JP 4-02, Health Services Support; Exec Summary

30 July 2001

Doctrine forHealth Service Support

in Joint Operations

Joint Publication 4-02

PREFACE

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1. Scope

This publication delineates requirementsand considerations for the health servicesupport (HSS) system as well as the HSSaspects of joint planning, special operations,and military operations other than war. It alsoaddresses force health protection, the healththreat, and the requirement for medicalintelligence.

2. Purpose

This publication has been prepared underthe direction of the Chairman of the JointChiefs of Staff. It sets forth doctrine to governthe joint activities and performance of theArmed Forces of the United States in jointoperations and provides the doctrinal basis forUS military involvement in multinational andinteragency operations. It provides militaryguidance for the exercise of authority bycombatant commanders and other jointforce commanders (JFCs) and prescribesdoctrine for joint operations and training. Itprovides military guidance for use by theArmed Forces in preparing their appropriateplans. It is not the intent of this publication torestrict the authority of the JFC fromorganizing the force and executing the missionin a manner the JFC deems most appropriateto ensure unity of effort in the accomplishmentof the overall mission.

3. Application

a. Doctrine and guidance established inthis publication apply to the commandersof combatant commands, subunifiedcommands, joint task forces, and subordinatecomponents of these commands. Theseprinciples and guidance also may apply whensignificant forces of one Service are attachedto forces of another Service or whensignificant forces of one Service supportforces of another Service.

b. The guidance in this publication isauthoritative; as such, this doctrine will befollowed except when, in the judgment of thecommander, exceptional circumstancesdictate otherwise. If conflicts arise betweenthe contents of this publication and thecontents of Service publications, thispublication will take precedence for theactivities of joint forces unless the Chairmanof the Joint Chiefs of Staff, normally incoordination with the other members of theJoint Chiefs of Staff, has provided morecurrent and specific guidance. Commandersof forces operating as part of a multinational(alliance or coalition) military commandshould follow multinational doctrine andprocedures ratified by the United States. Fordoctrine and procedures not ratified by theUnited States, commanders should evaluateand follow the multinational command’sdoctrine and procedures, where applicable andconsistent with US law, regulations, anddoctrine.

S. A. FRYVice Admiral, U.S. NavyDirector, Joint Staff

For the Chairman of the Joint Chiefs of Staff:

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TABLE OF CONTENTS

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EXECUTIVE SUMMARY ............................................................................................. v

CHAPTER IFORCE HEALTH PROTECTION

• Overview .................................................................................................................. I-1• Force Health Protection Pillars .................................................................................. I-2• Five Phases of Casualty Care Management ............................................................... I-3

CHAPTER IIHEALTH SERVICE SUPPORT OPERATIONS

• Mission .................................................................................................................... II-1• Objective ................................................................................................................. II-1• Principles ................................................................................................................. II-1• Organization ............................................................................................................ II-2• Relationships and Responsibilities ........................................................................... II-3• Patient Movement .................................................................................................... II-6

CHAPTER IIIHEALTH SERVICE SUPPORT PLANNING

• The Joint Operation Planning Process .................................................................... III-1• Health Service Support Planning Considerations .................................................... III-1• Health Service Support Command, Control, Communications, Computers, and

Intelligence Systems ............................................................................................ III-9• Health Service Support in Special Operations ....................................................... III-11• Health Service Support in US Coast Guard Operations ......................................... III-13• Health Service Support Planning Factors for Joint Operations ............................... III-13

APPENDIX

A Health Threat .................................................................................................... A-1B Medical Intelligence .......................................................................................... B-1C Format for Annex Q to an Operation Plan .......................................................... C-1D Multinational Operations .................................................................................. D-1E Military Operations Other Than War .................................................................. E-1F References ......................................................................................................... F-1G Administration Instructions ............................................................................... G-1

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GLOSSARY

Part I Abbreviations and Acronyms ................................................................... GL-1Part II Terms and Definitions .............................................................................. GL-4

FIGURE

I-1 National Military Strategy and Force Health Protection Relationship ............. I-1I-2 Phases of Casualty Care Management ............................................................ I-4II-1 Health Service Support Principles ................................................................. II-1II-2 Levels of Health Service Support .................................................................. II-3III-1 Health Service Support Planning Considerations ......................................... III-2III-2 Categories of Dental Care Considered During Joint Operation Planning ...... III-7III-3 Characteristics of Health Service Support Command, Control,

Communications, Computers, and Intelligence Systems ............................ III-9

EXECUTIVE SUMMARYCOMMANDER’S OVERVIEW

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The primary objectives offorce health protection areto protect the health of andprovide health servicesupport to US forces.

Force Health Protection Mission and Objectives

Discusses the Force Health Protection Mission andObjectives

Provides the Principles of Health Service Support (HSS)

Discusses HSS Planning and Coordination

Discusses Requirements for HSS in Special Operations

Discusses HSS in US Coast Guard Operations

Discusses HSS Command, Control, Communications,Computers, and Intelligence Systems

The three pillars of force health protection (FHP) are a healthyand fit force, casualty prevention, and casualty caremanagement. These pillars correlate to the National MilitaryStrategy pillars of “Shape”, “Prepare”, and “Respond”. TheFHP mission in joint operations is to minimize the effects ofwounds, injuries, disease, environment, occupational hazards,and psychological stressors on unit effectiveness, readiness,and morale. The combatant commander is responsible for theexecution of the FHP mission within his or her area ofresponsibility. The success of casualty care management withlimited medical forces in theater is directly dependent upon thecombatant commander’s aggressive enforcement of the firsttwo pillars. A proactive preventive medicine program and aphased health care delivery system accomplish the missionthat extends from actions taken prior to and at the point ofinjury or illness through the completion of definitive treatment.FHP in joint operations requires continuous intelligencegathering and analysis, planning, coordination, and trainingto ensure a prompt, effective, and unified health care effort.

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The principles of health service support (HSS) include thefollowing.

• Conformity. Integrate and comply with the commander’splan.

• Responsiveness. Provide timely access to HSS throughproximity or evacuation.

• Flexibility. Shift HSS resources to meet changingrequirements.

• Mobility. Anticipate the need for rapid movement ofHSS resources to support combat forces during operations.

• Continuity. Provide optimum, uninterrupted care andtreatment.

• Coordination. Ensure that HSS resources are efficientlyemployed and used effectively to support the plannedoperation.

Proper planning permits a systematic examination of all factorsin a projected operation and ensures interoperability with thecampaign or operation plan. Organization of the HSS systemis determined largely by the joint force’s mission, the medicalthreat, medical intelligence, and the theater evacuation policy.

Each commander of a combatant command, subunifiedcommand, and joint task force should appoint a joint forcesurgeon (JFS). Combatant command JFSs are responsible forcoordinating and integrating HSS within their theaters. Theyneed to assess component commands’ HSS requirements andcapabilities, both quantitatively and qualitatively, and provideguidance to enhance the effectiveness of HSS through shareduse of assets. Distribution of the respective component’s HSScapabilities (as directed by the geographic combatantcommander) will aid in ensuring efficient use of limited HSSresources.

Health Service Support Principles

Health Service Support Planning and Coordination

There are six principles ofhealth service support(HSS).

Timely, effective planningand coordination areessential to ensureadequate and sustainableHSS in a theater.

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Executive Summary

Timely patient movement plays an important role in HSS.Patient movement functions include medical regulating, patientevacuation, and en route medical care (i.e., medical staffingand patient movement items). Patient movement can be bysurface (land or water) or by air (rotary-wing or fixed-wingaircraft); however, air is preferred. Initial transport of patientsto the first and second levels of medical care is normally aService component responsibility. Army aeromedicalambulance assets provide dedicated patient movement to andfrom Navy hospital ships. Intratheater patient movement iscoordinated by a Theater Patient Movement RequirementsCenter (TPMRC). Intratheater forward aeromedical evacuationmay be coordinated by an aeromedical evacuation liaison team.Patient movement from the theater is a collaborative effortbetween TPMRC, the Global Patient Movement RequirementsCenter, and the component lift control agency.

The medical estimate includes an analysis of informationpertaining to enemy intentions, allied or coalition partners’capabilities, limitations, courses of action, environmentalfactors, occupational hazards, and potential FHPconsequences associated with a contemplated operation.The medical estimate includes all FHP facts, assumptions, anddeductions that can affect the operation. Based upon themedical estimate of the situation, the JFS, in coordination withthe component command surgeons, must plan HSS for thejoint force and develop policies and procedures that can bestsupport the joint operation.

The nature of special operations requires small, highly skilled,self-contained teams that can be easily inserted and extractedby air, sea, and land delivery methods. However, these samemission requirements mandate that special operations forces’(SOF) medical personnel possess a variety of enhanced medicalskills that enable them to operate under a multiplicity ofcircumstances with limited equipment. To compensate fordeficiencies inherent in SOF HSS capabilities, special operationsHSS planning must integrate conventional support into theconcept of the special operations mission withoutcompromising the security and objectives. The planning mustalso articulate the unique aspects of the operation that willcomplicate the delivery of HSS by conventional units.

Health Service Support in Special Operations

Because of the nature oftheir missions, specialoperations units have avery limited HSS structureand a limited number ofmedical personnel.

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United States Coast Guard (USCG) participation in Departmentof Defense (DOD) operations may require some HSS fromnearby DOD units, since organic USCG HSS is limited. USCGhelicopters may be utilized in medical evacuations as a lift ofconvenience, but they are not normally outfitted with medicalequipment or personnel.

Effective command, control, communications, computers, andintelligence (C4I) systems are vital to successful HSS. Earlyidentification of a theater’s C4I system requirements for HSSconnectivity is essential. HSS management informationsystems support the information management requirementsof HSS units across the range of military operations. Records,reports, and integrated systems are required to pass informationand assist in the evaluation of policies and procedures.

HSS provides prompt, effective, and unified health services toenhance the combat fighting ability of joint forces. HSS inoperations requires continuous planning, coordinating,synchronizing, and training. HSS is based upon a phasedhealth services system with varying capabilities of care andsituationally tailored to each operation.

Health Service Support in US Coast Guard Operations

Command, Control, Communications, Computers, andIntelligence Systems

CONCLUSION

Department of DefenseHSS units may be requiredto support US Coast Guardunits.

HSS requires adequatecommand, control,communications,computers, andintelligence systemssupport.

CHAPTER IFORCE HEALTH PROTECTION

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1. Overview

a. Force health protection (FHP)includes all measures taken by the chainof command and the military health systemto promote, improve, conserve, or restorethe mental or physical well-being ofpersonnel across the range of militaryoperations. The three pillars of FHP are ahealthy and fit force, casualty prevention,and casualty care management. Figure I-1 shows the relationship between the pillarsof the National Military Strategy (“Shape”,“Prepare”, and “Respond”) and thecorresponding pillars of FHP.

b. The geographic combatantcommander is responsible for theimplementation of FHP within his or her

“Better use medicines at the outset than at the last moment.”

Darius Publius, 42 BC

area of responsibility (AOR). The jointforce surgeon (JFS), appointed by thegeographic combatant commander, isresponsible for the coordination andintegration of the health service support(HSS) mission among the participatingService components. This ensures thatmaximum use and efficiency are attained fromthe deployed HSS resources. The success ofcasualty care management with limitedmedical forces is directly dependent upon thecombatant commander’s aggressiveenforcement of the first two pillars.

c. FHP is accomplished through thepromotion of wellness, physical and mentalconditioning, medical surveillance,preventive medicine, and the establishmentof a phased health care delivery system.

Figure I-1. National Military Strategy and Force Health Protection Relationship

NATIONAL MILITARY STRATEGY AND FORCEHEALTH PROTECTION RELATIONSHIP

SHAPE PREPARE RESPOND

FORCE HEALTH PROTECTION

HEALTHY andFIT FORCE

CASUALTYPREVENTION

CASUALTY CAREMANAGEMENT

NATIONAL MILITARY STATEGYNATIONAL MILITARY STATEGY

JOINT VISION 2010 FOCUSED LOGISTICS

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HSS includes, but is not limited to, thefollowing areas: medical treatment (to includearea support), patient movement,hospitalization, to include forward resuscitativesurgery, dental services, preventive medicine,veterinary services, combat stress control andmental health care services, health servicelogistic support, medical laboratory services,blood collection and distribution, and command,control, communications, computers, andintelligence (C4I).

d. FHP employs the right mix of HSScapabilities, at the right time and at the rightplace, to provide effective and efficient carefor US forces. The past HSS concept ofproviding definitive care in theater tomaximize returned to duty (RTD) status hasevolved to a concept that provides essentialcare in theater to either RTD within the theaterpatient movement policy or stabilize forpatient movement to the next level of care,with enhanced en route medical care anddefinitive care. Although this reduces themedical footprint in theater, it is dependenton uninterrupted airlift and will placeincreased demands on the personnelreplacement system. Increased reliance onreplacements rather than RTD may also affectunit cohesion.

2. Force Health ProtectionPillars

a. The first pillar of FHP promotes ahealthy and fit force and provides thecommander with an optimally fit Servicemember capable of withstanding thephysical and mental rigors associated withcombat and other military operations.Effective and enhanced quality of lifeguards the force against disease andnonbattle injury (DNBI), combat andoperational stress reactions (COSR), andother health threats. Wellness requirescontinuous attention before, during, and afterdeployment to sustain maximum readinessand operational capability.

• Wellness programs in joint operationsinclude physical and mental fitness,health promotion, and environmentaland occupational health. Physicalfitness improves performance throughprograms that build and maintainendurance, strength, flexibility, and goodemotional health. Health promotionencourages healthy life-styles throughgood nutrition, preventive dentistry,stress management, avoidance ofsubstance abuse, and the promotion ofhealth education and healthy familyrelationships.

• Physical and emotional fitness, healthpromotion, and environmental andoccupational health keep US forceshealthy on and off duty. Aggressivewellness programs promote quality oflife. Fit military members are lesslikely to be injured accidentally, canmore readily withstand exposure todiseases and excessive stress, and morepromptly heal from wounds orinjuries.

b. The second FHP pillar is casualtyprevention. Casualty prevention focuseson threats posed by enemy forces andoccupational and environmental healththreats. Failure to counter these threatsjeopardizes mission accomplishment.

• Enemy Threat. The enemy threatdepends on the enemy’s willingness andability to use force (conventional andnonconventional weapon systems,munitions, and nuclear, biological, andchemical (NBC) agents) to producecasualties. Aggressive HSS enhancesthe force’s ability to minimize combatinjuries resulting from continuousoperations, combat stress, and/orexposure to NBC agents.

• Health Threat. The health threatdepends on a complex set of

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environmental and occupational factorsthat combine to produce DNBIs andCOSRs and are a serious threat to USforces. There must be a comprehensivemedical data collection system withcontinuous surveillance and preventivemedicine measures (such asimmunization, pretreatment, andchemoprophylaxis programs andpolicies) to continuously counter thehealth threat. To manage or reduceCOSR, stress control measures should beimplemented. These measures includesurveying the unit to identify stressorsand excess stress and advising thecommander on interventions. This earlyintervention will reduce COSR-identifiedpersonnel requiring additional help, andlessen the chances of long-term disabilitysuch as posttraumatic stress disorder.These interventions occur before, during,and after deployment of forces (seeAppendix A, “Health Threat”).

• A robust health surveillance system is acritical component of FHP. Deploymenthealth surveillance includes identifyingthe population at risk (through, but notlimited to, pre- and post-deploymenthealth assessments), recognizing and

assessing hazardous exposures (medical,environmental, psychological, andoccupational), employing specificcountermeasures, and monitoring healthoutcomes.

c. The third FHP pillar, casualty caremanagement, includes patient care andmovement. It encompasses care providedfrom the point of injury through successivephases of medical care, including definitiveand rehabilitative management in hospitals inthe continental United States (CONUS) andoutside the continental United States(OCONUS).

3. Five Phases of Casualty CareManagement

The phases of casualty care managementare first responder, forward resuscitativesurgery, theater hospitalization, en route care,and care outside the theater (see Figure I-2).These phases ensure that patients receive theessential care in theater and movement todefinitive care outside the theater as soon aspractical.

a. Phase I — First Responder. The firstresponse may include self-aid and buddy aid,

Immunizations are a vital part of casualty prevention.

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combat lifesavers, combat medics, hospitalcorpsmen, physician assistants (PAs),physicians, or other medical personnel. Thefirst medical responder should have aworking knowledge of the next level of careavailable and the patient movement system.Within this phase, the focus of all health careproviders is to save life and limb and stabilizethe patient sufficiently to evacuate to the nextlevel of care. A stabilized patient is onewhose airway is secured, hemorrhage iscontrolled, shock is treated, and fractures areimmobilized. Threat to life or limb still existsbut has been decreased with medicalintervention. Stabilization is a necessaryprecondition for further patient movement.In combat settings, advance traumamanagement may differ significantly inpriorities and procedures from that practicedin peacetime.

