FM 4-02 (ATTP 4-02) Army Health System (August 2013) - page 4

 

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FM 4-02 (ATTP 4-02) Army Health System (August 2013) - page 4

 

 

Casualty Care
Table 7-2. Primary tasks and purposes of the hospitalization function (continued)
Hospital augmentation
Provide pathology augmentation in support of theater hospitals and consultative
team (pathology)
services, as required.
Medical team (renal
Provide medical augmentation to echelons above brigade hospitals. The medical
hemodialysis)
team (renal hemodialysis) provides renal hemodialysis care for patients with acute
renal failure and consultative services on an area basis.
Medical team
Provide medical augmentation to echelons above brigade hospitals. This team
(infectious disease)
provides infectious disease investigation, takes measures to control the spread of
disease, assures access to health services, and provides consultative services to
the Army Health System unit to which attached.
Medical detachment
Provide minimal care/convalescent care hospitalization, nursing, and rehabilitative
(minimal care)
services in support of echelons above brigade hospitalization. Provides oversight of
holding and monitoring facilities for decontaminated biologic patients/
communicable disease contacts.
SECTION III — DENTAL SERVICES
TREATMENT ASPECTS
7-7. The mission of the dental service support system is to promote dental health; prevent and treat oral
and dental disease; provide far forward dental treatment; provide early treatment of severe oral and
maxillofacial injuries; and augment medical personnel (as necessary) during mass casualty operations.
LEVELS OF DENTAL CARE
7-8. There are three levels of dental support within the AO: unit, hospital, and area. These levels are
defined primarily by the relationship of the dental assets supporting the patient population within each
level.
UNIT-LEVEL DENTAL CARE
7-9. Unit-level dental care consists of those services provided by dental personnel organic to the
supporting medical companies of BCTs and Special Forces groups. This module provides emergency
dental treatment to Soldiers during operations.
HOSPITAL-LEVEL DENTAL CARE
7-10. Hospital-level dental care consists of those services provided by the hospital dental staff to minimize
loss of life and disability resulting from oral and maxillofacial injuries and wounds. The hospital dental
staff provides operational dental care, which consists of emergency and essential dental support to all
injured or wounded Soldiers, as well as the hospital staff.
AREA DENTAL SUPPORT
7-11. Area dental support is provided for units that do not have organic dental assets. This coverage is
provided by the dental company (area support).
7-12. The dental company (area support) provides operational dental care and has dental assets which can
deploy when and where necessary to provide augmentation and/or reinforcement to the area support
squads.
CATEGORIES OF DENTAL CARE
7-13. Within the AO, dental service support assets provide operational care, which is comprised of
emergency dental care and essential dental care. Another category, normally found only in fixed facilities
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Chapter 7
in the U.S., is comprehensive care. These categories are not absolute in their limits; they are the general
basis for defining the dental service capabilities available at the different AHS roles of care.
OPERATIONAL DENTAL CARE
Emergency Care
7-14. Emergency care is provided to relieve oral pain, eliminate acute infection, control life-threatening
oral conditions (hemorrhage, cellulitis, or respiratory difficulty), and treat trauma to teeth, jaws, and
associated facial structures. It is the most austere type of care and is available to Soldiers engaged in
operations. Common examples of emergency treatments are simple extractions, providing antibiotics and
pain medication, and temporary fillings.
Essential Care
7-15. Essential care includes dental treatment necessary to intercept potential emergencies. This type of
operational care is necessary for preventing lost duty time and preserving the fighting strength. Soldiers in
dental Class 3 (potential dental emergencies) should be provided essential care as the operational situation
permits. Soldiers in dental Class 2 (untreated oral disease) should be provided essential care as the
operational situation and availability of dental resources permit. The scope of operational care includes
definitive restorations, minor oral surgery, exodontic, periodontic, and prosthodontic procedures, as well as
prophylaxis.
Comprehensive Care
7-16. Comprehensive care restores an individual’s optimal oral health, function, and aesthetics. This
category of care is usually reserved for operations that anticipate an extensive period of reception and
training in the AO. The scope of facilities needed to provide this level of dental support could equal that of
Role 3 MTFs.
