Health Service Support
Health service support is a single, integrated system. It consists of all services performed, provided, or arranged to promote, improve, conserve, or restore the mental and physical well-being of personnel in the Army and, as directed, for other services, agencies, and organizations. It is a continuum of care and support from the point of injury or wounding through successive levels to the continental United States (CONUS) base. This system encompasses the ten functional areas of medical treatment: area support, medical evacuation, medical regulating, hospitalization, preventive medicine, health service logistics, dental, veterinary, combat operational stress control services, and medical laboratory support. Health service support involves delineation of support responsibility by geographical area.
HEALTH SERVICE SUPPORT ACROSS THE LEVELS OF WAR
9-1. Health service support (HSS) includes activities across all levels of war. The following are considerations for HSS across the levels of war.
STRATEGIC HEALTH SERVICE SUPPORT
OPERATIONAL HEALTH SERVICE SUPPORT
TACTICAL HEALTH SERVICE SUPPORT
PRINCIPLES OF HEALTH SERVICE SUPPORT
9-7. Providing HSS is guided by six principles consistent with the principles discussed in JP 4-02:
LEVELS OF MEDICAL CARE
9-12. At Level IV, the patient is treated at an EAC CSH. Those patients not expected to RTD within the theater evacuation policy are stabilized and evacuated to a Level V facility.
9-14. There are ten functional areas within the Army Medical Department (AMEDD). The AMEDD integrates and synchronizes these functional areas, enabling the HSS system to meet the requirements of a force-projection Army.
MEDICAL EVACUATION AND MEDICAL REGULATING
9-15. Medical evacuation is the timely, efficient movement and provision of en route medical care of sick, injured, or ill persons from the battlefield or other locations to medical treatment facilities (MTFs). It is the responsibility of the gaining level HSS to evacuate or coordinate the evacuation from the lower level. The health care provider attending the patient determines the mode and precedence of evacuation. Air evacuation is the primary means of medical evacuation for urgent and priority casualties. In the combat zone, ground ambulance squads organic to medical sections, platoons, and companies evacuate patients within their AOs. Medical evacuation battalions evacuate patients from Level II MTFs to Level III hospitals. The battalion also evacuates patients laterally from hospital to hospital within the corps area, and from hospitals to U.S. Air Force (USAF) staging areas for evacuation out of the combat zone.
9-16. Strategic evacuation is a function of the USAF aeromedical evacuation system. The theater surgeon recommends a theater evacuation policy through the combatant commander and Joint Chiefs of Staff for approval by the SECDEF. The policy establishes the number of days an injured or ill soldier may remain in the theater to return to duty. Soldiers who will not return to full health within the established time are evacuated to definitive care facilities in CONUS or other designated locations. FM 8-10-6 has more details on evacuation.
9-17. Medical regulating is the coordinated movement of patients to MTFs that are best able to provide timely and required care. The corps medical command (MEDCOM), medical brigade medical regulating office (MRO) and, if established, joint patient movement requirements center (JPMRC) provide medical regulating in the combat zone. In the COMMZ, the theater MEDCOM/EAC medical brigade MROs and the theater patient movement requirements center (TPMRC) provide support. The TPMRC provides both intratheater and intertheater medical regulating. For example, if hospitals of other services within the theater have the necessary capabilities, the TPMRC may regulate Army patients to them. It also coordinates intertheater evacuation with the global patient movement requirements center (GPMRC). The TPMRC coordinates patient movement with the USAF aeromedical evacuation control center or, if air evacuation is not available or advisable, with the Military Sealift Command.
9-18. Hospitalization, provided by the CSH, is part of the theater-wide system for managing sick, injured, and wounded patients. The CSH capabilities include triage/emergency care, outpatient services, in-patient care, pharmacy, laboratory, blood banking, radiology, physical therapy, medical logistics, emergency/essential dental care, nutrition care, and patient administration services. For more information on theater hospitalization see FM 4-02.10.