• First Aid. Basic first aid is provided bythe individual (self-aid) or a buddy(buddy aid). Advanced first aid requiresadditional training and includes theinitiation of vascular volumereplacement through the use ofintravenous (IV) fluids. Advanced firstaid is provided by the combat lifesaver.First aid is the emergency or lifesaving

care given to a sick, injured, or woundedperson when a medically trainedindividual is not immediately available.Every Service member is expected toknow and apply basic lifesavingmeasures. Lifesaving measures areapplied to restore breathing andcirculation, to stop bleeding, to helpprevent shock and infection, and to splintor immobilize fractures.

• Combat Medic and/or CorpsmanCare. Combat medic and/or corpsmancare is the first medical care that a sick,injured, or wounded individual receivesfrom a medically trained individual.Combat medic and/or corpsman careentails the skillful application of physicalexamination techniques; performance ofemergency or lifesaving measures; andcontinual observation and care to ensurethat the airway remains open, thatbleeding has ceased, and that shock,infection, and further injury areprevented. It involves the effective useof medical supplies not available to thefirst aid provider and arrangement forpatient movement, as appropriate.

• Advanced Trauma Management. Thisphase of treatment includes care providedby personnel (physicians, dentists, PAs,and nurse practitioners) specificallytrained and equipped for traumamanagement. Procedures can includeinvasive measures (such as venous cutdowns or chest tubes) required to stabilizethe patient prior to further movement.

b. Phase II — Forward ResuscitativeSurgery. The forward resuscitative surgeryphase is the urgent initial surgery required torender a patient stabilized enough to withstandfurther movement to the next level of care.Forward resuscitative surgery is typicallyperformed on patients with signs andsymptoms of initial airway compromise,difficult breathing, and circulatory shock and

Figure I-2. Phases of CasualtyCare Management

First Responder

Forward ResuscitativeSurgery

Theater Hospitalization

En Route Care

Care Outside The Theater

PHASES OF CASUALTYCARE MANAGEMENT

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who do not respond to initial advancedtrauma management procedures. Thisresuscitation and stabilization is dependentupon far forward lightweight and mobilesurgical units. The capabilities, locations,and relationships of far forward surgical unitsto first responders and to more definitivelevels of care must be clearly delineated andcommunicated throughout the joint force.

c. Phase III — Theater Hospitalization.Theater hospitals will provide essential careto patients and prepare those who requirehigher care for evacuation out of theater.

d. Phase IV — En Route Care. En routecare involves the medical treatment of

A corpsman provides medical care.

patients during movement. This providesuninterrupted care from the point of injury orinitial illness until the patient arrives at thenext level of care.

e. Phase V — Care Outside the Theater.Care that is provided outside the theater mayinclude convalescent, restorative, andrehabilitative services and normally isprovided by military, Department of VeteranAffairs, CONUS civilian hospitals, andcommander in chief (CINC)-approved safehavens. It may include a period of minimalcare and increased physical activity necessaryto restore patients to functional health.

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CHAPTER IIHEALTH SERVICE SUPPORT OPERATIONS

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1. Mission

The HSS mission in joint operations isto minimize the effects of wounds, injuries,diseases, environmental and occupationalhazards, and psychological stressors onunit effectiveness, readiness, and morale.This mission is accomplished by acomprehensive HSS plan and phasedmedical care that extends from actions takenat the point of injury or illness, to movementfrom a theater for treatment. The effectivenessof HSS is measured by its ability to save lifeand limb; to reduce the DNBI and COSRrates; to return patients to duty as quickly andas far forward in the theater as possible; andto evacuate patients with minimum delay totheater hospitals or out of the theater, asappropriate.

2. Objective

The primary objective of HSS is toconserve the fighting strength of the forces.This objective is most effectively achievedthrough optimum use and integration ofavailable HSS assets. HSS in jointoperations requires continuous planning,coordinating, synchronizing, and trainingto ensure a prompt, effective, and unifiedhealth care effort.

3. Principles

Each Service component has an HSSsystem that encompasses six health careprinciples. Figure II-1 depicts theseprinciples.

a. Conformity. Conformity with thecombatant commander’s operation plan

“The preservation of the soldier's health should be [the commander's] firstand greatest care.”

George Washington

(OPLAN) is the most fundamental elementfor effectively providing HSS. Only byparticipating in the development of this plancan the HSS planner ensure adequate supportat the right time and the right place.

b. Responsiveness. The speed with whichmedical treatment is initiated is extremelyimportant in reducing morbidity and mortality.The efficient allocation of resources and thejudicious location of medical treatmentfacilities (MTFs) must optimize access to care.

c. Flexibility. Since a change in tacticalplans or operations may require redistributionor relocation of HSS resources to meet thechanging requirements, no more medicalresources should be committed nor MTFsestablished than are required to supportexpected patient densities.

d. Mobility. Since contact with supportedunits must be maintained, HSS elements must

Figure II-1. Health ServiceSupport Principles

Conformity

Responsiveness

Flexibility

Mobility

Continuity

Coordination

Conformity

Responsiveness

Flexibility

Mobility

Continuity

Coordination

HEALTH SERVICESUPPORT PRINCIPLES

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have mobility comparable to that of the unitsthey support. Mobility is measured by theextent to which a unit can move its personneland equipment with organic transportation.

e. Continuity. HSS must be continuoussince an interruption of treatment may causean increase in morbidity and mortality.

f. Coordination. The objective of thisprinciple is to ensure that HSS resources inshort supply are efficiently employed and usedeffectively to support the planned operation.Continuous coordination ensures that medicalfacilities are not placed in areas that interferewith combat operations. Additionally,continuous coordination ensures that the scopeand quality of medical treatment and care meetprofessional standards and policies.

4. Organization

HSS is organized into five levels of care(see Figure II-2).

a. Level I. Level I care consists of carerendered at the unit level. It includes self-aid, buddy aid, and combat lifesaver skills,examination, and emergency lifesavingmeasures such as the maintenance of theairway, control of bleeding, prevention andcontrol of shock, splinting or immobilizingfractures, and the prevention of further injury.Treatment may include restoration of theairway by invasive procedures; use of IVfluids and antibiotics; and the application ofsplints and bandages. These elements ofmedical management prepare patients forRTD or for transportation to a higher level ofcare. Supporting medical units are responsiblefor coordinating the movement of patientsfrom supported medical facilities.

b. Level II. At a minimum, Level II careincludes physician-directed resuscitation andstabilization and may include advancedtrauma management, emergency medicalprocedures, and forward resuscitative surgery.Supporting capabilities include basiclaboratory, limited x-ray, pharmacy, andtemporary holding facilities. Patients aretreated and RTD, or are stabilized formovement to a MTF capable of providing ahigher level of care. Surface or air movementis coordinated for transfer to a facilitypossessing the required treatmentcapabilities. Level II is the first level whereGroup O liquid packed red blood cells willbe available for transfusion.

c. Level III. Care is administered thatrequires clinical capabilities normally foundin a facility that is typically located in areduced-level enemy threat environment. Thefacility is staffed and equipped to provide

Helicopters provide mobility for healthcare providers.

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resuscitation, initial wound surgery, andpostoperative treatment. This level of caremay be the first step toward restoration offunctional health, as compared to proceduresthat stabilize a condition to prolong life.Blood products available may include freshfrozen plasma, Groups A, B, and O liquidcells and may include frozen Group O redcells and platelets.

d. Level IV. In addition to providingsurgical capabilities found at Level III, thislevel also provides rehabilitative and recoverytherapy for those who can RTD within thetheater patient movement policy. This levelof care may only be available in maturetheaters.

e. Level V. Level V definitive careincludes the full range of acute convalescent,restorative, and rehabilitative care and isnormally provided in CONUS by military andDepartment of Veterans Affairs hospitals, orcivilian hospitals that have committed bedsfor casualty treatment as part of the NationalDefense Medical System. On occasion,OCONUS military or allied and/or hostnation hospitals in CINC-approved safe

havens may also be used. This level mayinclude a period of minimal care andincreasing physical activity necessary torestore patients to functional health and allowthem to RTD or to a useful and productivelife.

5. Relationships andResponsibilities

a. Geographic combatant commanders areultimately accountable for HSS and forcoordinating and integrating HSS within theirtheaters. In joint operations, joint use ofavailable medical assets will be accomplishedto support the warfighting strategy andconcept of operations.

b. A JFS should be appointed for eachcombatant command, subunified command,and joint task force (JTF). As a specialtyadvisor, the JFS may report directly to the jointforce commander (JFC). The JFS coordinatesFHP matters for the JFC. The JFS sectionshould be jointly staffed and should be ofsufficient size to effectively facilitate thefollowing.

Figure II-2. Levels of Health Service Support

LEVELS OF HEALTH SERVICE SUPPORT

Definitive, convalescent, restorative, and rehabilitative care normallyprovided by the military, Department of Veterans Affairs, ContinentalUnited States civilian hospitals, or commander in chief-approved safehavens.

Not only surgical capability, as in Level III, but also further therapyduring the recovery and rehabilitative phase

Resuscitation, stabilization, and application of emergencyprocedures to prolong life

Care requiring clinical capabilities (surgery)

Self-aid, buddy aid, and combat lifesaver skills

LEVEL V

LEVEL IV

LEVEL III

LEVEL II

LEVEL I

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• Joint coordination of HSS initiatives.

• Performance of health threat assessment.

• Health service logistic support and bloodrequirements.

• Standardization and interoperability.

• Development of the HSS plan and courseof action (COA) analysis.

• Review of subordinate plans andoperations.

• Joint coordination of intratheater patientmovement.

• Theater health surveillance.

c. The combatant command JFSassesses component command HSSrequirements and capabilities, bothquantitatively and qualitatively, and providesguidance to enhance the effectiveness ofHSS. The combatant command JFS hasthe responsibility to perform the following.

• Advise the combatant commander on allHSS operations.

• Recommend and monitor preventivemedicine and care provided to the civilianpopulation and other beneficiaries.

• Assist the combatant commander informulating a recommended theaterpatient movement policy within thegeographic area.

• Assist the component commands inidentifying HSS requirements andcoordinating cross-Service support,where practical.

• Advise the combatant commanderconcerning the following.

•• The health of the command and othermedical factors that could affectoperations.

•• HSS aspects of combat operations.

•• Intratheater rest, rotation, andreconstitution policies and procedures.

•• Preventive medicine procedures.

•• Occupational and environmentalhealth.

Theater hospitals provide a full range of capabilities.

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•• Joint reception, staging, onwardmovement, and integration (JRSOI).

• Monitor and inform the combatantcommander on the status of HSSresources.

• Inform the combatant commanderconcerning the status of and assistancerequired by and provided to the civilianpopulace, Department of Defense (DOD)civilian employees, DOD contractpersonnel, enemy prisoners of war(EPWs), nongovernmental organizations(NGOs), and international organizations(IOs). Advise supporting civil affairsforces on humanitarian and civicassistance (HCA) activities within thetheater.

• Coordinate HSS provided to or receivedfrom, allies, coalition partners, hostnation (HN) military, or other friendlynations.

• Coordinate medical intelligence(Appendix B, “Medical Intelligence”)support for HSS organizations.

• Supervise the activities of the TheaterPatient Movement Requirements Center(TPMRC) and the Joint Blood ProgramOffice (JBPO).

• Coordinate support from the GlobalPatient Movement Requirements Center(GPMRC). (The GPMRC is a UnitedStates Transportation Command asset.)

This center is discussed in detail in JointPublication (JP) 4-02.2, Joint Tactics,Techniques, and Procedures for PatientMovement in Joint Operations.

• Coordinate support from the ArmedServices Blood Program Office(ASBPO). The ASBPO is responsiblefor the coordination of the blood

programs of the military Services andthe combatant commands. The ASBPOprovides an orderly system forcollection, storage, and distribution ofblood products across the range ofmilitary operations. The primaryresponsibility of the ASBPO is to ensurethat blood products, in the required typesand amounts, reach the theater in a ready-to-use condition.

For a detailed discussion of bloodmanagement, refer to JP 4-02.1, JointTactics, Techniques, and Procedures forHealth Service Logistics in JointOperations.

• Prepare the HSS Annex Q to theOPLAN.

• Prepare patient movement (lift-bed)requirements based on the casualtyestimates provided by the appropriatestaff.

• Obtain Service specific casualty rateinformation to model HSS force structureand casualty flow for the joint operation.When the size of the joint operationwarrants, use the most current Chairmanof the Joint Chiefs of Staff (CJCS)-approved automated medical planningtools to generate patient requirements andidentify shortfalls in medical forcestructure, equipment, and supplies.

• Identify possible requirements for fixed-wing patient airlift based on casualtyestimates.

d. The subordinate joint force JFS assessescomponent command HSS requirements andcapabilities (both quantitatively andqualitatively) and provides guidance toenhance the effectiveness of HSS. Thesubordinate joint force JFS has theresponsibility for the following.

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• Assist the component commands inidentifying HSS requirements andcoordinating cross-Service support,where practical.

• Advise the subordinate JFC concerning:

•• HSS aspects of combat operations;

•• Preventive medicine;

•• Health of command and other medicalfactors that could affect operations;

•• Occupational and environmentalhealth; and

•• JRSOI.

• Monitor and inform the subordinate JFCon the status of HSS resources.

• Inform the subordinate JFC concerningthe status of and assistance required byand provided to the civilian populace,DOD civilian employees, DOD contractpersonnel, EPWs, NGOs, and IOs.Advise supporting civil affairs (CA)forces on HCA activities within the jointforce operational area.

• Coordinate HSS provided to or receivedfrom allies, coalition partners, HNmilitary, or other friendly nations.

• Coordinate medical intelligence(Appendix B, “Medical Intelligence”)support for HSS organizations.

• Prepare the FHP HSS Annex Q to thejoint force OPLAN (See Appendix C,“Format for Annex Q to an OperationPlan”).

• Prepare patient movement (lift-bed)requirements based on the casualtyestimates and rates provided by theappropriate staff.

• Advise the subordinate JFC on all HSSoperations.

• Define and monitor preventive medicineand care provided to civilian populationand other beneficiaries.

• Assist HSS personnel and facilities tocomply with the 1949 GenevaConventions.

e. The combatant commander has directiveauthority for logistics within the AOR, toinclude the execution of the health servicelogistic support mission. One way thecombatant commander may exercise thisauthority is by designating one of the Serviceswithin the AOR (normally the predominantuser) as the single integrated medical logisticsmanager (SIMLM). The SIMLM’s mission,roles, and responsibilities for supporting jointforces must be clearly identified in conceptand operation plans.

Further information on the SIMLM is in JP4-02.1, Joint Tactics, Techniques, andProcedures for Health Service Logistics inJoint Operations.

f. The US Army is the DOD ExecutiveAgent for veterinary services for all Servicesand the advisor to the JFS on all veterinaryaffairs. This mission includes the control ofzoonotic diseases, veterinary care of DOD-owned animals, veterinary laboratory support,inspection and examination of subsistenceitems for quality and, when authorized,veterinary care for animals belonging to localindigenous personnel in conjunction withnation assistance or other operations. ArmyVeterinary Corps, Navy Preventive Medicine,and Air Force Public Health provide foodsafety services, assuring food quality.

6. Patient Movement

Timely patient movement plays animportant role in FHP and the design of

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HSS. Patient movement functions includemedical regulating, patient movement,patient in-transit visibility, and providing enroute care (e.g., medical staffing and patientmovement items (PMIs), etc.). Patientmovement can be by surface (land or water),or by air (rotary-wing or fixed-wing aircraft);however, air is preferred.

a. Initial movement of patients to a theaterhospital has historically been a Servicecomponent responsibility, but patientmovement can be coordinated within an AOR,as required, by a Joint Patient MovementRequirements Center. Intratheater forwardaeromedical evacuation (AE) may becoordinated by an AE liaison team. Armyaeromedical ambulance assets may providededicated patient movement to and fromNavy hospital ships. Intratheater patientmovement is coordinated by a TPMRC.Patient movement from the theater is a

collaborative effort between the TPMRC,GPMRC, and the component lift controlagency.

Patient movement procedures in jointoperations are described in JP 4-02.2, JointTactics, Techniques, and Procedures forPatient Movement in Joint Operations.

b. PMI refers to specific medicalequipment and durable supplies that must beavailable to support patient movement. Themission of the PMI system is to support in-transit medical capability by minimizing theremoval of equipment from patients; exchangePMIs without degrading medical capabilities;and provide prompt recycling of PMIs.

The PMI system is outlined in JP 4-02.1, JointTactics, Techniques, and Procedures forHealth Service Logistics Support in JointOperations.

