unit does not perform field maintenance on all organic equipment to include
COMSEC equipment.

 This unit supplements the maintenance and nutrition care capabilities of the field hospital,
(32-bed).

FUNCTIONS

Nutrition Care Section

This section augments the field hospital with additional personnel to increase nutrition services.

Patient Administration Section

This section augments the field hospital with additional personnel to increase patient administration
services.

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 105

ICW

This section augments the field hospital with three (3) ICWs to increase the intermediate nursing
care by managing surgical or medical patients whose conditions require observation for real or
potential life-threatening disease/injury. The acuity of care may range from those requiring constant
observation to those patients able to ambulate and begin to assume responsibility for their care.
The role of care and acuity of these patients may fluctuate depending on the intensity of their injury
or illness. Although not routine, ICW patients may require monitoring devices and ventilator
support. Each ICW consists of 20-Beds.

MOBILITY

This unit has no organic vehicles and relies on the HHD hospital center’s transportation section for
mobility.

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

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106 Army Health System Doctrine Smart Book 1 June 2020

MEDICAL DETACHMENT, MINIMAL CARE

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08949K000 MED DET, MINIMAL CARE 7 0 31 0 38

MISSION

To provide minimal care/convalescent care, hospitalization, nursing, and rehabilitative services in
support of theater hospitals.

ASSIGNMENT

To a MEDBDE [SPT], and normally attached to a hospital center (240-bed) or CSH (248-bed).

DEPENDENCIES

This unit is dependent upon the following:

 Appropriate elements within the theater for religious, legal, force health protection,
finance, and personnel and administrative services.

 The hospital to which attached for food service, water distribution, personnel and
administrative services, unit health services, patient administration, medical
maintenance, supply (all classes), and unit maintenance for the detachment’s
communication equipment and power generation.

 The hospital to which attached for additional power requirements.

 The dental company (area support) (DCAS) and the COSC for augmentation of treatment
capabilities.

EMPLOYMENT

The Medical Detachment, Minimal Care provides nursing, physical therapy, and occupational
therapy services for those patients expected to return to duty (RTD) within the theater evacuation
policy or who are awaiting further medical evacuation. Each squad of the detachment may be
employed seperately providing 40 minimal care beds per squad.

BASIS OF ALLOCATION
This unit supports the requirement for all Combat Zone Minimal Care Ward (MCW) bed
requirements (25% of the total wounded in action (WIA)/disease and non-battle injury (DNBI);
21.5% of Blister; and 55% of Nerve) and all communications zone (COMMZ) MCW bed
requirements (75% of the total bed requirements with an 70% skip policy). To get total bed
requirements, Minimal Care Detachment, bed requirements must be added to the intensive care
unit (ICU)/intermediate care ward (ICW) bed requirements generated by the Corps and EAC
Hospital.

CAPABILITIES

This unit provides—

 C2 of organic elements to include HSS, planning, policies, and support operations within
the detachments area of responsibility.

 Information to commanders and their staffs on the health and status of Soldiers in their
command.

 Augmentation of the hospital to which attached to provide hospitalization and minimal
nursing care for up to 120 patients and for reconditioning and rehabilitation for those

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 107

patients who can return to duty within the theater evacuation policy or who are awaiting
further medical evacuation.

 Physical therapy and occupational therapy services for patients.

 Augmentation for the emergency nursing capabilities of the hospital to which attached
during mass casualty situations.

 Augmentation to the nutrition care capabilities of the hospital to which attached to support
patient feeding of this detachment.

 Augmentation to the patient admin section of the hospital to which attached to support
patient records.

 Three days of supply level for all organic elements upon deployment and during routine
operations.

 Individuals of this organization can assist in the coordinated defense of the unit’s area or
installation.

This unit does not perform field maintenance on any organic equipment to include COMSEC
equipment.

FUNCTIONS

The function of this detachment is to perform minimal care nursing, occupational therapy, and
physical therapy for the patients admitted to the hospital to which attached and to other eligible
personnel as determined by the medical command (deployment support) and medical brigade
(support). Organic personnel of the detachment set up and break down unit shelters and power-
generating equipment in preparation for detachment operations or detachment movement, set up
the nursing care and occupational therapy, physical therapy areas, and perform routine minimal
care nursing and rehabilitation and reconditioning for patients expected to return to duty within the
theater evacuation policy or who are awaiting medical evacuation and require continued nursing
supervision to include those individuals being monitored after suspected biological warfare agent
and communicable disease contact. The detachment is normally attached to the hospital and
provides a detachment headquarters, an occupational and physical therapy section, and three
minimal care wards.

Detachment Headquarters

The section provides C2 and administrative support. Performs unit plans and movement, routine
and specialized operations, mission-related task organization, and coordinates directly with the
hospital to which attached. Personnel of the headquarters and support section provide
maintenance and supply and services to augment the respective sections of the hospital to which
attached.

Occupational and physical therapy section

This section provides occupational therapy and physical therapy services to the detachment’s
inpatients. Personnel in this section augment the respective sections of the hospital to which
attached.

Minimal care ward 40 Bed (3)

This section three minimal care nursing squads provide nursing supervision and management of
medical or surgical patients who are ambulatory and partially self-sufficient and are in the final
stages of recovery, awaiting return to duty, or who are awaiting further medical evacuation. The
focus of nursing management is on an aggressive therapeutic environment which speeds recovery
for RTD or which ensures stabilization and preparation for medical evacuation. Nursing personnel
administer medications and treatments which cannot be done by the patient and provide instruction
in self-care and posthospitalization health maintenance. Nursing personnel coordinate with the
occupation/physical therapy personnel for rehabilitation and reconditioning of patients. Nursing
personnel also coordinate with the hospital to which attached for routine and emergency medical

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108 Army Health System Doctrine Smart Book 1 June 2020

treatment needs of patients.

MOBILITY

This unit requires 35 percent mobility of its TOE equipment to be transported in a single lift using
organic equipment. This organization does not have organic lift capability and requires
transportation support for movement. This unit has 181,305 pounds (16,600 cubic feet) of TOE
assets requiring transportation.

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

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 109

HOSPITAL AUGMENTATION TEAM, HEAD AND NECK

SRC TITLE REQ
OFF

REQ
WO

REQ
ENL

REQ
CIV

REQ
TOT

08527KA00 HOSP AUG TM, HEAD & NECK 9 0 9 0 18

MISSION

To provide ear, nose and throat surgery, neurosurgery and eye surgery augmentation in support of
theater hospitals and consultative services as required.

ASSIGNMENT

To an MEDCOM [DS] or MEDBDE [SPT], and normally attached to a hospital, either the CSH (248
Bed) or the HHD, Hospital Center.

DEPENDENCIES

This unit is dependent on—

 Appropriate elements within the theater for religious, legal, force health protection,
finance, and personnel and administrative services.

 The hospital to which it is attached will provide sheltered OR, commonly used equipment,
pre and postoperative nursing care for all patients, field feeding (to include patient field
feeding), FHP, personnel and administrative services, unit level maintenance,
transportation, security, patient administration, coordination of medical evacuation, power
to support all equipment (except that related to the Computerized Tomography) and all
classes of supply.

EMPLOYMENT

This team will be employed with and further attached to hospitals.

BASIS OF ALLOCATION

One per 650 conventional hospital patients in the theater.

CAPABILITIES

This unit provides—

 Initial and secondary ear, nose, and throat surgery and consultation services in support
of theater hospitals.

 Initial and secondary neurosurgery and consultation services in support of theater
hospitals.

 Initial and secondary eye surgery and consultation services in support of theater
hospitals.

 Augmentation to the hospital operating room surgical and nursing services.

 A MMS radiology, computerized tomography which enables the hospital to perform
computerized tomography examinations.

 Three days of supply for use upon deployment and during routine operations.

 Individuals of this organization can assist in the coordinated defense of the unit’s area or
installation.

This unit does not perform field maintenance on any organic equipment.

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110 Army Health System Doctrine Smart Book 1 June 2020

FUNCTIONS

The function of the hospital augmentation team (head and neck) is to provide preoperative
assessment and perform neurosurgery; ear, nose, and throat surgery; and ophthalmic surgery for
patients admitted to the hospital to which the unit is attached. The team will also provide the hospital
with neurosurgical, ophthalmic, and otolaryngological consultation services and postoperative
follow up.

The equipment for the hospital augmentation team (head and neck) no longer includes the MMS
(radiology, CT). This set is provided by the field hospital (32 bed) so the hospital augmentation
team (head and neck) can perform CT scans prior to surgery and will decrease the requirement for
exploratory surgery. The hospital augmentation team (head and neck) does not include an OR and
work areas and will perform surgery utilizing the OR and central materiel supply complex of the
hospital to which it is attached. When attached to the hospital, it falls under the supervision of the
chief, professional services.

MOBILITY

This unit has no organic mobility. This unit has 55,046 pounds (5,031 cubic feet) of TOE assets
requiring external transportation support.

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 111

FORWARD RESUSCITATIVE AND SURGICAL
DETACHMENT (FRSD)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08528KA00
MEDICAL DETACHMENT, FORWARD
RESUSCITATIVE AND SURGICAL (FRSD)

13 0 7 0 20

08528KB00

MEDICAL DETACHMENT, FORWARD
RESUSCITATIVE AND SURGICAL (FRSD)
AIRBORNE

13 0 7 0 20

MISSION

The FRSD provides forward damage control resuscitation and damage control surgery in support
of unified land operations, either independently, or as part of a future unified action partner coalition,
for short and extended military HSS operations.

ASSIGNMENT

Assigned to MEDCOM [DS] or MEDBDE [SPT] and attached to a hospital center or CSH when not
operationally employed and further attached forward to a medical company. W hen the FRSD is
attached to a Role 2 BSMC, MCAS, or when co-located with another service Role 2 medical
organization capable of meeting its support requirements, the FRSD can provided urgent initial
surgery for otherwise nontransportable patients. In this configuration, the FRSD and Role 2 MTF
maximize health system synergies and capabilities such as access to x-ray, ancillary support,
patient holding and proximity to evacuation modalities. In this configuration, the FRSD when co-
located with a role II facility provides a surgical element much smaller than the Role 3 MTF (Army
CSH or hospital center). The FRSD may also augment a Role 3 MTF to provide additional surgical
capability if required.

DEPENDENCIES

This unit is dependent upon—

 Appropriate elements within the theater for religious, legal, FHP, finance, and personnel
and administrative services.

 When operationally attached to a BSMC (Airborne, Armor, Infantry, and SBCTs), the
brigade medical supply office/section provides medical equipment maintenance and
repair and Class VIII A and B (blood) resupply. The BCTs general support aviation
battalion (GSAB) for patient aeromedical evacuation. In the corps (EAB), the MMB for
medical maintenance and repair and Class VIII A and B (blood) resupply. The MLC and
medical detachment, blood support, and ground ambulance evacuation of patients,
MCGA.

 Appropriate elements of the sustainment brigade, quartermaster company (aerial delivery
support) or the brigade support battalion (BSB) (airborne), Infantry BCT (airborne) for
rigging when airdrop operations are required (airborne only).

 If deployed as part of a multinational or coalition force, joint task force, or in support of
special operations forces, it is critical that the HSS planner consider personnel and
equipment augmentation in the following areas: command, control and communications,
medical operations planning, power generation, vehicle maintenance, food service, force
protection, patient administration, pharmacy, patient holding, instrument sterilization,
Class VIII resupply, medical equipment maintenance and repair, x-ray services, medical
laboratory services, and sick call (primary care physician).

 Field feeding support is provided by the organization to which it is attached.

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112 Army Health System Doctrine Smart Book 1 June 2020

EMPLOYMENT

The FRSD is assigned to the MEDCOM [DS], MEDBDE [SPT], and attached to a hospital
center/CSH, when not operationally employed and further attached to a medical company.

BASIS OF ALLOCATION

One per committed armored, infantry (not including infantry brigade combat team [airborne]) BCT.
One per BCT assigned to a theater conducting stability and reconstruction operations.

CAPABILITIES

This unit provides—

 A standardized, rapidly deployable, networked, self-mobile, modular, and scalable
resuscitative and surgical team capable of supporting short (<72hr) and extended (>72hr)
operations, including the ability to support split based operations. The team will be
modular and scalable, with the ability to provide emergency treatment to receive, triage,
and prepare incoming patients for surgery, and provide the required surgery and
continued postoperative care the following configurations to support single or split based
operations.

 Complete FRSD, consisting of the following components; administration/supply, two
surgical and two resuscitative elements (20 personnel). In this configuration the FRSD
provides emergency treatment to receive, triage, and prepare 30 incoming casualties for
surgery over a 72 hour period; provides the required surgery and continued postoperative
care for critically wounded/injured patients with organic MES. Postoperative care can
manage 8 patients over 6 hours postsurgery

 Two resuscitative and surgical elements, capable of supporting split based operations,
each consisting of administration/supply, surgical and resuscitative sections (10
personnel). In this configuration the FRSD provides emergency treatment to receive,
triage, and prepare 12 incoming casualties for surgery over a 72 hour period; provides
the required surgery and continued postoperative care for critically wounded/injured
patients with organic MES. Postoperative care can manage 4 patients over 6 hours
postsurgery

 Two surgical elements, capable of supporting very short duration (24 hours) operations,
consisting of only a surgical element (6 personnel). In its smallest configuration, the single
surgical element provides emergency treatment to receive, triage, and prepare 4
incoming casualties for surgery. It also provides the required surgery and limited
continued postoperative care for those critically wounded/injured patients over a period
of 24 hours with its organic MES.

 Urgent initial surgery for otherwise nontransportable patients, primarily when attached to
a Role 2 MTF to maximize health system synergies (e.g. access to x-ray, ancillary
support, patient holding, proximity to evacuation modalities), or when co-located with
another organization capable of meeting its support requirements.

 HSS operations for both short (<72hr) and extended (>72hr) duration missions dependent
on METT-TC, provided that it achieves its personnel work rest cycles and gains
associated dependency support (see 8.0).

 Postoperative acute nursing care for up to 8 patients simultaneously for up to 6 hours
prior to further patient evacuation.

 Technical advice and assistance to the supported unit surgeon and the surgeon
section/medical operations center for the surgical services portion of the supported unit
plans and policies.

 Surgical augmentation of the Role 3 MTFs surgical capability.

 Individuals of this organization can assist in the coordinated defense of the unit’s area or
installation.

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 113

 This unit does not perform field maintenance on organic equipment to include COMSEC
equipment.

FUNCTIONS

Administration/supply section

This section provides unit-level administration, supplies management, maintenance and
operational planning support. The cell is led by the senior clinician of the FRSD, whose primary
function is as the O5 61J clinician within the surgical section.

Surgical section

This section provides surgical services including anesthesia services, infection control and damage
control surgery as well as postoperative care including; initial burn management, continuing trauma
resuscitation (e.g. blood products, parenteral fluids, advanced airway management, IV/IO/Central
line placement, etc.), and critical care services (e.g. management of mechanical ventilation,
advanced wound management and postoperative recovery care (e.g. pain management,
pulmonary therapy, fluid resuscitation). To enable the most efficient surgical throughput, each
surgical section is designed to be supported by a resuscitation section. A surgical section can be
employed separately from the FST for very short duration operation (24hr), normally conducted in
support of special operations forces missions. The surgical section can provide limited ancillary
services to include point of care lab assay measurement and imaging modalities to assist with
ongoing assessment and to guide further treatments and interventions.

Resuscitative section

This section provides advanced trauma management including; initial burn management and
trauma resuscitation (e.g. blood products, parenteral fluids, advanced airway management,
IV/IO/Central line placement, etc.). The resuscitative section can also provide limited ancillary
services with point of care lab assay measurement and imaging modalities (such as, ultrasound)
to assist with initial assessment and ongoing patient management and treatment.

MOBILITY

This unit requires 100 percent mobility of its TOE equipment to be transported in a single lift using
organic equipment.

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114 Army Health System Doctrine Smart Book 1 June 2020

Figure 3-22. Complete Forward Resuscitative Surgical Detachment

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

Configuration
Personnel In Each Element Capabilities

Admin/Supply Surgical Resuscitative Emergency Treatment Post-Op Care for

FRSD (20 pax) 2 p 12 p 6 p 30 over 72 hrs 8 over 6 hrs

Split-based (10 pax) 1 p 6 p 3 p 12 over 72 hrs 4 over 6 hrs

Surgery (6 pax) 0 6 p 0 4 over 24 hrs Limited

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 115

Visual Depiction:

PARA 101 PARA 102 PARA 103

ADMINISTRATION/SUPPLY SECTION FORWARD SURGICAL SECTION FORWARD RESUSCITATIVE SECTION

O5 61J FRSD Chief/General Surgeon O4 61M Orthopedic Surgeon (PROFIS) O3 62A Emergency Physician (PROFIS)

O2 70B67 Field Medical Assistant O4 66S Critical Care Nurse O3 66T Emergency Nurse

E7 68W40 Detachment SGT O3 66F Clinical Nurse Anes (PROFIS) E5 68W20 Emergency Care SGT

E6 68D30 Operating Room NCO O3 62A Emergency Physician

E5 68C20 Practical Nurse O3 66T Emergency Nurse

O4 61J General Surgeon (PROFIS) E5 68W20 Emergency Care SGT

O4 61M Orthopedic Surgeon (PROFIS)

O3 66F Clinical Nurse Anes

O3 66S Critical Care Nurse

E5 68D20 Operating Room SGT

E4 68C10 Practical Nurse SP

New 267D Medical Equipment Set

ANALYZER BLOOD: (AB) 4

DEFIBRILLATOR MONITOR RECORDER 2

ELECTROSURGICAL APPARATUS MOBILE 2

FLUID WARMING SYS: (FWS) 4

MONITOR PATIENT VITAL SIGNS 2

MONITOR PATIENT VITAL SIGNS: (MVS) 6

MEDICAL OXYGEN CONCENTRATOR MOC 4

PUMP INTRAVENOUS INFUSION PIV 4

REFRIGERATOR SOLID STATE BIO 4

THERMOREGULATOR: PATIENT AUTO:MANUAL 2

TABLE OPERATING ROOM FIELD 2

SINK UNIT SURGICAL SCRUB AND UTENSIL HOSPITAL FIELD 2

ULTRA SOUND DIAGNOSTIC SYSTEM: HAND-CARRIED 2

VENTILATOR VOLUME PTBL 6

Emerg
Care
SGT

E5 – 68W

Emerg
Nurse

O3 – 66T

Emerg
Care
SGT

E5 – 68W

Emerg
Nurse

O3 – 66T

ER
Physician

O3 – 62A

O4 – 66S

Critical
Care
Nurse

E5 – 68W

Practical
Nurse

E6 – 68D

OR
NCO

O3 – 66S

Critical
Care
Nurse

O3 – 66F

CRNA

E4 – 68C

Practical
Nurse

E5 – 68D

OR
SGT

E7 – 68W

Det
SGT

O2 – 70B

MS
Officer

O5 – 61J

FRSD
Chief

General
Surgeon

O4 – 61M

Ortho
Surgeon

PROFIS

CRNA

O3 – 66F

PROFIS

Ortho
Surgeon

O4 – 61M

PROFIS

O4 – 61J

General
Surgeon

PROFIS

ER
Physician

O3 – 62A

PROFIS

Pre-Op
OR

Post-Op

Basic Configuration

5k Gen

5k Gen

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116 Army Health System Doctrine Smart Book 1 June 2020

FORWARD SURGICAL TEAM (FST)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08528KA00 MED TM, FORWARD SURGICAL (FST) 10 0 10 0 20

08528KB00 MED TM, FORWARD SURG (ABN) 10 0 10 0 20

MISSION

To provide a rapidly deployable, urgent initial surgical service in the BCT AO.

ASSIGNMENT

To the (MEDCOM [DS] or MEDBDE [SPT] and attached to a hospital center (240-bed) or CSH
(248-bed), when not operationally employed and further attached forward to a medical company.

DEPENDENCIES

This unit is dependent upon the following:

 Appropriate elements within the theater for religious, legal, FHP, finance, and personnel
and administrative services.

 When operationally attached to a BSMC (Airborne, Armor, Infantry, and SBCTs), the
brigade medical supply office/section provides medical equipment maintenance and
repair and Class VIII A and B (blood) resupply. The BCTs general support aviation
battalion for patient aeromedical evacuation. In the corps (EAB), the MMB for medical
maintenance and repair and Class VIII A and B (blood) resupply. The MLC and medical
detachment, blood support, and ground ambulance evacuation of patients, medical
company (ground ambulance).

 Appropriate elements of the sustainment brigade, quartermaster company (aerial delivery
support) or the brigade support battalion (BSB) (airborne), Infantry BCT (airborne) for
rigging when airdrop operations are required (airborne only).

 Appropriate elements of the sustainment brigade for sling load operations, as required.

 If deployed as part of a multinational or coalition force, joint task force, or in support of
special operations forces, it is critical that the HSS planner consider personnel and
equipment augmentation in the following areas: command, control and communications,
medical operations planning, power generation, vehicle maintenance, food service, force
protection, patient administration, pharmacy, patient holding, instrument sterilization,
Class VIII resupply, medical equipment maintenance and repair, x-ray services, medical
laboratory services, and sick call (primary care physician).

 Field feeding support is provided by the organization to which it is attached.

EMPLOYMENT

The FRSD is assigned to the MEDCOM [DS], MEDBDE [SPT], and attached to a hospital
center/CSH, when not operationally employed and further attached to a medical company.

BASIS OF ALLOCATION

One per BCT, one per Airborne BCT, one per Special Forces Group, and one per BCT assigned
to a theater conducting stability and reconstruction operations.

CAPABILITIES

This unit provides—

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 117

 Continuous operations in conjunction with a supporting medical company for up to 72
hours.

 Urgent initial surgery for otherwise nontransportable patients.