9-19. The CSH may be augmented by one or more medical detachments, hospital augmentation teams, or medical teams. These may include-
HEALTH SERVICE LOGISTICS
9-20. The health service logistics (HSL) system encompasses planning and executing medical supply operations, medical equipment maintenance and repair, blood storage and distribution, and optical fabrication and repair. It also includes contracting services, medical hazardous waste management and disposal, production and distribution of medical gases, and blood banking services for Army, joint, multinational, and interagency operations. The appropriate command surgeon provides technical guidance. The system is anticipatory, with select units capable of operating in a split-based mode. The theater HSL system consists of the following organizations:
9-21. The MLMC is subordinate to the theater MEDCOM or senior medical command and control (C2) headquarters in theater. It is responsible for providing theater-level centralized management of critical Class VIII commodities, patient movement items, and medical maintenance within the theater. The MLMC normally uses split-based operations. During an initial employment into an austere theater, the MLMC base normally remains in the CONUS while deploying a support team into the theater, linking the strategic to the operational level of logistics. The support team also links Class VIII management with the distribution system within the AO by co-locating a distribution section with the support operations section of the TSC or a COSCOM. When so designated, the MLMC, with the MEDLOG battalion, serves as the single integrated medical logistics manager (SIMLM) for joint operations. It also serves as the medical contracting manager for the theater.
9-22. The MEDLOG battalion is subordinate to the theater MEDCOM or the corps MEDCOM. It is responsible for providing C2 and supervising operations for a variable number of attached MEDLOG companies, logistics support companies, and a BSD. This overall control covers the whole spectrum of MEDLOG and blood management operations
9-23. The logistics support company (subordinate to the MEDLOG battalion) provides medical materiel, medical maintenance and repair, and multi- and single-vision optical lens fabrication and repair to EAC and corps medical units operating in the AO. It also provides backup support to the MEDLOG company. This company forms the MEDLOG base for the AO.
9-24. The MEDLOG company (subordinate to the MEDLOG battalion) provides medical materiel, medical maintenance, and multivision optical lens fabrication and repair to division and corps medical units operating within the division AO. The MEDLOG company has no organic blood support capability. A cell from the BSD collocates to provide blood support to the division. The company is normally under the C2 of the HHD, MEDLOG battalion. The company has the capability for limited self-sustainment during initial operations, meeting the requirement for early entry into the AO or as part of a task organization.
9-25. Blood support is a combination of four systems: medical, technical, operational, and logistics. The management and distribution of all resuscitative fluids (including albumin) is a HSL function. Theater blood support depends on resupply from the CONUS base. Liquid blood products enter the theater through USAF blood transshipment centers for further shipment to Army BSDs. Army hospitals acquire necessary blood products from these BSDs. Blood support for Level II MTFs (including FSTs) consists of a limited number of group-type O liquid red blood cell units. All hospitals have blood-banking capabilities that allow them to store blood products. The combatant command establishes a single blood management program. The program is theater-wide and interfaces with the CONUS blood banking system. The theater and CONUS blood programs are a combined effort (JP 4-02.1). All components within the combatant command maintain blood programs. The Army Blood Program Office (ABPO) interfaces with the area joint blood program office (AJBPO). The AJBPO interfaces with the Armed Services Blood Program Office in CONUS.
9-26. The BSD (subordinate to the MEDLOG battalion) serves as the Army's blood supply unit (BSU). It provides blood collection, manufacturing, storage, and distribution of blood and blood products to division, corps, and EAC medical units, and to other operations (see FM 4-02.1). The detachment provides flexibility to shift personnel assets between collection and distribution missions as required. Blood and blood products are stored and distributed under rigid specification and managed by standard information systems. Air movement is the preferred method for moving blood and blood products. Army blood support in the AO is the responsibility of the supporting BSD. The BSU collects, manufactures, receives, stores, and distributes blood and blood products on an area basis. The commander of the BSU may also serve as the AJBPO as part of the Theater Joint Blood Program. Primary blood support in the AO during a high tempo operation is based on resupply from the CONUS donor base. Commanders may task the Army BSU to provide blood to other services on an area basis.