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Intentionally Blank

CHAPTER IIIHEALTH SERVICE SUPPORT PLANNING

III-1

1. The Joint OperationPlanning Process

The Joint Operation Planning andExecution System is the policy, procedures,and automated data processing systemused for developing, coordinating,reviewing, approving, and disseminatingjoint OPLANs. Operational planners musttake many factors into account to select thebest or most appropriate means of performinga joint force mission. The amount of timeavailable for planning influences the entireprocess. Joint operation planning is comprisedof deliberate and crisis action planning. TheGlobal Command and Control System(GCCS) provides the means by whichplanners develop and execute OPLANs andoperation orders (OPORDs). The GCCSfurnishes warfighters at all levels with theneeded connectivity, rapid access, flexibility,and simplicity in operations for acomprehensive, interoperable, globalcommand and control (C2) capability.

2. Health Service SupportPlanning Considerations

Timely, effective planning and coordinationare essential to ensure adequate andsustainable HSS in a theater. Proper planning

“A corps of medical officers was not established solely for the purpose ofattending the wounded and sick . . . the labors of medical officers cover amore extended field. The leading idea, which should be constantly kept inview, is to strengthen the hands of the Commanding General by keeping hisarmy in the most vigorous health, thus rendering it, in the highest degree,efficient for enduring fatigue and privation, and for fighting. In this view, theduties of such a corps are of vital importance to the success of an army, andcommanders seldom appreciate the full effect of their proper fulfillment.”

Major Jonathan LettermanMedical Director of the Civil

War Army of the Potomac

permits a systematic examination of all factorsin a projected operation and ensuresinteroperability with the campaign plan orOPLAN (see Appendix C, “Format for AnnexQ to an Operation Plan”). Organization ofthe HSS system is determined by the jointforce’s mission, the health threat, medicalintelligence, anticipated number of patients,duration of the operation, the theater patientmovement policy, available lift, andhospitalization and movement requirements(see Figure III-1).

a. Threat. The threat is a composite ofongoing or potential enemy actions;occupational, environmental, geographical,and meteorological conditions; endemicdiseases that can reduce the effectiveness ofthe joint force through wounds, injuries,illness, and psychological stressors; and theemployment of weapons of mass destruction(WMD). See Appendix A, “Health Threat.”

b. Medical Intelligence. Medicalintelligence is produced from the collection,evaluation, and analysis of informationconcerning the health threats and medicalcapabilities of foreign countries that haveimmediate or potential impact on policies,plans, or operations. See Appendix B,“Medical Intelligence.”

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c. Patient Movement. Timely patientmovement plays an important role in thedesign of HSS. Patient movement is the endresult of the collaborative lift-bed planning,and involves selection of patients formovement based on consideration of medicalcondition, locating available beds, routeplanning, and the selection of movementplatforms and movement control. The HSSplanner should consider using all means ofpatient movement.

For further guidance, refer to JP 4-02.2, JointTactics, Techniques and Procedures for PatientMovement in Joint Operations.

d. Clinical Capabilities and HealthService Logistic Support. Specific clinicalcapabilities, location, health service logisticsupportability, and bed requirements must beconsidered when planning HSS and must bedetailed in the respective OPLAN. HSSplanners must consider the following.

• Sufficient personnel with the clinicalcapabilities necessary to provide care forthe expected number and types of patientsin the theater.

• Specific clinical capability, relativemobility, logistic supportability, and the

Figure III-1. Health Service Support Planning Considerations

HEALTH SERVICE SUPPORTPLANNING CONSIDERATIONS

HEALTH SERVICESUPPORTPLANNING

CONSIDERATIONS

ThreatMedical

Intelligence

PatientMovement

PatientMovement Items

MedicalSurveillance

Prevention of StressCasualties

Mass CasualtySituations

Host-SupportNation

Preventive andVeterinary Medicine

Clinical Capabilitesand Health ServiceLogistic Support

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Health Service Support Planning

necessity to ensure a logical expansionof capabilities in theater.

• Critical time and distance factors thatimpact on morbidity and mortality rates.

• Health service logistic issues, including:

•• Standardization;

•• Use of a SIMLM system;

•• Items requiring special handling;

•• Transportation;

•• Type and quantity of medical suppliesneeded;

•• Supply procedures and sustainmentrequirements; and

•• Medical equipment maintenance andsupport requirements.

• Blood supply and distribution.

e. Patient Movement Items. PMIs arespecific medical equipment and durablesupplies that must be available to support the

patient. Examples of PMIs includeventilators, litters, patient monitors, and pulseoximeters. The mission of the PMI systemis to support patients in-transit, to exchangein-kind PMIs without degrading medicalcapabilities, and to provide prompt recyclingof PMIs. It is the originating MTF’sresponsibility to provide the PMIs requiredto support the patient during movement. PMIsaccompany a patient throughout the chain ofmovement, from the originating MTF to thedestination MTF, whether it is an intratheateror intertheater transfer. Planners must ensurethat PMIs are available at the correct locationand ready for use and PMI centers areestablished (establishment of theater PMIcenters and cells is the responsibility of theUS Air Force). PMI centers are establishedto support worldwide theater requirements.PMI centers will be located at airports ofembarkation and/or debarkation withinCONUS and OCONUS to match AE supportplans. PMI centers and cells will receive,refurbish (i.e., technical inspection,calibration, repair, and replenishment ofexpendable supplies to maintain a 3-day levelof supplies), redistribute, and return PMIscollected from MTFs. PMI centers can beaugmented with personnel and equipmentfrom the other Services; liaison personnel

Planners must account for the medical situation in the operational area.

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may also be assigned. At the time an MTFinitiates a patient movement requestrequiring PMIs, the PMI center and/or cellwill initiate action for the exchange of in-kind PMIs.

For further guidance on PMIs, refer to JP4-02.2, Joint Tactics, Techniques andProcedures for Patient Movement in JointOperations.

f. Preventive Medicine and MedicalSurveillance. Risk assessment and analysisas well as preventive medicine measuresmust be included early in HSS planning.The theater medical surveillance program isinitiated and the means to counter the healththreats in the operational area are identifiedbefore the forces arrive. Specific preventivemedicine procedures are generally theresponsibility of the component commands.However, the geographic combatantcommander, with advice from the JFS, mayexercise directive authority and changecomponent responsibilities based onoperational or geographic considerations.

• Preventive medicine is theanticipation, communication,prediction, identification, prevention,education, risk assessment, and controlof communicable diseases, illnessesand exposure to endemic,occupational, and environmentalthreats. These threats include nonbattleinjuries, combat stress responses, WMD,and other threats to the health andreadiness of military personnel.Communicable diseases includeanthropod-, vector-, food-, waste-, andwaterborne diseases. Preventativemedicine measures include fieldsanitation, medical surveillance, pestand vector control, disease riskassessment, environmental andoccupational health surveillance, waste(human, hazardous, and medical)

disposal, food safety inspection, andpotable water surveillance.

• Medical surveillance is defined as theongoing, systematic collection of healthdata essential to the evaluation,planning, and implementation ofpublic health practice, closelyintegrated with timely disseminationof data as required by higherauthority. Theater medical surveillanceis essential for early identification ofhealth threats within the operational areain order to prevent, neutralize, minimize,or eliminate them. The medicalsurveillance program must cover allperiods from predeployment, deployment,redeployment and post deployment. Thisinformation must be included in theHealth Services Support Annex (AnnexQ) to the joint OPLAN and/or OPORDs u p p o r t i n g t h e o p e r a t i o n . Acomprehensive medical surveillanceprogram includes preventive andepidemiological activities to ensure thatcommanders are kept informed on thehealth of the force, health threats,occupational and environmental threats,stressors, risks, and available preventivemedicine and stress control measuresbefore, during, and after deployment.

For further information refer to JP 3-35,Joint Deployment and RedeploymentOperations, DOD Directive 6490.2, JointMedical Surveillance, and DODInstruction 6490.3, Implementation andApplication of Joint MedicalSurveillance for Deployments.

•• Protocols are required for vaccines,chemoprophylaxes, barrier creams,and pretreatments which arerecommended for deployed forces andwhich are not approved for general useor are not approved for the purpose forwhich they are being administered

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under the Food and DrugAdministration’s guidelines. If thevaccine or medication is to beadministered without a member’s priorconsent, the Secretary of Defense mustgenerally obtain a waiver of informedconsent requirements in accordancewith title 10, US Code (USC), section1107(f).

•• Establishment of a centralrepository for all specimens andsamples, to include suspectedbiological warfare and chemicalwarfare agents and data, must becoordinated with the AssistantSecretary of Defense (Health Affairs).

g. Prevention of Stress Casualties.Prevention of stress casualties and controlof combat and operational stress is acommand and leader responsibility. HSSand other personnel at all levels playimportant supporting roles. A coordinatedprogram must be planned for the prevention,treatment, and RTD of combat stress reactioncasualties. Active education, training, andprevention programs assist with controllingstress and preparing unit leaders and HSSpersonnel to identify and manage stressreactions in units.

h. Mass Casualty (MASCAL)Situations. Procedures for handlingMASCALs must be established to includecasualty management resulting fromWMD, combat, or other militaryoperations. Particular emphasis is placedon the flexibility of HSS units to respond tosudden changes in the casualty situation.Successful management of a MASCALsituation is a complex task where successrelies as much on well-practiced logistics andcommunications as it does on skilled medicaltreatment. The JFS must ensure that thecommunications, transportation, triage andemergency management, patient movement,and health service logistic supportmanagement aspects of the MASCAL planare thoroughly rehearsed.

i. Host-Nation Support (HNS). HNScan be a significant force multiplier. HNSshould be equivalent to US standards oracceptable to the geographic combatantcommander. The JFS must assess HNm e d i c a l c a p a b i l i t i e s a n d m a k erecommendations to the JFC on their use fordeployed US forces. In many operations, HNblood supplies do not meet US standards of care.The JFS should make arrangements to store anduse blood products from US-approved sourceseven if HN MTFs are planned to support the

Mass casualties can also result from natural disasters.

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deployed force. HNS may reduce the liftrequirements necessary to deploy HSS to thejoint operations area (JOA).

For further information, refer to JP 5-00.2,Joint Task Force Planning Guidance andProcedures.

j. Additional HSS PlanningConsiderations. Additional HSS planningconsiderations that the JFS must take intoaccount to support joint operations are asfollows.

• Ensure that an adequate joint medicalcommunications architecture isestablished to provide compatible andresponsive communications for themilitary HSS system.

• Ensure that adequate standardizationand interoperability policies are inplace to ensure that all deployablemedical systems supporting jointoperations are interoperable betweenService components.

• Review entitlements, applicable laws,and regulations for the provision of USmilitary HSS to nonmilitary beneficiaries(civilian employees, DOD contractors, orother nonmilitary participants) andmilitary and nonmilitary personnel ofanother nation. Ensure that policies arepublished, disseminated and understoodby all HSS personnel.

• Coordinate HSS requirement insupport of natural disasters.

• Coordinate support with outside reliefagencies (Red Cross, NGOs, and IOs)in theater to ensure complete visibilityfor overall medical situation andrequirements, including integratedtransfer of responsibilities for policiesand procedures.

• Amphibious Task Force. Amphibioustask force HSS planning responsibilitiesare closely related to those of the landingforce. Detailed, coordinated, andparallel planning is required between thecommander of the amphibious task forceand the commander of the landing force.Each surgeon of these commands hasspecific HSS planning responsibilitiesthat are detailed in JP 3-02, JointDoctrine for Amphibious Operations.

• Airborne Operations. Airborneoperations establish a lodgment in anisolated uncertain or hostile environment.Detailed, coordinated, and joint planningis required between the commander ofthe airborne task force and the JFC. Eachsurgeon of these commands has specificHSS planning responsibilities that aredetailed in JP 3-17, Joint Doctrine andTactics, Techniques, and Procedures forAir Mobility Operations, and JP 3-18,Joint Doctrine for Forcible EntryOperations.

Additional considerations and a detailedHSS planning checklist can be found inJP 5-00.2, Joint Task Force PlanningGuidance and Procedures.

k. HSS for Returned US Prisoners ofWar (POWs) and Detained Personnel. Thegeographic combatant commander establishesa theater plan on the proper handling andprovision of HSS for returned US POWs anddetained personnel.

l. HSS for EPW. In consonance withprovisions outlined in the GenevaConventions, EPWs held by US forces areafforded the same level of HSS as US forces.Seriously wounded, injured, or sick EPWswill be segregated from US, allied, andcoalition patients and will be evacuated fromthe combat zone through HSS channels assoon as possible. The JTF commander must

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ensure that appropriate security is providedto guard the EPWs. Medical personnel willnot be used as guards. As much as possible,medical care of EPWs will be provided byqualified retained or detained medicalpersonnel from that same nation.

m. Dental Service

• Joint operations planning mustinclude the consideration of twocategories of dental services. Onecategory of dental care is provided withinthe operational area and an additionalcategory in the support base (see FigureIII-2).

• The planning process includes anevaluation of the size and anticipatedduration of the operation, along withcategories of dental care required tosupport the operation.

•• Category I — Operational Care.Care given for the relief of oral pain,elimination of acute infection, control oflife-threatening oral conditions(hemorrhage, cellulitis, or respiratorydifficulties), and treatment of trauma toteeth, jaws, and associated facialstructures is considered emergencycare. It is the most austere type of careand is available to Service members

engaged in tactical operations. Commonexamples of emergency treatments aresimple extractions, antibiotics, painmedication, and temporary fillings.Essential non-emergency care includesdental treatment necessary to interceptpotential emergencies. This type ofoperational care is necessary forprevention of lost duty time andpreservation of fighting strength.Personnel in Dental Class 3 (potentialdental emergencies) should be providedthis level of care as the tactical situationpermits. Common examples of essentialnon-emergency care are basicrestorations, extractions, interim pulpaltherapy (pulpectomy), treatment ofperiodontal conditions, and simpleprosthetic repairs. Essential non-emergency care is consistent with LevelII HSS. Essential non-emergency careis also intended to maintain the overalloral fitness of personnel at a levelconsistent with combat readiness. Mostdental disease is chronic and recurring.Oral health status will deteriorate fromthe day of deployment if essential care isnot provided by deployed dental support.Those in Dental Class 2 (untreated oraldisease) should be provided essentialcare as the tactical situation andavailability of dental resources permit.This level of care is the highest category

Figure III-2. Categories of Dental Care Considered During Joint Operation Planning

CATEGORIES OF DENTAL CARE CONSIDEREDDURING JOINT OPERATION PLANNING

Comprehensive Care

Operational CareOperational Care

Comprehensive Care

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of operational care available in theoperational area and is provided by areasupport dental units.

•• Category II — ComprehensiveCare. Treatment to restore an individualto optimal oral health, function, andesthetics. Comprehensive dental caremay be achieved incidental to providingoperational care in individuals whoseoral condition is healthy enough to beaddressed by the category of careprovided. This category of care is usuallyreserved for HSS plans that anticipatean extended period of reception andtraining in theater. The scope of facilitiesneeded to provide this level of dentalsupport could equal that of Level IIImedical facilities.

• Planning for dental services mustinclude the potential for augmentingthe medical effort during MASCALsituations. Joint operations of limitedsize or duration may limit dental servicesto predeployment screening, whicheliminates planning for deployment ofdental personnel and equipment.

n. Veterinary Service

• The US Army is the DOD ExecutiveAgent for veterinary support for theServices. In some instances, support isalso provided to allies and/or coalitionpartners, HN agencies, and other federalagencies. The appropriate mix ofveterinary units provides support. Theseunits are tasked-organized to supportfood safety and quality assurance, andthe health care mission for government-owned animals. Services include sanitarysurveillance for food source and storagefacilities, and procurement, surveillance,and examination of foodstuffs for foodsafety. The veterinary unit through thegeographic combatant commander isresponsible for publication of a directory

of approved food sources for theoperational area.

• When deployed in military operations,veterinary support and preventivemedicine capabilities reduce thevulnerability of multinational and USforces to DNBI. The CONUS-basedforce projection forces require an earlyveterinary and preventive medicinepresence in the operational area whereversubsistence, bottled water, and/or ice areprocured, shipped, stored, or issued.Procurement of fresh foods andbeverages is supported by veterinarypersonnel through sanitary inspection oflocal food establishments in theoperational area. Food inspection isnecessary to ensure food safety, qualityassurance, and adequate food hygiene.The potential of food-borne disease, thethreat of NBC contamination ofsubsistence, the need to assess thezoonotic endemic disease threats, and theneed to provide health care to militaryworking dogs all require an earlyveterinary presence throughout the entireoperational area. To ensure protectionof the force against the threats identifiedabove, veterinary services must be activeparticipants in all joint and multinationaloperations.