PRIMARY TASKS
7-17. Table 7-3 discusses the primary tasks of the dental services function.
Table 7-3. Primary tasks and purposes of the dental services function
Primary Task
Purpose
Comprehensive dental care
Restore an individual to optimal oral health, function, and aesthetics. Normally
provided in continental United States-support base.
Operational dental care
Provide treatment in austere environments for Soldiers engaged in operations.
Operational care is provided in the area of operations and consists of
emergency dental care and essential dental care.
Emergency dental care
Relieve oral pain, eliminate acute infection, control life-threatening oral
conditions (hemorrhage, cellulitis, or respiratory difficulty) and treat trauma to
teeth, jaws, and associated facial structures.
Essential dental care
Prevent potential dental emergencies and maintain the overall oral fitness of
Soldiers at levels consistent with combat readiness.
Oral maxillofacial surgery
Provide oral maxillofacial surgery capability to minimize loss of life and
disability resulting from oral and maxillofacial injuries and wounds within the
area of operations.
7-6
FM 4-02
26 August 2013
Casualty Care
SECTION IV — BEHAVIORAL HEALTH/NEUROPSYCHIATRIC TREATMENT
TREATMENT ASPECTS
7-18. Behavioral health/neuropsychiatric treatment exists when there is an explicit therapist-patient or
therapist-client relationship. Behavioral health/neuropsychiatric treatment is provided for Soldiers with
behavioral disorders to sustain them on duty or to stabilize them for referral/transfer. This is usually a
brief, time-limited treatment as dictated by the operational situation. Behavioral health/neuropsychiatric
treatment includes counseling, psychotherapy, behavior therapy, occupational therapy, and medication
therapy. Treatment assumes an ongoing process of evaluation and may include assessment modalities such
as psychometric testing, neuropsychological testing, laboratory and radiological examination, and COSC
providers’ discipline-specific evaluations.
7-19. Behavioral health/neuropsychiatric treatment is provided to Soldiers with diagnosed behavioral
disorders and who require more intentions for their diagnoses. It is both inappropriate and detrimental to
treat Soldiers with combat and operational stress reactions as if they are behavioral disordered patients. A
therapeutic relationship may promote dependency and foster the patient role. Likewise, medication therapy
and the highly structured treatment modalities imply the patient role. Medication for transient symptom
relief (insomnia or extreme anxiety) may not be detrimental if there is no expectation that medication will
continue to be prescribed.
7-20. Treatment standards are the same in the deployed environment as in garrison. When operational
requirements dictate that clinical standards of treatment/care are waived or relaxed, it must be approved by
the AO COSC consultant. Treatment should be tailored to the anticipated availability of the Soldier and
the COSC provider. Short-term interventions are more practical than long-term commitments. If longer-
term treatment is necessary, design the intervention in time-limited modules. Under no circumstances
should treatment diminish the Soldier’s ability to provide self-care and to defend himself. Exceptions
include emergency stabilization and preparation for evacuation. In addition, the Department of Veterans
Affairs/DOD Clinical Practice Guidelines website
(http://www.healthquality.va.gov ) offers clinicians
evidence-based assessment and treatment algorithms for acute stress disorder, posttraumatic stress disorder,
and many other behavioral/neuropsychiatric disorders.
PRIMARY TASKS
7-21. Table 7-4 discusses the primary tasks of the BH/neuropsychiatric treatment. The remaining primary
tasks of the COSC function are depicted in Table 12-1.
Table 7-4. Primary tasks and purposes of behavioral health/neuropsychiatric treatment
Primary Task
Purpose
Identify and diagnose behavioral
Identify and initiate treatment for patients with behavioral health/
health/neuropsychiatric disorder/
neuropsychiatric disease processes.
disease
Stabilize patient
Stabilize behavioral health/neuropsychiatric patients for evacuation from
the theater for treatment of disease process in the continental United
States-support base.