 Emergency treatment to receive, triage, and prepare incoming patients for surgery;
provide the required surgery; and continued postoperative care for up to 30 critically
wounded/injured patients over a period of 72 hours with its organic medical equipment
sets.

 Postoperative acute nursing care for up to 8 patients simultaneously per team prior to
further patient evacuations.

 Technical advice and assistance to the division surgeon and the division surgeon
section/division medical operations center for the surgical services portion of the division
plans and policies.

 Current information concerning surgical augmentation of Role 2 MTFs to higher
headquarters.

 Team augmentation of the surgical capability of Role 3 hospitals.

FUNCTIONS

FST

The FST performs triage/preoperative resuscitation, initial surgery, and postoperative nursing care.
Organic personnel set up and break down the shelter system in preparation of operations or unit
movement, prepare the patient for surgery, perform essential surgeries for a maximum of 30
patients within 72 hours, and provide postoperative nursing care and stabilization for medical
evacuation to the next role of medical care. The FST performs unit plans and movement, routine
and specialized operations, and mission related task organization, and coordinates directly with the
Role 2 MTF to which it may be attached or collocated.

MOBILITY

This unit is 100 percent mobile and is able to transport all of its TOE equipment in a single lift using
organic vehicles.

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118 Army Health System Doctrine Smart Book 1 June 2020

MEDICAL COMPANY (AREA SUPPORT)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08457K000 MEDICAL COMPANY (AREA SPT) 13 0 63 0 76

MISSION

To provide Role 1 and 2 FHP to units located in the AO of the MCAS.

ASSIGNMENT

This company is assigned to the HHD, MMB.

DEPENDENCIES

This unit is dependent upon—

 Appropriate elements of the theater for religious, legal, FHP, finance, and personnel and
administrative services.

 FRSD for surgical augmentation of nontransportable patients requiring surgical
intervention in preparation for evacuation by air ambulance.

 Field feeding company, for field feeding support.

 MCAA for rotary-wing air ambulance support.

 MCGA for ground MEDEVAC.

EMPLOYMENT

The MCAS is employed with the MMB and is employed primarily in the consolidation area (corps
and division support areas). It provides area AHS support for designated non BCT units/troops.

BASIS OF ALLOCATION

1 per 10,000 non-BCT troops supported in the committed BCT/div HQs/corps HQs and committed
theater area.

CAPABILITIES

This unit provides—

 C2 of attached units which include medical planning and coordination of patient
movement within and outside of the MCAS’s AO.

 Treatment of patients with DNBI, triage of mass casualties, EMT, initial
resuscitation/stabilization, advanced trauma life support, and preparation for further
evacuation of ill, injured, and wounded patients who are incapable of returning to duty
within 72 hours.

 Treatment squads which are capable of operating independently of the MCAS for limited
periods of time.

 Evacuation of patients from units within the MCAS’s AO to the treatment squads of the
MCAS.

 Emergency medical supply/resupply to units operating within the AO of the MCAS.

 Behavioral health consultation and support, to include coordinating operations of
attached COSC elements operating within the AO of the MCAS.

 Pharmacy services, and multi-shift laboratory and radiological services commensurate
with Role 2 AHS MTFs.

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 119

 Emergency dental care to include stabilization of maxillofacial injuries, sustaining dental
care designed to prevent or intercept potential dental emergencies, and limited preventive
dentistry.

 Patient holding for up to 40 patients per MCAS.

 Outpatient consultation services for patients referred from units with only Role 1 AHS
support capabilities.

 Food service support for staff, patients, and other medical elements (attached) dependent
upon the MCAS for support. Staff is military occupational specialty (MOS) 92G and not
trained to provide or provisioned to provide special diets. Role 3 elements have the
required staff and provisioned for patients in need of specialized dietary requirements.

 Individuals of this organization can assist in the coordinated defense of the unit’s area or
installation.

This unit does not perform field maintenance on organic equipment (including COMSEC
equipment) except for medical equipment. The medical maintenance personnel will perform limited
maintenance on the unit’s organic medical equipment. The remaining maintenance personnel will
augment the maintenance capability of the unit that performs field maintenance on the unit’s
organic vehicles and power equipment.

FUNCTIONS

Company HQs

Provides C2 for the company and other medical units that may be attached. Also provides general
and medical supply/re-supply, arms maintenance, chemical, CBRN operations and
communications-equipment support to organic and attached elements.

Mental health section

This section provides training and advice in the control of stressors, the promotion of positive
combat stress behaviors, and the identification, handling, and management of misconduct stress
behavior and battle stressed soldiers. It coordinates COSC training for supported units through the
MCAS company commander and battalion psychiatrist. The section collects and records social
and psychological data and counsels personnel with personal, behavioral, or psychological
problems

Treatment platoon HQs

The treatment platoon operates a Role 2 MTF. It receives, triages, treats, and determines the
disposition of patients based upon their medical condition. This platoon provides professional
services in the areas of minor surgery, internal medicine, general medicine, and general dentistry.
In addition, it provides basic diagnostic laboratory and radiological services and patient holding
support.

Medical treatment squads (2)

This section provides emergency and routine sick call treatment to soldiers assigned to units within
the AO. These squads can perform their functions while located in the company area, or they can
split and operate as separate treatment teams (Team A and Team B) for limited periods of time.
While operating in these separate modes, they may operate up to four treatment stations. They
can be assigned to reinforce or reconstitute similar treatment squads.

Area support squad

This section includes a dental element, a medical laboratory element, and an X-ray element, which
has field x-ray capabilities. Provides for basic services commensurate with Role 2 medical
treatment.

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120 Army Health System Doctrine Smart Book 1 June 2020

Area support treatment squad

This is the base medical treatment element of a Role 2 MTF (does not deploy away from the MCAS)
and is not used to reinforce or reconstitute other medical units. It provides sick call services and
initial resuscitative treatment, both advanced trauma medicine and EMT, for supported units.

Patient holding squad

This section operates the holding ward facility within a corps/division. The holding ward is staffed
and equipped to provide care for up to 40 patients.

Ambulance platoon HQs

This is the C2 for ambulance platoon operations. It maintains communications to direct ground
ambulance evacuation of patients. It provides ground ambulance evacuation support for units
receiving area support from the MCAS to the company’s treatment squad location (MTF) or to the
supporting Role 3 MTF.

Ambulance squad (4)

Ground evacuation of patients from units and organic treatment squads/teams (aid stations) within
the support sector of the MCAS. Ambulance squad personnel perform TCCC, EMT, evacuate
patients, and provides for their continued care.

MOBILITY

This unit is 100 percent mobile and is able to transport all of its TOE equipment in a single lift using
organic vehicles.

Figure 3-24. Medical Company (Area Support)

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 121

BRIGADE SUPPORT MEDICAL COMPANY
(AIRBORNE, ARMOR, INFANTRY, AND STRYKER)

SRC TITLE REQ
OFF

REQ
WO

REQ
ENL

REQ
CIV

REQ
TOT

08027K000
MEDICAL COMPANY, BRIGADE SUPPORT BATTALION (ARMORED
BCT)

15 0 67 0 82

08037K000
MEDICAL COMPANY, BRIGADE SUPPORT BATTALION (INFANTRY
BCT)

15 0 67 0 82

08047K000 MEDICAL COMPANY, BSB (AIRBORNE BCT) 15 0 67 0 82

08057K000 MEDICAL COMPANY, BCT (STRYKER BCT) 16 0 70 0 86

MISSION

To provide Role 2 AHS support to maneuver battalions with organic medical platoons. This
company provides both Role 1 and 2 medical treatment on an area basis to those units without
organic medical assets operating in the BCT AO.

ASSIGNMENT

Organic to the BSB.

DEPENDENCIES

This unit is dependent upon the following:

 Appropriate elements within the theater for religious, legal, finance, and personnel and
administrative services.

 The HHC, BSB, for food service support, religious support, and unit administration.

 Field (maintenance) company, BSB, for field maintenance of all organic equipment (less
medical).

 Distribution company, BSB, for supply support.

 FST/FRSD, for surgical augmentation.

 MCAA for aeromedical evacuation.

EMPLOYMENT

This company is located in the brigade support area. It provides role 1 and 2 AHS support and has
treatment teams that can operate independently from the company for limited periods of time.

BASIS OF ALLOCATION

One per BCT.

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122 Army Health System Doctrine Smart Book 1 June 2020

CAPABILITIES

This unit provides—

 C2 of attached units, which include medical planning and coordination of patient
movement within and outside the brigade.

 Treatment of patients with DNBI, combat operational stress reaction (COSR), triage of
mass casualties, advanced trauma management, initial resuscitation and stabilization,
and preparation for further evacuation of patients incapable of returning to duty.

 Ground evacuation for patients from BASs and designated casualty collection points
(CCPs) to the BSMC.

 Operational dental care that consists of emergency and essential dental care designed
to circumvent potential dental emergencies.

 Class VIII supply/resupply to units in the brigade area.

 Unit-level medical equipment maintenance.

 Medical laboratory and radiology services commensurate with Role 2 MTFs.

 Outpatient consultation services for patients referred from Role 1 MTFs.

 Patient holding for up to 20 patients able to return to duty within 72 hours.

 Limited reinforcement and augmentation to supported maneuver battalion medical
platoons.

 Regeneration of severely attrited BASs.

 Treatment squads that are capable of operating independently for limited periods of time
that provide advanced trauma management and sick call as required. A treatment squad
is capable of breaking down into two treatment teams, which can also operate
independently for limited periods of time.

 Preventive medicine support.

 Individuals of this organization are provided weapons for personal defense and protection
of the patients under their care.

 This unit performs field maintenance on medical equipment except COMSEC equipment.

FUNCTIONS

Company HQs

Provides C2 of the company and attached medical units. It also provides medical administration,
general and medical supply, CBRN defensive operations, and communications support. The HQs
is organized into command, supply, operations, and communications elements. Within a SBCT,
this section provides supply point distribution of Class VIII push-packages for medical unit’s combat
lifesavers operating in the BCT’s AO. Unit medical equipment maintenance is organically provided
by one medical maintenance specialist.

Preventive medicine section

This section ensures personnel implement preventive medicine measures (PMM) to protect against
food, water, and vector-borne diseases and environmental injuries.

Mental health section

This section provides advice and assistance in the areas of behavioral health and COSC.

Medical Treatment platoon HQs

This is the C2 element of the platoon. It determines and directs the disposition of patients and
coordinates for their further evacuation.

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 123

Medical treatment squad

This section provides augmentation to the battalion medical platoons within the BCT with the ability
to split and operate as separate treatment teams for a limited period of time. These squads provide
sick call operations, EMT, and advanced trauma management. They can be assigned to reinforce
or reconstitute similar treatment squads.

Area support squad

This section provides operational dental care, which consists of emergency and essential dental
care. Essential dental care is designed to prevent or circumvent potential dental emergencies.
Also, provides limited clinical laboratory and radiology services commensurate with Role 2 MTFs.

Medical treatment squad (area)

This is the base medical treatment element (does not deploy away from the BSMC and is not used
to reinforce or reconstitute other medical units) that provides troop clinic-type services and
advanced trauma management within the brigade support area.

Patient holding squad

This section provides nursing care for up to 20 patients expected to return to duty within 72 hours.

Evacuation platoon HQs

This provides C2 of the ambulance squads. It also provides communications for the platoon to
direct ground evacuation of patients from units receiving area support.

Evacuation squad (forward) (3)

This provides ground evacuation from within the brigade operational area. Each squad is
comprised of two teams.

Evacuation squad (area) (2)

This provides ground evacuation from within the brigade operational area. Each squad is
comprised of two teams.

Brigade medical supply office

This office is responsible for providing Class VIII supplies and equipment, to include unit-level
medical maintenance and repair, and executes the brigade MEDLOG plans. The BSMC organic
to a SBCT does not have this section. The HQs section is task organized to accomplish this
mission.

MOBILITY

This unit is 100 percent mobile and is able to transport all of its TOE equipment in a single lift using
organic vehicles.

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124 Army Health System Doctrine Smart Book 1 June 2020

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

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 125

MEDICAL COMPANY (AIR AMBULANCE)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08317K000 MED CO AA (15 ACFT) 11 29 69 0 109

MISSION

To provide aeromedical evacuation support within the brigade and corps.

ASSIGNMENT

Organic to the GSAB.

DEPENDENCIES

This unit is dependent upon—

 Appropriate elements within the theater AHS support.

 The HHC of the GSAB, for unit religious, legal, finance, and personnel and administrative
services and unit CBRN support.

 The forward support company of the GSAB, for Class III, automotive and generator
maintenance, and field feeding.

 The aviation support company of the GSAB, for aviation unit maintenance of organic
aircraft, including unit level supply support for aircraft Class IX.

 USAF weather team; in the HHC of the aviation brigade, for air weather service support.

EMPLOYMENT

Employed in the theater, corps, division, or echelon above brigade. It is tactically located where it
can best control its assets, and execute; its patient evacuation mission.

BASIS OF ALLOCATION

One per GSAB.

CAPABILITIES

This unit provides—

 Fifteen helicopter ambulances to evacuate critically wounded or other patients consistent
with evacuation priorities and operational considerations, from points as far forward as
possible, to Brigade medical treatment facilities and hospitals. Total lift capability utilizing
all assigned aircraft is 90 litter patients or 105 ambulatory patients, or some combination
thereof.

 One Area Support MEDEVAC platoon (3 aircraft) that will normally locate with the
company HQs. Four forward support MEDEVAC platoons (3 aircraft each) that can be
independently or group deployed.

 Air crash rescue support.

 Expeditious delivery of whole blood, biological, and medical supplies to meet critical
requirements.

 Rapid movement of medical personnel and accompanying equipment/supplies to meet
the requirements for mass casualty, reinforcement/reconstitution, or emergency
situations.

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126 Army Health System Doctrine Smart Book 1 June 2020

 Movement of patients between hospitals, aero-medical staging facilities, hospital ships,
casualty receiving and treatment ships, seaports, and railheads in the brigade AO.

 Individuals of this organization can assist in the coordinated defense of the unit’s area or
installation.

This unit does not perform field maintenance on any organic equipment to include COMSEC
equipment.

FUNCTIONS

Company HQs/area support MEDEVAC platoon

Provides C2 of all area support and forward support MEDEVAC operations, and provides logistical
and administrative support for the company. Also provides area support aeromedical evacuation
within the Brigade AO.

Forward support MEDEVAC platoon (X4)

Provides a task-organized means for aeromedical evacuation in support of the brigade. Also,
provides emergency movement of medical personnel and emergency delivery of whole blood,
biological, and medical supplies and equipment.

MOBILITY

This unit is 100 percent mobile and is able to transport all of its TOE equipment in a single lift using
organic vehicles. Units will be dependent on appropriate elements of the brigade, division, or corps
for supplemental transportation.

Figure 3-26. Medical Company (Air Ambulance)

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 127

MEDICAL COMPANY (GROUND AMBULANCE)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08453K000 MED CO, GROUND AMBULANCE 4 0 61 0 65

MISSION

To provide ground evacuation within the JOA.

ASSIGNMENT

To a HQs, MMB or a MEDBDE [SPT].

DEPENDENCIES

This unit is dependent upon—

 Appropriate elements within the AOR for religious, FHP, HSS, legal, finance, personnel
and administrative services.

 Communications and communications-security support when not assigned or attached
to a higher medical HQs.

 Vehicle and generator maintenance support when not assigned or attached to the MMB.

 Separately deployed teams are dependent upon a host unit for life support operations
and decontamination support in a CBRN environment.

 Field feeding company, or supported BCT for field feeding support.

EMPLOYMENT

Employed in EAB. It is tactically located where it can best control its assets and execute its patient
evacuation mission.

BASIS OF ALLOCATION

For LSCO, 0.33 per BCT, 0.5 per division HQs and 2 per senior Army HQ.

For stability tasks, 0.33 per BCT, 0.5 per division HQs and 2 per senior Army HQs and add for
directed support to host nation PAR at one company per 42,000 supported population.

For enable civil authority, basis of allocation adjustments will be based on roles of care directed
and PAR supported.

CAPABILITIES

This unit provides—

 Single lift evacuation of 96 litter patients or 192 ambulatory patients, or a combination of
both.

 Evacuation of patients from the BSMC and MCAS to supporting hospitals.

 Reinforcement of BSMC evacuation assets.

 Reinforcement of covering force and deep battle operations.

 Movement of patients between hospitals and in route patient staging systems, railheads,
or seaports in brigade and EAB areas.

 Area evacuation support beyond the capability of the MCAS.

 Emergency movement of medical supplies.

 Vehicle refueling support for the MMB, when co-located.

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128 Army Health System Doctrine Smart Book 1 June 2020

 The maintenance personnel will augment the maintenance capability of the unit that
performs field maintenance on organic vehicles and power generation equipment.

 Individuals of this organization can assist in the coordinated defense of the unit’s area or
installation.

This unit does not perform field maintenance on any organic equipment including COMSEC
equipment.

The transportation and handling of human remains is a logistics function and not a medical function.

FUNCTIONS

Company HQs

Provides mission command, administration, and logistical support for subordinate ambulance
platoons.

Ambulance platoon HQs

Provides mission command for the subordinate ambulance squads.

Evacuation section

This section operates ambulances and provides en route medical care for patients in their care.

MOBILITY

This unit is 100 percent mobile and is able to transport all of its TOE equipment in a single lift using
organic vehicles.

Figure 3-27. Medical Company (Ground Ambulance)

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1 June 2020 Army Health System Doctrine Smart Book 129

DENTAL COMPANY (AREA SUPPORT)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08473K000 DENTAL COMPANY (AREA SPT) 30 0 58 0 88

MISSION

The mission of the dental company (area support) (DCAS) is to provide on an area basis
operational dental care consisting of emergency and essential dental care, designed to eliminate
potential dental emergencies.

ASSIGNMENT

To MEDCOM [DS], or MEDBDE [SPT].

DEPENDENCIES

This unit is dependent upon the following:

 Appropriate elements within the theater for religious, legal, FHP, finance, personnel and
administrative services.

 The support maintenance company, for all field level maintenance.

 Field feeding company, for field feeding support.

EMPLOYMENT

The DCAS is employed with the MEDCOM [DS] or MEDBDE [SPT] within a theater. Dental teams
may be employed in the BCT area to provide forward operational dental care.

BASIS OF ALLOCATION

Based upon the ratio of one dentist in support of 1,175 troops, one DCAS is allocated per 43,000
Army population supported in the theater.

CAPABILITIES

This unit provides—

 C2 of subordinate dental elements.

 Operational dental care, consisting of emergency dental care and essential dental care.

 Reinforcement and reconstitution of BCT/regiment dental assets.

 Far forward operational dental care to small and forward deployed troop concentrations.

 This section is composed of 3 forward support treatment sections. Each section is
composed of 6 treatment teams for a total of 18 forward treatment teams for area support.

 Augmentation of medical assets during mass casualty situations.

 Individuals of this organization can assist in the coordinated defense of the unit’s area or
installation.

This unit does not perform field maintenance on organic equipment (including COMSEC
equipment) except for medical equipment. The medical maintenance personnel will perform limited
maintenance on the unit’s organic medical equipment. The remaining maintenance personnel will
augment the maintenance capability of the unit that performs field maintenance on the unit’s
organic vehicles and power equipment.

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FUNCTIONS

Company HQs

Provides C2 and daily unit level administration and logistical support for the organization and
assigned and attached elements.

Support section

Provides nonclinical support activities to include wheel vehicle, power generation and medical
equipment maintenance for the organization.

Field dental clinic (area)

Provides operational dental care consisting of emergency dental care and essential dental care.
The clinic is broken down into a specialty section and general dentistry section. The specialty
section provides comprehensive dental care, endodontics, periodontics, and prosthodontics
specialty care.

Forward support platoon HQs

Provides C2, and administrative support to the treatment sections.

Forward support treatment section (x3)

Provides operational dental care consisting of emergency dental care and essential dental care
throughout the combat zone and isolated troop concentrations. Each forward support treatment
section consists of six (6) semi-mobile teams made up of a dental officer, dental technician, dental
equipment/supplies and mobile electric power.

MOBILITY

This unit is capable of transporting 133,700 pounds (11,073.0 cubic feet) of TOE equipment with
organic vehicles. This unit has 79,758 pounds (6,473.3 cubic feet) of TOE equipment requiring
transportation. This unit is 50% mobile and can transport half of its TOE equipment in a single lift
using its organic vehicles. Units will be dependent on appropriate elements of the brigade,
division, or corps for supplemental transportation.

Figure 3-28. Dental Company (Area Support)

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1 June 2020 Army Health System Doctrine Smart Book 131

MEDICAL LOGISTICS COMPANY

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08480K000 MEDICAL LOGISTICS COMPANY 2 1 67 0 70

08487KA00 MEDICAL LOGISTICS COMPANY (BASE) 1 1 43 0 45

08487KB00 MED LOG CO (EARLY ENTRY TEAM) 1 0 6 0 7

08487KC00 MED LOG CO (CONTACT REPAIR TEAM) 0 0 9 0 9

08487KD00
MED LOG CO (FORWARD DISTRIBUTION
TEAM)

0 0 9 0 9

MISSION

To provide Class VIII support, optical lens fabrication and repair, and medical equipment
maintenance and repair for the BCT and EAB units, to include augmented support to the field
hospital.

ASSIGNMENT

Assigned to a higher-level medical element, usually the HHD MMB.

DEPENDENCIES

 HHD, MMB for appropriate elements of the MEDBDE [SPT] for AHS support,
transportation, power generator maintenance support, religious, legal finance, personnel
and administrative services, automation and technical intelligence for captured medical
materiel and communications maintenance support. The base and early entry team have
30 percent mobility and are dependent on transportation for movement. The MLC will be
dependent on transportation organization for movement of all equipment and delivery of
Class VIII supplies.

 Unit to which assigned or attached for food service support.

 Quartermaster field service company (modular) for shower and laundry support in support
for divisional and nondivisional troops.