• Comprehensive veterinary medical andsurgical programs are required tomaintain the health of government-owned animals. Veterinary animal healthcare provides an effective combatmultiplier by providing complete medicalcare to all military working dogssupported in the operational area and bymonitoring endemic animal diseasethreats of military significance.Veterinary personnel work closely withArmy, Air Force, and Navy preventivemedicine units to provide coordinatedFHP support.

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For additional information onveterinary services, see field manual(FM) 8-10-18, Veterinary Services.

3. Health Service SupportCommand, Control,Communications,Computers, and IntelligenceSystems

Effective C4I systems are vital tosuccessful HSS in joint operations. HSSfunctions depend upon responsive C4Isystems to tie all aspects of support togetherand allow JTF commanders to direct,monitor, and be proactive in decisionmakingas situations develop (see Figure III-3).

a. C2 of HSS organizations normallyrests with the component commands. TheJFS will recommend C2 relationships basedon mission, enemy, terrain and weather,troops and support available, and timeavailable.

b. Early identification of a theater’s C4Isystem requirements for HSS connectivityis essential. At a minimum, HSScommunications must support reliable,constant communications within a theater,from the theater to CONUS, and link the mostforward HSS elements in the theater througheach level in the phased HSS system, throughthe Service component command’sheadquarters or JTF headquarters to the final

Figure III-3. Characteristics of Health Service Support Command, Control,Communications, Computers, and Intelligence Systems

CHARACTERISTICS OF HEALTH SERVICE SUPPORTCOMMAND, CONTROL, COMMUNICATIONS,

COMPUTERS, AND INTELLIGENCE SYSTEMS

Command and control of healthservice support organizationsnormally rests with thecomponent commands.

Early identification of a theater’scommand, control, communications,computers, and intelligence systemrequirements for health servicesupports connectivity is essential.

Records and reports arerequired to pass informationand assist in the evaluation ofpolicies and procedures.

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destination MTF. The success of HSSoperations depends upon reliablecommunications over dedicated and parallelsystems. HSS communications planners,working with the joint force command,control, communications, and computersystems directorate (J-6), must identifyfrequencies and encryption sets and/or codesthat are common between Service componentsupport forces assigned to HSS missions. Ifno commonality exists, then planners shouldconsider assigning a component to develop atheater communications plan that ensuresadequate communications support to allcomponents. A theater communications planshould be formulated during deliberateplanning. This is done through complete anddetailed descriptions of systems and systems’requirements (frequency, classification, etc.)in all Service documents and consolidated ina joint OPLAN or operation plan in conceptformat.

• Patient movement vehicles and aircraftmust be equipped with the propercommunications equipment to facilitate in-theater communications in support of HSSoperations. The component commandHSS units must plan to provide thenecessary communications equipment.

• Long-haul telecommunications serviceswill be provided through the DefenseInformation Services Network and itscomponent systems, the DefenseSwitched Network, Defense DataNetwork, Automated Digital Network(and its follow-on replacement, theDefense Message System), SecureInternet Protocol Router Network,Nonsecure Internet Protocol RouterNetwork, and the Defense SatelliteCommunications System.

• All frequency requirements for organicequipment must be coordinated with theJFC’s J-6 staff. All HSS should be

developed and certified to operate onthe Global Combat Support System.

• Theater medical information programsmust be timely, accurate, and relevant.They must cover the following:

•• Theater medical information;

•• Blood management;

•• Patient tracking and movement;

•• Health service logistic support; and

•• Medical surveillance.

c. Records and reports are required to passinformation and assist in the evaluation ofpolicies and procedures. The combatantcommand surgeon (a JFS) will determine theamount and nature of HSS information essentialto the geographic combatant commander andforward appropriate reporting guidelines to anysubordinate JFSs or component commandsurgeons. These subordinate surgeons willconsolidate their command or componentreports and forward them to the unifiedcommand surgeon.

Medical information in itself is notclassified. However, medical informationcan become an operations security(OPSEC) indicator in the context of aparticular military operation. OPSECmeasures to reduce or eliminate theseindicators may entail restrictions on medicalinformation dissemination and are detailedin OPLANs or OPORDs. OPSEC measuresmay require encryption of medicalinformation for transmission. However,hospital ships may not possess or use aclassified code for their radios or other meansof communications without risking loss oftheir Geneva Conventions protections.Patient information is sensitive and prudentmeasures must always be taken to protect

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patient confidentiality pursuant to the PrivacyAct of 1974 and consistent with internationallaw. This is one area in which the JFS andhis or her staff should seek legal advice toensure that a hospital ship or other medicalunit retains its protected status under theGeneva Conventions while still complyingwith US law.

4. Health Service Support inSpecial Operations

a. General. Special operations forces(SOF) are specially organized, trained, andequipped forces of the Army, Navy, and AirForce that conduct unconventionalwarfare, direct action, specialreconnaissance, foreign internal defense,combatting terrorism, psychologicaloperations, CA, counterproliferation ofWMD, and information operations. SOFmissions are often highly classified andconducted in remote and/or denied settings.The nature of SOF missions requires small,highly skilled, self-contained teams that canbe easily inserted and extracted by air, sea,and land. HSS of special operations unitsis characterized by an austere structureand a limited number of medical personnelwith enhanced medical skills, to includeemergency treatment, advanced traumamanagement (ATM), preventive medicineand limited veterinary and dental care.The primary focus of SOF HSS is to provideLevel I and II essential care and sustaincasualties until force extraction from theoperational area. Consequently, joint medicalplanners must develop a flexible medicalstructure linking the required conventionalhealth care pillars as far forward as the jointspecial operations task force, forwardoperations bases, and intermediate stagingbases. Critical support requirements includeforward surgical support, blood and bloodproducts, and linkage to strategic airmovement.

b. Organic HSS Capability

• Medical planning. The United StatesCommander in Chief, Special OperationsCommand, provides SOF to thesupported commanders. To provide thenecessary unity of command, eachgeographic combatant commander hasestablished a subordinate unifiedcommand to serve as the functionalspecial operations command (SOC). TheSOC component commander coordinatesconventional HSS packages to augmentSOF organic medical capability.

• SOF HSS. SOF enlisted medicalpersonnel receive enhanced medicaltraining that allows independent dutycapabilities which exceed those of theirconventional counterparts.

• Operational detachments

•• Army special operations forces(ARSOF) HSS assets assigned to specialforces teams and Ranger companies arecapable of providing Level I care.ARSOF support units have surgeons,flight surgeons, PAs, emergency medicaltechnicians (EMTs), and medics toprovide Level I capabilities. CA unitshave no organic HSS. CA battalions havemedical personnel assigned, but areorganized to provide advice and expertiseto the supported missions and not HSSto the force. Medically trained personnelof CA battalions provide assistance inidentifying and assessing foreign publicand private health systems, to includehealth and sanitation systems, agencies,personnel, and facilities. CA specialistswork with nongovernmental andinternational health organizations torehabilitate or develop functional healthand sanitation systems within the AOR.The other organic HSS capabilities of

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preventive medicine, laboratory,veterinary, and dental support arelocated in the special forces groups(SFGs). A health service logisticcapability exists in SFGs, Rangerbattalions, and SOF support units.Because ARSOF possess no organicmedical movement capability, SOF unitsoften depend on casualty evacuation(CASEVAC). CASEVAC is thetransport of casualties by nonmedicalunits, utilizing nonmedical assetswithout en route medical care.Utilization of vehicles of opportunity fortransport of casualties may be necessary.

•• Naval special operations forces’(NAVSOFs’) organic capabilities includeLevel I HSS for the unit. Health careand medical movement beyond Level Iare supported by various Navyconventional units, such as the floatingplatform from which the team is staged,or Army and Air Force conventionalunits providing medical support on anarea basis. Additionally, conventionalNavy and Marine Corps units withorganic Level II capability can provideHSS to the NAVSOF units. AE is notavailable and must be provided bysupporting units. NAVSOF units haveno preventive medicine, laboratory,veterinary, or dental support. NAVSOFunits deploy with basic loads of medicalsupplies and can be resupplied.

•• Air Force special operations forces(AFSOF) HSS capabilities are alignedwith AFSOF operational units andconsist of SOF medical elements (flightsurgeons, PAs, and independent dutytrained EMTs-paramedics) trained toperform CASEVAC, to include medicalstabilization and emergency interventionin-flight utilizing aircraft of opportunity.In addition, AFSOF forces includepararescue specialists. Although they

may be EMTs, paramedics are trainedfor pre-hospital trauma life support (andin some cases, advanced trauma lifesupport), pararescue specialists onspecial tactics teams are not medicalassets under Geneva Conventions andare not counted against medical billets.AFSOF have Level I and limited LevelII capability, to include emergencymedicine, ATM, CASEVAC for SOFunits, preventive medicine, medicalintelligence, field laboratory, limitedbiological warfare and chemical warfareagent treatment, and short-term patientholding and staging capabilities.Mission requirements may dictatedeploying a stand-alone personnelpackage and/or utilizing medical rapidresponse deployment kits or inconjunction with a SOF air transportabletreatment unit.

c. SOF Health Service Support Planning

• The goal of special operations HSSplanning is twofold: first, provideintegrated, augmented conventionalsupport into the concept of the specialoperations mission without compromisingthe objectives; second, articulate theunique challenges of the operation thatwill complicate the delivery of HSS byconventional units. The SOF HSS mustensure that the conventional HSS plannerunderstands these aspects. Theconventional HSS planner must translateSOF-unique requirements into theconventional HSS infrastructure bestsuited to support the mission.

• Unique challenges of HSS to SOF mustbe incorporated into HSS planning at thetheater JFS staff level, with fullknowledge and concurrence of SOCplanning staff. (SOC components areauthorized HSS planners and commandsurgeons during full mobilization.) HSS

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must be planned and coordinated withsubordinate joint force elements by thetheater JFS staff.

• The JFS and theater SOC and/or SOFcomponent HSS planners developcomprehensive operational area-specificplans to support the special operationsmission planning and execution cycle.Essential aspects of these plans link SOFwith conventional HSS. Additionally,strategic and operational circumstancesmay require arrangement for HNhospital support for special operationsmissions terminating in friendlyterritories within a theater.

• Typically, casualties will be evacuatedby pre-planned team extraction on SOFplatforms.

• Consider a modified movement(extended) policy for SOF to allowlonger recovery periods and to permitefficient RTDs.

• Segregate SOF casualties from theconventional patient population tofacilitate debriefing.

• SOF entry to the conventional HSSsystem normally will occur at the firstMTF of admission.

Refer to JP 3-05.1, Joint Tactics,Techniques, and Procedures for JointSpecial Operations Task ForcesOperations, for detailed SOF-uniqueHSS planning considerations.

5. Health Service Support in USCoast Guard Operations

a. General. The US Coast Guard (USCG)frequently supports DOD operations, both inCONUS and OCONUS. USCG support mayconsist of cutters with helicopters, land-based

port security units, and coastal patrols withsmall boats. These individual units may beassigned to different Service components orcommands, and often they must rely onresources, including HSS from other units.The resources should be provided by thenearest Service component.

b. USCG HSS Capability

• USCG HSS is limited to partial Level Icapability. Small boats on coastal patrolswill have an EMT only. Each cutter willhave one independent duty corpsman,and each port security unit will have aPA.

• Helicopters deployed aboard cutters aredesigned as surveillance platforms andlack medical equipment of any kind.They may be used in CASEVACsituations.

6. Health Service SupportPlanning Factors for JointOperations

In addition to coordinating joint forceHSS requirements, HSS planning for jointope ra t i ons i nvo lves o the r ma jo rconsiderations, including coordinating HSSrequirements with other combatantcommands, allied, and other friendly forces.The tool approved for calculating medicalrequirements is the medical analysis tool(MAT). MAT is an automated applicationprogram that takes Service-specific casualtyrates, admission rates, and population at risk(PAR) from time-phased force anddeployment data (TPFDD), deliberateplanning, theater patient movement policy,and merges those figures to generate jointmedical requirements. The planners thenperform a risk assessment and COA analysisto assess the most effective use of medicalforces. MAT produces credible medicalrequirements for beds, patients to be

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evacuated, Class VIII (both medicalresupply and blood), losses to bereplaced, and numbers of hospitaladmissions. In addition, it providesmedical requirements for PAR reports,planning factors used, and bedcapabilities (as compared to bedrequirements) report. The MAT caninput a PAR report from the TPFDD, andmerge Service scenarios to create a jointscenario. Services are responsible forgenerating and maintaining casualty ratesfor contingency operations. JFSs shouldobtain Service-specific casualty ratesthrough the combatant command.

a. Theater Patient Movement Policy

• The theater patient movement policy isset by the Secretary of Defense (SecDef)in coordination with the geographiccombatant commander prior to OPLANexecution. Upon execution, thegeographic combatant commanderadjusts the theater patient movementpolicy as needed.

• The theater patient movement policy isexecuted by the CINC. The theater patientmovement policy delineates the maximumnumber of days that patients may be heldwithin the command for treatment prior tofurther movement or RTD. Patients whocannot be RTD within the specified numberof days are evacuated to the next higherlevel of care for further treatment. Shortermovement policies within the theaterreduce theater bed requirements andincrease the number of beds requiredelsewhere. Shorter movement policies alsoincrease movement requirements. Thetheater patient movement policy is flexibleand can change as the tactical situationdictates.

• In accordance with SecDef policy andCJCS guidance, the patient movement

policy is normally 7 days for the combatzone and a combined total of 15 daysfor the combat zone andcommunications zone. This does notimply that a patient must be held intheater for the entire period. Patientsnot expected to RTD within the numberof days expressed in the theater patientmovement policy will normally beevacuated:

•• As soon as their medical conditionpermits or when local stabilizationcapabilities have been reached; or

•• When medical authorities havedetermined that travel will not aggravatetheir medical condition (at a minimum,patients will have their airway secured,bleeding stopped, shock treated, andfractures stabilized); and

•• When suitable receiving MTFs andtransportation have been arranged.

b. Estimate for Theater HSSRequirements. The estimate for theater HSSrequirements is based on empirical dataaccumulated for each Service for the majorcategories of patients wounded-in-action andDNBI. Planning factors, such as the theaterpatient movement policy, bed availability,casualty rates, admission rates, and the patientmovement delay policy are analyzed tocalculate HSS theater requirements.Empirical data includes:

• PAR;

• Patient movement delay;

• Average length of stay;

• Percent evacuated; and

• Dispersion factors. Dispersion factors arecontained in the Joint Strategic

III-15


Capabilities Plan, Health ServicePlanning Guidelines. These guidelinesshould be used as defaults for all CJCS-directed planning factors.

c. Planning Factor for Class VIII(b)Blood Products. The planning factor forblood products in a theater is 4.0 units of liquidred blood cells per initial admission. Thisfactor accounts for all blood use through alllevels of care. An appropriate breakout is 1.0unit per wounded in action and/or nonbattleinjury at Level I, 2.0 units at Level II and 1.0unit at Levels III and IV. The receipt,storage, and distribution of blood productsrequire special consideration and

procedures to ensure a coordinated effort andmaximum use of communications, storagefacilities, and transportation. The Air Forcecomponent will staff and operate bloodtransshipment centers (BTCs). The centersare located at major airfields, and bloodproducts are managed by the JBPO or areaJBPO. One or more BTCs are located in eachjoint force AOR and/or JOA.

See JP 4-02.1, Joint Tactics, Techniques, andProcedures for Health Service LogisticsSupport in Joint Operations, for detailedinformation on Class VIII supplies and bloodsupport operations.

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Intentionally Blank

APPENDIX AHEALTH THREAT

A-1

1. General

A health threat is the composite of allongoing or potential enemy actions andenvironmental conditions that could reducethe effectiveness of friendly forces. Theseactions and conditions include wounds,injuries, or diseases. Information to assessthe medical threat caused by enemy actionsshould be obtained from the IntelligenceDirectorate (J-2) and Operations Directoratecommunities.

2. Elements of the HealthThreat

a. Infectious diseases which occur naturallyare also referred to as endemic diseases.Historically, infectious diseases have beenresponsible for four times more casualtiesthan battle injuries. Many naturallyoccurring infectious diseases have shortincubation periods. They may causesignificant numbers of casualties within thefirst 48 hours of a deployment or contact.Other infectious diseases with longerincubation periods may not create casualtiesfor several weeks. Some examples ofmilitarily significant, naturally occurringinfectious disease threats are as follows.