SECTION V — CLINICAL LABORATORY SERVICES
CLINICAL
7-22. All Role 2 MTFs provide basic clinical laboratory services within the AO. They perform basic
procedures in hematology, urinalysis, microbiology, and serology. Role 2 MTFs receive, maintain, and
transfuse blood products.
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Chapter 7
7-23. The clinical laboratory in the CSH performs procedures in biochemistry, hematology, urinalysis,
microbiology, and serology in support of clinical activities. The CSH also provides blood-banking
services.
PRIMARY TASKS
7-24. Table 7-5 discusses the primary tasks of the clinical laboratory services function. The primary tasks
for the AML and/or operational medical laboratory services are discussed in Table 13-2.
Table 7-5. Primary tasks and purposes of the clinical laboratory services
Primary Task
Purpose
Analysis of medical specimens
Provide for the identification, diagnosis, and treatment of diseases and
pathogens.
Provide blood-banking services to include capability to type and
crossmatch blood samples and perform limited testing of whole blood.
Blood -banking services
Provide laboratory support to type and crossmatch blood specimens for
transfusion services.
Provide limited testing of blood products.
7-8
FM 4-02
26 August 2013
Chapter 8
Medical Evacuation
Medical evacuation encompasses both the evacuation of Soldiers from the point of
injury or wounding to an MTF staffed and equipped to provide essential care in the
AO and further evacuation from the AO to provide definitive, rehabilitative, and
convalescent care in CONUS.
SECTION I — INTEGRATED MEDICAL EVACUATION SYSTEM
MEDICAL EVACUATION SYSTEM
8-1. Medical evacuation is the system which provides the vital linkage between the roles of care
necessary to sustain the patient during transport. This is accomplished by providing en route medical care
and emergency medical intervention, if required, which enhances the individual’s prognosis and reduces
long-term disability.
8-2. Army medical evacuation is a multifaceted mission accomplished by a combination of dedicated
ground and air evacuation platforms synchronized to provide direct support, general support, and area
support within the AO. At the operational level, organic or direct support medical evacuation resources
locate, acquire, treat, and evacuate Soldiers from the point of injury or wounding to an appropriate MTF.
Soldiers are then stabilized, prioritized, and prepared for further evacuation, if required, to an MTF capable
of providing required essential care within the AO.
8-3. The mission of Army medical evacuation assets is the evacuation and provision of en route medical
care to wounded. However, the essential and vital functions of medical evacuation resources encompass
many additional missions and tasks that support the AHS. Medical evacuation resources/assets are used to
transfer patients between MTFs within the AO and from MTFs to USAF mobile aeromedical staging
facilities or aeromedical staging facilities; emergency movement of Class VIII, blood and blood products,
medical personnel and equipment; and serve as messengers in medical channels.
8-4. The appropriate level of care must be maintained throughout the continuum of care. A patient who
has received complex care such as damage control resuscitation or damage control surgery requires
continuous maintenance of the critical care support that was initiated at the forward MTF. To avoid the risk
that these patients will deteriorate during transport, the level of care should not be decremented during en
route care. Based on the appropriate level of care, the medical personnel providing en route care may be
paramedics, nurses, or other properly trained medical specialists. When possible, this en route care should
be used as far forward as mission, enemy, terrain and weather, troops and support available, time available,
and civil considerations allows.
THEATER EVACUATION POLICY
8-5. The theater evacuation policy is established by the Secretary of Defense, with the advice of the Joint
Chiefs of Staff, and upon the recommendation of the combatant commander. The policy establishes, in
number of days, the maximum period of noneffectiveness (hospitalization and convalescence) that patients
may be held within the AO for treatment. This policy does not mean that a patient is held in the AO for the
entire period of noneffectiveness. A patient who is not expected to be ready to return to duty within the
number of days established by the theater evacuation policy is treated, stabilized, and then evacuated out of
the AO. This is done providing that the treating physician determines that such evacuation will not
aggravate the patient’s disabilities or medical condition. For example, a theater evacuation policy of seven
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Chapter 8
days does not mean that a patient is held in the AO for seven days and then evacuated. Instead, it means
that a patient is evacuated as soon as possible after the determination is made that he cannot be returned to
duty within seven days following admission to a Role 3 MTF.