EMPLOYMENT

The company will normally be under the mission command of the MMB, forming the MEDLOG
company base for the AOR.

BASIS OF ALLOCATION

One per 13 short tons of Class VIII supplies processed per day.

CAPABILITIES

This unit—

 Provides 220 hours per day of field level medical equipment maintenance and repair.

 Provides Class VIII support, optical lens fabrication and repair, and medical equipment
maintenance and repair support.

 The receive and storage sections, shipping section and the stock control section can
process up to 9 short tons of Class VIII supplies per day.

 Coordinates for emergency delivery of Class VIII supplies.

 Provides field and limited sustainment medical equipment maintenance and repair,
scheduled services support, repair parts, and Medical Standby Equipment Program items

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132 Army Health System Doctrine Smart Book 1 June 2020

for medical units operating within the theater AOR, to include unified action partners, when
directed.

 Can coordinate for higher priority delivery of Class VIII supplies.

 Can build and position preconfigured push-packages, as required, in support of brigade
and below and EAB units.

 The optical section can provide single and multi-vision optical lens fabrication and repair to
support a maximum force of 22,000 troops.

 Can provide the distribution capability for a theater lead agent for medical materiel when
required.

 Can provide organic unit maintenance.

 Provides one early entry team, three contact repair teams, and three forward distribution
teams, who can process up to 4 short tons Class VIII per day.

 Quantities designate the minimum essential wartime requirement for personnel and
equipment.

 For unit maintenance capability, see the section I of each subordinate TOE.

FUNCTIONS

Company Headquarters

Provides unit-level administration, general supply, arms maintenance, as well as CBRN operations
support. Personnel of this section supervise unit operations, general supply and communications.
During the development of the theater, or during other operations, the MLC can be self-sustaining
for short periods of time (72-hours).

Logistics Support Platoon Headquarters

This section is responsible for ensuring that stocks remain in an issuable condition while in storage.
This includes the prior planning of receipt of supplies, locating stocks in a way that provides for
first-in/first-out handling, utilizing space efficiently and maintaining segregation and disposition of
stock as determined by the accountable officer/platoon leader. The Logistics Support Platoon is
composed of a headquarters, receive/storage section, shipping section and stock control section.

Logistics Support Section

This section can receive and position pre-configured push packages until normal automated
requisition flow is established. This team will have the ability to handle higher priority resupply for
specific line item requisitioning of medical supplies and equipment (as required) out of its authorized
stockage list in support of medical units deployed to the area of responsibility. The team will provide
in-transit visibility of Class VIII supplies. The early entry logistics support personnel will reintegrate
with the Receive/Storage Section and the medical maintenance personnel will reintegrate with the
Biomedical Maintenance Section once the base is deployed.

Receive/Storage Section

This section is responsible for preparing and processing receipt documents for incoming shipments.
This section is also responsible for the storage, preservation, location, and accountability for
medical supplies and equipment.

Shipping Section

This section plans for release of materiel to transportation, coordinates for vehicles, stages
shipments for pick-up, and prepares movement documents.

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1 June 2020 Army Health System Doctrine Smart Book 133

Stock Control Section

This section coordinates all stock control functions. Also maintains accountability for all Class VIII
materiel received, stored and issued in the MLC.

Optical Section

This section performs optical lens fabrication and repair of single and multi-vision prescription
lenses and military combat eye protection lenses and inserts to support a maximum force of 22,000
troops.

Maintenance Platoon Headquarters

This headquarters is responsible for field and limited sustainment medical equipment maintenance
and repair. This platoon is composed of two elements: the biomedical maintenance section and the
organizational maintenance section. This platoon is responsible for field level maintenance of
organization equipment.

Biomedical Maintenance Section

This section performs field and limited sustainment medical maintenance and repair. It also
performs field maintenance for units in its area of operations that do not have organic medical
equipment maintenance; personnel assigned.

Biomedical Maintenance Team

This team will establish and track medical equipment density and schedule service information from
the Logistics Information Warehouse for all medical units during theater opening operations. The
Biomedical Maintenance Team will provide limited medical standby equipment utilizing
regeneration enablers and field level repair upon request.

Organizational Maintenance Section

This section is responsible for vehicle maintenance, equipment records and repair parts, fuel
distribution, power generation repair, refrigeration and automation systems repair.

Contact Repair Teams

These teams can be rapidly deployed to provide medical equipment maintenance and repair. The
contact repair teams can augment any medical organization to include Joint or multinational
partners and can collocate with the BSMC if that medical company is collocated with an FST/FRSD.
The contact repair teams are designed to operate at EAB and go far-forward into the brigade area.
This section can deploy three contact repair teams, which is identified under SRC 08487KC00.
The contact repair teams will consist of three personnel each. These teams will provide field and
level maintenance and repair support to all medical units within their AOR. The contact repair
teams will be employed by the MMB based on Mission Enemy Terrain Troops – Time and Civil
considerations data, or by the request of the brigade surgeon to the MMB. The contact repair
teams will deploy to medical units, to include all units within the BCT that have organic medical
equipment. The teams will bring limited repair parts and Medical Standby Equipment Program
capabilities. While these teams are employed forward, they will technically inspect all medical
equipment within their area as proactive maintenance measures.

Forward Distribution Teams

These teams receive and process supplies at strategic air and sea hubs in theater, facilitating
medical materiel movement.

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MOBILITY

This unit requires 30 percent mobility of its TOE equipment to be transported in a single lift using
its organic vehicles.

Contact Repair and Forward Distribution Teams are 100 percent mobile and are able to transport
all of its TOE equipment in a single lift using organic vehicles.

Figure 3-29. Medical Logistics Company

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MEDICAL DETACHMENT
(VETERINARY SERVICE SUPPORT)

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08300K000
MEDICAL DETACHMENT, VETERINARY
SERVICES

10 1 46 0 57

08516KA00
HEADQUARTERS, MEDICAL
DETACHMENT, VETERINARY SERVICES

3 1 12 0 16

08516KB00
FOOD PROCUREMENT AND
LABORATORY TEAM

1 0 6 0 7

08516KC00
VETERINARY MEDICAL AND SURGICAL
TEAM

1 0 3 0 4

08516KD00 VET SVC SPT TEAM 1 0 6 0 7

MISSION

The MDVSS provides equipment and personnel to provide dispersed veterinary Role 1 and 2
medical and resuscitative surgical care; veterinary Role 3 comprehensive canine medical/surgical
care to military and DOD contract working dogs; definitive and restorative military working dog
dental care to include endodontic procedures; and evacuation/hospitalization support for military
working dogs and hospitalization support to DOD contract working dogs; endemic zoonotic and
foreign animal disease epidemiology surveillance and control; animal facility and kennel
inspections; commercial food source audits for DOD procurement; food protection, quality, and
sanitation inspections; food defense vulnerability assessments; food and water risk assessments;
field confirmatory microbiological and presumptive chemical laboratory analysis of food and bottled
water; and veterinary support to stability tasks and defense support of civil authorities (DSCA)
activities. This unit is normally assigned to a MMB, (MEDBDE [SPT], MEDCOM [DS] or equivalent
sister service organization. This unit executes Army veterinary proponent requirements as the sole
provider of veterinary services to the DOD.

ASSIGNMENT

To a MEDCOM [DS], MEDBDE [SPT], or MMB.

DEPENDENCIES

This unit is dependent upon the following:

 Appropriate elements of the AOR for religious, legal, FHP, HSS, field feeding, finance,
and personnel and administrative services.

 Separately deployed teams are dependent upon the host unit for life support operations.

 Communications and communications-security support when not assigned or attached
to a higher medical HQ.

 Vehicle and generator maintenance and vehicle recovery support when not assigned or
attached to the MMB.

 Transportation services when single lift requirements exceed unit capability.

 MLC, for medical equipment maintenance and Class VIII supply support.

 A controlled environment with a stable temperature to minimize contamination of
laboratory samples; to minimize contamination of surgical patients; and ensure proper
operation of equipment.

 Reach back capability for theater validation and definitive levels of microbiological
analysis of food and bottled water; and field confirmatory, theater validation, and definitive
levels of chemical analysis of food and bottled water and for veterinary Role 4 medical
care for military working dogs (MWDs).

 When attached or assigned to USN, USAF, or USMC units, requirements for support are
the same as above.

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136 Army Health System Doctrine Smart Book 1 June 2020

EMPLOYMENT

The MDVSS will be employed in the AO.

The unit deploys the HQ and subordinate teams: The HQs, (HQ, MDVSS), the food procurement
and laboratory team, the veterinary medical and surgical team, and five veterinary service support
teams (VSSTs), form the MDVSS.

The veterinary teams may be geographically dispersed to align with their primary customers or
those units/activities such as aerial port of debarkation/sea port of debarkation, or corps and theater
level Class I points requiring support.

The unit can be task-organized across team lines or subdivided to meet a variety of functional
scenarios within the stated mission.

The HQs section may be located in the center of operations or near other medical units with mission
command functions.

This unit functions well in conjunction with preventive medicine units.

The MDVSS provides one or more VSSTs for early entry capability to provide veterinary
medical/surgical care to military and DOD contract working dogs and to support initial food
inspection requirements.

The MDVSS may be aligned with civil military operations centers at BCTs, with CA units, or with
task-organized provincial reconstruction teams when directed for support of stability tasks.

The MDVSS supports joint forces in execution of the Army’s function of sole provider of veterinary
services to the DOD.

BASIS OF ALLOCATION

For LSCO, maximum of: one MDVSS per 60,000 personnel supported in all U.S. forces, DOD
components & other units/organizations as directed or one per 300 MWDs & DOD contracted
working dogs in support of all U.S. forces, DOD components & other units/organizations as directed
or one per senior Army HQs.

For Army support to other services, add three additional MDVSSs.

For special operations forces, one VSST per combined joint special operations task force (offset
by workload).

For stability tasks, same as major combat operations (phase I-III).

For enable civil authority, adjustments will be based on roles of care directed & PAR supported.

CAPABILITIES

This unit provides—

 Early entry capabilities for establishment of initial veterinary Role 1 and Role 2
medical/resuscitative surgical care to military and DOD contract working dogs, and food
inspection support in the AOR.

 Veterinary Role 1 and Role 2 medical/resuscitative surgical care to military and DOD
contract working dogs, and food inspection support in the AOR.

 Veterinary Role 3 advanced canine medical/surgical care and definitive and restorative
military working dog dental care to include endodontic procedures.

 Veterinary Role 3 evacuation/hospitalization support for military working dogs and
Veterinary Role 3 hospitalization for DOD contract working dogs.

 Endemic zoonotic and foreign animal disease epidemiology surveillance and control.

 Animal facility and kennel inspections.

 Commercial food source audits for DOD procurement.

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1 June 2020 Army Health System Doctrine Smart Book 137

 Food safety, quality, and sanitation inspections.

 Food defense vulnerability assessments.

 Food and water risk assessments.

 Field confirmatory microbiological and presumptive chemical food and bottled water
laboratory analysis.

 Veterinary support to stability tasks and DSCA activities.

FUNCTIONS

Detachment Headquarters

This headquarters is responsible for C2, unit administration and supply functions, unit movement
planning, Intellectual capital and coordination/liaison experience for stability tasks, foreign
humanitarian assistance, and DSCA activities, and liaison with foreign government officials.

Food Procurement and Laboratory Team

This team is responsible for field confirmatory microbiological and presumptive chemical laboratory
analysis of food and bottled water, food protection audits of commercial food facilities, JBAIDS
testing for CBRN agents in subsistence, and support stability tasks and DSCA activities in areas
requiring higher degrees of expertise in food protection, food diagnostics, and infrastructure
reestablishment particularly with respect to food facilities, distribution, and sanitation.

Veterinary Medical and Surgical Team

This team is responsible for veterinary Role 1-3 medical care to units deployed within the AO,
comprehensive medical and surgical veterinary care, definitive and restorative military working dog
dental care to include endodontic procedures, consultative expertise and referral hospitalization,
patient preparation for evacuation and coordinate evacuation assets, coordination with veterinary
Role 4 facility for evacuation of patients, and support to stability tasks within their area of operations
with a focus on infrastructure rebuilding of the animal health care and institutional veterinary training
programs.

Veterinary Service Support Teams (X5)

This team is responsible for early entry, food protection support, presumptive laboratory analysis
of food and bottled water, food protection audits of commercial food facilities and sanitation
inspections of military food facilities to include assessment of potential military construction sites
for food production or storage, installation food defense vulnerability assessments, food and water
risk assessments, surveillance inspection of CBRN contamination of Class I subsistence as
directed, support stability tasks through all phases to include civil-military and foreign humanitarian
assistance operations and special operations force (SOF) and Role 1 and 2 veterinary treatment
teams.

MOBILITY

This unit requires 60 percent mobility of its TOE equipment to be transported in a single lift using
organic vehicles.

Food procurement and laboratory team, is 100 percent mobile and able to transport all of its TOE
equipment in a single lift using organic vehicles.

Veterinary medical and surgical team, is 50 percent mobile and only able to transport half of its
TOE equipment in a single lift using organic vehicles

VSST, is 67 percent mobile and only able to transport two thirds of its TOE equipment in a single
lift using organic vehicles

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138 Army Health System Doctrine Smart Book 1 June 2020

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

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 139

MEDICAL DETACHMENT,
COMBAT AND OPERATIONAL STRESS CONTROL

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08460K000 MEDICAL DETACHMENT COSC 15 0 29 0 44

08463KA00 MED DET COSC MAIN SUPPORT 9 0 17 0 26

08463KB00 MED DET COSC FORWARD SUPPORT 6 0 12 0 18

MISSION

To provide COSC prevention and treatment services in direct support of BCT, division/corps, and
ASCC, and on an area basis to a joint or combined force as directed in other military operations.
The forward support section provides prevention and limited fitness activity support to maneuver
brigades and area support to units in the brigade support area.

ASSIGNMENT

Assigned to an MMB.

DEPENDENCIES

This unit is dependent upon the following:

 Appropriate elements of the theater for religious, legal, FHP, finance, and personnel and
administrative services.

 HHD MMB, or appropriate external elements for medical administration, logistical
support, MEDLOG, medical regulating, evacuation, coordination for return to duty of
recovered COSR soldiers and field maintenance for equipment.

 Field feeding company, or supported BCT for field feeding support.

EMPLOYMENT

This detachment is employed in the theater in supporting tactical division/corps and ASCC. COSC
detachment provides C2 for the main support section and the forward support section when it
deploys as a complete detachment. The COSC medical detachment has the capability to deploy
a forward support section supporting a division as required. The supported unit provides C2 for
the forward support section.

The forward support section performs prevention and limited fitness activity support to maneuver
brigades and area support to units in brigade support areas. COSC detachment provides C2 for
the main support section and the forward support section when it deploys as a complete
detachment. The COSC medical detachment has the capability to deploy a forward support section
In support of division/corps as required. The forward support section will require C2 to be provided
by the supported unit.

Both support sections have the capability to break down into six 3-man teams.

BASIS OF ALLOCATION

1 per 39,000 Army population supported in theater. Minimum of one.

CAPABILITIES

This unit provides—

 Planning and staff advice to C2 HQs regarding the stressors affecting the troops, mental
readiness, morale and cohesion.

 Preventive consultation and stress education support to leaders, chaplains, and medical
personnel.

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140 Army Health System Doctrine Smart Book 1 June 2020

 Neuropsychiatric care, triage and stabilization.

 Assistance to nonmedical units with rest category COSR casualties and the return
to duty of recovered COSR soldiers.

 Holding/restoration capability of 50 soldiers for up to 3 days.

 Reconstitution to supported units.

 Debriefings after critical events and after action reports, case evaluation, and
neuropsychiatric triage and stabilization.

FUNCTIONS

Detachment headquarters

This section provides advice, planning, and coordination for COSC to include employment and
coordination of COSC assets. Also provides unit-level personnel, supply, patient administration,
and vehicle maintenance.

Main support section

This section provides flexible, modular, task organized COSC support in a variety of modularized
teams. The 18-person behavioral health team, comprised of up to six 3-person sub-teams which
perform prevention and limited fitness activity support.

Forward support section

This section provides flexible, modular, task organized COSC support in a variety of modularized
teams.

MOBILITY

Main support section: This unit can transport 47% of its organic personnel and equipment in a
single lift using its authorized organic vehicles. Units will be dependent on appropriate elements of
the brigade, division, or corps for supplemental transportation.

Figure 3-31. Combat and Operational Stress Control

Army Health System Unit Synopsis

1 June 2020 Army Health System Doctrine Smart Book 141

MEDICAL DETACHMENT, PREVENTIVE MEDICINE

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08429K000 MED DET, PREVENTIVE MED 2 0 11 0 13

MISSION

To provide technical consultation support on preventive medicine issues throughout the TO.

ASSIGNMENT

To a MEDCOM [DS], MEDBDE [SPT], MMB, MCAS, or a task force medical mission control HQs
in the corps or EAB. The detachment may be attached to a unit in the brigade, corps, or EAB.

DEPENDENCIES

This team is dependent upon appropriate elements within the theater for religious, legal, FHP,
finance, and personnel and administrative services.

EMPLOYMENT

When attached to units in the corps or EAB, the detachment collocates on a temporary basis with
the supported unit until the mission is completed or the mission priority changes. When attached
to a BCT, the detachment collocates with the preventive medicine section of a medical company to
ensure coordination of support efforts. When deployed in general support, the detachment
collocates with a medical unit or HQs.

BASIS OF ALLOCATION

One detachment per 17,000 personnel supported at the corps or EAB.

CAPABILITIES

This unit provides—

 Ability to gather information systematically to input into an automated medical
surveillance system to produce real-time tactically significant health threat profiles.

 Guidance to the command concerning PMM by performing a medical assessment of the
command and the potential impact of (DNBI) on military operations.

 Epidemiological investigations to include case-contact interviewing, contact tracing, and
outbreak investigations.

 On-site water quality analysis.

 Monitoring of water and field ice production and distribution.

 Collection of water, soil, and air samples from sources that may pose environmental,
occupational, or industrial hazards to US troops for definitive analysis by EAB/CONUS
laboratories.

 Food service sanitation inspections of field feeding sites.

 Monitoring and guidance on proper field sanitation and waste disposal techniques.

 Guidance on the prevention of climatic injuries (heat, cold, and altitude).

 Direct pest management support including aerial spray missions utilizing aerial spray
equipment.

 Direct medical entomology consultation on: arthropod-borne disease; use of pesticides;
poisonous plants and animals, and measures for control or avoidance of disease vectors
of military significance.

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142 Army Health System Doctrine Smart Book 1 June 2020

 Collection of water and ice samples for CBRN surveillance and establishes and maintains
a chain of custody for samples, and forwarding samples to supporting medical
laboratories for identification.

 Coordination with the chemical corps CBRN reconnaissance and biological detection
units for collection of air and soil environmental samples for laboratory analysis.

 Information on specific PMM to counter health threats.

 Training and certification for field sanitation team and food service personnel.

 Health promotion education.

 Inspection of cargo destined out of theater for plants, arthropods, rodents, soil, and other
items as specified to prevent their introduction into the United States, its territories and
possessions, or other nations.

 Assistance in the issuance of vessel clearances for entry into the destination ports, as
authorized.

 Staff estimates of health threats in the AO.

 One wheeled vehicle mechanic (MOS 91B) to augment the maintenance capability of the
unit that performs maintenance on its organic vehicles.

 Three teams as necessary to perform missions.

 Individuals of this organization can assist in the coordinated defense of the unit’s area or
installation.

This unit does not perform field maintenance on any organic equipment including COMSEC
equipment.

FUNCTIONS

Headquarters section

This section provides C2 of assigned personnel. Provides coordination with supporting units to
ensure the detachment’s administrative, communication, general and medical supplies, and
maintenance needs are being provided while attached to medical or other supporting units.

Preventive medicine team (3)

These teams are responsible for conducting evaluations within their assigned AO and/or to be task-
organized to provide direct preventive medicine support to designated BCTs, corps, or EAB units,
as required.

Figure 3-32. Medical Detachment, Preventive Medicine

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1 June 2020 Army Health System Doctrine Smart Book 143

MEDICAL DETACHMENT, BLOOD SUPPORT

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08430K000
MEDICAL DETACHMENT, BLOOD
SUPPORT

2 0 19 0 21

08489KA00
HEADQUARTERS, MEDICAL
DETACHMENT, BLOOD SUPPORT

1 0 5 0 6

08489KB00
COLLECTION, STORAGE &
DISTRIBUTION TEAM

1 0 5 0 6

08489KC00
COLLECTION, MANUFACTURING &
DISTRIBUTION TEAM

0 0 5 0 5

08489KD00 DISTRIBUTION TEAM 0 0 4 0 4

MISSION

Provides collection, manufacturing, storage, and distribution of blood and blood products to BCTs
and echelons above brigade medical units and to other services as required.

ASSIGNMENT

To the MMB.

DEPENDENCIES

This unit is dependent upon the following:

 Appropriate elements within the theater for religious, legal, AHS support, finance, and
personnel and administrative services.

 The medical detachment, blood support (MDBS) is dependent upon higher level medical
elements, usually the HHD, MMB and appropriate elements of the theater MEDBDE
[SPT] for AHS support, supplemental transportation, technical intelligence for captured
medical materiel, power generator maintenance support, communications maintenance
support and additional automotive and utilities maintenance support. Additionally, the
Teams when deployed separate from the base will be dependent upon a host unit for life
support operations.

This unit requires field feeding company, or supported BCT, for field feeding support.

EMPLOYMENT

The MDBS will normally be under the mission command of the HHD, MMB. The detachment has
the capability for 72-hours, limited self-sustainment during initial operations. The detachment can
deploy a HQ and a collection storage and distribution team, and/or a collection manufacturing and
distribution team and or a distribution team. The HQ may forward deploy any of these Teams as
required. See the section I of each subordinate TOE for employment statements.