• Acute upper respiratory diseases

• Acute diarrheal diseases

• Viral hepatitis

• Japanese encephalitis

• Scrub typhus

• Malaria

• Sexually transmitted diseases

• Leishmaniasis

• Leptospirosis

• Arbovirus infections (dengue, sandflyfever)

• Hemorrhagic fever with renal syndrome

• Schistosomiasis

b. Extreme environmental conditions inthe form of heat, cold, high humidity, and highaltitude can pose significant health hazardsto an unacclimated, unprepared, and poorlyconditioned military force. Employment ofUS forces in areas where these conditionsexist without adequate opportunity foracclimatization may significantly decreasecombat performance.

c. Conventional warfare munitionsinclude small arms, high velocity weapons,rockets, bombs, artillery, bayonets, and otherwounding devices, either individual or crew-served. This threat may be encountered inall geographic areas and can be employedby adversaries across the range of militaryoperations. Research and development insmart munitions and extended range artillery,coupled with more powerful high explosives,will increase the threat from these types ofweapons. Area denial munitions are likely tobe present and pose a major psychological andphysical threat. Wounds from booby traps,mines, and nontraditional weapons can alsobe encountered.

d. Biological warfare is the employmentof biological agents to produce casualtiesin humans or animals or cause damage toplants or materiel. The intentional use ofthese disease-causing organisms (pathogens),toxins, or other agents of biological origin is

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designed to weaken resistance to attack andreduce the will and/or the ability to wage war.

• Historically, biological warfare hasprimarily involved the use of pathogensto sabotage food and water supplies andspread disease among populations.These pathogens may fall into one of thefollowing categories:

•• Naturally occurring, unmodifiedinfectious agents;

•• Toxins, venoms, and their biologicallyactive fractions;

•• Modified infectious agents; and

•• Bioregulators and physiologicallyactive compounds.

• Biotechnology is a tool for theproduction of biological warfareagents. Naturally occurring infectiousorganisms can be made more virulent anddrug resistant and could possibly bemanipulated to render protective vaccinesineffective. Such developments couldgreatly complicate the ability to detectand identify biological warfare agentsand the ability to operate in areascontaminated by these agents or whileunder biological attack. The causativeagents for anthrax, tularemia, plague, andcholera, as well as botulinum toxin,staphylococcus, enterotoxin, andmycotoxin, are believed to have beenadopted as biological warfare agents bypotential US adversaries. The reports ofthe use by the former Soviet Union oftoxins in Southeast Asia have heightenedthe concerns of possible future use ofbiological agents.

e. Chemical warfare is the employmentof chemical agents to produce casualties inhumans or animals, or to secure terrain.As a result of confirmed chemical warfare

agent use by Iraq against Iranian forces andprobable use by the former Soviet Union inAfghanistan, there is continuing heightenedinterest in the use of chemical munitions anddelivery methods. Nerve and blister agentsappear to be the agents most available indeveloping countries. Agents which couldbe employed by numerous conventionalweapons systems include:

• Nerve agen ts — O-Ethy l S-D i i s o p r o p y l a m i n o m e t h y lMethylphosphonothiolate (VX), thickenedVX, sarin, and thickened soman;

• Vesicants (thickened lewisite and amustard and lewisite mixture);

• Choking agents (phosgene); and

• Cyanogens— (hydrogen cyanide andcyanogen chloride).

Toxic industrial chemical and materialcontamination poses a significantenvironmental threat to joint and multinationalforces, not because of the weaponization ofchemical munitions but as a result of thecollateral effects accompanying conventionaldestruction. This is particularly true in denselypopulated, built-up industrialized regions.

f. Directed-energy weapons focusradiation on a target to induce electronic,thermal, or structural and human(particularly eye) damage and can causemission failure. The radiation is composedof three types: radio frequency, laser, andcharged particle beam. There have beennumerous reports of personnel sustaining eyedamage while using optic devices and beingexposed to a bright flashing light emanatingfrom warships or other sources. These reportssuggest an increasing threat from lasers to bothair and ground forces.

g. Blast effect weapons, such as fuel airexplosives, represent an emerging medical

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Health Threat

threat. Gas-filled body organs, such as ears,lungs, and digestive tract, are the mostsusceptible to primary blast injury. Thisemerging threat may result in lower lethalitybut a greater number of wounded and asignificantly increased medical workload.

h. Strategic deployability of US forces isa major element of US political and militarystrategy. Forces may be required to operatewithout rest for extended periods of timeduring mobilization, staging, airbornetransportation, and combat insertion intohostile areas. Modern combat, with itsincreased lethality, rapid maneuvers,technological skill requirements, exposure toNBC weapons, and day or night all-weatheroperations, will stress personnel to theirendurance limits. Under these conditions,the significance of stress as a majorcontributor of casualties cannot beoverstated.

i. Flame and incendiary systems includenapalm and white phosphorus for aerialdelivered bombs. Possible uses of flame andincendiary weapons include the clearing ofdifficult defensive positions such as caves,bunkers, buildings, and soft shelter orvehicular targets. Flame has also been usedquite effectively in previous conflicts in anantitank role.

j. The primary nuclear warfare threatwas the Soviet Union. However, open-sourceinformation suggests that other countries havedeveloped a nuclear weapons capability.Planners expect a minimum of 10 to 20percent casualties within a division-size forcethat has experienced a nuclear strike. Thispercentage may be a low estimate, sinceproximity to ground zero is the criticalfactor in determining weapon effects on theforce. In addition to casualties, a nuclearweapon detonation can generate anelectromagnetic pulse that will result incatastrophic failure of some electronic

equipment components (including patientsupport equipment).

k. Enemy uses of radioactive material orradiological dispersal devices (RDDs) inoperational areas pose a new threat todeployed US forces. These devices orradioactive material can create areas ofradioactivity without causing the blast orthermal effects of nuclear weapons. US forcescan be exposed to potentially hazardous levelsof radiation in an otherwise conventionaloperational environment. Terrorists,assassins, individuals sympathetic to a specificcountry’s views, or opposing forces candisperse radioactive material or employRDDs. Planners must consider the possibilityof radioactive material and/or RDDs beingused against US forces in future operations.The casualty load generated by this potentialhazard can overwhelm an MTF, especially inimmature theaters and military operationsother than war (MOOTW) environments.

l. Disease Surveillance and Reporting.Joint Staff directives require all deployedmilitary organizations to have a medical unitto conduct disease and nonbattle injurysurveillance; track incidence and trends ofdiseases, injury, and health conditions ofmilitary operational significance; and providereal-time risk reduction recommendations tocommanders.

3. The Threat to HSSPersonnel and Operations

a. Commanders can anticipateincreased casualty densities among HSSpersonnel over those experienced in mostprevious conflicts. Health threat elementswith the greatest potential for forcedegradation during combat operations are asfollows.

• Battle injuries because of artillery, smallarms, and fragmentation weapons.

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• Casualties caused by combat stress.

• The collective effects of NBC, RDDs,and conventional weapons.

• Premeditated attack upon HSS units,personnel, or Class VIII supplies.

• The continually increasing range ofindirect fire weapons.

• The enhanced wounding capabilityand destructiveness of munitions andweapon systems.

• Significant increases in casualty densitiesthat cause local or general overloads ofthe HSS system, resulting in physicaland psychological stress.

• Infectious diseases, temperatureextremes, and toxic industrial chemicalsand/or materials.

b. Enemy combat operations in friendlyrear areas may interdict lines ofcommunications and disrupt necessaryhealth service logistic activities. Thisdisruption will produce a serious negativeeffect on the ability of personnel to retrieveand evacuate wounded, injured, and sickpersonnel and deliver health care. Althoughenemy combat operations may threaten theHSS combat mission by disrupting HSSoperations or threatening the survival of HSSpersonnel, they are not considered for thepurposes of this publication to be medicalthreats.

c. Prolonged periods of intense,continuous operations will tax HSSpersonnel to the limit of their psychologicaland emotional endurance. This stress andfatigue will cause both quantitative andqualitative degradation in the ability of theHSS system to deliver health care at asustained level. The proper training ofdental personnel in procedures such astaking vital signs and performing minorsurgery may allow for augmentation of themedical staff, and provide some temporaryrelief.

d. HSS units are not expected to be theprimary target for NBC attacks; however,logistic base complexes may be primecandidates for such enemy operations. Aselements of logistic complexes, HSSorganizations must anticipate collateralcontamination from attacks on adjacentfacilities. Forward HSS assets have an evenhigher probability of being required to operatein or near areas contaminated by NBCweapons. Decontamination of casualties isnormally the responsibility of the Service unitby nonmedical personnel; however, medicalpersonnel should be prepared to conductdecontamination operations for those earlycasualties arriving at the MTF who have notbeen previously decontaminated. Thisensures that medical units can providetreatment of casualties. Patient decontaminationsites may be located in the general proximityof MTFs to ensure that medical supervisionof patient decontamination is available.

APPENDIX BMEDICAL INTELLIGENCE

B-1

1. General

a. The Defense Intelligence Agency(DIA) develops and disseminates medicalintelligence. The two major intelligencecategories of primary use to the HSS plannerare general medical intelligence (DODDirective 6420.1R, Armed Forces MedicalIntelligence Center) and medical intelligence.Armed Forces Medical Intelligence Center(AFMIC), Fort Detrick, Maryland, is the soleproducer of medical intelligence for DIA.AFMIC currently produces and disseminatesfinished intelligence products via studies,message traffic, compact disk-read onlymemory (CD-ROM), and on-line electronicsystems.

b. DOD military medical personnelfrequently use the term medical intelligenceincorrectly to mean any medical informationof military importance; however, the term“medical intelligence” officially refers tointelligence on medical and related matters.By this definition, medical intelligenceincludes only finished intelligence productsproduced by an authorized intelligence agencysuch as AFMIC through the intelligence cycle.Medical intelligence is intended to provideHSS operations and planning staffs withbasic guidance for understanding, acquiring,using, and applying intelligence andintelligence systems in the conduct of HSSoperations, medical threat analysis andmanagement, threat-based conceptdevelopment, medical research, and doctrinedevelopment. Other sources of medicalinformation may be used in assessingpotential threats (e.g., US Army and AirForce preventive medicine units and Navalenvironmental and preventive medicine units,Defense Pest Management InformationAnalysis Center, and the World HealthOrganization).

2. Medical Estimate of theSituation

a. The medical estimate’s purpose is toprovide an analysis of HSS informationpertaining to enemy intentions, allied orcoalition partner’s capabilities, limitations,COAs, and potential HSS consequencesassociated with a contemplated operation.The HSS estimate may be written or oral.

b. The HSS estimate will include all HSSfacts, assumptions, and deductions that canaffect the operation. The JFS must befamiliar with the concept of operations andobtain medical intelligence concerning thetheater from indigenous sources, thesupporting intelligence activity, AFMIC, andnational intelligence agencies. The JFS mustconduct a thorough evaluation of the enemysituation, the friendly situation, and thetheater from the standpoint of effects on thehealth of the joint force and HSS operations.

c. Prior to deployment, the JFC shouldensure that a predeployment vulnerabilityassessment has been conducted. Theseassessments will normally include a medicalmember qualified to evaluate the safety andvulnerability of local food and water sources,perform an epidemiological risk assessment,evaluate local medical capabilities, perform avector-pest risk assessment, determine theadequacy of hygiene in local billeting andpublic facilities, industrial contaminants (pastand present), and perform an environmentalrisk assessment coordinated with the engineerbaseline environmental survey.

d. The medical estimate is an analysisof the health threat and HSS capabilitiesto determine vulnerabilities and estimatedrequirements of the joint force.

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• Patient estimates are calculated todetermine requirement, distribution ofmedical assets , PAR, poss ibleMASCALs, and patient movement. TheJFS consults Service wartime planningreferences to assist in determiningrequirements for the operation. Hospitalestimates and other support requirementsare derived from these data.

• Having de te rmined the HSSrequirements, the JFS considers theresources that are readily available tomeet the requirements. Maximum useof available personnel, supplies andequipment, and joint use of facilitiespromote effectiveness of the command’s HSS. Considering support requirementsand resources available, the JFSdetermines the proposed COA thatcan be supported.

• The JFS identifies shortfalls that mayimpact on the JTF COA development andselection.

e. Based upon the medical estimate of thesituation, the JFS, in coordination with thejoint force component command surgeons,must plan for HSS policies and proceduresthat can be best adapted to the jointoperation. In many instances, existingstanding operating procedures can be usedwith little or no modification. In otherinstances, entirely new procedures may haveto be developed and implemented. Standardsmust be established to deal with the type andtiming of physical, dental, and mentalexaminations and inspections necessary toensure that personnel in the theater or thosearriving are fit for duty. Physical standardsare normally Service-specified; however, thegeographic combatant commander may directadditional or special requirements based onoperational, geographic, or climaticconditions.

3. Significance of MedicalIntelligence

a. Accurate and timely intelligence is acritical combat support tool for planning,executing, and sustaining military operations.It is equally important in achievingoptimum planning, execution, andsustainment of HSS operations, the medicalreadiness of the command, and the overallcombat readiness of the unit.

b. At the strategic level, the objective isto contribute to the formulation of nationaland military strategies. At the operationallevel, intelligence focuses on the jointcampaign and operations. At the tacticallevel, intelligence is oriented toward thespecific operational area and a given operationin greater detail. Intelligence, properly usedand applied, can become a powerful forcemultiplier by providing the critical essentialelements of information required to assist HSSstaffs.

4. Sources of MedicalIntelligence

AFMIC Products. Most AFMICproducts commonly used by HSS plannersfall into the category of recurring, finishedintelligence. These products include (but arenot limited to) the following.

a. Infectious disease risk assessments(IDRAs), which assess the risk frominfectious diseases of operational militarysignificance on a country-by-country basisworldwide. IDRAs are available onINTELINK and INTELINK S. (For accessto INTELINK and INTELINK Sprograms, contact your intelligence officer.)

b. Environmental health riskassessments (EHRAs), which assessenvironmental health risks of military

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Medical Intelligence

significance on a country-by-country basisworldwide. EHRAs are available onINTELINK.

c. Medical, environmental, diseaseintelligence, and countermeasures CD-ROMs provide worldwide infectious diseaseand environmental health risks hyperlinkedto the joint Service-approved countermeasurerecommendations, military and civilian healthcare delivery capabilities, operationalinformation, disease vector ecologyinformation, and reference data.

d. Health service assessments aredesigned to provide consumers the bottom-line assessment of the health servicecapabilities of a country, with limiteddescriptive data and examples relating onlyto critical elements of the civilian and militaryhealth care systems. The studies are producedon countries with a validated productionrequirement by an intelligence consumer, orwith a high potential for US force deployment.

e. The AFMIC’s quick reaction supportresponds to time-sensitive, quick reactionintelligence production and supportrequests for operational contingencies. Quickreaction tasking is normally accepted byAFMIC if the requirements of the task can becompleted in a maximum of 40 personnelhours of analytical work. Requests areaccepted telephonically (open and securec o m m u n i c a t i o n s ) a n d b y d i r e c tcorrespondence or message format.

Whenever possible, formal methods ofcommunications are encouraged. The JFSshould request medical intelligence via theirJ-2.

f. AFMIC Wire, which is a currentintelligence document, presenting analysis ofnewly reported information of potentialinterest to consumers. In addition to thescheduled wire, special wires are producedperiodically, generally on topics of immediateinterest to deployed or deploying forces.

g. Disease Occurrence World Wide, whichprovides time-sensitive updates to the IDRAs.It is published weekly as an unclassifiedmessage, with a classified supplement, ifnecessary.

h. Communications with AFMIC. Therequest for information is a way of askingAFMIC for answers to questions that are notfound in published studies. Generally, arequest for information is a project requiring40 or fewer hours for AFMIC to complete.Request for information should be directedthrough command J-2 to AFMIC.

• Mailing address:Director, Armed Forces MedicalIntelligence Center (Operations)1607 Porter StFort Detrick, MD 21702-5004

• Message: DIRAFMIC FT DETRICKMD//OPS//

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Intentionally Blank

APPENDIX CFORMAT FOR ANNEX Q TO AN OPERATION PLAN

C-1

____________ (Classification)

HeadquartersLocationDate, time, and zone

ANNEX Q TO ______________ OPLAN ________ ( )HEALTH SERVICE SUPPORT( )

( ) REFERENCES:

a. Geneva Convention for the Amelioration of the Condition of the Wounded and Sick inArmed Forces in the Field, 12 August 1949.

b. Geneva Convention for the Amelioration of the Condition of the Wounded, Sick, andShipwrecked Members of Armed Forces at Sea, 12 August 1949.

c. Geneva Convention Relative to the Treatment of Prisoners of War, 12 August 1949.

d. Geneva Convention Relative to the Protection of Civilian Persons in Time of War, 12August 1949.

e. JP 3-11, Joint Doctrine for Operations in Nuclear, Biological, and Chemical (NBC)Environments.

f. JP 4-01, Joint Doctrine for the Defense Transportation System.

g. JP 4-02, Doctrine for Health Service Support in Joint Operations.

h. JP 4-02.1, Joint Tactics, Techniques, and Procedures for Health Service Logistics Supportin Joint Operations.

i. JP 4-02.2, Joint Tactics, Techniques, and Procedures for Patient Movement in JointOperations.

j. JP 4-04, Joint Doctrine for Civil Engineering Support.

k. JP 4-05, Joint Doctrine for Mobilization Planning.

l. Center of Military History Publication 83-3, Emergency War Surgery: 2d US Revision ofthe Emergency War Surgery North Atlantic Treaty Organization (NATO) Handbook, 1988.