EVACUATION PRECEDENCE
The following paragraph implements STANAG 2087 and 3204.
8-6. The initial decision for evacuation priorities is made by the treatment element or the senior
nonmedical person at the scene. Soldiers are evacuated by the most expeditious means of evacuation based
on their medical condition, assigned evacuation precedence, and availability of medical evacuation
platforms. Patients may be evacuated from the point of injury or wounding to an MTF in closest proximity
to the point of injury/wounding to ensure they are stabilized to withstand the rigors of evacuation over
great distances. The evacuation precedences for the Army operations at Roles 1 through 3 are—
z
Priority I, URGENT is assigned to emergency cases that should be evacuated as soon as
possible and within a maximum of one hour to save life, limb, or eyesight and to prevent
complications of serious illness and to avoid permanent disability.
z
Priority IA, URGENT-SURG is assigned to patients who must receive far forward surgical
intervention to save life and stabilize for further evacuation.
z
Priority II, PRIORITY is assigned to sick and wounded personnel requiring prompt medical
care. This precedence is used when the individual should be evacuated within four hours or if
his medical condition could deteriorate to such a degree that he will become an URGENT
precedence, or whose requirements for special treatment are not available locally, or who will
suffer unnecessary pain or disability.
z
Priority III, ROUTINE is assigned to sick and wounded personnel requiring evacuation but
whose condition is not expected to deteriorate significantly. The sick and wounded in this
category should be evacuated within 24 hours.
z
Priority IV, CONVENIENCE is assigned to patients for whom evacuation by medical vehicle is
a matter of medical convenience rather than necessity.
Note. The NATO STANAG 3204 has deleted the category of Priority IV, CONVENIENCE.
However, this category is still included in the U.S. Army evacuation priorities as there is a
requirement for it in an OE.
RESPONSIBILITIES
8-7. The Service component commander is responsible for medical evacuation at the operational level
and is responsible for executing the medical evacuation of his forces. Strategic aeromedical evacuation is
the responsibility of the U.S. Transportation Command.
8-8. Within Army support to other Services, Army resources may provide ship-to-shore medical
evacuation on an area support basis. Medical evacuation from shore-to-ship for deployed USN and U.S.
Marine Corps forces could also be available within the Army’s support capabilities.
ORGANIZATIONS
8-9. There are two types of U.S. Army medical evacuation platforms—air (rotary-wing) and ground.
These platforms are dedicated and designed, equipped, and staffed to perform the medical evacuation
mission.
8-2
FM 4-02
26 August 2013
Medical Evacuation
GROUND AMBULANCES
8-10. Ground ambulances are organic to BCT maneuver battalion medical platoons and to both the brigade
support medical company and the medical company (area support). In the maneuver battalion medical
platoons, the actual vehicle platform (wheeled or tracked) varies with the type of parent unit. Both the
brigade support medical company and the medical company (area support) have wheeled vehicles.
Maneuver Battalion Medical Platoon
8-11. The organic medical platoon ground ambulances provide medical evacuation support from the point
of injury, company aid post, or casualty/patient collection point to the battalion aid station. In armor BCTs
depending upon the mission, enemy, terrain and weather, troops and support available, time available, and
civil considerations factors and the medical evacuation plan, the tracked ambulances may evacuate the
patient to an ambulance exchange point and transfer the patient to a wheeled ambulance for further
movement to an MTF. This enables the tracked ambulance to keep pace with the maneuvering force.
Brigade Support and/or Area Support Medical Company Evacuation Platoon
8-12. The medical company (brigade support) evacuation platoon provides medical evacuation support on
an area basis to units within its assigned AO. Additionally, it provides direct support to evacuate patients
from the supported battalion aid stations to the medical company Role 2 MTF.
8-13. The medical company (area support) provides supported EAB units with medical evacuation support
on an area basis for those units that do not have organic medical evacuation resources.