BASIS OF ALLOCATION

LSCO: 0.035 per field hospital; 0.035 per hospital augmentation detachment (surgical 24-bed);
0.039 per FRSD; and 0.007 per MCAS/BSMC (First MDBS arrives with the arrival of the first Field
Hospital, or FRSD or MCAS/BSMC).

Army Support to other Services Rule: 1 per JOA

SOF Rule: 0.039 per FRSD; and 0.007 per MCAS/BSMC (First MDBS arrives with the arrival of
the first FRSD or MCAS/BSMC)

Stability Tasks Rule: 0.035 per field hospital; 0.035 per hospital augmentation detachment
(surgical 24-bed); 0.039 per FRSD; and 0.007 per MCAS/BSMC (First MDBS arrives with the arrival
of the first Field Hospital, or FRSD or MCAS/BSMC)

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CAPABILITIES

This unit provides—

 Establish the theater blood distribution plan within the JOA, including storage levels and
locations, and the schedule of re-supply.

 Prepare and submit JOA blood reports to the combatant command joint blood program
office and the Armed Services Blood Program Office.

 Implement, monitor, and enforce Armed Services Blood Program Office and joint blood
program office policies and procedures within the JOA.

 Receive and store up to 5,100 refrigerated and/or frozen blood products from CONUS or
other U.S. MTFs, and further distribute these blood products to supported medical
treatment facilities and medical units.

 Operate in a hub and node distribution manner over a large geographic area.

 Provide consultation with commanders from company to theater level regarding blood
support.

 Conduct and coordinate administrative and logistical support to sustain operations.

 Receive and account for blood and blood product shipments from the armed services
whole blood processing laboratory or expeditionary blood trans-shipment centers.

 Maintain theater blood storage depot. Store blood and blood products pending transfer
to distribution & collection sections.

 Distribute blood and blood products to medical treatment facilities down to and including
level 2 organizations.

 Determine and provide the appropriate blood products and blood types to each facility
according to the facility capabilities and role of care.

 Coordinate movement of blood and blood products and track shipments in transit to
ensure proper delivery.

 Properly screen potential emergency whole blood donors and initiate retrospective viral
marker testing on locally collected whole blood. Collect, process and test whole blood
from the available donor pool when needed for a specific emergent medical condition,
such as massive blood loss coupled with a coagulopathy requiring the transfusion of
certain coagulation factors found only in fresh blood products. Proper processing of blood
may include testing and/or treatment of blood to render potential viruses and bacteria
inactive.

 Ensure DOD/Armed Services Blood Program Office policy and procedures are followed
with respect to emergency blood donations and transfusions.

 Properly screen emergency platelet-apheresis donors and initiate retrospective viral
marker testing on locally collected platelet products.

 Collect single-donor platelets by apheresis when needed to address specific medical
conditions, such as uncontrolled bleeding requiring the transfusion of platelets and
coagulation factors. Proper processing of blood may include testing and/or treatment of
blood to render potential viruses and bacteria inactive.

See specific TOE section I for a complete list of capabilities and limitations of this organization.

FUNCTIONS

Medical Detachment Headquarters, Blood Support

This section provides C2 for the Medical Detachment, Blood Support. Personnel of this section
supervise Teams and perform unit plans and operations and general supply support activities.
Commander functions as the Area Joint Blood Program Officer. This headquarters will deploy
when any other team of the Medical Detachment, Blood Support is called into service.

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Collection Storage and Distribution Team

This team receives, inspects, accounts, stores and ships blood products to supported units. Team
can store up to 3,900 units of blood with secondary mission to collect under emergency conditions
of up to 100 units of fresh whole blood and or up to 8 Apheresis platelets per day when not
distributing blood products.

Collection Manufacturing and Distribution Team

This team receives, inspects, accounts, stores and ships blood products to supported units. Team
can store up to 900 units of blood with secondary mission to collect under emergency conditions of
up to 100 units of fresh whole blood and or up to 8 Apheresis platelets per day when not distributing
blood products.

Distribution Team

This team receives, inspects, accounts, stores and ships blood products to supported units. Team
can store up to 300 units of blood.

MOBILITY

The Medical Detachment Headquarters, Blood Support is 100 percent mobile and is able to
transport all of its TOE equipment in a single lift using organic vehicles.

The Collection Storage and Distribution Team is 50 percent mobile and only able to transport half
of its TOE equipment in a single lift using organic vehicles.

Collection Manufacturing and Distribution Team is 30 percent mobile and only able to transport a
third of its TOE equipment in a single lift using organic vehicles.

Distribution Team is 50 percent mobile and only able to transport half of its TOE equipment in a
single lift using organic vehicles.

Figure 3-33. Medical Detachment, Blood Support

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MEDICAL DETACHMENT, OPTOMETRY

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08567KA00 MEDICAL TEAM, OPTOMETRY 2 0 4 0 6

MISSION

Provides optometry care and optical fabrication to a BCT on an area basis.

ASSIGNMENT

To a MEDCOM [DS] or a MEDBDE [SPT] with further attachment to a MMB and may be further
attached to the BSMC of a BCT.

DEPENDENCIES

This unit is dependent upon the following:

 Appropriate elements of the (division or corps) for legal, finance, maintenance, personnel
and administrative support, laundry and bath services, and clothing exchange for unit
personnel and communications/information management support, and security of EPWs.

 The unit to which it is attached for water distribution, personnel and administrative
services, AHS support, patient evacuation, medical equipment maintenance and repair,
logistic support, and field maintenance of team vehicles, and communications equipment.

 MMB, for C2 as well as logistic support.

 This unit requires field feeding company, or supported BCT, for field feeding support.

EMPLOYMENT

Medical team, optometry is employed in all intensities of conflict when a BCT is deployed. Task-
organized elements are deployed for brigade-sized offensive, defensive, stability, and defense
support of civil authorities tasks METT-TC-dependent. The medical team, optometry supports a
BCT in the division AO and is usually attached to the MMB with further attachment to the BSMC.

BASIS OF ALLOCATION

One per 15,000 population supported in an AO.

CAPABILITIES

This unit provides—

 A medical team, optometry consisting of six personnel that can be divided into two teams
(optometry teams A and B). Each team has the capability to provide optometry support
limited to eye examination, optical fabrication, frame assembly, and repair services to
brigade and nonbrigade units in the AO as far forward as possible.

 Initial diagnosis and management of eye injuries on the battlefield.

 Examinations to detect, prevent, diagnose, treat, and manage ocular related disorders,
injuries, diseases, and visual dysfunctions.

 Assembly, repair and fabrication of single vision spectacles.

 Individuals of this organization are all medical personnel and cannot assist in the
coordinated defense of the unit’s area or installation.

 This unit does not perform field maintenance on any organic equipment.

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FUNCTIONS

Optometry team

This team provides limited optometry services. These include routine eye examinations and
refractions and spectacle frame assembly.

MOBILITY

This unit is 50% mobile and can transport half of its TOE equipment in a single lift using its organic
vehicles. Units will be dependent on appropriate elements of the brigade, division, or corps for
supplemental transportation.

Figure 3-34. Medical Detachment, Optometry

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MEDICAL LOGISTICS MANAGEMENT CENTER

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08670K000 MED LOG MGMT CTR 14 3 41 0 58

08699KA00
MEDICAL LOGISTICS MANAGEMENT
CENTER (MLMC), BASE 10 1 21 0 32

08699KB00

MEDICAL LOGISTICS MANAGEMENT
CENTER (MLMC) FORWARD TEAM
(EARLY ENTRY) 2 2 10 0 14

08699KC00

MEDICAL LOGISTICS MANAGEMENT
CENTER (MLMC) FORWARD TEAM
(FOLLOW ON) 2 0 10 0 12

MISSION

To provide centralized, theater-level inventory management of Class VIII materiel in accordance
with the ASCC surgeon’s policy.

ASSIGNMENT

To the MEDCOM [DS].

DEPENDENCIES

This unit is dependent upon appropriate elements within the theater for religious, legal, AHS
support, finance, and personnel and administrative services.

Field feeding company, for field feeding support.

EMPLOYMENT

The medical logistics management center (MLMC), maintains operations within CONUS to provide
centralized, strategic-level management of critical Class VIII materiel, patient movement items,
optical fabrication, and medical equipment maintenance for multiple theaters.

BASIS OF ALLOCATION

One unit required in the force. Unit contains a nondeploying base, two forward teams (early entry),
and two forward teams (follow on). Each team deploys and supports a theater.

CAPABILITIES

This organization provides the following as shown in their respective TOEs:

 Monitoring of theater MEDLOG operations.

 Monitoring of the receipt and processing of Class VIII requisitions from MEDLOG units of
all Services.

 Reviewing and analyzing of demands, and computing theater requirements for Class VIII
supplies, medical equipment, medical equipment maintenance and repair, and optical
fabrication.

 Implementation of plans, procedures, and programs for medical materiel management
systems.

 Medical materiel management data and reports, as required.

 SIMLM information management and distribution coordination mission to Joint Forces,
as directed.

 Management interface with CONUS Class VIII national inventory control point.

 Management of critical items and analysis of production capabilities.

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 Liaison with the materiel distribution manager at brigade/corps and theater levels for
distribution of Class VIII supplies within the AO.

 Deployment of two early entry forward teams, and two follow on MLMC forward teams,
as required into two theaters.

 One light wheeled vehicle maintainer, MOS 91B1O to supplement the maintenance
capability of the unit to which assigned or attached.

FUNCTIONS

Headquarters Section

This section provides C2 and administrative support for the MLMC.

Support Division

This division coordinates medical logistics staff functions. It is responsible for placement and
operation of the two MLMC Early Entry Forward Teams and two MLMC follow on forward teams,
and the execution of operational plans.

Materiel Management Division

This division is responsible for monitoring Class VIII materiel management in CONUS and multiple
Theaters on a daily basis. Monitors requisitions for critical items and analyzes stockage objectives.
Interfaces with national inventory control point and performs special studies and analysis of
logistical data. Receives all theater requisitions for Class VIII materiel for resupply/replenishment
actions.

Medical Maintenance Management Division

This division provides the planning, direction, and coordination for medical equipment maintenance
operations. Serves as the medical equipment maintenance consultant for the ASCC Surgeon.
Reviews maintenance status and performance reports and manages the allocation of maintenance
personnel assets and medical stand-by equipment program items.

Detachment Headquarters

This section provides C2 of the MLMC. Personnel of this section will supervise and perform unit
and general supply functions. Maintenance personnel will supplement a collocated unit for daily
work assignments to support the MLMC.

MLMC Forward Support Teams, (Early Entry) (X2)

The MLMC has two early entry forward teams. One forward team will deploy into the theater to
provide centralized management of medical materiel, medical equipment maintenance and repair,
medical logistics contracting operations, and coordination of the distribution of Class VIII materiel
within the AO. The chief logistics of this team serves as the team commander when deployed.
The early entry team collocates with the distribution management center of the theater sustainment
command (TSC). The team will provide the information management and distribution coordination
portion of the SIMLM mission, when the Army is designated as the SIMLM by the combatant
commander, for joint operations. The team is assigned to the MEDCOM (DS) and collocates with
the distribution management center of the TSC/expeditionary sustainment command. The team is
assigned to the medical brigade when there is no MEDCOM (DS) in the theater. The early entry
team collocates with the ASCC distribution operations section or the sustainment brigade when the
TSC is not deployed.

MLMC Support Teams, Follow On (x2)

These teams continue to provide additional centralized management of medical materiel, medical

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equipment maintenance, and coordination of the distribution of Class VIII materiel within the AO.
The follow-on team collocates with the distribution management center within the TSC. The follow-
on team can provide liaison officers (or NCOs) to the division/corps/ASCC surgeon’s location, as
required. The team will provide the information management and distribution coordination portion
of the SIMLM mission, when the Army is designated as the SIMLM by the combatant commander,
for joint operations. The team is assigned to the MEDCOM and collocates with the distribution
management center of the TSC/expeditionary sustainment command. The team is assigned to the
medical brigade when there is no MEDCOM (DS) in the theater. The follow-on team collocates
with the division/corps distribution operations section of the sustainment brigade when the TSC is
not deployed. These follow-on teams are not designed to operate independently. They will always
operate with the MLMC forward team (early entry) TOE 08699GB00.

MOBILITY

The MLMC (Base) is only 10 percent mobile and is dependent on appropriate elements of the
brigade, division, or corps for supplemental transportation.

MLMC forward early entry and follow on teams are 100 percent mobile and able to transport
all of its TOE equipment in a single lift using organic vehicles.

Figure 3-35. Medical Logistics Management Center

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AREA MEDICAL LABORATORY

SRC TITLE REQ OFF REQ WO REQ ENL REQ CIV REQ TOT

08668K000 AREA MEDICAL LABORATORY 19 0 21 0 40

MISSION

To identify and evaluate health hazards in the AO through unique medical laboratory analyses and
rapid health hazard assessments of nuclear, biological, chemical, endemic disease, occupational
and environmental health threats.

ASSIGNMENT

To an MEDCOM [DS] or MEDBDE [SPT], and may be further attached to other deployed medical
units as needed.

DEPENDENCIES

This unit is dependent upon appropriate elements within the theater for religious, legal, FHP,
finance, and personnel and administrative services.

This unit requires maintenance support on organic equipment.

Field feeding company, for field feeding support.

CAPABILITIES

This unit provides—

 Analytical, investigative and consultative capabilities to identify nuclear, biological and
chemical threat agents in biomedical specimens and other samples from the AO.

 Analytical, investigative and consultative capabilities to assist in the identification of
occupational and environmental health hazards and endemic diseases.

 Special environmental control and containment to evaluate biomedical specimens for the
presence of highly infectious or hazardous agents of operational concern.

 Data and data analysis to support medical analysis and operational decisions.

 Medical laboratory analysis to support the diagnosis of zoonotic and significant animal
diseases that impact on military operations.

 Tailorable force projections to support war and other operations.

 Deployed modular sections or sectional teams will normally be deployed forward in the
corps area where they will interface with preventive medicine teams, veterinary teams,
forward support medical units, biological integrated detection system teams, and
chemical company elements operating in the corps area.

 Individuals of this organization can assist in the coordinated defense of the unit’s areas
or installation.

This unit does not perform field maintenance on organic equipment.

FUNCTIONS

Headquarters section

This section provides command, control, communications, computers, and intelligence to include
coordinating for secure and nonsecure capabilities, automation and computer analysis support
requirements for the laboratory to facilitate split-based operations and administrative and logistical
support for the unit.

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Endemic disease section

This section provides analytical, investigative, and consultative services on endemic diseases.

Occupational and environmental health section

This section monitors and evaluates OEH hazards to deployed forces and provides medical
assessment and consultation on associated hazards.

NBC Section

This section provide analytical, investigative, and consultative services to assist in the identification
of CBRN threat agents in biomedical specimens and other samples.

MOBILITY

This unit is 10% mobile and can transport a tenth its TOE equipment in a single lift using its organic
vehicles. Units will be dependent on appropriate elements of the brigade, division, or corps for
supplemental transportation.

Figure 3-36. Area Medical Laboratory

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PART FOUR

Army Health System by Strategic Role

INTRODUCTION

As the Army’s focus transitions to large-scale ground combat in a multi-domain
operations environment, FM 3-0, Operations, was revised and includes a great
deal of discussion about the Army’s four strategic roles—Shaping the
operational environment, Preventing armed conflict, conducting LSCO, and
Consolidating Gains. Part Four describes the activities and tasks within each
of the ten medical functions specific to each of the Army strategic roles.
Naturally, tasks are very dependent on the operating environment. A
MEDCOM [DS] would have different tasks in Europe than it would have in the
Pacific region in the Shape role. However, described within this section are
many of the generic activities that would be common and it is then dependent
on leaders and mission command planning to scope the specific tasks that
support the goals in each of the strategic roles.

Adversaries have studied the manner in which U.S. forces deployed and
conducted operations over the past three decades. Several have adapted,
modernized, and developed capabilities to counter U.S. advantages in the air,
land, maritime, space, and cyberspace domains. Military advances by Russia,
China, North Korea, and Iran most clearly portray this changing threat. The
AHS must be prepared for this.

While the AHS forces must be manned, equipped, and trained to operate
across the range of military operations, LSCO against a peer threat represents
the most significant readiness requirement. Army Medicine doctrinal
publications along with FM 3-0 provides doctrine for how AHS forces do this.
FM 3-0 is concerned with operations using current Army capabilities,
formations, and technology in today’s OE. It expands on the material in ADRP
3-0 by providing tactics describing how theater armies, corps, divisions, and
brigades work together and with unified action partners to successfully
prosecute operations short of conflict, prevail in LSCO, and consolidate gains
to win enduring strategic outcomes.

The logic maps in Part Four begins with an anticipated OE that includes
considerations during shape, prevent, LSCO, and consolidate gains against a
peer threat. Within each phase of an operation, the Army’s operational concept
of unified land operations guides how Army forces conduct operations. In
LSCO, Army forces combine offensive, defensive, and stability tasks to seize,
retain, and exploit the initiative in order to shape OEs, prevent conflict, conduct
LSCO, and consolidate gains. The philosophy of mission command guides
AHS commanders, staffs, and subordinates in their approach to FHP and HSS
operations. The mission command warfighting function enables commanders
and staffs of AHS formations to synchronize and integrate medical support

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across multiple domains. Throughout operations, Army forces maneuver to
achieve and exploit positions of relative advantage across all domains to
achieve objectives and accomplish missions. AHS Commanders, staffs, and
subordinates must understand the operational art depicted in FM 3-0 in order
to better support the warfighter.

4-1. Throughout Part Four of this publication, refer to Table 4-1 for all abbreviations used in
Figures 4-1 through 4-40.

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

1 Role 1 (BAS)

2 Role 2 (BSMC or MCAS)

3 Role 3 (field hospital, CSH, or hospital center)

4 Role 4 (CONUS-based hospitals and other safe havens)

AFRRI Armed Forces Radiobiology Research Institute

AML area medical laboratory

APOD aerial port of debarkation

APS Army Pre-Positioned Stock

AXP ambulance exchange point

BAS battalion aid station

BSMC brigade support medical company

CCP casualty collection point

CDC Centers for Disease Control and Prevention

CSH combat support hospital

CONUS continental United States

COSC combat and operational stress control

CRT contact repair team

DCAS dental company (area support)

DMC distribution management center

EE early entry

FDT forward distribution team

FPLT food procurement and lab team

FRSD forward resuscitative surgical detachment

FWD forward

JDDOC joint deployment and distribution operations center

MCAA medical company (air ambulance)

MCAS medical company (area support)

MCGA medical company (ground ambulance)

MDBS medical detachment (blood support)

MDVSS medical detachment (veterinary service support)

MEDBDE [SPT] medical brigade (support)

MEDCOM [DS] medical command (deployment support)

MLC medical logistics company

MLMC medical logistics management center

MLST medical logistics support team

MMB medical battalion (multifunctional)

MMC medical materiel center

PM preventive medicine

POI point of injury

SPOD sea port of debarkation

SPT support

surg surgical

TLAMM theater lead agent for medical materiel

USAMRICD United States Army Medical Research Institute of Chemical Defense

USAMRIID United States Army Medical Research Institute of Infectious Diseases

VMST veterinary medical and surgical team

VSST veterinary service support team

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SHAPE

4-2. Shaping activities are continuous within an AOR. The combatant command (command
authority) uses them to improve security within partner nations, enhance international legitimacy,
gain multinational cooperation, and influence adversary decision making. This cooperation includes
information exchange and intelligence sharing, obtaining access for U.S. forces in peacetime and
crisis, and mitigating conditions that could lead to a crisis.

4-3. Shaping activities are directly tied to authorities provided in various titles of the United States
Code and approved programs, and integrated and synchronized with the Department of State,
other government agencies, country teams, and ambassadors’ plans and objectives. The
Department of State and the United States Agency for International Development develop the joint
regional strategy to address regional goals, management, operational considerations, and
resources. Each country team develops an individual country plan to address country context, joint
mission goals, and coordinated strategies for development, cooperation, security, and diplomatic
activities. Working with the Department of State and various country teams, the geographic
combatant commander (GCC) and planners develop a theater strategy to influence regional and
country conditions to achieve national objectives. The theater strategy is translated into a theater
campaign plan (TCP). The TCP guides the shaping activities conducted throughout the AOR by
joint forces.

4-4. The ASCC significantly contributes to the planning, execution, and assessment of the GCC’s
TCP. Army forces conduct operations to shape with various unified action partners through careful
coordination and synchronization facilitated by the ASCC through the GCC, and when authorized,
directly with the partner nation’s military forces. Army forces provide security cooperation
capabilities AOR-wide, including building defense and security relationships and partner military
capacity through exercises and engagements, gaining or maintaining access to populations,
supporting infrastructure through assistance visits, and fulfilling executive agent responsibilities.
Military-to-military contacts and exchanges, joint and combined exercises, various long-term
persistent military engagements, and other security cooperation activities provide the foundation of
the GCC’s TCP.

SHAPE STRATEGIC ROLE
 Planning considerations: Personnel and equipment movement, tactical commander’s

plans and objectives, site selection (if providing care during Shape), main supply route
(MSR)/alternate supply route, PAR, movement plans, sustaining medical skills, MASCAL,
CBRN.

 Risks/gaps that will cause AHS support to fail: Unit readiness issues, personnel
shortages. Lack of proper synchronization/integration with MMB.

 Possible mitigation strategies: Assign under MMB—MED BDE-MEDCOM [DS] as
higher HQs for oversight and readiness.

 Possible DOTMLPF changes: Force design update to assigned MEDCOM [DS] theater
and habitual relationship with assigned/attached units where possible.

 Command/Support Relationships: Assigned to MMB, area support for EAB units
without Role 2.

MEDICAL COMMAND AND CONTROL

4-5. During operations to Shape, plan for deployment and conduct of operations against a
determined adversary with anti-access/anti-denial (A2/AD) capabilities. Medical assets may
participate in building capacity and partnerships through host-nation and multinational partners.