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1. ( ) Situation

a. ( ) General.

• ( ) Purpose. To provide a concept of operations, assign tasks, and provide guidance toensure an effective HSS system to support the operations envisaged in the OPLAN.

• ( ) Applicability. Refer to TASK ORGANIZATION, OPLAN. List other commands towhich this appendix applies.

b. ( ) Enemy Forces. Annex B (Intelligence).

c. ( ) Friendly Forces. Summarize capabilities (including weapon systems that may influencethe HSS system mission).

d. ( ) Assumptions. List key assumptions affecting HSS planning.

e. ( ) Limitations. List key limiting factors affecting HSS capability.

2. ( ) Mission. State a clear, concise statement of the overall mission of the HSSsystem

3. ( ) Execution

a. ( ) Concept of Operations. Describe the overall concept of HSS to meet missionrequirements.

• ( ) Transition. State the concept of transition from peacetime HSS posture to wartime.

• ( ) Responsibility and command relationships. State component command’s responsibility.Indicate responsibility and scope of HSS of US forces under operational control of otherthan US commanders and allied forces to provide HSS for each other’s combatants.

• ( ) Hospitalization. Describe the concept of operations for hospitalization. Include abrief assessment of initial in-theater HSS treatment capabilities.

• ( ) Patient movement (to include validating, regulating, and movement). Describe theoverall concept of patient movement (land, sea, and air).

• ( ) Host-nation support. Address HN HSS-availability and assess the status of theseactivities.

• ( ) Adjunct HSS. If applicable, address the following: EPWs, civilian internees, detainees,formerly captured US military personnel, evasion and recovery operations, noncombatantevacuation operations, and civil affairs. Outline the concept to provide HSS and treatmentas well as personnel and material support.

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Format for Annex Q to an Operation Plan

• ( ) Joint blood program. Outline the concept for blood components support and resupply.

• ( ) Preventive medicine, medical surveillance, and combat stress control. Describe theconcept for support.

• ( ) Theater patient movement policy. State the objective theater patient movement policy(to establish requirements) and the supportable policy.

• ( ) Medical regulating. Outline the concept for medical regulating to, within, and fromthe theater.

• ( ) Dental services. Include the scope and responsibility for dental services in eachoperational area.

• ( ) Veterinary services. As dictated by the mission.

• ( ) Other areas. As dictated by the mission.

b. ( ) Tasks. Identify joint responsibilities of subunified, joint task force, and componentcommanders for HSS.

c. ( ) Coordinating Instructions. Outline the required key intracommand coordination (forexample, personnel, Joint Transportation Board, and engineering support).

4. ( ) Administration and Logistics

a. ( ) HSS Materiel. Describe the general concept for supply and resupply support, includingsingle manager (if applicable), regionalization, and procedures for cross-leveling andredistributing HSS materiel and policies for local acquisition.

b. ( ) Reports. State what and how to format all HSS reports.

5. ( ) Command and Control

a. ( ) Command. Ensure HSS C2 is fully consistent with the overall command structure.

b. ( ) HSS Communications. Briefly describe how to transmit HSS information within andfrom the theater. Identify any dedicated secure or unsecure communication requirements andcapability.

t/GeneralCommander in Chief

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Appendices:1 — Patient Movement Requirement System2 — Joint Blood Program3 — Hospitalization4 — Return to Duty5 — Health Service Logistics (Class VIII A) System6 — Preventive Medicine7 — HSS Command, Control, Communications, and Computers8 — Host-Nation Support9 — HSS Sustainability Assessment10 — HSS Intelligence Support to Military Operations11 — Veterinary Service12 — HSS Planning Responsibilities and Task Identification13 — Medical Laboratory Services(Classification)

HeadquartersLocationDate, time, and zone

APPENDIX DMULTINATIONAL OPERATIONS

D-1

1. Health Service Support inMultinational Operations

General. General logistic support doctrineapplies equally to HSS. Multinational supportoperations are complicated by a number ofcharacteristics that impact fundamentallyupon the provision of HSS.

a. Unique nature of every individualoperation.

b. Geographic, topographic, and climaticvariations of the operational area.

c. Numbers of individual nations involvedin each operation.

d. Variations in national standards of HSSand equipment.

e. Language and communicationsdifferences.

f. Political complexity and dynamic natureof each operational scenario.

g. Mission of medical support forces.

h. Differences in individual nationalobjectives and/or restrictions for participationin operations and integration of overallmission goals.

i. Medical staffs face unique problemsaffecting the health of multinational personneldeployed on operations. Therefore,operational HSS requires clearly defined anddistinctive guidance. JFCs and staff shoulddetermine which guidance and/or standardsto follow in multinational operations.

j. HSS plans must be tailored to eachoperation and meet the demands of geography,individual national needs, language, andcommunication difficulties. Plans must becapable of rapid implementation, but at thesame time be flexible enough to managerapidly changing operational demands.

k. Every deployed multinational force musthave a surgeon and/or chief medical officer(CMO) who has direct access to themultinational force commander (MNFC).

l. Each deployed national contingent thathas HSS personnel must have a singledesignated individual who has the clinicalresponsibility for all national HSS matters.Under North Atlantic Treaty Organizationterminology, this person is known as thenational Senior Medical Officer.

2. Multinational OperationsPrinciples

Contributing nations retain ultimateaccountability for the health of their forces,but, the MNFC will normally share theresponsibility for or have an interest in thehealth of assigned forces. To meet thisrequirement, the MNFC needs appropriateHSS staff available at the early stages ofplanning HSS for an operation.

a. International Conventions for theTreatment of the Sick and Wounded. HSSfor operations will comply with provisions ofthe Geneva Conventions. Persons entitledunder the terms of the Conventions shall,without discrimination, receive medicaltreatment on the basis of their clinical needsand the availability of HSS resources.

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b. Standards of HSS. Operational HSSto multinational forces must meet standardsthat are acceptable to all participating nations.Care provided to US forces participating in amultinational operation must meet USstandards.

c. Estimation of Medical Risk.Estimation of medical risk and the associatedcasualty rates is the responsibility of theindividual nation with HSS advice of themultinational operational staffs.

d. Multinational Levels of HSS. Inmultinational operations, there are four levelsof HSS that should be available to allmultinational forces. They are organized ona progressive basis. Levels of HSS will beprovided appropriately to a particularoperation. Policy for national contributionswill generally be as follows.

• Level I — National responsibility.

• Level II — National and/or Lead Nation.For the United States, Level II is anational responsibility.

• Level III — National and/or Lead Nation.For the United States, Level III is anational responsibility.

• Level IV — National and/or ForceProvided (Contracted). For the UnitedStates, Level IV is a nationalresponsibility.

3. Health and Fitness EntryStandards

To qualify to participate in themultinational force (and for subsequentmultinational resourced medical treatment,patient movement, and personal disabilitycompensation), national contingents andindividuals allocated or contracted tomultinational operations must meet the basic

standards of individual health and physicalfitness laid down by the CMO staff.

4. Statement of Requirement

HSS requirements are to be determined bythe appropriate MNFC in consultation withcontributing nations and the HSS planningstaff. HSS resources will be specified as thosenecessary to prevent and control DNBI andto collect, evacuate, and treat casualties.

5. National Structure

National HSS systems should be retainedas an organic force structure to thecontributing nation’s forces as much aspossible. However, HSS planners must seekto take advantage of economies of scale whichmay be achieved from multinational conceptssuch as lead nation responsibilities, rolespecialization, and mutual assistance.

6. Provision of Resources

Contributing nations bear ultimateresponsibility for ensuring the provision ofHSS to their forces allocated to multinationaloperations. This may be discharged in anumber of ways, including agreements withother nations or the appropriate multinationalplanning staffs and MNFCs.

7. Treatment of EntitledPersonnel

From the outset of an operation, policy mustbe established regarding the entitlement ofnon-US military and/or nonmilitary staffs andother authorized personnel in-theater and forall medical treatment other than emergencymeasures.

8. HSS Liaison

HSS planning staffs are to ensure thatmethods are established to provide regular and

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Multinational Operations

efficient liaison between national contingentsand theater HSS resources, particularlymonitoring inpatients at Levels III and IV,and for all intratheater and intertheaterpatient movement.

9. HNS Capability

The HNS resources available in theoperational area are the key to determining thesize and capability of the HSS organization thatthe multinational force must establish. The moreHNS available for use, the less that has to befound from contributing nations. Overall, amixture of medical intelligence analysis and on-the-ground reconnaissance assesses HNScapabilities. A key issue will be the standardsof HSS available, compared to the multinationalforce and national contingent criteria.

10. Considerations

a. Maximum effort must be made to tailorHSS mission requirements. HSS plannersmust find a balance of capabilities. Anexample may be to organize a single nationto provide a particular function, such as AE,for all contingents.

b. Establishing the patient movementpolicy is a command decision of each nation.HSS and logistic staffs will advise. The forcetheater surgeon (sometimes known as themultinational CMO) will promulgaterecommendations and will monitor theestablished patient movement policy.

c. C4I. Comprehensive and effective C4Iis fundamental to the HSS plan. It beginsprior to deployment, with the establishmentof a competent HSS planning team at themultinational force headquarters. It is alsocrucially dependent upon the following.

• Clearly established lines of accountabilityand control agreed to by all participatingcontingents.

• Liaison at every level including HNS andany NGOs and IOs in theater.

d. Preventive Medicine Capability. Theexpertise to manage preventive medicineresponsibilities must be made available at alllevels. The requirement will be for preventivemedicine units as well as individual experts.The provision of this capability lends itselfwell to a lead nation approach. The shape andsize of in-theater preventive medicinecapability will be dictated primarily by thefollowing.

• The size of the multinational force to besupported, its dispersal, and the theatertopography.

• The capability of national contingents toimplement preventive measuresindependently.

• The responsibility to ensure thatp e r s o n n e l a r e p r e p a r e d a n dappropriately trained in field preventivem e d i c i n e m e a s u r e s p r i o r t odeployment to an operation. This mustinclude the necessary pretreatments,chemoprophylaxes, barrier creams, andimmunizations.

•• Recommendations for pretreatment,immunization, and chemoprophylaxis forthe multinational force will be made bythe CMO during the initial planningstage, but it remains the responsibility ofeach nation ultimately to ensure that itspersonnel are adequately protected.

•• A multinational force policy must beissued as early as possible regarding theprophylaxis measures that must be takenby all individuals deploying into theoperational area. Instructions must covermeasures to be taken prior todeployment, while in-theater, and duringpost-deployment.

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JP 4-02

• It is a national responsibility to maintainhigh standards with regard to theprovision of food and water, as well asfield sanitation standards.

•• JFS and/or CMO will inspect andaudit national measures to ensure thatacceptable standards are maintained inthese areas.

•• Minimum standards acceptable to allparticipating nations must be maintainedif the MTFs are to be used to supportpersonnel outside the respective nationalforce.

e. The CMO’s force hygiene officer isresponsible for coordinating preventivemedicine services such as regional sprayingor vector control and advising on placing localpopulation centers and/or facilities off limits.

f. Education on prevention of diseases is anational responsibility.

11. Patient Movement inMultinational Operations

The theater patient movement policy,known in some nations as a holding policy, isthe key to balancing the treatment capabilityavailable at each level of care against therequired medical patient movement assets.The provision of resources will be coordinatedby the multinational force HSS planning staff,but will comprise assets from a number ofsources, including HNS. Theater medicalpatient movement requires careful planningand an acquisition cross-Service agreement.

a. Patient movement from point of injuryto Level I — National responsibility.

b. Patient movement from Level I to LevelII/III — National, Force, and Lead Nation.

c. Patient movement to Level IV — Force,National, and Lead Nation.

12. Personnel in MultinationalOperations

a. National c o n t i n g e n t s w i l l b eexpeditiously notified through designatednational liaison points of contact of individualsthat become critically injured and/or ill or die.

b. Medical obligations under internationallaw will be particularly crucial to themanagement of non-force personnel such asEPWs, civilian refugees, detainees, and non-force combatants. HSS plans must detail thedegree of care to be offered to these groupsand how continuity of care is to be provided,when needed.

c. Only urgent medical treatment, withinthe capability of the deployed multinationalmedical force and not otherwise available, willbe offered to civilian refugees.

• Detainees and non-force combatantsmay receive urgent medical treatment inforce MTFs, but are unlikely to remainin Level III or be evacuated to force-provided Level IV MTFs for continuingtreatment. An alternative source ofdefinitive treatment must be organizedas part of the overall HSS plan.

• National law will concern a range ofissues, particularly regarding theprovision of medical evidence forinquiries into deaths and severe injury.

13. Health Service Logistics inMultinational Operations

The holding, issuing, and accounting forall medical, dental, and veterinary supplies( equ ipmen t , pha rmaceu t i ca l , andconsumables) to a multinational force is amajor undertaking. It is a joint responsibilityof the CMO and the chief health servicelogistics officer, whose offices must cooperateto create a system with the necessaryreliability, flexibility, and speed. The supply

D-5

Multinational Operations

of blood and blood products to multinationaloperations is a complex and sensitive issue,stemming from the wide disparity of standardsbetween nations and the legal constraintsincumbent upon some of them. Consequentlyit is considered as a separate function withinhealth service logistics. The availability ofblood and blood products is essential formanagement of the seriously injured and sick.For the majority of multinational operations,this will require its provision at Level III andat Level II if providing resuscitative surgicalcare.

a. For multinational operations, the generalprinciple is that national contingents shouldbe responsible for the supply of blood to theirown injured and sick. In reality, this is notalways a practical proposition. Therequirement must, therefore, be that all bloodand blood products used in-theater complywith internationally agreed upon standards.Where a particular nation cannot accept thisas policy, they must organize their own systemof supply at national expense.

b. The most cost-effective and rationalapproach is for the force HSS planning staffsto coordinate supplies through the lead nation,using supplies from a nation whose blood and

blood products are acceptable to allcontingents.

Refer to JP 4-02.1, Joint Tactics, Techniques,and Procedures for Health Service LogisticsSupport in Joint Operations.

14. Legal Issues inMultinational Operations

a. Both international and national law,particularly concerning the medicalmanagement of refugees, detainees, and non-entitled civilians, must be considered inmultinational operations. JFSs should beparticularly sensitized to the limits imposedby title 10, USC, which outlines under whatconditions non-DOD beneficiaries can receivemedical treatment from US medical forces.

b. Any pathological materials and/ortissues taken in the course of conducting anautopsy or preparing a death certificate mustbe turned over to the decedent’s nationalrepresentative. Human remains are returnedthrough designated mortuary affairspersonnel. In addition to the legal issues, thereare many cultural differences with regard tothe disposition of deceased personnel.

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Appendix D

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Intentionally Blank

APPENDIX EMILITARY OPERATIONS OTHER THAN WAR

E-1

1. HSS in Military OperationsOther Than War

a. The health threat is traditionallyevaluated for its impact on US forces alone.When preparing for and conductingoperations during MOOTW, elements of thehealth threat to the indigenous population,allied and coalition forces, US Governmentemployees, DOD contractors and, asappropriate, IOs and NGOs must also beassessed. The impact of the health threatas a contributing factor to social, political,and economic stability in both peace andother operational environments must beconsidered. The general environment inwhich these types of operations are conductedranges from peaceful, developing countrieswith no apparent internal or externalinstabilities to countries with limited resourcesand a poorly led population assailed by activeinsurgent movements, diseases, anddependency on foreign humanitarianassistance (FHA).

b. Within MOOTW, US efforts mayfocus on foreign internal defense operationssuch as security assistance, FHA, or HNlogistic support. These operations are oftenconducted in areas where social services havebeen disrupted, resulting in poor sanitation,inadequate food and water distribution, civildisturbances, and general civil unrest.Significant health threats are likely to benaturally occurring endemic and epidemicdiseases, uncontrolled distribution ofhazardous wastes and hazardous materials,and environmental extremes.

c. In general, areas where assistance teamsand units may be employed will likely have avery low standard of living and high incidenceof endemic and epidemic diseases. US forcesserving in these areas will enter with very little,

if any, natural immunity to endemic diseases.The degree of cultural and social interactionrequired to support the mission, as well as thesharing of food, quarters, and recreationalfacilities with local nationals, will increaseexposure of US personnel to diseases endemicto the host country. For the most part,assistance operations will last a relativelyextended period of time (past 30 days) andwill increase the risk of contracting theendemic disease.

d. In MOOTW environments, insurgentor terrorist forces may not recognizeprotection afforded to MTF and HSSpersonnel by the Geneva Conventions.HSS activities may be perceived as primetargets by these groups, especially if thesefacilities are perceived as making a majorcontribution to the HN government. MTFswill also be vulnerable to theft and raids onClass VIII supplies by insurgents or terroristsfor their own support or to support blackmarket activities.

e. In some situations, the in-countrycomponents of the US logistic system insupport of US assistance forces will beaustere. Often the HSS structure will requirereliance on contracting from local sources forfood, water, sanitation, public health, andhealth industry resources if in compliance withregulatory and policy guidance. Procurementof fresh foods and beverages and contractingof food storage facilities are supported byveterinary personnel through sanitaryinspection of local food establishments in theoperational area. Coordination withCommander in Chief, US TransportationCommand for intertheater patient movementcan be greater in MOOTW scenarios than inwar. US Navy and US Marine Corpstransportation assets may be used to supportall aspects of HSS in MOOTW, based on the

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Appendix E

JP 4-02

availability and proximity to coastal waters.When tarmacs are available, coordination withUS Air Force transportation should beconsidered when time is a factor. Thesecircumstances will demand comprehensiveHSS planning. HSS planning must be basedon current, accurate medical intelligence andinclude the total involvement of the CountryTeam prior to the execution of operations.