9-27. The MLST is a table of distribution and allowances (TDA) organization consisting of MEDLOG personnel (military, DA civilians, and contractors) from the U.S. Army Medical Materiel Agency (USAMMA). The MLST normally deploys with the U.S. Army Materiel Command (USAMC) logistics support element (LSE). The MLST supports the reception and onward movement of APS, unit sets, and sustainment stocks prepositioned in the AO. The MLST provides medical materiel and maintenance capability, equipment accountability, and transfer support of reception operations at air and seaports of debarkation. The MLST is a component of the USAMC and is under the operational control of the LSE until a theater support command is established. The MLST transitions its mission to the theater MEDLOG battalion or the MLMC. After completing the mission transition, the MLST redeploys to CONUS. At the end of the operation, the MLST may again deploy to the AO to support the redeployment of U.S. forces and materiel from the AO to follow-on CONUS or OCONUS locations.
9-28. Within the theater of operations, there are three levels of dental support: unit, hospital, and area. These levels are defined primarily by the relationship of the dental assets supporting the patient population within each level.
9-29. Unit-level dental care consists of those services provided by a dental module organic to divisional and nondivisional medical companies and all special forces groups. This module provides emergency dental treatment to soldiers during tactical operations.
9-30. Hospital-level dental care consists of those services provided by the hospital dental staff to minimize loss of life and disability resulting from oral and maxillofacial injuries and wounds. The hospital dental staff provides operational dental care, which consists of emergency and essential dental support to all injured or wounded soldiers as well as the hospital staff.
9-31. Dental service companies provide dental support on an area support basis. These dental units provide operational care. The dental companies are composed of modular dental teams capable of operating separate dental treatment facilities (DTFs) or of consolidating units and operating one large facility, depending on the METT-TC. Other teams provide far-forward emergency and essential dental care.
9-32. Within the theater, dental service support provides operational care, which is composed of emergency dental care and essential dental care. Another category, normally found only in fixed facilities in the United States, is comprehensive care. These categories are not absolute in their limits; they are the general basis for defining the dental service capabilities available at the different HSS levels of care. Categories are-
9-33. The U.S. Army Veterinary Service is the executive agent for veterinary support to all services and other U.S. agencies in theater. Appropriate mixes of veterinary units provide this support. These units can be task-organized to support food safety and quality assurance, and the medical care mission for government-owned animals. Services include sanitary surveillance for food source and storage facilities, procurement, and surveillance and examination of foodstuffs for safety and quality. The veterinary unit is responsible for publishing a directory of approved food sources for the theater/AO. Veterinary preventive medicine provides an effective combat multiplier through monitoring endemic zoonotic (animal) disease threats of military significance. The animal medical care mission provides complete medical care to all government-owned animals, especially military working dogs (MWDs), in the AO. The potential of food-borne disease, the threat of NBC contamination of subsistence, the need to assess the zoonotic disease threat, and the need to provide health care to government-owned animals requires a veterinary presence throughout the entire AO. Comprehensive veterinary medical and surgical programs are required to maintain the health of government-owned animals. See FM 8-10-18 for more details.
9-34. In past conflicts, DNBI rendered more soldiers combat ineffective than combat action. Preventive medicine services to counter the medical threat and prevent DNBI are the most effective, least expensive means of providing commanders with the maximum number of healthy soldiers. The Armed Forces Medical Intelligence Center conducts area studies on diseases for all regions. Medical companies of brigade and divisional support battalions, area support medical battalions, separate brigade support battalions, and medical troops of ACR support squadrons provide preventive medicine services. They receive additional support from the PVNTMED detachments of the corps and EAC medical brigades. See FM 4-02.17 for more details.
COMBAT OPERATIONAL STRESS CONTROL
9-35. Combat operational stress control (COSC) conserves the fighting strength by minimizing losses due to battle fatigue and neuropsychiatric disorders. The focus of Army COSC is on-
9-36. Brigade/division support battalion and separate brigade medical companies, armored cavalry regiment medical troops, and ASMBs provide COSC support. They receive further support from CSC companies or detachments assigned to the corps and EAC medical brigades. FM 22-51, FM 8-51, and FM 6-22.5 discuss COSC programs and activities.
AREA MEDICAL SUPPORT
MEDICAL LABORATORY SUPPORT
MEDICAL INFORMATION SYSTEMS
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