4-6. This is the time to train and set conditions to win the next conflict by ensuring the readiness
of personnel, equipment, and sufficiency of materiel (operational readiness). Participate in
combined exercises, and deploy to combat training centers (organic support) as part of the parent

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organization. Develop personnel in the formation and key leaders. Conduct contingency planning.
Conduct emergency deployment readiness exercise with the combat load.

4-7. Planners should identify other training requirements during mission analysis and plan for
integration of Army special operations forces (ARSOF) and conventional forces in the fight. Plan
for and practice operations security (OPSEC). Reduce visual, aural, and electromagnetic
signatures across the spectrum. Plan for and conduct appropriate concealment and camouflage
techniques when moving and set.

Figure 4-1. Medical Command and Control in Shaping

MEDICAL TREATMENT (ORGANIC AND AREA SUPPORT)

4-8. During shaping, plan for deployment and conduct of operations against a determined
adversary with A2/AD capabilities. Medical assets may participate in building capacity and
partnerships through host-nation and multinational partners. They continue to train in both clinical
and tactical procedures to standard both individually and collectively.

4-9. This is the time to train and set conditions to win the next conflict by ensuring the readiness
of personnel, equipment, and sufficiency of materiel (operational readiness). Participate in
combined exercises, and deploy to combat training centers (organic support) as part of the parent
organization.

4-10. Plan for and practice OPSEC. Reduce visual, aural, and electromagnetic signatures across
the spectrum. Plan for and conduct appropriate concealment and camouflage techniques.

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Figure 4-2. Medical Treatment in Shaping

HOSPITALIZATION

4-11. During shaping, CSHs and hospital centers have the difficult training tasks associated with
remaining ready to deploy to a TO. Potentially, the two most difficult areas to remain proficient at
are the clinical skills of the medical providers and maintaining the ability to provide medical mission
command, especially considering elements that may deploy as a part of a hospital are not organic
to the senior mission commander. The hospitals conduct field training exercises, staff exercises
and Role 3 support to combat training centers and require medical providers to attend these events.
A large percentage of the providers work at defense health agency medical treatment facilities and
remain proficient in their individual skills. The challenge for the operational hospital is to integrate
these providers into hospital operations utilizing the equipment and procedures of the CSH or
hospital center, which may be different than the installation MTF they are accustomed to working.

4-12. Other operations include supporting Soldier readiness activities, assessing prepositioned
stocks, and planning/rehearsing elements of the hospital to provide limited Role 3 early entry
support.

4-13. Additionally, Role 3 hospitals can support ongoing engagements with partner nations to
increase those nations’ capacities and capabilities to provide medical care. While conducting
medical engagements, the hospital staff is gaining a great deal of situational understanding of the
medical capabilities and health threats within the operational area, both will be important if a large-
scale deployment occurs in the area.

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Figure 4-3. Hospitalization in Shaping

MEDICAL EVACUATION (TO INCLUDE MEDICAL REGULATING)

4-14. The MEDEVAC units will continue to train on individual, collective, mission essential task list
(commonly known as METL), conduct clinical training and rotations to sustain medical skills and
certifications, and pursue professional development courses. The MEDEVAC units must be
proficient not only to conduct the primary MEDEVAC tasks, but to rapidly disassemble their
equipment, move to a new location, and re-establish themselves to respond to MEDEVAC
requests, under all weather conditions. Medical planners should attend staff courses such as the
joint medical planner’s course when available, especially for 67J and 70H (officer) and 68W
(enlisted) occupational specialties on division or corps staff.

4-15. Staff exercises may be held at tactical through operational levels to train and rehearse the
planning and operation of a MEDEVAC system including CCPs, ambulance exchange points
(AXPs), evacuation routes, MEDEVAC requests, synchronization of MTFs, and medical regulating.
Units may prepare time-phased and deployment data, update equipment sets, and prepare
containers and vehicles for deployment.

4-16. Key shaping activities may include support to military exercises and involve additional
requirements such as support to ship to shore and shore to ship or overwater missions. Associated
requirements such as deck landing qualification, helicopter emergency underwater egress and
helicopter emergency egress devise training should be identified early in order to ensure it is
included in training plans.

4-17. Military engagements include interactions with foreign military medical personnel and foreign
and domestic civilian authorities. The MEDEVAC units can support security cooperation and
security force assistance goals through activities such as MEDEVAC training to build partner
capacity. MEDEVAC support to foreign internal defense may be constrained by the number of
MEDEVAC vehicles and type and location of MTFs. In some instances, casualty evacuation
(CASEVAC) may be utilized to move a casualty to a MTF or an AXP manned by MEDEVAC aircraft
due to extended distances and limited assets. Humanitarian assistance missions provide Army

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MEDEVAC units opportunity to perform its mission while strengthening partnership between the
U.S. and the supported nation.

Figure 4-4. Medical Evacuation in Shaping

DENTAL SERVICES

4-18. Dental readiness is fundamental to maintaining unit readiness and reducing noncombat
dental casualties during deployments. Mobilization and deployment dental processing will create
a massive dental workload. Dental capability may be depleted by deployment of active army dental
personnel.

4-19. Lessons learned from previous mobilizations indicate that—

 Little time is available for treatment of dental emergencies during mobilization and
deployment operations.

 High levels of dental readiness and dental preparedness reduce mobilization dental
processing and treatment time.

 Three to five days is the average length of time a Soldier is lost to his unit when he must
be evacuated for dental emergencies.

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Figure 4-5. Dental Services in Shaping

PREVENTIVE MEDICINE SERVICES

4-20. PVNTMED support is designed to prevent casualties from DNBI through medical
surveillance, OEH surveillance, and health assessments, PMM of hygiene and sanitation, and
personal protective measures. Medical planners, in conjunction with the MEDCOM [DS], must
ensure that a thorough analysis of the existing health threat has been accomplished and of the host
nation’s ability to mitigate or reduce the health threat. The health threat analysis is then used in
the development of the medical requirements for a given operation.

4-21. Operations to Shape are designed to bring together those activities intended to promote
regional stability and to set the conditions for a favorable outcome in the event of a military
confrontation. Army operations to Shape are also conducted to dissuade adversaries from potential
military conflict. As part of operations to Shape, the Army maintains trained and ready forces to
support campaign plans, to serve as a forward presence to promote U.S. interests, to react to
contingencies, and to develop the military capabilities of allied and friendly nations.

4-22. Preventive medicine detachments and teams possess the trained personnel and equipment
ready to deploy to a theater and to provide the expertise to counter health threats in support of
Shape operations. They are closely involved in Soldier readiness activities for deploying forces and
engage in partnerships with host nations. Preventive medicine personnel are also deployed with
both early-entry and follow-on forces to identify and address local health threats. Major PVNTMED
planning considerations for Shape operations consist of the following: building partner capability
and capacity; collecting medical intelligence and identifying health threats; ensuring supported units
have completed pre-deployment PVNTMED related training (that is, field sanitation team training,
basic food and drinking water safety, etc.) and conducting health threat briefings. Preventive
medicine detachments and teams can be assigned to a MEDCOM [DS], MEDBDE [SPT], MMB,
MCAS, or a medical mission task force HQs in the corps and EAB. They may be attached to a unit
in the BCT, corps, or EAB.

4-23. More specifically, preventive medicine operations to Shape also consist of the following:
comprehensive health surveillance, identification of medical health threats, conduct field sanitation

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team training, provide food service training, provide health threat briefings, health promotion
education, conduct health threat analysis, develop pest management plan, and provide information
on PMM to counter health threats.

Figure 4-6. Preventive Medicine in Shaping

COMBAT AND OPERATIONAL STRESS CONTROL

4-24. During shaping, COSC detachments have the difficult training tasks associated with
remaining ready to deploy to a TO. This may include sending behavioral health teams to combat
training centers to be attached to or in direct support of the maneuver unit. In addition to ensuring
they, themselves, are trained and prepared to deploy, they may support Soldier readiness activities.
These activities may include training and education of Soldiers and leaders on all aspects of
remaining mentally healthy during operations.

4-25. Additionally, COSC detachments may support ongoing engagements with partner nations to
increase those nations’ capacities and capabilities to provide behavioral health care. While
conducting medical engagements, the staff is gaining a great deal of situational understanding of
the medical capabilities and health threats within the operational area, both will be important if a
large-scale deployment occurs in the area.

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

VETERINARY SERVICE SUPPORT

4-26. Veterinary services are provided to enhance the health of the command through three broad-
based functions—food inspection services, animal medical care, and veterinary preventive
medicine (to include the prevention of zoonotic diseases transmissible to man). As the DOD sole
provider, the Army provides veterinary service support to the USAF (minus food inspection support
on USAF installations), Army, USN, and USMC forces, as well as other federal agencies, host
nation, and multinational forces, when directed.

4-27. Army operations to Shape bring together all of the activities intended to promote regional
stability and set the conditions for a favorable outcome in the event of a military confrontation. Army
operations to SHAPE help dissuade adversary activities designed to achieve regional goals short
of military conflict. As part of operations to Shape, the Army provides trained and ready forces to
GCCs in support of their TCP. The ASCC and subordinate Army forces assist the GCC in building
partner capacity and capability and promoting stability across the AOR. Army operations to Shape
are continuous throughout a GCC’s AOR and occur before, during, and after a joint operation within
a specific operational area. Shaping activities include security cooperation and forward presence
to promote U.S. interests, developing allied and friendly military capabilities for self-defense and
multinational operations, and providing U.S. forces with peacetime and contingency access to a
host nation. Regionally aligned and engaged Army forces are essential to achieving objectives to
strengthen the global network of multinational partners and preventing conflict. The Army garrisons
forces and pre-positions equipment in areas to allow national leaders to respond quickly to
contingencies. Operational readiness, training, and planning for potential operations by Army
forces at home station are also a part of operations to SHAPE. Army operations to Shape
correspond to continuous shaping activities within the joint phasing model (FM 3-0).

4-28. Veterinary service support to Shape activities includes continuing the food protection mission
including sanitation audit inspections of food establishments and inspecting operational rations
(ready to eat meals and unitized group rations), as well as ensuring that military working animals
are healthy and ready to deploy. The medical detachment (veterinary service support) can be
assigned to the MEDCOM [DS], MEDBDE [SPT], MMB, or an equivalent sister Service

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organization. Its structure is such that it can deploy subordinate teams based on mission
requirements.

4-29. More specifically, veterinary service support to Shape also includes the following:
identification of animal diseases of military significance (zoonotic and economic), providing
preventive and medical care to government owned animals, sanitation audits of commercial food
sources for DOD procurement, conducting inspections for food safety, quality, and sanitation, food
defense vulnerability assessments, food and water risk assessments, animal facility inspections,
and veterinary support to stability tasks.

Figure 4-8. Veterinary Services in Shaping

MEDICAL LOGISTICS (TO INCLUDE BLOOD MANAGEMENT)

4-30. Providing AHS support to set the theater establishes the foundation for planning, sustaining,
and achieving effective medical support to the TCP. During shaping operations strategic and
theater level medical organizations work together to set the theater and coordinate with
sustainment organizations at echelon for maintenance, transportation, supply, distribution, and
engineering support for the full range of medical operations. The U.S. Army Medical Materiel
Agency manages and maintains medical Army Pre-positioned Stock (APS) assets for TSG and
provides the Class VIII portion of APS readiness reporting up through the Army Materiel Command.
Under a strategic partnership between the Army Medical Department and Defense Logistics
Agency, installation medical supply activities at designated Army installations conduct medical
materiel management and supply support operations using the Defense Working Capital Fund.
The installation medical supply activities, in coordination with deploying medical units, also provide
preconfigured push-packages to support early entry operations until line item requisitioning is
established.

4-31. During operations to shape, the ASCC surgeon develops the MEDLOG plan to meet Army
and joint HSS and FHP requirements that are specific to the region. Efforts would be made where
appropriate, to initiate multinational support agreements for Class VIIIb (blood and blood products)

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for the joint operations area. The MEDCOM (DS) executes and directs theater Class VIII support
through use of modular MEDLOG units, to include the MLC (with possible use of the MLC early
entry team for Class VIIIa and medical equipment maintenance support for early deploying units)
and the 6th Medical Logistics Management Center assigned to the theater force pool and task-
organized as required to the MEDBDE (SPT) assigned to the MEDCOM (DS) or attached to the
ASCC. Coordination through S-4 channels for development of medical operational requirements
for medical and nonmedical contracts is also a key activity during shaping operations.

Figure 4-9. Medical Logistics in Shaping

MEDICAL LABORATORY SERVICE

4-32. The medical laboratory service is considered one of the medical functions under the AHS and
its mission is under the FHP warfighting function. The AML includes capabilities in the identification
and theater validation of suspect CBRN agents, endemic diseases, and OEH hazards. Its focus is
the total health environment of the AO, not individual patient care. The AML is the Army’s
specialized theater laboratory that deploys worldwide as a unit or by task organizing teams to
perform surveillance, analytical laboratory testing, and health hazard assessments of
environmental, occupational, endemic, and CBRN threats in support of Soldier protection and
weapons of mass destruction missions. It can perform tests on air, water, soil, food, waste, and
both insect and animal vectors for a broad range of microbiological, radiological, and/or chemical
contaminants under two basic scenarios. First, it provides theater validation level of identification
in support of TO. Second, in contingency operations, it provides immediate hazard identification in
high risk environments and rapid laboratory analysis and theater validation level of identification to
assist commanders in operational decision making. The AML is organized into teams: analytical
chemistry section; microbiology section; and OEH surveillance section.

4-33. Operations to Shape are designed to bring together those activities intended to promote
regional stability and to set the conditions for a favorable outcome in the event of a military
confrontation. Army operations to Shape are also conducted to dissuade adversaries from potential
military conflict. As part of operations to Shape, the Army maintains trained and ready forces to

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support campaign plans, to serve as a forward presence to promote U. S. interests, to react to
contingencies, and to develop the military capabilities of allied and friendly nations.

4-34. In support of Shape operations, the AML and its teams may be assigned/attached to a
MEDCOM [DS] (DS), a MEDBDE [SPT], and may be further attached to other deployed medical
units, as needed.

Figure 4-10. Medical Laboratory in Shaping

PREVENT

4-35. The intent of operations to prevent is to deter adversary actions and stop further deterioration
of a particular situation. Prevent activities enable the joint force to gain positions of relative
advantage prior to future combat operations. Operations to prevent are characterized by actions
to protect friendly forces and indicate the intent to execute subsequent phases of a planned
operation. With the shift from shaping to deterrence, the ASCC shifts to refining contingency plans
and preparing estimates for landpower based on GCC’s guidance. The ASCC and subordinate
Army forces perform the following major activities during operations to prevent—

 Execute flexible deterrent options (FDOs) and flexible response options.

 Set the theater.

 Tailor Army forces.

 Project the force

PREVENT STRATEGIC ROLE
 Planning Considerations: Personnel and equipment movement, tactical commander’s

plans and objectives, site selection (if providing care during Prevent), MSR/alternate
supply route, PAR, movement plans, sustaining medical skills, MASCAL, CBRN.

 Risks/gaps that will cause AHS support to fail: Equipment and personnel shortages.
Lack of proper synchronization/integration with MMB.

 Possible mitigation strategies: Assign under MMB for mission command and support.

 Possible DOTMLPF changes: None.

 Command/Support Relationships: Assigned to MMB, area support for EAB units
without Role 2.

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MEDICAL COMMAND AND CONTROL

4-36. During operations to prevent, increased readiness and show of force operations may result
in increased injury; in addition, these activities provide an opportunity for associated medical units
to participate in individual and collective training opportunities.

4-37. This is an opportunity during set the theater for units to establish or improve bases. During
this activity, medical treatment access, protection, and inclusion in this activity is utilized.

4-38. Units are prepared to provide direct and area medical support as needed for units are on
station without requisite medical support, or integration of additive medical treatment support
arriving on station.

4-39. During mobilization, training, readiness, and predeployment health assessments and
activities take place. Employment include but are not limited to, entry operations, offensive
operations, defensive operations, security and stability tasks and all those activities imply for
medical treatment both organic and area.

Figure 4-11. Medical Command and Control in Prevent

MEDICAL TREATMENT (ORGANIC AND AREA SUPPORT)

4-40. Operations to prevent are designed to deter adversary actions contrary to U.S. interests.
Army operations to prevent are typically conducted in response to activities that threaten unified
action partners and require the development of credible forces in theater by an increase in partner
training and integration with U.S. forces activities and concurrent planning for current and future
operations. Synchronization, partner integration (medical treatment and supporting activities),
tailored for the operational environment, area of operations, and adversary intentions and
capabilities are key to success.

4-41. This is an opportunity during set the theater for units to establish or improve bases.

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4-42. Units are prepared to provide area and organic medical support as needed for units are on
station.

4-43. During mobilization, training, readiness, and predeployment health assessments and
activities take place.

Figure 4-12. Medical Treatment in Prevent

HOSPITALIZATION

4-44. During prevent, CSHs and hospital centers continue training all aspects of their required
capabilities. Hospital staffs are engaged in mission analysis and coordination with the MEDBDE
to ensure all aspects of deployment and employment are adequate. Especially key for the hospital
is coordinating army prepositioned stock draws, if applicable, support during reception, staging,
onward movement, and integration activities (to include early entry Role 3), and ensuring the right
capabilities are available if a transition to large-scale ground combat occurs.

4-45. Role 3 hospitals may still be supporting ongoing engagements with partner nations to
increase those nations’ capacities and capabilities to provide medical care. While conducting
medical engagements, the hospital staff is gaining a great deal of situational understanding of the
medical capabilities and health threats within the operational area, both will be important if a large-
scale deployment occurs in the area.

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Figure 4-13. Hospitalization in Prevent

MEDICAL EVACUATION (TO INCLUDE MEDICAL REGULATING)

4-46. At the strategic level, the ASCC plans and coordinates Army capabilities to set the theater.
Planners assess available intelligence to identify health threats, foreign medical capabilities and
infrastructure, PAR, viable routes for evacuation and locations for MTFs and units. Planners may
also develop contingency or operation plans. During operations to prevent, a corps HQs may
deploy into an operational area as a tactical HQs with subordinate divisions and brigades as a show
of force, or, may deploy an early entry command post to provide control over arriving forces.
Medical planners within the corps surgeon section should begin planning early, develop an
understanding of the mix of forces and how to best support them with the available MEDEVAC
assets which may include units and capabilities from other services and casualty evacuation
augmentation.

4-47. Units and personnel who are part of a readiness force or who have been designated for
specific operation will have completed clinical rotations and training events and be available for
immediate recall and deployment. During operations to prevent, units could be part of a tailored
force in support of force projection. Force projection is the ability to project the military instrument
of national power from the United States or another theater, in response to requirement for military
operations (JP 3-0).

4-48. MEDEVAC units may provide area MEDEVAC support during reception, staging, onward
movement and integration, at ports of embarkation, debarkation, and along movement routes.
Medical planners may coordinate with U.S. or host nation organizations for some aspects of
support.

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4-49. The following figure is an example of MEDEVAC activities during operations to prevent:

Figure 4-14. Medical Evacuation in Prevent

DENTAL SERVICES

4-50. Dental care provided for deployed Soldiers in theater is referred to as operational dental care.
Operational dental care consists of emergency dental care and essential dental care. Because of
their size and mobility the dental assets are capable of conducting expeditionary and joint
operations and once deployed are better able to quickly respond to ever-changing mission
requirements.

4-51. The DCAS is employed with the MEDCOM [DS] or the MEDBDE [SPT] within a theater. Once
in place they can deploy forward dental treatment sections to provide area dental support. Dental
teams may be employed in the BCT area to provide forward emergency and preventive dental care.

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Figure 4-15. Dental Services in Prevent

PREVENTIVE MEDICINE SERVICES

4-52. Operations to Prevent are designed to deter adversary actions contrary to U.S. interests.
Army operations to prevent are typically conducted in response to activities that threaten unified
action partners and require the development or repositioning of credible forces in a theater to
demonstrate the willingness to fight if deterrence fails. These operations are tailored in scope and
scale to achieve a strategic or operational level objective.

4-53. Major PVNTMED planning considerations for PREVENT operations consist of the following:
conducting OEH surveillance and base camp assessments; environmental sampling;
entomological and epidemiological assessments; and tracking DNBI statistics. Preventive
medicine detachments and teams can be assigned to a MEDCOM [DS], MEDBDE [SPT], MMB,
area support medical company (ASMC), or a medical mission task force HQs in the Corps and
EAB. They may be attached to a unit in the Brigade, Corps, or EAB.

4-54. During PREVENT operations, increased readiness and show of force operations may result
in increased injury; in addition, these activities provide an opportunity for associated medical units
to participate in individual and collective training opportunities.

4-55. More specifically, preventive medicine operations to Prevent also consist of the following:
conduct similar operations to Shape strategic role, increase partner capacity and capabilities,
provide guidance to the command concerning PMM, epidemiological investigations, on-site water
quality analysis, monitoring of water and field ice production and distribution, collection of samples
(water, soil, air), food service sanitation inspections of field feeding sites, monitoring and training
on proper field sanitation and waste disposal techniques, pest management support, entomologic
consultation, and base camp assessments.

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Figure 4-16. Preventive Medicine in Prevent

COMBAT AND OPERATIONAL STRESS CONTROL

4-56. During prevent, COSC detachments continue training all aspects of their required capabilities.
Through the MMB, COSC leadership is engaged in mission analysis and coordination to ensure all
aspects of deployment and employment are adequate. As with shaping, COSC units may be
significantly involved with the pre-deployment preparation and Soldier readiness activities of
operational units.

4-57. COSC detachments may still be supporting ongoing engagements with partner nations to
increase those nations’ capacities and capabilities.