For additional information on MOOTW, referto JP 3-07, Joint Doctrine for MilitaryOperations Other Than War.

f. Legal issues during MOOTW mayconcern both international and nationallaw.

• Medical obligations under internationallaw will be particularly crucial to themanagement of non-force personnelsuch as EPWs, civilian refugees,detainees, and non-force combatants.HSS plans must detail the degree of careoffered to these groups and howcontinuity of care is to be provided, whenneeded.

•• Urgent medical treatment, nototherwise available, will be offered tocivilian refugees and is dependent uponthe operational situation.

•• Detainees and non-force combatantsmay receive urgent medical treatment inforce MTFs, but are unlikely to remainin Level III or be evacuated to force LevelIV MTFs for definitive treatment. Analternative source of definitive treatmentmust be organized as part of the overallHSS plan.

• National law will concern a range ofissues, particularly regarding theprovision of medical evidence forinquires into deaths and severe injury.

g. Financial issues for considerationduring MOOTW include:

• The size and shape of HSS resourcesavailable to support the HSS concept ofoperations;

• Maintenance costs, particularly theprovision of medical materiel, resupply,and patient movement; and

• Donated medical supplies, eligibilitydetermination, credentialing, malpracticesuits, and reimbursement procedures forHSS and supplies.

APPENDIX FREFERENCES

F-1

The development of JP 4-02 is based upon the following primary references.

1. Multinational Documents

a. NATO STANAG 2068, Emergency War Surgery (Edition 4) (Amendment 3), 17 October1991.

b. Geneva Convention for the Amelioration of the Condition of the Wounded and Sick inArmed Forces in the Field, 12 August 1949.

c. Geneva Convention for the Amelioration of the Condition of the Wounded, Sick, andShipwrecked Members of Armed Forces at Sea, 12 August 1949.

d. Geneva Convention Relative to the Treatment of Prisoners of War, 12 August 1949.

e. Geneva Convention Relative to the Protection of Civilian Persons in Time of War, 12August 1949.

2. DOD Publications

a. DOD Directive 6420.1R, Armed Forces Medical Intelligence Center (AFMIC), 30September 1996.

b. DOD Directive 6490.2, Joint Medical Surveillance, 30 August 1997.

c. DOD Instruction 6480.4, Armed Services Blood Program (ASBP) OperationalProcedures.

d. DOD Instruction 6490.3, Implementation and Application of Joint Medical Surveillancefor Deployments, 7 August 1997.

e. DOD Publication 5200.2-R, Personnel Security Program, January 1987.

f. DOD Regulation 515.21-M1,

3. Joint Publications

a. JP 0-2, Unified Action Armed Forces (UNAAF).

b. JP 1-0, Doctrine for Personnel Support to Joint Operations.

c. JP 1-02, Department of Defense Dictionary of Military and Associated Terms.

d. JP 3-02, Joint Doctrine for Amphibious Operations.

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Appendix F

JP 4-02

e. JP 3-05.3, Joint Special Operations Operational Procedures.

f. JP 3-07, Joint Doctrine for Military Operations Other Than War.

g. JP 3-17, Joint Tactics, Techniques, and Procedures for Air Mobility Operations.

h. JP 3-33, Joint Force Capabilities.

i. JP 3-35, Joint Deployment and Redeployment Operations.

j. JP 3-50.2, Doctrine for Joint Combat Search and Rescue (CSAR).

k. JP 3-50.21, Joint Tactics, Techniques, and Procedures for Combat Search and Rescue.

l. JP 3-57, Joint Doctrine for Civil-Military Operations.

m. JP 3-57.1, Joint Doctrine for Civil Affairs, (under development).

n. JP 4-01, Joint Doctrine for the Defense Transportation System.

o. JP 4-02.1, Joint Tactics, Techniques, and Procedures for Health Service Logistics Supportin Joint Operations.

p. JP 4-02.2, Joint Tactics, Techniques, and Procedures for Patient Movement in JointOperations.

q. JP 4-04, Civil Engineering Support.

r. JP 4-05, Joint Doctrine for Mobilization Planning.

s. JP 5-00.2, Joint Task Force Planning Guidance and Procedures.

t. CJCSI 3110.03, Logistics Supplement to Joint Strategic Capabilities Plan, 1 March1999.

4. Army Publications

a. FM 8-10-18, Veterinary Services.

b. FM 8-55, Planning for Health Service Support, 9 September 1994.

5. Navy and Marine Corps Publications

NAVMAT P-4000-2 Series.

F-3

References

6. Air Force Publications

a. AFI 41-106, Medical Readiness Planning and Training, 1 March 1999.

b. USAF War and Mobility Plan (WMP 1), Volume 1, Medical Service Annex F, Sept. 97.

F-4

Appendix F

JP 4-02

Intentionally Blank

APPENDIX GADMINISTRATIVE INSTRUCTIONS

G-1

1. User Comments

Users in the field are highly encouraged to submit comments on this publication to:Commander, United States Joint Forces Command, Joint Warfighting Center Code JW100,116 Lake View Parkway, Suffolk, VA 23435-2697. These comments should addresscontent (accuracy, usefulness, consistency, and organization), writing, and appearance.

2. Authorship

The lead agent for this publication is the US Army. The Joint Staff doctrine sponsor forthis publication is the Director for Logistics (J-4).

3. Supersession

This publication supersedes JP 4-02, 26 April 1995, Doctrine for Health Service Supportin Joint Operations.

4. Change Recommendations

a. Recommendations for urgent changes to this publication should be submitted:

TO: HQDA WASHINGTON DC//DASG-HCD-D//INFO: JOINT STAFF WASHINGTON DC//J7-JDETD//

Routine changes should be submitted to the Director for Operational Plans and JointForce Development (J-7), JDETD, 7000 Joint Staff Pentagon, Washington, DC20318-7000, with info copies to the USJFCOM JWFC.

b. When a Joint Staff directorate submits a proposal to the Chairman of the JointChiefs of Staff that would change source document information reflected in thispublication, that directorate will include a proposed change to this publication as anenclosure to its proposal. The Military Services and other organizations are requestedto notify the Director, J-7, Joint Staff, when changes to source documents reflected inthis publication are initiated.

c. Record of Changes:

CHANGE COPY DATE OF DATE POSTEDNUMBER NUMBER CHANGE ENTERED BY REMARKS__________________________________________________________________________________________________________________________________________________________________________________________________________________

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Appendix G

JP 4-02

5. Distribution

a. Additional copies of this publication can be obtained through Service publicationcenters listed below (initial contact) or the USJFCOM JWFC in the event that the jointpublication is not available from the Service.

b. Only approved joint publications and joint test publications are releasable outsidethe combatant commands, Services, and Joint Staff. Release of any classified jointpublication to foreign governments or foreign nationals must be requested through thelocal embassy (Defense Attaché Office) to DIA Foreign Liaison Office, PSS, PO-FL,Room 1A674, Pentagon, Washington, DC 20301-7400.

c. Additional copies should be obtained from the Military Service assignedadministrative support responsibility by DOD Directive 5100.3, 1 November 1988,Support of the Headquarters of Unified, Specified, and Subordinate Joint Commands.

Army: US Army AG Publication Center SL1655 Woodson RoadAttn: Joint PublicationsSt. Louis, MO 63114-6181

Air Force: Air Force Publications Distribution Center2800 Eastern BoulevardBaltimore, MD 21220-2896

Navy: CO, Naval Inventory Control Point700 Robbins AvenueBldg 1, Customer ServicePhiladelphia, PA 19111-5099

Marine Corps: Commander (Attn: Publications)814 Radford Blvd, Suite 20321Albany, GA 31704-0321

Coast Guard: Commandant Coast Guard (G-OPD), US Coast Guard2100 2nd Street, SWWashington, DC 20593-0001

CommanderUSJFCOM JWFC Code JW2102Doctrine Division (Publication Distribution)116 Lake View ParkwaySuffolk, VA 23435-2697

d. Local reproduction is authorized and access to unclassified publications isunrestricted. However, access to and reproduction authorization for classified jointpublications must be in accordance with DOD Regulation 5200.1-R, InformationSecurity Program.

GLOSSARYPART I — ABBREVIATIONS AND ACRONYMS

GL-1

AE aeromedical evacuationAFMIC Armed Forces Medical Intelligence CenterAFSOF Air Force special operations forcesAOR area of responsibilityARSOF Army special operations forcesASBPO Armed Services Blood Program OfficeATM advanced trauma management

BTC blood transshipment center

C2 command and controlC4I command, control, communications, computers, and

intelligenceCA civil affairsCASEVAC casualty evacuationCD-ROM compact disk read-only memoryCINC commander in chiefCJCS Chairman of the Joint Chiefs of StaffCMO chief medical officerCOA course of actionCONUS continental United StatesCOSR combat and operational stress reactions

DIA Defense Intelligence AgencyDNBI disease and nonbattle injuryDOD Department of Defense

EHRA environmental health risk assessmentEMT emergency medical technicianEPW enemy prisoner of war

FHA foreign humanitarian assistanceFHP force health protectionFM field manual

GCCS Global Command and Control SystemGPMRC Global Patient Movement Requirements Center

HCA humanitarian and civic assistanceHN host nationHNS host-nation supportHSS health service support

GL-2

Glossary

JP 4-02

IDRA infectious disease risk assessmentIO international organizationIV intravenous

J-2 intelligence directorate of a joint staffJ-6 command, control, communications, and computer systems

directorate of a joint staffJBPO Joint Blood Program OfficeJFC joint force commanderJFS joint force surgeonJOA joint operations areaJP joint publicationJRSOI joint reception, staging, onward movement, and integrationJTF joint task force

MASCAL mass casualtyMAT medical analysis toolMNFC multinational force commanderMOOTW military operations other than warMTF medical treatment facility

NAVSOF Naval special operations forcesNBC nuclear, biological, and chemicalNGO nongovernmental organization

OCONUS outside continental United StatesOPLAN operation planOPORD operation orderOPSEC operations security

PA physician assistantPAR population at riskPMI patient movement itemPOW prisoner of war

RDD radiological dispersal deviceRTD returned to duty

SecDef Secretary of DefenseSFG special forces groupSIMLM single integrated medical logistics managerSOC special operations commandSOF special operations forces

TPFDD time-phased force and deployment dataTPMRC Theater Patient Movement Requirements Center

GL-3

Glossary

USC United States CodeUSCG United States Coast Guard

VX nerve agent (O-Ethyl S-DiisopropylaminomethylMethylphosphonothiolate)

WMD weapons of mass destruction

aeromedical evacuation. The movement ofpatients under medical supervision to andbetween medical treatment facilities by airtransportation. (JP 1-02)

aeromedical evacuation liaison team. AnAir Force medical team that providesenhanced liaison support between theforward user and the aeromedicalevacuation system. The aeromedicalevacuation liaison team providesoperational, clinical, and communicationslinks necessary to prepare patients for flight,and initiates fixed wing evacuation ofcasualties. Also called AELT. (This termand its definition are applicable only in thecontext of this publication and cannot bereferenced outside this publication.)

casualty. Any person who is lost to theorganization by having been declared dead,duty status—whereabouts unknown,missing, ill, or injured. (JP 1-02)

casualty category. A term used tospecifically classify a casualty for reportingpurposes based upon the casualty type andthe casualty status. Casualty categoriesinclude killed in action, died of woundsreceived in action, and wounded in action.(JP 1-02)

casualty evacuation. The movement ofcasualties. It includes movement both toand between medical treatment facilities.Any vehicle may be used to evacuatecasualties. Also called CASEVAC. (Thisterm and its definition are approved forinclusion in the next edition of JP 1-02.)

casualty status. A term used to classify acasualty for reporting purposes. There areseven casualty statuses: (1) deceased, (2)duty status—whereabouts unknown, (3)missing, (4) very seriously ill or injured,

(5) seriously ill or injured, (6)incapacitating illness or injury, and (7) notseriously injured. (JP 1-02)

casualty type. A term used to identify acasualty for reporting purposes as either ahostile casualty or a nonhostile casualty. (JP1-02)

combat and operational stress. Theexpected and predictable emotional,intellectual, physical, and/or behavioralreactions of Service members who havebeen exposed to stressful events in war ormilitary operations other than war. Combatstress reactions vary in quality and severityas a function of operational conditions, suchas intensity, duration, rules of engagement,leadership, effective communication, unitmorale, unit cohesion, and perceivedimportance of the mission. (This term andits definition are approved for inclusion inthe next edition of JP 1-02.)

combatant command. A unified or specifiedcommand with a broad continuing missionunder a single commander established andso designated by the President, through theSecretary of Defense and with the adviceand assistance of the Chairman of the JointChiefs of Staff. Combatant commandstypically have geographic or functionalresponsibilities. (JP 1-02)

combat service support. The essentialcapabilities, functions, activities, and tasksnecessary to sustain all elements ofoperating forces in theater at all levels ofwar. Within the national and theater logisticsystems, it includes but is not limited to thesupport rendered by Service forces inensuring the aspects of supply,maintenance, transportation, healthservices, and other services required byaviation and ground combat troops to

GL-4 JP 4-02

PART II — TERMS AND DEFINITIONS

permit those units to accomplish theirmissions in combat. Combat servicesupport encompasses those activities at alllevels of war that produce sustainment toall operating forces on the battlefield. Alsocalled CSS. (JP 1-02)

combat zone. 1. That area required bycombat forces for the conduct of operations.(JP 1-02)

command and control. The exercise ofauthority and direction by a properlydesignated commander over assigned andattached forces in the accomplishment ofthe mission. Command and controlfunctions are performed through anarrangement of personnel, equipment,communications, facilities, and proceduresemployed by a commander in planning,directing, coordinating, and controllingforces and opera t ions in theaccomplishment of the mission. Also calledC2. (JP 1-02)

communications zone. Rear part of theaterof war or theater of operations (behind butcontiguous to the combat zone) whichcontains the lines of communications,establishments for supply and evacuation,and other agencies required for theimmediate support and maintenance of thefield forces. Also called COMMZ. (JP1-02)

directed energy. An umbrella term coveringtechnologies that relate to the productionof a beam of concentrated electromagneticenergy or atomic or subatomic particles. (JP1-02)

disease and nonbattle injury casualty. Aperson who is not a battle casualty but whois lost to the organization by reason ofdisease or injury, including persons dyingof disease or injury, by reason of beingmissing where the absence does not appear

to be voluntary, or due to enemy action orto being interned. (JP 1-02)

en route care. The care required to maintainthe phase treatment initiated prior toevacuation and the sustainment of thepatient’s medical condition duringevacuation. (This term and its definitionare approved for inclusion in the nextedition of JP 1-02.)

essential care. That care received within atheater that is dependent upon the mission,enemy, terrain, troops, time available, andother civilian considerations. It includesfirst responder care, forward resuscitativesurgery, and en route care as well astreatment and hospitalization to return thepatient to duty or to stabilize for movementto a higher level of care. (This term andits definition are approved for inclusion inthe next edition of JP 1-02.)

evacuation. 1. The process of moving anyperson who is wounded, injured, or ill toand/or between medical treatment facilities.(JP 1-02)

evacuation policy. 1. Command decisionestablishing the maximum number of daysthat patients may be held within thecommand for treatment. Patients who, inthe opinion of responsible medical officers,cannot be returned to a duty status withinthe period prescribed are evacuated by thefirst available means, provided the travelinvolved will not aggravate theirdisabilities. (This term and its definitionmodify the existing term and its definitionand are approved for inclusion in the nextedition of JP 1-02)

first responder phase. A phase of medicalcare in which health care providers’ focusis to save life and limb and stabilize thepatient sufficiently to withstand evacuationto the next level of care. This first response

GL-5

Glossary

GL-6

Glossary

JP 4-02

may include first aid (self-aid and buddyaid, combat lifesavers) or medicalassistance by combat medics, hospitalcorpsmen, physician assistants, orphysicians. (This term and its definitionare approved for inclusion in the nextedition of JP 1-02.)

force health protection. All servicesperformed, provided, or arranged by theServices to promote, improve, conserve, orrestore the mental or physical well beingof personnel. These services include, butare not limited to, the management of healthservices resources, such as manpower,monies, and facilities; preventive andcurative health measures; evacuation of thewounded, injured, or sick; selection of themedically fit and disposition of themedically unfit; blood management;medical supply, equipment, andmaintenance thereof; combat stress control;and medical, dental, veterinary, laboratory,optometry, medical food, and medicalintelligence services. (This term and itsdefinition are approved for inclusion in thenext edition of JP 1-02.)

foreign internal defense. Participation bycivilian and military agencies of agovernment in any of the action programstaken by another government to free andprotect its society from subversion,lawlessness, and insurgency. (JP 1-02)

forward aeromedical evacuation. Thatphase of evacuation that provides airlift forpatients between points within thebattlefield, from the battlefield to the initialpoint of treatment, and to subsequent pointsof treatment within the combat zone. (JP1-02)

forward resuscitative surgery. The urgentinitial surgery required to render patientstransportable for further evacuation tomedical treatment facilities staffed andequipped to provide for their care. Forward

resuscitative surgery is performed onpatients with signs and symptoms of initialairway compromise, difficult breathing,and circulatory shock and who do notrespond to initial emergency medicaltreatment and advanced traumamanagement procedures. (This term andits definition are approved for inclusion inthe next edition of JP 1-02.)