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Figure 4-17. COSC in Prevent

VETERINARY SERVICES

4-58. Army operations to Prevent include all activities to deter an adversary’s undesirable actions.
These operations are an extension of operations to shape designed to prevent adversary
opportunities to further exploit positions of relative advantage by raising the potential costs to
adversaries of continuing activities that threaten U.S. interests. Prevent activities are generally
weighted toward actions to protect friendly forces, assets, and partners, and to indicate U.S. intent
to execute subsequent phases of a planned operation. As part of a joint force, Army forces may
have a significant role in the execution of directed flexible deterrent options. Additionally, Army
Prevent activities may include mobilization, force tailoring, and other predeployment activities; initial
deployment into a theater to include echeloning command posts; employment of intelligence
collection assets; and development of intelligence, communications, sustainment, and protection
infrastructure to support the joint force commander’s concept of operations. Army operations to
prevent correspond to the deter phase in a joint operation (FM 3-0).

4-59. Veterinary service support to prevent activities includes continuing the food protection
mission including sanitary audit inspections of food establishments and inspecting operational
rations (ready to eat meals and unitized group rations) as well as ensuring that military working
animals are healthy and ready to deploy. The medical detachment (veterinary service support) can
be assigned to the MEDCOM [DS], MEDBDE [SPT], MMB, or an equivalent sister Service
organization. Its structure is such that it can deploy subordinate teams based on mission
requirements.

4-60. More specifically, veterinary service support to the Prevent strategic role also includes:
complete preventive and medical care to government owned animals, medically prepare MWDs for
deployment, food defense vulnerability assessments, and endemic zoonotic and transboundary
animal disease epidemiology surveillance and control.

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Figure 4-18. Veterinary Services in Prevent

MEDICAL LOGISTICS (TO INCLUDE BLOOD MANAGEMENT)

4-61. Army operations to prevent are an extension of shaping operations and are designed to
prevent adversary opportunities to further exploit positions of relative advantage. Key AHS
activities during prevent include the provision of medical support to flexible deterrence and flexible
response options and setting the theater for possible escalation. During operations to prevent,
strategic and theater level medical organizations coordinate with sustainment units at echelon for
maintenance, supply and services, facilities, transportation, general skills (with emphasis on
interpreter support), distribution of Class VIII, and engineering support to medical operations in
support of flexible deterrence/response options and possible expansion should escalation occur.
The Office of The Surgeon General (OTSG) releases medical APS assets as required. The U.S.
Army Medical Materiel Agency coordinates with AMC for release of medical APS to identified
rotational medical units and deploys a Medical Logistics Support Team to interface with APS and
issue medical stocks. The MEDCOM (DS) leverages the 6th Medical Logistics Management Center
to interface with the theater sustainment command/expeditionary sustainment command
distribution management center (DMC) for coordination and establishment of the Class VIII
distribution chain.

4-62. Planning considerations for Class VIIIb support during prevent include coordinating with the
Armed Services Blood Program Office, Joint Blood Program Officer, Area Joint Blood Program
Officer, Armed Service Whole Blood Processing Laboratory (ASWBPL), and Expeditionary Blood
Transshipment Center to establish a theater blood distribution plan within the joint operations area,
including storage levels, locations, and the schedule of re-supply.

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Figure 4-19. Medical Logistics in Prevent

MEDICAL LABORATORY SERVICE

4-63. Operations to prevent are designed to deter adversary actions contrary to U.S. interests.
Army operations to prevent are typically conducted in response to activities that threaten unified
action partners and require the development or repositioning of credible forces in a theater to
demonstrate the willingness to fight if deterrence fails. These operations are tailored in scope and
scale to achieve a strategic or operational level objective.

4-64. In support of Prevent operations, the AML and its teams may be assigned/attached to a
MEDCOM [DS] (DS), a MEDBDE [SPT], and may be further attached to other deployed medical
units, as needed.

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Figure 4-20. Medical Laboratory in Prevent

LARGE SCALE COMBAT OPERATIONS

4-65. During LSCO, Army forces defeat the enemy. Defeat of enemy forces in close-combat
operations (defensive and offensive tasks) is normally required to achieve campaign objectives and
national strategic goals after the commencement of hostilities. Planning for sequels to consolidate
gains at higher levels should be informed by combat operations and vice versa. However, the
demands of large-scale combat operations consume all available staff capability at the tactical
level.

4-66. LSCO against a peer threat, commanders conduct decisive action to seize, retain, and exploit
the initiative. This involves the orchestration of many simultaneous unit actions in the most
demanding of operational environments. Large-scale combat operations introduce levels of
complexity, lethality, ambiguity, and speed to military activities not common in other operations.
LSCO require the execution of multiple tasks synchronized and converged across multiple domains
to create opportunities to destroy, dislocate, disintegrate, and isolate enemy forces.

4-67. Army forces defeat enemy organizations, control terrain, protect populations, and preserve
joint force and unified action partner freedom of movement and action in the land and other domains.
Corps and division commanders are directly concerned with those enemy forces and capabilities
that can affect their current and future operations. Accordingly, joint interdiction efforts with a near-
term effect on land maneuver normally support land maneuver. Successful corps and division
operations may depend on successful joint interdiction operations, including those operations to
isolate the battle or weaken the enemy force before battle is fully joined.

4-68. During LSCO, Army forces enable joint force freedom of action by denying the enemy the
ability to operate uncontested in multiple domains. Army leaders synchronize the efforts of multiple
unified action partners to ensure unity of effort. Army forces adapt continuously to seize, retain,
and exploit the initiative. Army forces use mobility, protection, and firepower to strike the enemy
unexpectedly from multiple directions, denying the enemy freedom to maneuver and creating
multiple dilemmas that the enemy commander cannot effectively address.

4-69. Army forces generally constitute the preponderance of land combat forces, organized into
corps and divisions, during large-scale combat operations. Army forces seize the initiative, gain

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and exploit positions of relative advantage in multiple domains to dominate an enemy force, and
consolidate gains. Corps and divisions execute decisive action tasks, where offensive and
defensive tasks make up the preponderance of activities. Commanders must explicitly understand
the lethality of large-scale combat operations to preserve their combat power and manage risk.
Commanders leverage cyberspace operations, space capabilities, and information-related
capabilities in a deliberate fashion to support ground maneuver. Commanders also use ground
maneuver and other land-based capabilities to enable maneuver in the other domains.

4-70. The BCTs and subordinate echelons concentrate on performing offensive and defensive
tasks and necessary tactical enabling tasks. During LSCO they perform only those minimal
essential stability tasks necessary to comply with the laws of land warfare. They do not conduct
operationally significant consolidate gains activities unless assigned that mission in a consolidation
area. BCT commanders orchestrate rapid maneuver to operate inside an enemy’s decision cycle
and create an increasing cascade of hard choices for the enemy commander.

4-71. It is imperative that AHS Commanders, staffs, and subordinates maintain an operational
understanding of the tenants set forth in FM 3-0. Full understanding and application of the
operational art depicted in FM 3-0 will ensure the AHS principles are intertwined within the
application of FM 3-0 ensuring the seamless delivery of FHP and HSS to the warfighter.

LSCO STRATEGIC ROLE
 Planning Considerations: Personnel and equipment movement, tactical commander’s

plans and objectives, site selection (if providing care during Prevent), MSR/alternate
supply route, PAR, movement plans, sustaining medical skills, MASCAL, CBRN.

 Risks/gaps that will cause AHS support to fail: Equipment and personnel shortages.
Lack of proper synchronization/integration with MMB.

 Possible mitigation strategies: Assign under MMB for mission command and support.

 Possible DOTMLPF changes: None.

 Command/Support Relationships: Assigned to MMB, area support for EAB units
without Role 2.

MEDICAL COMMAND AND CONTROL

4-72. Seizing the initiative during LSCO results in higher rates of casualties with rapid and fluid
phase lines of attack. Dwell time is limited, communication, rapid evacuation (if possible), potential
for conducting prolonged care with limited Class VIII may be possible.

4-73. Peer threats are brutal with elements that do not practice discipline in concealment,
camouflage, emplacement and displacement and OPSEC. Enemy indirect and direct fires coupled
with enhanced situational awareness, punishes combatant elements as well as medical elements.
There are no safe havens to conduct medical treatment in organic support, or, area support any
deployed role of care.

4-74. In LSCO, evacuation lines will become extended as maneuver forces achieve success
requiring increased synchronization between MEDEVAC units and MTFs to validate AXP and unit
locations and status. MTFs must be emptied of patients in order to be capable of moving to sustain
proximity with the supported unit(s). This places great demands upon MEDEVAC elements as well
as the area support elements in the AO. Though Role 1 units are not designed or manned to hold
patients, the combat situation may require it, consideration of this possibility requires that thought
be given this potential event.

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Figure 4-21. Medical Command and Control in LSCO

MEDICAL TREATMENT (ORGANIC AND AREA SUPPORT)

4-75. Conducting offensive tasks and seizing the initiative during offensive operations results in
higher rates of casualties with rapid and fluid offensive and defensive maneuvers by the
combatants. Movement and maneuver is frequent, dwell time is limited, communication,
synchronization, rapid evacuation (if possible), combined with necessity for conducting prolonged
care with limited Class VIII is possible.

4-76. Enemy indirect and direct fires coupled with their enhanced situational awareness, punishes
combatant elements as well as medical elements. There are no safe havens to conduct medical
treatment in organic support, or area support at any deployed role of care.

4-77. In large scale combat, evacuation lines will become extended as maneuver forces achieve
success requiring increased synchronization between MEDEVAC units and MTFs to validate
AXPs, unit locations and status. MTFs must be emptied of patients in order to be capable of moving
to sustain proximity with the supported unit(s). This places great demands upon MEDEVAC
elements as well as the area support elements in the AO. Though Role 1 units are not designed
or manned to hold patients, the combat situation may require it, consideration of this possibility
requires that thought be given this potential event.

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Figure 4-22. Medical Treatment in LSCO

HOSPITALIZATION

4-78. The hospital center and CSH provides Role 3 medical support to a maneuvering division, per
rule of allocation. Role 3 hospitals have to remain as flexible as possible. While the hospital center
was designed to be flexible and modular, it is still a significant effort to relocate any part or all of
the hospital. Commanders and staffs must plan for and maintain situational understanding of
possible requirements to relocate Role 3 capabilities. This may include task organizing limited
amounts of Role 3 capabilities (that is, damage control resuscitation, damage control surgery, ICU)
and employing it in direct support of a maneuver unit engaged in heavy combat operations. In
addition, support may include providing hospitalization to detainees. This will require a significant
amount of coordination with the MEDBDE and other enabling capabilities within the AO (such as,
military police and sustainment units).

4-79. The ability to evacuate patients during large-scale ground combat will likely be limited and
may only occur during short periods when the operational situation is permissive enough.
Therefore, hospitals need to be prepared to provide care for patients for prolonged periods of time,
which might be longer than they are comfortable with or longer than the theater evacuation policy
normally allows for. Class VIII stocks, bed management, medical regulating, and maximizing RTDs
are just a few key considerations in a prolonged care situation.

4-80. The hospital supports reconstitution by maximizing the return to duty rate within the limits of
the theater MEDEVAC policy and patient status, as close to the supported unit as possible.

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Figure 4-23. Hospitalization in LSCO

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

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MEDICAL EVACUATION (TO INCLUDE MEDICAL REGULATING)

4-81. Ground and air MEDEVAC units provide direct support to BCTs and area support to units
operating within the BCT AOR. Patients are evacuated, higher from lower, from POI or company
CCPs to Role 1, from Role 1 to the BSMC Role 2, and from Role 2 to Role 3. Patients may bypass
the next higher role of care in order to obtain specialty care if needed. In the corps and division
support areas, MEDEVAC support is provided on an area basis by MCAS and MCGA companies
as well as MCAA.

4-82. During large-scale combat operations against a peer threat, units will simultaneously conduct
actions to seize, retain, and exploit the initiative. The complexity and lethality of the environment
will require MEDEVAC units to operate across multiple domains (air, land, cyber), in a synchronized
effort with the MTFs to clear the battlefield thereby sustaining the initiative of the maneuver
commander.

4-83. A key aspect of large scale combat operations is its joint nature. Medical planners and
commanders can mitigate problems by providing a plan that synchronizes MEDEVAC, CASEVAC,
and treatment capabilities, addresses constraints and limitations, and standardizes terms and
procedures. Other Service representatives should be included into planning efforts when feasible
and integrated into battle rhythm events pertaining to MEDEVAC and MTFs.

The following figure is an example of MEDEVAC activities during large-scale combat operations:

Figure 4-24. Medical Evacuation in LSCO

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DENTAL SERVICES

4-84. Dental personnel have the additional wartime role of augmenting medical personnel during
mass casualty situations. Under these circumstances, dental officers may be called upon to
augment and assist the medical staff of these facilities in treating the sick and injured.

4-85. Dental teams may be employed throughout the AOR dependent on METT-TC.

Figure 4-25. Dental Services in LSCO

PREVENTIVE MEDICINE SERVICES

4-86. The Army provides the joint force in LSCO significant and sustained land power, which is the
ability to gain, sustain, and exploit control over land, resources, and people. Army capabilities are
applied to neutralize and defeat enemy forces through maneuver, fires, special operations,
cyberspace operations, electronic warfare, space operations, sustainment, and area security.

4-87. Major PVNTMED LSCO planning considerations consist of the following: FHP requirements
identified in the PREVENT strategic role; PVNTMED assets are allocated based on one
detachment per 17,000 troops supported at EAB; providing disease prevention and control
services; field PVNTMED services; environmental health; and health surveillance and
epidemiology. Preventive medicine detachments and teams can be assigned to a MEDCOM [DS],
MEDBDE [SPT], MMB, ASMC, or a medical mission task force HQs in the Corps and EAB. They
may be attached to a unit in the brigade, corps, or EAB

4-88. More specifically, preventive medicine operations to support LSCO also consist of the
following: activities listed for Shape and Prevent, plan for and execute surging capabilities in direct
support of main effort units, maintain a location best able to provide support without encumbering
maneuver forces, provide Level III preventive medicine support to detainee operations, and to begin
planning for transition of support to Consolidate Gains strategic role.

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Figure 4-26. Preventive Medicine in LSCO

COMBAT AND OPERATIONAL STRESS CONTROL

4-89. The COSC detachment provides behavioral health support to a division/corps, one
detachment per 39,000, per rule of allocation. COSC detachments have to remain as flexible as
possible. The COSC detachment is capable of deploying small teams to forward maneuver units
to provide direct support or augment the unit’s organic behavioral health capabilities. In addition to
behavioral health triage, care and stabilization the unit provides planning and staff advice to
operational HQs regarding the stressors affecting the Soldiers, mental readiness, morale, and
cohesion. COSC personnel continue to provide education and training for leaders, chaplains and
medical personnel as well as preventive consultation.

4-90. The ability to evacuate patients during large-scale ground combat will likely be limited and
may only occur during short periods when the operational situation is permissive enough.
Therefore, units need to be prepared to provide care for patients for prolonged periods of time,
which might be longer than they are comfortable with or longer than the theater evacuation policy
normally allows for. Class VIII stocks, bed management, medical regulating, and maximizing RTDs
are just a few key considerations in a prolonged care situation.

4-91. The COSC detachment supports reconstitution by maximizing the return to duty rate within
the limits of the theater MEDEVAC policy and patient status, as close to the supported unit as
possible.

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Figure 4-27. COSC in LSCO

VETERINARY SERVICE SUPPORT

4-92. During LSCO, Army forces focus on the defeat and destruction of enemy ground forces as
part of the joint team. Army forces close with and destroy enemy forces in any terrain, exploit
success, and break their opponent’s will to resist. Army forces attack, defend, conduct stability
tasks, and consolidate gains to attain national objectives. Divisions and corps are the formations
central to the conduct of large-scale combat operations, organized, trained and equipped to enable
subordinate organizations. The ability to prevail in ground combat is a decisive factor in breaking
an enemy’s will to continue a conflict. Conflict resolution requires the Army to conduct sustained
operations with unified action partners as long as necessary to achieve national objectives.
Conducting LSCO corresponds to seize the initiative and dominate phases of a joint operations
(FM 3-0).

4-93. As the sole provider of DOD veterinary service support, Army veterinary service personnel
will be in direct support of the USMC, USN, USAF, as well as other federal agencies, host nation,
and multinational forces, as directed. Veterinary service support to LSCO includes the food and
water mission including sanitary audit inspections of local food establishments and inspecting
operational rations (ready to eat meals and unitized group rations), veterinary public health
(prevention and mitigation of the effects of foodborne disease and the prevention of zoonotic
diseases transmissible to man), and maintaining the health and treating military working animals
and coordinating evacuation of military working dogs and DOD contract working dogs. The medical
detachment (veterinary service support) can be assigned to the MEDCOM [DS], MEDBDE [SPT],
MMB, or an equivalent sister Service organization. Its structure is such that it can deploy
subordinate teams based on mission requirements. Veterinary support is present across the range
of military operations.

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Figure 4-28. Veterinary Services in LSCO

MEDICAL LOGISTICS (TO INCLUDE BLOOD MANAGEMENT)

4-94. When preparing for AHS support to LSCO, the OTSG releases APS Army War Reserve
Stocks as required. The U.S. Army Medical Materiel Agency coordinates with Army Materiel
Command for release of medical Army War Reserve Stocks to identified medical units. Strategic
medical logistics organizations work through USAMMA to coordinate with—

 DLA for national capacity surge of Class VIIIa.

 The national medical enterprise for increased medical equipment maintenance and repair
support.

 Financial management personnel for anticipated international enterprise or host nation
outsourcing for projected and emerging Class VIIIa shortfalls in operations plans.

4-95. At the strategic level, the OTSG also coordinates with the Defense Health Agency and the
national health system for increased requirements for medical services and the Armed Services
Blood Program for surge of Class VIIIb (blood and blood products). The MEDCOM (DS) maintains
theater level coordination with the theater sustainment command/expeditionary sustainment
command for maintenance, supply and services, facilities, transportation, general skills (with
continued emphasis on interpreter support), distribution of Class VIII, and engineering support to
medical operations in support of LSCO. The MEDCOM (DS) leverages regional medical
agreements and provides medical enterprise reach-back to mitigate theater-level medical shortfalls
in support of LSCO. Measures are also being taken to resource, coordinate, sustain, and
synchronize large scale casualty events. The MEDCOM (DS) and MEDBDE (SPT) interface and
integrate into the transportation network to monitor movement of incoming personnel and
equipment, and extend the medical materiel chain as necessary. Medical logistics elements
conduct resupply of class VIIIa by push package in coordination with sustainment elements and by
lifts of opportunity. Class VIIIb blood and blood products are distributed to Role 2 and 3 MTFs and
down to Role 1 battalion aids stations. Walking blood banks may also be established.

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Figure 4-29. Medical Logistics in LSCO

MEDICAL LABORATORY SERVICE

4-96. The Army provides the joint force in LSCO significant and sustained land power, which is the
ability to gain, sustain, and exploit control over land, resources, and people. Army capabilities are
applied to neutralize and defeat enemy forces through maneuver, fires, special operations,
cyberspace operations, electronic warfare, space operations, sustainment, and area security.

4-97. In support of LSCO operations, the AML and its teams may be assigned/attached to a
MEDCOM [DS] (DS), a MEDBDE [SPT], and may be further attached to other deployed medical
units, as needed.

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Figure 4-30. Medical Laboratory in LSCO

CONSOLIDATE GAINS

4-98. Army forces provide the combatant command (command authority) the ability to capitalize on
operational success by consolidating gains. Consolidate gains is an integral part of winning armed
conflict and achieving success across the range of military operations. It is essential to retaining
the initiative over determined enemies and adversaries. Army forces reinforce and integrate the
efforts of all unified action partners when they consolidate gains.

4-99. Army forces consolidate gains in support of a host nation and its civilian population, or as part
of the pacification of a hostile state. These gains may include the establishment of public security
temporarily by using the military as a transitional force, the relocation of displaced civilians,
reestablishment of law and order, performance of humanitarian assistance, and restoration of key
infrastructure. Concurrently, corps and divisions must be able to accomplish these activities while
sustaining, repositioning, and reorganizing subordinate units to continue operations in the close
area.

4-100. Upon successful termination of LSCO, Army forces in the close area transition rapidly to
the conduct of consolidation of gains activities. Alternatively, they may be relieved in place by
another unit. Consolidation of gains activities may encompass a lengthy period of postconflict
operations prior to redeployment. This transition to consolidation of gains may occur even if large-
scale combat operations are occurring in other parts of an AO in order to exploit tactical success.
Anticipation and early planning for activities after large-scale combat operations ease the transition
process.

4-101. The combatant command (command authority) defines the conditions to which an AO is to
be stabilized. The ASCC is normally the overseer of the orderly transition of authority to appropriate
U.S., international, interagency, or host-nation agencies. The ASCC and subordinate commanders
emphasize those activities that reduce postconflict or postcrisis turmoil and help stabilize a
situation. Commanders address the decontamination, disposal, and destruction of war materiel.
They address the removal and destruction of unexploded ordnance and the responsibility for
demining operations. (The consolidation of friendly and available enemy mine field reports is critical
to this mission.) Additionally, the ASCC must be prepared to provide AHS support, emergency

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1 June 2020 Army Health System Doctrine Smart Book 187

restoration of utilities, support to social needs of the indigenous population, and other humanitarian
activities as required. (See ADRP 3-07 and FM 3-07 for more information on the performance of
stability tasks.)

4-102. The consolidation of gains is an integral part of all operations. Corps and division
headquarters assign purposefully task-organized forces designated consolidation areas to begin
consolidate gains activities concurrent with large-scale combat operations. Consolidate gains
activities provide freedom of action and higher tempo for those forces committed to the close, deep,
and support areas. Units begin consolidate gains activities after achieving a minimum level of
control and when there are no on-going large-scale combat operations in a specific portion of their
AO. Corps and divisions can designate a maneuver force responsible for consolidation areas.
Forces assigned the mission of consolidating gains execute area security and stability tasks. This
enables freedom of action for units in the other corps and division areas by allowing them to focus
on their assigned tasks and expediting the achievement of the overall purpose of the operation.
Initially the focus is on combined arms operations against bypassed enemy forces, defeated
remnants, and irregular forces to defeat threats against friendly forces in the support and
consolidation areas, as well as those short of the rear boundaries of BCT in the close area. Friendly
forces may eventually create or reconstitute an indigenous security force through security
cooperation activities as the overall focus of operations shifts from large-scale combat operations
to consolidating gains. Optimally, a division commander would assign a BCT to secure a
consolidation area. A division is the preferred echelon for this mission in a corps AO. The
requirement for additional forces to consolidate gains as early as possible should be accounted for
early during planning with appropriate force tailoring by the ASCC.

MEDICAL COMMAND AND CONTROL

4-103. Operations to consolidate gains requires that medical treatment is considered for the
support of both stability tasks (restore essential services) as well as provided required support of
the deployed force and potential follow on force. Any shortage of medical equipment, Class VIII
and personnel should be addressed now.

4-104. Postdeployment health assessments, with preparation of redeployment should address
potential behavioral health concerns as well.

4-105. If there is a plan for follow on forces, a plan for transfer of authority with addressing of any
medical treatment, PVNTMENT, host nation, and multinational partners is addressed. Interaction
with the host nation and populace is key particularly after a fight with new follow on forces flowing
in. The transfer of medical treatment responsibilities is as important for the health of the command
and individual Soldier as conduct of the initial entry operations over the long haul.

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

MEDICAL TREATMENT (ORGANIC AND AREA SUPPORT)

4-106. Consolidating gains requires that medical treatment is considered for the support of both
stability tasks (restore essential services) as well as provided required support of the deployed
force and potential follow on force. Any shortage of medical equipment, Class VIII and personnel
should be addressed now.

4-107. Postdeployment health assessments, with preparation of redeployment should address
potential behavioral health concerns as well.

4-108. If there is a plan for follow on forces, a plan for transfer of authority with any medical
treatment concerns, PVNTMENT issues, host-nation matters, and multinational partner
involvement addressed as required.

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Figure 4-32. Medical Treatment in Consolidating Gains

HOSPITALIZATION

4-109. Consolidating gains may include many different kinds of ongoing mission support
requirements. While some maneuver units may still be engaged in combat operations, others may
have transitioned to stability tasks. Hospitals must maintain situational understanding in order to
remain flexible and conform to the operational commander’s requirements. This will require the
hospital to continue to assess running estimates and be prepared to provide all aspects of Role 3
care while reducing capacities in support of redeployment operations and downsizing the footprint
in theater (such as, reducing the number of ICU and ICW beds). Additionally, many of the partner
engagement activities that occurred in shape and prevent will require support in consolidate gains.
Key to the successful consolidation of gains will be for the host nation to reestablish its own ability
to care for its population, which includes a medical system that is self-sufficient.

4-110. During transition operations, coordination between the outgoing and incoming commands
is vital to ensure a smooth hand off and continuity of operations. Coordination should be made
between the outgoing and incoming commands to determine if medical assets (personnel,
equipment, and supplies) are required to be left behind including planning for disposal of equipment
and supplies that cannot be redeployed.

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Figure 4-33. Hospitalization in Consolidating Gains

MEDICAL EVACUATION (TO INCLUDE MEDICAL REGULATING)

4-111. Consolidation of gains consists of security and stability tasks but may include combat
against remnant or bypassed enemy forces. This presents a threat to MEDEVAC units and teams
utilizing evacuation routes or manning AXPs and should be mitigated by accompanying security
assets.

4-112. MEDEVAC support during the consolidation of gains may be on an area or direct support
basis to maneuver forces conducting consolidation of gains in corps or division consolidation areas.
MEDEVAC operations follows the traditional support provided to combat forces.

4-113. MEDEVAC support during operations to consolidate gains may require a MEDEVAC
company to provide direct support to maneuver forces in one area while supporting stability tasks
in another. A key factor for MEDEVAC support will be for the host nation to reestablish its own
ability to provide medical services for its population to a reasonable level it possessed prior to
hostilities and to support the legitimacy of the host nation.

4-114. The following figure is an example of MEDEVAC activities during consolidate gains.

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Figure 4-34. Medical Evacuation in Consolidating Gains

DENTAL SERVICES

4-115. Numerous categories of personnel seek care in U.S. facilities during consolidate gains
where host-nation civilian medical infrastructure is nonexistent or is not capable of providing
adequate care. Conducting a medical assessment does not obligate the U.S. military to provide
the full spectrum of medical care. Although it does obligate the MTF to provide immediate
stabilization for life-, limb-, and eyesight-threatening medical conditions and to prepare the patient
for evacuation to the appropriate civilian or national contingent MTF when the patient’s medical
condition permits.

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Figure 4-35. Dental Services in Consolidating Gains

PREVENTIVE MEDICINE SERVICES

4-116. Consolidate Gains are the activities designed to make enduring any temporary operational
success and set the conditions for a stable environment allowing for a transition of control to
legitimate authorities. Army forces provide the joint force commander significant capability to
Consolidate Gains. This strategic role occurs in the AO where LSCO are no longer taking place.
Activities consist of security and stability tasks, as well as combat operations against bypassed
enemy forces and remnants of defeated units. Consolidate Gains will be conducted by Army forces
throughout the range of military operations.

4-117. Consolidate Gains operations requires that medical treatment is considered for the support
of both stability tasks (restore essential services), as well as required support to the deployed force
and potential follow on force. Shortages of medical equipment, Class VIII supplies, and personnel
issues should be addressed in this strategic role. In support of Consolidate Gains activities,
PVNTMED detachments will be involved in working with host nations to assist their efforts to
perform stability tasks for their populations. They will also continue to be involved with similar
responsibilities and tasks found in Prevent and LSCO roles.

4-118. In addition, PVNTMED personnel will be involved in efforts to support units engaged in
redeployment. Preventive medicine detachments and teams can be assigned to a MEDCOM [DS],
MEDBDE [SPT], MMB, ASMC, or a medical mission task force HQs in the corps and EAB. They
may be attached to a unit in the brigade, corps, or EAB.

4-119. In addition to previous strategic roles’ activities, preventive medicine operations to support
Consolidate Gains also consist mainly in the area of building host-nation capabilities and preparing
for incoming preventive medicine detachments. Activities also include transition and reconstitution
efforts.

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Figure 4-36. Preventive Medicine in Consolidating Gains

COMBAT AND OPERATIONAL STRESS CONTROL

4-120. During consolidate gains, COSC detachments may again be involved with stability activities
in order to increase the partner nation’s ability to care for its own population. In addition to their
own redeployment efforts, and as units prepare to redeploy, COSC capabilities may be employed
to support the health assessments of individual Soldiers.

4-121. During transition operations, coordination between the outgoing and incoming commands
is vital to ensure a smooth hand off and continuity of operations. Coordination should be made
between the outgoing and incoming commands to determine if medical assets (personnel,
equipment, and supplies) are required to be left behind including planning for disposal of equipment
and supplies that cannot be redeployed.

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Figure 4-37. COSC in Consolidating Gains

VETERINARY SERVICE SUPPORT

4-122. Army operations to Consolidate Gains include activities to make enduring any temporary
operational success and to set the conditions for a sustainable environment, allowing for a transition
of control to legitimate civil authorities. The Consolidate Gains strategic role is an integral and
continuous part of armed conflict, and it is necessary for achieving success across the range of
military operations. Army forces deliberately plan to consolidate gains during all phases of an
operation. Early and effective Consolidate activities are a form of exploitation conducted while
other operations are ongoing, and they enable the achievement of lasting favorable outcomes in
the shortest time span. Army forces conduct these activities with unified action partners. In some
instances, Army forces will be in charge of integrating forces and synchronizing activities to
consolidate gains. In other situations, Army forces will be in support. Army forces may conduct
stability tasks for a sustained period of time over large land areas. While Army forces Consolidate
Gains throughout an operation, consolidating gains becomes the focus of Army forces after large-
scale combat operations have concluded. Army operations to Consolidate Gains correspond with
stabilize and enable civil authority phases of a joint operation (FM 3-0).

4-123. As the sole provider of DOD veterinary service support, during the consolidate gains phase
Army veterinary service personnel will be in direct support of the USMC, USN. USAF, as well as
other federal agencies, host nation, and multinational forces, as directed. Veterinary service
support includes the food and water mission including sanitary audit inspections of local food
establishments and inspecting operational rations (ready to eat meals and unitized group rations),
veterinary public health (prevention and mitigation of the effects of foodborne disease and the
prevention of zoonotic diseases transmissible to man), and maintaining the health and treating
military working animals and coordinating evacuation of military working dogs and DOD contract
working dogs. Additional Stability tasks for veterinary service personnel include advising local
animal, agricultural, and veterinary industry personnel; assessing damage of veterinary and animal
infrastructure; and providing animal medical care to local animals. In addition, the transition of
veterinary missions to host nations, with the main effort being building host-nation veterinary
capabilities. The medical detachment (veterinary service support) can be assigned to the

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MEDCOM [DS], MEDBDE [SPT], MMB, or an equivalent sister service organization. Its structure
is such that it can deploy subordinate teams based on mission requirements.

Figure 4-38. Veterinary Services in Consolidating Gains

MEDICAL LOGISTICS (TO INCLUDE BLOOD MANAGEMENT)

4-124. During consolidation of gains, enterprise level organizations continue delivering AHS
support to recovering personnel and generating medical combat power in response to contingency
requirements. Theater and operational level elements including the MEDCOM (DS) and TSC as
well as the MEDBDE (SPT) and sustainment BDE coordinate for maintenance, supply and
services, facilities, transportation, maintenance, general skills (with emphasis on interpreter
support), distribution of Class VIII, and engineering support to medical operations in support of
offensive, defensive, and stability tasks. Theater and operational level medical elements also
develop requirements for medical and nonmedical contracting support and shaping activities are
also being conducted for transition back to competition.

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Figure 4-39. Medical Logistics in Consolidating Gains

MEDICAL LABORATORY SERVICE

4-125. Consolidate Gains are the activities designed to make enduring any temporary operational
success and set the conditions for a stable environment allowing for a transition of control to
legitimate authorities. Army forces provide the joint force commander significant capability to
Consolidate Gains. This strategic role occurs in the AO where LSCO are no longer taking place.
Activities consist of security and stability tasks, as well as combat operations against bypassed
enemy forces and remnants of defeated units. Consolidate Gains will be conducted by Army forces
throughout the range of military operations.

4-126. In support of operations, the AML and its teams may be assigned/attached to a MEDCOM
[DS] (DS), a MEDBDE [SPT], and may be further attached to other deployed medical units, as
needed.

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Figure 4-40. Medical Laboratory in Consolidating Gains

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SUMMARY

This doctrinal reference tool will be updated as necessary when doctrinal
publications are revised and published on the Army Publishing Directorate
website. As with all doctrine, the Doctrine Literature Division invites feedback
and recommendations on this publication. Please send an email to the
Doctrine Literature Division email address: usarmy.jbsa.medical-
[email protected]

The intent of this Doctrine Smart Book was not to provide all of the doctrinal
answers the readers seek. It was intended to provide summaries of the most
significant content within medical doctrine and to provide the references for
where more detailed information can be found. Hopefully, readers will utilize
this publication for quick reference, but seek to become more professionally
developed by inculcating doctrine in their personal and unit training and
education.

1 June 2020 Army Health System Doctrine Smart Book 1

GLOSSARY

SECTION I – ACRONYMS AND ABBREVIATIONS

A2 anti-access

AD anti-denial

ADCON administrative control

ADP Army doctrine publication

ADRP Army doctrine reference publication

AHS Army Health System

AML area medical laboratory

AO area of operations

AOR area of responsibility

APS Army Pre-positioned Stock

ARSOF Army special operations forces

ASCC Army Service component command (also referred to as theater Army)

ASMC area support medical company

ATP Army techniques publication

AXP ambulance exchange point

BAS battalion aid station

BCT brigade combat team

BSA brigade support battalion

BSMC brigade support medical company

BW biological warfare

C2 command and control

CA civil affairs

CASEVAC casualty evacuation

CBRN chemical, biological, radiological, and nuclear

CCDR combatant commander

CCP casualty collection point

CE communications-electronics

CM campaign module

CMS central materiel services

COMSEC communications security

CONUS continental United States

COSC combat and operational stress control

COSR combat and operational stress reaction

CSH combat support hospital

DCAS dental company (area support)

Glossary

2 Army Health System Doctrine Smart Book 1 June 2020

DNBI disease and nonbattle injury

DOD Department of Defense

DSCA defense support of civil authorities

EAB echelons above brigade

EEM early entry module

EM expansion module

EMT emergency medical treatment

EPW enemy prisoners of war

FHP force health protection

FM field manual

FRSD forward resuscitative surgical detachment

FST forward surgical team

GCC geographic combatant commander

GSAB general support aviation battalion

HHC headquarters and headquarters company

HHD headquarters and headquarters detachment

HQ headquarters

HSS health service support

ICU intensive care unit

JOA joint operations area

JP joint publication

LSCO large-scale combat operations

MASCAL mass casualty

MC4 medical communications for combat casualty care

MCAA medical company (air ambulance)

MCAS medical company (area support)

MCGA medical company (ground ambulance)

MDBS medical detachment (blood support)

MDO multi-domain operations

MDVSS medical detachment (veterinary service support)

MEDBDE (SPT) medical brigade (support)

MEDCOE Medical Center of Excellence

MEDCOM (DS) medical command (deployment support)

MEDEVAC medical evacuation

MEDLOG medical logistics

MES medical equipment sets

METT-TC mission, enemy, terrain and weather, troops and support available, time
available, and civil considerations

MHS military health system

MLC medical logistics company

MLMC medical logistics management center

MMB medical battalion (multifunctional)

Glossary

1 June 2020 Army Health System Doctrine Smart Book 3

MMS medical materiel set

MOS military occupational specialty

MSR main supply route

MTF medical treatment facility

MWD military working dog

NATO North Atlantic Treaty Organization

NBC nuclear, biological, and chemical

OE operational environment

OEH occupational and environmental health

OPCON operational control

OPLAN operational plan

OPORD operation order

OPSEC operations security

OR operating room

OTSG Office of The Surgeon General

PAR population at risk

POI point of injury

PPM preventive medicine measures

PREOP preoperation

PROFIS Professional Filler System

PVNTMED preventive medicine

RTD return to duty

SBCT Stryker brigade combat team

SIMLM single integrated medical logistics manager

SOF special operations forces

TACON tactical control

TCCC tactical combat casualty care

TCP theater campaign plan

TOE table of organization and equipment

TPMRC theater patient movement requirements center

TSC theater sustainment command

UMT unit ministry team

U.S United States

USAF United States Air Force

USMC United States Marine Corps

USN United States Navy

WIA

wounded in action

Glossary

4 Army Health System Doctrine Smart Book 1 June 2020

SECTION II – TERMS

aeromedical evacuation

The movement of patients under medical supervision to and between medical treatment facilities by
air transportation. Also called AE. (JP 4-02)

ambulance control point

A manned traffic regulating, often stationed at a crossroad or road junction, where ambulances are
directed to one of two or more directions to reach loading points and medical treatment facilities.
(ATP 4-02.2)

ambulance exchange point

A location where a patient is transferred from one ambulance to another en route to a medical
treatment facility. Also called AXP. (ATP 4-02.2)

ambulance loading point

This is the point in the shuttle system where one or more ambulances are stationed ready to receive
patients for evacuation. (ATP 4-02.2)

ambulance relay point

A point in the shuttle system where one or more empty ambulances are stationed to advance to a
loading point or to the next relay post to replace departed ambulances. (ATP 4-02.2)

ambulance shuttle system

A system consisting of one or more ambulance loading points, relay points, and when necessary,
ambulance control points, all echeloned forward from the principal group of ambulances, the
company location, or basic relay points as tactically required. (ATP 4-02.2)

amnesia

A lack of memory. Amnesia related to trauma, such as concussion, can be either antegrade or
retrograde. Antegrade amnesia is the inability to form new memories following the traumatic event
(typically not permanent). (ATP 4-02.5)

area of operations

An operational area defined by the joint force commander for land and maritime forces that should
be large enough to accomplish their missions and protect their forces. Also called AO. (JP 3-0)

area support

A method of logistics, medical support, and personnel services in which support relationships are
determined by the location of the units requiring support. Sustainment units provide support to units
located in or passing through their assigned areas. (ATP 4-90).

Army Health System

A component of the Military Health System that is responsible for operational management of the
health service support and force health protection missions for training, predeployment, deployment,
and postdeployment operations. Army Health System includes all mission support services
performed, provided, or arranged by the Army Medicine to support health service support and force
health protection mission requirements for the Army and as directed, for joint, intergovernmental
agencies, coalition, and multinational forces. Also called AHS.

battalion aid station

The forward-most medically staffed treatment location organic to a maneuver battalion. (ATP 4-
02.3)

battle injury

Damage or harm sustained by personnel during or as a result of battle conditions. Also called BI.
(JP 4-02)

Glossary

1 June 2020 Army Health System Doctrine Smart Book 5

casualty

Any person who is lost to the organization by having been declared dead, duty status— whereabouts
unknown, missing, ill, or injured. (JP 4-02)

casualty collection point

A location that may or may not be staffed, where casualties are assembled for evacuation to a
medical treatment facility. (Currently the proponent is FM 4-02 but will be moved to ATP 4-02.2
when revised.)

casualty evacuation

The movement of casualties aboard nonmedical vehicles or aircraft without en route medical care.
Also called CASEVAC. (Currently the proponent is FM 4-02 but will be moved to ATP 4-25.13 when
revised.)

choking agent

A chemical warfare agent which produces irritation to the eyes and upper respiratory tract and
damage to the lungs, primarily causing pulmonary edema. Also known as lung-damaging agent.
(ATP 4-02.85)

combat and operational stress control

A coordinated program of actions taken by military leadership to prevent, identify, and manage
reactions to traumatic events that may affect exposed organizations and individuals during unified
land operations. Also called COSC. (Currently the proponent is FM 4-02 but will be moved to ATP
4-02.51 when published.)

combat and operational stress reaction

Describes the wide range of anticipated, maladaptive psychological and physical symptoms,
generally transient, of any severity and nature which occur in individuals without any apparent
mental disorder in response to combat and operational stress exposure, and which usually subside
within hours or days. (ATP 4-02.5)

combat lifesaver

A nonmedical Soldier of a unit trained to provide enhanced first aid as a secondary mission.
(Currently the proponent is FM 4-02 but will be moved to ATP 4-02.3 when revised.)

continuity of care

Attempt to maintain the role of care during movement between roles at least equal to the role of care
at the preceding facility. (FM 4-02)

definitive care

Care or treatment which returns an ill or injured Soldier achieving maximum medical improvement.
(FM 4-02)

definitive treatment

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

dental care

The preventive and restorative treatments of the hard and soft oral structures, which is comprised
of operational dental care and comprehensive dental care. (Currently the proponent is ATP 4-02.5,
but will be in ATP 4-02.19 when revised.)

direct support

(Army) a support relationship requiring a force to support another specific force and authorizing it to
answer directly to the supported force’s request for assistance. (FM 3-0)

disease and nonbattle injury

All illnesses and injuries not resulting from enemy or terrorist action or caused by conflict. Also
called DNBI. (JP 4-02).

Glossary

6 Army Health System Doctrine Smart Book 1 June 2020

emergency medical treatment

The immediate application of medical procedures to the wounded, injured, or sick by specially
trained medical personnel. (FM 4-02)

en route care

The care required to maintain the phased treatment initiated prior to evacuation and the sustainment
of the patient’s medical condition during evacuation. (Currently the proponent is FM 4-02 but will be
moved to ATP 4-02.2 when revised.)

essential care

The absolutely necessary initial, en route, resuscitative, and surgical care provided to save, stabilize,
and return as many Soldiers to duty as quickly as possible. (FM 4-02)

first aid (self-aid/buddy aid)

Urgent and immediate lifesaving and other measures which can be performed for casualties (or
performed by the victim himself) by nonmedical personnel when medical personnel are not
immediately available. (Currently the proponent is FM 4-02 but will be moved to ATP
4-02.11 when published.)