Global Patient Movement RequirementsCenter. A joint activity reporting directlyto the Commander in Chief, USTransportation Command, the Departmentof Defense single manager for theregulation of movement of uniformedservices patients. The Global PatientMovement Requirements Center authorizestransfers to medical treatment facilities ofthe Military Departments or the Departmentof Veterans Affairs and coordinatesintertheater and inside continental UnitedStates patient movement requirements withthe appropriate transportation componentcommands of US TransportationCommand. (JP 1-02)

health service logistic support. A functionalarea of logistic support that supports thejoint force surgeon’s health service supportmission. It includes supplying Class VIIImedical supplies (medical material toinclude medical peculiar repair parts usedto sustain the health service supportsystem), optical fabrication, medicalequipment maintenance, blood storage anddistribution, and medical gases. See alsohealth service support; joint force surgeon.(JP 1-02)

health service support. All servicesperformed, provided, or arranged by theServices to promote, improve, conserve, orrestore the mental or physical well beingof personnel. These services include butare not limited to the management of healthservices resources, such as manpower,monies, and facilities; preventive and

GL-7

Glossary

curative health measures; evacuation of thewounded, sick, or injured; selection of themedically fit and disposition of themedically unfit; blood management;medical supply, equipment, andmaintenance thereof; combat stress control;and medical, dental, veterinary, laboratory,optometric, medical food, and medicalintelligence services. Also called HSS. (JP1-02)

health threat. A composite of ongoing orpotential enemy actions; environmental,occupational, and geographic andmeteorological conditions; endemicdiseases; and employment of nuclear,biological, and chemical weapons (toinclude weapons of mass destruction) thatcan reduce the effectiveness of joint forcesthrough wounds, injuries, illness, andpsychological stressors. (This term and itsdefinition modify the term “medical threat”and its definition and are approved forinclusion in the next edition of JP 1-02.)

hospital. A medical treatment facility capableof providing inpatient care. It isappropriately staffed and equipped toprovide diagnostic and therapeutic services,as well as the necessary supporting servicesrequired to perform its assigned mission andfunctions. A hospital may, in addition,discharge the functions of a clinic. (JP 1-02)

hostile casualty. A person who is the victimof a terrorist activity or who becomes acasualty “in action.” “In action”characterizes the casualty as having beenthe direct result of hostile action, sustainedin combat or relating thereto, or sustainedgoing to or returning from a combat missionprovided that the occurrence was directlyrelated to hostile action. Included arepersons killed or wounded mistakenly oraccidentally by friendly fire directed at ahostile force or what is thought to be ahostile force. However, not to beconsidered as sustained in action and not

to be interpreted as hostile casualties areinjuries or death due to the elements, self-inflicted wounds, combat fatigue, andexcept in unusual cases, wounds or deathinflicted by a friendly force while theindividual is in an absent-without-leave,deserter, or dropped-from-rolls status, oris voluntarily absent from a place of duty.(JP 1-02)

host-nation support. Civil and/or militaryassistance rendered by a nation to foreignforces within its territory during peacetime,crisis or emergencies, or war based uponagreements mutually concluded betweennations. Also called HNS. (JP 1-02)

INTELINK and INTELINK-S. Secure,classified intelligence networks that canprovide medical intelligence products.(This term and its definition are applicableonly in the context of this publication andcannot be referenced outside thispublication.)

intertheater evacuation. Evacuation ofstabilized patients between the originatingtheater and points outside the theater, toinclude the continental United States andother theaters. En route care is providedby medical attendants qualified for thespecific mode of transportation. (This termand its definition modify the existing termand its definition and are approved forinclusion in the next edition of JP 1-02.)

in-transit visibility. The ability to track theidentity, status, and location of Departmentof Defense units, and non-unit cargo(excluding bulk petroleum, oils, andlubricants) and passengers; medicalpatients; and personal property from originto consignee or destination across the rangeof military operations. Also called ITV. (JP1-02)

intratheater evacuation. Evacuation ofstabilized patients between points within the

GL-8

Glossary

JP 4-02

theater. En route care is provided bymedical attendants qualified for the specificmode of transportation. (This term andits definition modify the existing term andits definition and are approved for inclusionin the next edition of JP 1-02.)

joint force. A general term applied to a forcecomposed of significant elements, assignedor attached, of two or more MilitaryDepartments, operating under a single jointforce commander. (JP 1-02)

joint force commander. A general termapplied to a combatant commander,subunified commander, or joint task forcecommander authorized to exercisecombatant command (command authority)or operational control over a joint force. (JP1-02)

joint force surgeon. A general termapplied to a medical officer appointed bythe joint force commander to serve as thejoint force special staff officer responsiblefor establishing, monitoring, orevaluating joint force health servicesupport. (This term and its definitionmodify the existing term and itsdefinition and are approved for inclusionin the next edition of JP 1-02.)

killed in action. A casualty categoryapplicable to a hostile casualty, other thanthe victim of a terrorist activity, who is killedoutright or who dies as a result of woundsor other injuries before reaching a medicaltreatment facility. See also casualtycategory. (JP 1-02)

mass casualty. Any large number of casualtiesproduced in a relatively short period of time,usually as the result of a single incident suchas a military aircraft accident, hurricane, flood,earthquake, or armed attack, that exceeds locallogistical support capabilities. See alsocasualty. (JP 1-02)

medical evacuees. Personnel who arewounded, injured, or ill and must bemoved to or between medical facilities.(JP 1-02)

medical intelligence. That category ofintelligence resulting from collection,evaluation, analysis, and interpretation offoreign medical, bioscientific, andenvironmental information which is ofinterest to strategic planning and to militarymedical planning and operations for theconservation of the fighting strength offriendly forces and the formation ofassessments of foreign medical capabilitiesin both military and civilian sectors. (JP 1-02)

medical regulating. The actions andcoordination necessary to arrange for themovement of patients through the levels ofcare. This process matches patients with amedical treatment facility that has thenecessary health service support capabilitiesand available bed space. (This term andits definition modify the existing term andits definition and are approved for inclusionin the next edition of JP 1-02.)

medical surveillance. The ongoing,systematic collection of health data essentialto the evaluation, planning, andimplementation, of public health practice,closely integrated with timelydissemination of data as required by higherauthority. (This term and its definition areapproved for inclusion in the next editionof JP 1-02.)

medical treatment facility. A facilityestablished for the purpose of furnishingmedical and/or dental care to eligibleindividuals. (JP 1-02)

National Command Authorities. ThePresident and the Secretary of Defense ortheir duly deputized alternates orsuccessors. (JP 1-02)

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Glossary

nonhostile casualty. A person who becomesa casualty due to circumstances not directlyattributable to hostile action or terroristactivity. Casualties due to the elements,self-inflicted wounds, and combat fatigueare nonhostile casualties. (JP 1-02)

not seriously injured. The casualty status ofa person whose injury may or may notrequire hospitalization; medical authoritydoes not classify as very seriously injured,seriously injured, or incapacitating illnessor injury; and the person can communicatewith the next of kin. See also casualty status.(JP 1-02)

occupational and environmental healththreats. Threats to the health of militarypersonnel and to military readiness createdby exposure to hazardous agents,environmental contamination, or toxicindustrial materials. (This term and itsdefinition are approved for inclusion in thenext edition of JP 1-02.)

originating medical facility. A medicalfacility that initially transfers a patient toanother medical facility. (JP 1-02)

patient. A sick, injured, wounded, or otherperson requiring medical/dental care ortreatment. (JP 1-02)

patient movement. The act or process ofmoving a sick, injured, wounded, or otherperson to obtain medical and/or dental careor treatment. Functions include medicalregulating, patient evacuation, and en routemedical care. (This term and its definitionare approved for inclusion in the nextedition of JP 1-02.)

patient movement requirements center. Ajoint activity that coordinates patientmovement. It is the functional merging ofjoint medical regulating processes,Services’ medical regulating processes, and

coordination with movement componentsfor patient evacuation. This may be joint,reporting to the joint task force surgeon;theater, reporting to the theater surgeon;or global, reporting to the United StatesTransportation Command surgeon. (Thisterm and its definition are approved forinclusion in the next edition of JP 1-02.)

preventive medicine. The anticipation,communication, prediction, identification,prevention, education, risk assessment, andcontrol of communicable diseases, illnessesand exposure to endemic, occupational,and environmental threats. These threatsinclude nonbattle injuries, combat stressresponses, WMD, and other threats to thehealth and readiness of military personnel.Communicable diseases includeanthropod-, vector-, food-, waste-, andwaterborne diseases. Preventativemedicine measures include field sanitation,medical surveillance, pest and vectorcontrol, disease risk assessment,environmental and occupational healthsurveillance, waste (human, hazardous,and medical) disposal, food safetyinspection, and potable water surveillance.(This term and its definition are approvedfor inclusion in the next edition of JP 1-02.)

prisoner of war. A detained person asdefined in Articles 4 and 5 of the GenevaConvention Relative to the Treatment ofPrisoners of War of August 12, 1949. Inparticular, one who, while engaged incombat under orders of his or hergovernment, is captured by the armed forcesof the enemy. As such, he or she is entitledto the combatant’s privilege of immunityfrom the municipal law of the capturingstate for warlike acts which do not amountto breaches of the law of armed conflict.For example, a prisoner of war may be, butis not limited to, any person belonging toone of the following categories who hasfallen into the power of the enemy: a

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Glossary

JP 4-02

member of the armed forces, organizedmilitia or volunteer corps; a person whoaccompanies the armed forces withoutactually being a member thereof; a memberof a merchant marine or civilian aircraftcrew not qualifying for more favorabletreatment; or individuals who, on theapproach of the enemy, spontaneously takeup arms to resist the invading forces. (JP1-02)

restorative and rehabilitative care. Aperiod of minimal care and increasingphysical activity necessary to restorepatients to functional health and allow theirreturn to duty or useful and productive life.Restorative and rehabilitative treatmentmay be available in theater on a limitedbasis due to the theater evacuation policy.This treatment is normally provided in thecontinental United States. (This term andits definition are approved for inclusion inthe next edition of JP 1-02.)

resuscitative care. The aggressivemanagement of life- and limb-threateninginjuries. Interventions include emergencymedical treatment, advanced traumamanagement, and lifesaving surgery toenable the patient to tolerate evacuation tothe next level of care. (This term and itsdefinition are approved for inclusion in thenext edition of JP 1-02.)

safe haven. 1. Designated area(s) to whichnoncombatants of the United StatesGovernment's responsibility andcommercial vehicles and materiel may beevacuated during a domestic or other validemergency. (JP 1-02)

seriously ill or injured. The casualty statusof a person whose illness or injury isclassified by medical authority to be of suchseverity that there is cause for immediateconcern, but there is not imminent dangerto life. See also casualty status. (JP 1-02)

seriously wounded. A casualty whoseinjuries or illness are of such severity thatthe patient is rendered unable to walk orsit, thereby requiring a litter for movementand evacuation. (This term and itsdefinition modify the existing term and itsdefinition and are approved for inclusionin the next edition of JP 1-02.)

slightly wounded. A casualty whose injuriesor illness are relatively minor, permittingthe patient to walk and/or sit. (This termand its definition modify the existing termand its definition and are approved forinclusion in the next edition of JP 1-02.)

unaccounted for. An inclusive term (not acasualty status) applicable to personnelwhose person or remains are not recoveredor otherwise accounted for followinghostile action. Commonly used whenreferring to personnel who are killed inaction and whose bodies are not recovered.See also casualty; casualty category;casualty status; casualty type. (JP 1-02)

very seriously ill or injured. The casualtystatus of a person whose illness or injury isclassified by medical authority to be of suchseverity that life is imminently endangered.See also casualty status. (JP 1-02)

walking patient. A patient whose injuriesand/or illness are relatively minor,permitting the patient to walk and notrequire a litter. (This term and its definitionmodify the existing term and its definitionand are approved for inclusion in the nextedition of JP 1-02.)

wellness. Force health protection programthat consolidates and incorporatesphysical and mental fitness, healthpromotion, and environmental andoccupational health. (This term and itsdefinition are approved for inclusion inthe next edition of JP 1-02.)

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Glossary

wounded. See seriously wounded; slightlywounded. (JP 1-02)

wounded in action. A casualty categoryapplicable to a hostile casualty, other thanthe victim of a terrorist activity, who hasincurred an injury due to an external agentor cause. The term encompasses all kindsof wounds and other injuries incurred inaction, whether there is a piercing of thebody, as in a penetration or perforated

wound, or none, as in the contused wound.These include fractures, burns, blastconcussions, all effects of biological andchemical warfare agents, and the effectsof an exposure to ionizing radiation or anyother destructive weapon or agent. Thehostile casualty’s status may be veryseriously ill or injured, seriously ill orinjured, incapacitating illness or injury, ornot seriously injured. See also casualtycategory. (JP 1-02)

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Glossary

JP 4-02

Intentionally Blank

Assess-ments/

Revision

CJCSApproval

TwoDrafts

ProgramDirective

ProjectProposal

J-7 formally staffs withServices and CINCs

Includes scope ofproject, references,milestones, and who willdevelop drafts

J-7 releases ProgramDirective to Lead Agent.Lead Agent can beService, CINC, or JointStaff (JS) Directorate

STEP #2Program Directive

The CINCs receive the JP andbegin to assess it during use

18 to 24 months followingpublication, the Director J-7,will solicit a written report fromthe combatant commands andServices on the utility andquality of each JP and theneed for any urgent changes orearlier-than-scheduledrevisions

No later than 5 years afterdevelopment, each JP isrevised

STEP #5Assessments/Revision

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ENHANCEDJOINT

WARFIGHTINGCAPABILITY

Submitted by Services, CINCs, or JointStaff to fill extant operational void

J-7 validates requirement with Services andCINCs

J-7 initiates Program Directive

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STEP #1Project Proposal

All joint doctrine and tactics, techniques, and procedures are organized into a comprehensive hierarchy asshown in the chart above. is in the series of joint doctrinepublications. The diagram below illustrates an overview of the development process:

Joint Publication (JP) 4-02 Logistics

JOINT DOCTRINE PUBLICATIONS HIERARCHYJOINT DOCTRINE PUBLICATIONS HIERARCHY

JP 1-0 JP 2-0 JP 3-0

PERSONNEL

JP 4-0 JP 5-0 JP 6-0

LOGISTICSINTELLIGENCE OPERATIONS C4 SYSTEMSPLANS

JOINTDOCTRINE

PUBLICATION

Lead Agent forwards proposed pub to JointStaff

Joint Staff takes responsibility for pub,makes required changes and prepares pubfor coordination with Services and CINCs

Joint Staff conducts formal staffing forapproval as a JP

STEP #4CJCS Approval

Lead Agent selects Primary ReviewAuthority (PRA) to develop the pub

PRA develops two draft pubs

PRA staffs each draft with CINCs,Services, and Joint Staff

STEP #3Two Drafts

JP 1

JOINTWARFARE

JP 0-2

UNAAF

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JP 4-02, Health Services Support; Exec Summary

Education

Transcript of JP 4-02, Health Services Support; Exec Summary