5 R’s

Actions used for combat and operational stress reaction control that include—Reassure of normality;
Rest (respite from combat or break from the work); Replenish bodily needs (such as thermal comfort,
water, food, hygiene, and sleep); Restore confidence with purposeful activities and contact with his
unit; Return to duty and reunite Soldier with his unit. (ATP 4-02.5)

force health protection

(Army) Force health protection are measures that promote, improve, or conserve the behavioral and
physical well-being of Soldiers comprised of preventive and treatment aspects of medical functions
that include: combat and operational stress control, dental services, veterinary services, preventive
medicine, and laboratory services. Enabling a healthy and fit force, prevent injury and illness, and
protect the force from health hazards. (FM 4-02).

forward resuscitative surgery

Urgent initial surgery required to render a patient transportable for further evacuation to a medical
treatment facility staffed and equipped to provide for the patient’s care. (Currently the proponent is
FM 4-02 but will be moved to ATP 4-02.25 when published.)

health service support

(Army) Health service support is support and services performed, provided, and arranged by the
Army Medicine to promote, improve, conserve, or restore the behavioral and physical well-being of
personnel by providing direct patient care that include medical treatment (organic and area support)
and hospitalization, medical evacuation to include medical regulating, and medical logistics to
include blood management. (FM 4-02)

hospital

A medical treatment facility capable of providing inpatient care. It is appropriately staffed and
equipped to provide diagnostic and therapeutic services, as well as the necessary supporting
services required to perform its assigned mission and functions. A hospital may, in addition,
discharge the functions of a clinic. (Currently the proponent is FM 4-02 but will be moved to ATP 4-
02.10 when published.)

hostile casualty

A person who is the victim of a terrorist activity or who becomes a casualty “in action.” “In action”
characterizes the casualty as having been the direct result of hostile action, sustained in combat or
relating thereto, or sustained going to or returning from a combat mission provided that the
occurrence was directly related to hostile action. Included are persons killed or wounded
mistakenly or accidentally by friendly fire directed at a hostile force or what is thought to be a
hostile force. However, not to be considered as sustained in action and not to be interpreted as
hostile casualties are injuries or death due to the elements, self-inflicted wounds, combat and

Glossary

1 June 2020 Army Health System Doctrine Smart Book 7

operational stress reaction, and except in unusual cases, wounds or death inflicted by a friendly
force while the individual is AWOL, deserter, or dropped-from-rolls status or is voluntarily absent
from a place of duty. (AR 638-8)

inpatient

A person admitted to and treated within a Role 3 and 4 hospital and who cannot be returned to duty
within the same calendar day. (Currently the proponent is FM 4-02 but will be moved to ATP 4-
02.10 when published.)

lines of patient drift

Natural routes along which wounded Soldiers may be expected to go back for medical care from a
combat position. (Currently the proponent is FM 4-02 but will be moved to ATP 4-02.2 when
published.)

mass casualty

Any number of human casualties produced across a period of time that exceeds available medical
support capabilities. Also called MASCAL. (JP 4-02)

medical evacuation

The timely and effective movement of the wounded, injured, or ill to and between medical treatment
facilities on dedicated and properly marked medical platforms with en-route care provided by
medical personnel. Also called MEDEVAC. (Currently the proponent is FM 4-02 but will be moved
to ATP 4-02.2 when published.)

medical evaluation or assessment

A meeting between a Soldier and a person with medical training (combat medic, physician assistant,
physician, or other health care provider) to ensure the health and well-being of the Soldier.
Components of this evaluation include reviewing a history (events surrounding injury, review of
symptoms, and the like), a physical examination, and a review of the treatment plan with the Soldier.
(ATP 4-02.5)

medical regulating

The actions and coordination necessary to arrange for the movement of patients through the roles
of care and to match patients with a medical treatment facility that has the necessary health service
support capabilities, and available bed space. (JP 4-02)

medical treatment facility

(Army) Medical treatment facility refers to any facility established for the purpose of providing
medical treatment. This includes battalion aid stations, Role 2 facilities, dispensaries, clinics, and
hospitals. (FM 4-02)

mild traumatic brain injury/concussion

The diagnosis of concussion is made when two conditions are met. In the absence of
documentation, both conditions are based on self-report information. An injury event must have
occurred. The individual must have experienced one of the following: Alteration of consciousness
lasting less than 24 hours. Loss of consciousness, if any, lasting for less than 30 minutes. Memory
loss after the event, called posttraumatic amnesia, that lasts for less than 24 hours. Normal structural
neuroimaging. (ATP 4-02.5)

military acute concussion evaluation

A three-part medical screening tool developed by the Defense and Veterans Brain Injury Center to
assist clinical providers with the evaluation of concussion. This tool is available to medical personnel
by e-mailing: [email protected] Also referred to as MACE. (ATP 4-02.5)

neuroimaging

A radiographic imaging study to evaluate the brain, to include computerized tomography scan or a
magnetic resonance imaging. (ATP 4-02.5)

Glossary

8 Army Health System Doctrine Smart Book 1 June 2020

nontransportable patient

A patient whose medical condition is such that he could not survive further evacuation to the rear
without surgical intervention to stabilize his medical condition. (Currently the proponent is FM 4-02
but will be moved to ATP 4-02.2 when revised.)

outpatient

A person receiving medical/dental examination and/or treatment from medical personnel and in a
status other than being admitted to a hospital. Included in this category is the person who is treated
and retained (held) in a medical treatment facility (such as a Role 2 facility) other than a hospital.
(Currently the proponent is FM 4-02 but will be moved to ATP 4-02.10 when published.)

patient

A sick, injured or wounded Soldier who receives medical care or treatment from medically trained
personnel. (FM 4-02)

patient decontamination

The removal and/or the neutralization of hazardous levels of chemical, biological, radiological, and
nuclear contamination from patients before admission into a medical treatment facility under the
supervision of medical personnel to prevent further injury to the patient during the decontamination
process. (ATP 4-02.7)

patient estimates

Estimates derived from the casualty estimate prepared by the personnel staff officer/assistant chief
of staff, personnel. The patient medical workload is determined by the Army Health System support
planner. Patient estimate only encompasses medical casualty. (Currently the proponent is FM 4-
02 but will be moved to ATP 4-02.55 when published.)

patient movement

The act of moving a sick, injured, wounded, or other person to obtain medical and/or dental
treatment. (Currently the proponent is FM 4-02 but will be moved to ATP 4-02.2 when revised.)

posttraumatic amnesia

Period of amnesia following a traumatic brain injury. (ATP 4-02.5)

preventive medicine

The anticipation, prediction, identification, prevention, and control of communicable diseases
(including vector-, food-, and waterborne diseases), illnesses, injuries, and diseases due to
exposure to occupational and environmental health threats, including nonbattle injury threats,
combat and operational stress reactions, and other threats to the health and readiness of military
personnel and military units. (Currently the proponent is FM 4-02 but will be moved to ATP 4-02.17
when published.)

reconditioning program

An intensive 4- to 7-day program (may be extended by exception to theater evacuation policy) of
replenishment, physical activity, therapy, and military retraining for combat and operational stress
control casualties and neuropsychiatric cases (including alcohol and drug abuse) who require
successful completion for return to duty or is evacuated for further neuropsychiatric evaluation. (ATP
4-02.5)

resuscitative care

Advanced trauma management care and surgery limited to the minimum required to stabilize a
patient for transportation to a higher role of care. (Currently the proponent is FM 4-02 but will be
moved to ATP 4-02.25 when published.)

return to duty

A patient disposition which, after medical evaluation and treatment when necessary, returns a
Soldier for duty in his unit. (FM 4-02)

Glossary

1 June 2020 Army Health System Doctrine Smart Book 9

soldier restoration

A 24- to 72-hour (1- to 3-day) program in which Soldiers with combat and operational stress
reactions receive treatment. (ATP 4-02.5)

stabilized patient

(Joint) A patient whose airway is secured, hemorrhage is controlled, shock treated, and fractures
are immobilized. (JP 4-02)

tailgate medical support

An economy of force device employed primarily to retain maximum mobility during movement halts
or to avoid the time and effort required to set up a formal, operational treatment facility (for example,
during rapid advance and retrograde operations). (Currently the proponent is FM 4-02 but will be
moved to ATP 4-02.3 when revised).

theater evacuation policy

A command decision indicating the length in days of the maximum period of noneffectiveness that
patients may be held within the command for treatment, and the medical determination of patients
that cannot return to duty status within the period prescribed requiring evacuation by the first
available means, provided the travel involved will not aggravate their disabilities or medical
condition. (Currently the proponent is FM 4-02 but will be moved to ATP 4-02.2 when revised).

triage

The process of sorting casualties based on need for treatment, evacuation, and available resources.
(FM 4-02)

SECTION III – ARMY HEALTH SYSTEM SYMBOLOGY

The AHS symbology listed below are a synopsis of medical symbols located in ADP 1-02. They
provide the detailed requirements for composing and constructing symbols. The rules for building
a set of military symbols allow enough flexibility for users to create any symbol to meet their
operational needs. This also includes control measure symbols. Readers can find defined terms
used for symbology in ADP 1-02, Chapter 1, including cross-references to publications that discuss
usage of control measure symbols. All control measure symbols found in ADP 1-02 are linked to
doctrine.

Glossary

10 Army Health System Doctrine Smart Book 1 June 2020

Medical Main Icons

Function Icon

Note. The icon has been
enlarged for better visibility
and is not proportional to the
orientation or example

Example

Hospital (medical treatment
facility)

Any facility established for the
purpose of providing medical
treatment. This includes
battalion aid stations, Role 2
facilities, dispensaries, clinics,
and Role 3 hospitals/MTFs.
(FM 4-02)

.

Medical

Promotes, improves,

conserves, or restores the

behavioral and physical well-

being of personnel in the Army,

and as directed in other

Services, agencies, and

organizations. (See FM 4-02 for

more information on medical.)

Medical Sector 1 modifiers

Note. Modifiers for medical units are offset to the right to avoid overlapping with the main icon

Function Icon Note. The icon has
been enlarged for better
visibility and is not proportional
to the orientation or example

Example

Medical Role 1 – Unit-level
medical care capability
provided by the combat medic
or medical treatment provided
by the battalion aid station.
(see FM 4-02)

1

Medical Role 2 – capability to
provide care by area support
squads or medical treatment
platoons of medical companies
with greater medical
capabilities available than Role
1. (see FM 4-02)

2

Glossary

1 June 2020 Army Health System Doctrine Smart Book 11

Medical Sector 2 modifiers

Note. Modifiers for medical units are offset to the right to avoid overlapping with the main icon. Modifiers
in GREEN are proposed symbols and not current doctrine.

Function Icon Note. The icon has been
enlarged for better visibility and is
not proportional to the orientation
or example

Example

Blood – A capability to receive,
account, store, and distribute
blood and blood products. (see
ATP 4-02.1)

COSC – A capability that
provides behavioral health
services such as consultation
and combat and operational
stress control. (see FM 4-02)

.

Dental services – A capability
to provide consultation, early
treatment of severe oral and
maxillofacial injuries; and the
augment medical personnel (as
necessary) during mass
casualty operations. (See FM 4-
02)

Medical Role 3 – Capability to
provide medical treatment
facilities that are staffed and
equipped to provide care for all
categories of patients,
including resuscitation, initial
wound surgery, damage
control surgery, and
postoperative care. (see FM 4-
02)

3

Medical Role 4 – Medical care
capability found at Installation
level DHA CONUS-based
MTFs and other safe havens
(to include robust overseas
MTFs). (see FM 4-02)

4

Medical evacuation

The timely and effective
movement of the wounded,
injured, or ill to and between
medical treatment facilities on
dedicated and properly marked
ground and air medical
platforms with en route care
provided by medical personnel.
Also called MEDEVAC. (ATP
4-02.2)

.

Glossary

12 Army Health System Doctrine Smart Book 1 June 2020

Medical

Medical bed – A capability to
identify and locate available
bed assets for current and
anticipated needs. (see FM 4-
02, ATP 4-02.5, ATP 4-02.55)

Medical laboratory – A place
equipped for experimental
study in a science or for testing
and analysis. (FM 4-02)

LAB

Optometry – A capability to
provide optometry care, optical
fabrication, and repair support
(see FM 4-02)

.

Patient evacuation
coordination PEC

Preventive medicine – A
capability that provides
consultation and conducts
medical surveillance which also
includes, health risk
communication, education, field
sanitation, pest and vector
control, disease risk
assessment, environmental and
occupational monitoring and
health surveillance, preventive
medicine measures, health
threat controls for waste
(human, hazardous, and
medical) disposal, food safety
inspection, and potable water
surveillance. (see FM 4-02)

Surgical – A capability to
provide life or limb saving
operative treatment using
specialized instruments to
repair or stabilize a patient.
(see FM 4-02)

Veterinary service – A
capability that provides
consultation, animal care, food
protection, and veterinary public
health services. (See FM 4-02)

V

Glossary

1 June 2020 Army Health System Doctrine Smart Book 13

Medical main icons for activities

Function Icon

Note. The icon has been
enlarged for better visibility
and is not proportional to the
orientation or example

Example

Emergency medical
operations

.

Point of injury POI
.

Triage

Medical sector 1 modifiers for activities

Function Icon Example

Emergency collection
evacuation point ECEP

Medical CBRN control measures

Control Measure Template Example

Wounded personnel
decontamination site

Glossary

14 Army Health System Doctrine Smart Book 1 June 2020

Medical sustainment control measures

Control Measure Main Icon (Field A)
Construct example and
symbol translation

Ambulance exchange point

A location where a patient is
transferred from one ambulance to
another en route to a medical
treatment facility.

AXP

Ambulance control point

A point where ambulances may
take one of two or more directions
to reach loading points.

ACP

Ambulance load point

A point where one or more
ambulances are stationed ready to
receive patients for evacuation.

ALP

Ambulance relay point

A point where one or more empty
ambulances are stationed.

ARP

Casualty collection point

A specific location where
casualties are assembled to be
transported to a medical treatment
facility, for example, a company aid
post.

CCP

Medical evacuation pickup
point

U.S. Class IX

A sustainment distribution point
control measures symbol for
medical supply

Glossary

1 June 2020 Army Health System Doctrine Smart Book 15

AHS unit or element symbols

Title Symbol Amplifier Definition

Medical Command
(Deployment Support)

18th Medical Command
(Deployment Support); United
States Indo-Pacific Command

Medical Brigade (Support)

1st Medical Brigade (Support);
18th Medical Command
(Deployment Support)

Medical Battalion
(Multifunctional)

261st Medical Battalion,
Multifunctional; 44th Medical
Brigade (Support)

Hospital Center
(240-bed)

Combat Support Hospital
(248-bed)

9th Hospital Center; 1st
Medical Brigade (Support) w/
240-Bed Capability

47th Combat Support Hospital;
62nd Medical Brigade
(Support), w/ 248-Bed
Capability

Field Hospital

(32-bed)

32-Bed, 586th Field Hospital;
531st Hospital Center, w/ 32-
Bed Capability

Hospital Augmentation
Detachment

(Surgical, 24-bed)

24-Bed, 534th Hospital
Augmentation Detachment,
Surgical; 627th Hospital
Center, w/ 24-Bed Capability

Hospital Augmentation
Detachment

(Medical, 32-bed)

32-Bed, 433rd Hospital
Augmentation Detachment,
Medical; 32nd Hospital Center,
w/ 32-Bed Capability

++
xxxx

18MEDCOM [DS]

USINDOPACOM

1MEDBDE [SPT]

18MEDCOM [DS]

X

++

261MMB

44MEDBDE [SPT]

II

MF

II
3

9HOSP CTR

1MEDBDE[SPT] 240-BED

II
3

47CSH

62MEDBDE[SPT] 248-BED

I
3

586FLD HOSP

531HOSP CTR 32-BED

3
534SURGICAL

627HOSP CTR 24-BED

3
433MEDICAL

32HOSP CTR 32-BED

Glossary

16 Army Health System Doctrine Smart Book 1 June 2020

AHS unit or element symbols (continued)

Hospital Augmentation
Detachment

(ICW, 60-bed)

60-Bed, 431st Hospital
Augmentation Detachment,
ICW; 16th Hospital Center, w/
60-Bed Capability

Forward Resuscitative and
Surgical Detachment (FRSD)

Forward Surgical Team (FST)

250th FRSD; 62nd Medical
Brigade (Support)

Medical Detachment

(Minimal Care, 120-bed)

120-Bed, 319th Medical
Detachment, Minimal Care;
531st Hospital Center, w/ 12-
Bed Capability

Hospital Augmentation Team

(Head and Neck)

499th Medical Detachment,
Head & Neck; 1st Medical
Brigade (Support)

Medical Company

(Area Support)

575th Medical Company, Area
Support; 56th Medical
Battalion, Multifunctional, w/
40-Bed capability

Brigade Support Medical
Company

(Airborne)

20-Bed, C Company, 82nd
Brigade Support Battalion;
505th Parachute Infantry
Regiment; 82nd Airborne
Division, w/ 20-Bed Capability

Brigade Support Medical
Company

(Armor)

C Company, 47th Brigade
Support Battalion; 2nd Brigade
Combat Team; 1st Armored
Division, w/ 20-Bed Capability

Brigade Support Medical
Company

(Infantry)

C Company, 101st Brigade
Support Battalion; 2nd Brigade
Combat Team; 1st Infantry
Division, w/ 20-Bed Capability

Brigade Support Medical

Company

(Stryker)

C Company, 296th Brigade
Support Battalion; 1st Stryker
Brigade Combat Team; 7th
Infantry Division, w/ 20-Bed
Capability

250FRSD

62MEDBDE [SPT]

3
431ICW

16HOSP CTR 60-BED

319MINIMAL CARE

531HOSP CTR 120-BED

I
2

575MCAS

56MMB 40-BED

499HEAD NECK

1MEDBDE [SPT]

3

82BSB

505ABB

82ABD

2
I

20-BED

47BSB

2BDE

1AD

2
I

20-BED

101BSB

1BDE

1ID

2
I

20-BED SPT

296BSB

1SBCT

7ID

2
I

20-BED

Glossary

1 June 2020 Army Health System Doctrine Smart Book 17

AHS unit or element symbols (continued)

Medical Company
(Air Ambulance)

C Company, 6th General
Support Aviation Battalion;
101st Combat Aviation
Brigade; 101st Airborne
Division (Air Assault)

Medical Company
(Ground Ambulance)

560th Medical Company,
Ground Ambulance; 168th
Medical Battalion,
Multifunctional, w/ 24 M997
Capability

Dental Company
(Area Support)

464th Dental Company, Area
Support; 421st Medical
Battalion, Multifunctional; 30th
Medical Brigade (Support)

Medical Logistics Company

582nd Medical Logistics
Company; 61st Medical
Battalion, Multifunctional; 1st
Medical Brigade (Support)

Medical Detachment
(Veterinary Service Support)

248th Medical Detachment,
Veterinary Service Support;
261st Medical Battalion,
Multifunctional; 1st Medical
Brigade (Support)

Medical Detachment
(Combat and Operational
Stress Control)

85th Medical Detachment,
Combat and Operational
Stress Control; 61st Medical
Battalion, Multifunctional

Medical Detachment
(Preventive Medicine)

255th Medical Detachment,
Preventive Medicine; 56th
Medical Battalion,
Multifunctional

Medical Detachment

(Blood Support)

95th Medical Detachment,
Blood Support; 168th Medical
Battalion, Multifunctional; 65th
Medical Brigade (Support)

Medical Detachment

(Optometry)

24th Medical Detachment,
Optometry; 261st Medical
Battalion, Multifunctional

95BLOOD

168MMB

65MEDBDE (SPT)

6 GSAB

101CAB

101AAD

I

I
464DCAS

421MMB

30MEDBDE [SPT]

I
582MLC

61MMB

1MEDBDE (SPT)

248MDVSS

261MMB

44MEDBDE (SPT) V

255PM

56MMB

24OPTO

261MMB

24 M997
560MCGA

168MMB

I

85COSC

61MMB

Glossary

18 Army Health System Doctrine Smart Book 1 June 2020

AHS unit or element symbols (continued)

AHS vehicle symbols

Wheeled Vehicle
Ambulance (M997)
(High Mobility (Cross Country)

(1) 4-Litter, M997; Equipped with
a ground ambulance Medical
Equipment Set (MES); Assigned
to 2nd Battalion, 327th Infantry
Battalion, 101st Airborne
Division (Air Assault)

Wheeled Vehicle
Ambulance
(Limited Cross Country)

(1) 2-Litter, Wheeled Vehicle
Ambulance (Civilian); Paramedic
on board

Armored Personnel Carrier
Ambulance (M113)

Armored Multi-Purpose Vehicle
(Medical Evacuation)

(1) 4-Litter, M113; Equipped with
a ground ambulance MES;
Assigned to 1st Battalion, 37th
Armor Regiment 1st Armored
Division

Armored Wheeled
Ambulance (M1133)
(High Mobility (Cross Country)

(1) 4-Litter, M1133; Equipped
with a ground ambulance MES;
Assigned to 1st Battalion 17th
Stryker Infantry Battalion; 2nd
Stryker Brigade Combat Team;
7th Infantry Division

Medical Logistics Management
Center

6th Medical Logistics
Management Center; 18th
Medical Command (Deployment
Support)

Area Medical Laboratory

1st Area Medical Laboratory;
18th Medical Command
(Deployment Support)

6MLMC

18MEDCOM (DS)

++

++

LAB

1AML

18MEDCOM (DS)

M997 4-LITTER

GRND AMB MES

2/327 101AAD

1

M997 2-LITTER

PARAMEDIC

1

M113 4-LITTER

GRND AMB MES

1/37 1AD

1

M1133 4-LITTER

GRND AMB MES

1/17SBCT 7ID

1

Glossary

1 June 2020 Army Health System Doctrine Smart Book 19

AHS vehicle symbols (continued)

Rotary wing, in flight

(1) 4-Litter, HH-60M MEDEVAC
helicopter; Equipped with an air
ambulance MES; Assigned to
3rd General Support Aviation
Battalion (GSAB), 25th Combat
Aviation Brigade (CAB)

Rotary wing, on ground

(1) 2-Litter, HH-60M MEDEVAC
helicopter; Equipped with an air
ambulance MES; Assigned to
2nd GSAB, 227th CAB

Fixed wing, in flight

(1) 73-Litter, C-130; Equipped
with an aeromedical evacuation
equipment kit; Assigned to
USAF

Fixed wing, on ground

(1) 36-Litter, 54 ambulatory,
C-17; Equipped with an
aeromedical evacuation
equipment kit; Assigned to
USAF

Military Noncombatant
(Hospital Vessel)

(1) 500-Bed, USN Hospital Ship
(USS Comfort); Assigned to the
USN

(1) 500-Bed, USN Hospital Ship
(USS Mercy); Assigned to the
USN

Civilian/Merchant (Hospital
Ship)

(1) 80-Bed, Civilian operated
hospital ship

HH-60M 4-LITTER

AIR AMB MES

3/25GSAB

1

HH-60M 2-LITTER

AIR AMB MES

2/227GSAB

1

C130 74-LITTER

AEROMED EVAC EQUIP

USAF

1

C17 36L / 54A

AEROMED EVAC EQUIP

USAF

1

1

MERCY SHIP

80-BED

CIVILIAN

USS COMFORT

500-BED

USN

1

USS MERCY

500-BED

USN
AH

1