Medical Company (Ground Ambulance)
8-14. The mission of the medical company (ground ambulance) is to provide ground evacuation within the
theater. This unit provides direct support to BCTs and is employed in the EAB to provide area support. It
is tactically located where it can best control its assets and execute its patient evacuation mission. This unit
has a single-lift capability for evacuation of 96 litter patients or 192 ambulatory patients.
AIR AMBULANCES
8-15. The medical company (air ambulance) (HH-60) is assigned to the general support aviation battalion,
combat aviation brigade. This unit provides air medical evacuation for all categories of patients consistent
with evacuation precedence and other operational considerations within the AO. It evacuates patients from
point of injury or Roles 1 and 2 MTFs to theater hospitals established in EAB. This unit has a single-lift
capability of 72 litter patients or 84 ambulatory patients, or some combination thereof.
PRIMARY TASKS
8-16. Table 8-1 discusses the primary tasks of the medical evacuation function.
Table 8-1. Primary tasks and purposes of the medical evacuation function
Primary Task
Purpose
Acquire, locate, treat, stabilize, and
Clear the battlefield of casualties to facilitate and enhance the tactical
evacuate
commander’s freedom of movement. This task is performed by the
medical crew of the evacuation platform.
En route medical care
Maintain the patient’s medical condition during transport and provide
emergency medical intervention when required. This task is performed
by the medical evacuation crew.
Area support
Provide medical evacuation for units without organic medical
evacuation assets. This task is performed by medical evacuation
platforms in Roles 1 and 2 and by medical evacuation platforms in the
medical company (ground ambulance) and the medical company (air
ambulance).
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Chapter 8
Table 8-1. Primary tasks and purposes of the medical evacuation function (continued)
Primary Task
Purpose
Emergency movement of medical
Provide a rapid response for the emergency movement of scarce
personnel, supplies, and equipment
medical resources throughout the operational environment when
required by the tactical situation.
Transfer of patients between
Provide a capability to cross-level patients within the theater hospitals
medical treatment facilities and
and to transport patients being evacuated out of the theater to staging
mobile aeromedical staging
facility prior to flight departure.
facilities
Medical property transfer
Provide a reciprocal procedure to exchange like medical property when
patients are evacuated with equipment accompanying them.
Medical regulating support
Provide support to medical regulating activities to ensure vital linkup
between tactical evacuation support and the scheduling of patients for
evacuation out of theater by strategic aeromedical evacuation
resources.
8-17. For additional information on medical evacuation and medical regulating, refer to JP 4-02 and
AR 40-3.
SECTION II — MEDICAL REGULATING
8-18. Medical regulating is the coordination and control of moving patients to MTFs which are best able to
provide the required specialty care. This system is designed to ensure the efficient and safe movement of
patients.
8-19. Medical regulating entails identifying the patients awaiting evacuation, locating the available beds,
and coordinating the transportation means for movement. Careful control of patient evacuation to
appropriate hospitals is necessary to—
z
Effect an even distribution of cases.
z
Ensure adequate beds are available for current and anticipated needs.
z
Route patients requiring specialized treatment to the appropriate MTF.
8-20. The factors that influence the scheduling of patient movement include—
z
Patient’s medical condition (stabilized to withstand evacuation).
z
Tactical situation.
z
Availability of evacuation means.
z
Locations of MTFs with special capabilities or resources.
z
Current bed status of MTFs.
z
Surgical backlogs.
z
Number and location of patients by diagnostic category.
z
Location of airfields, seaports, and other transportation hubs.
z
Communications capabilities (to include radio silence procedures).
SECTION III — STRATEGIC MEDICAL EVACUATION/PATIENT MOVEMENT
8-21. Medical evacuation occurs at the tactical and strategic levels and requires the synchronization and
integration of Service component medical evacuation resources and procedures with the DOD worldwide
evacuation system operated by the U.S. Transportation Command.
8-22. A comprehensive medical evacuation plan is essential to ensure effective, efficient, and responsive
medical evacuation is provided to all wounded, injured, and ill Soldiers in the AO. The Army medical
evacuation plan flows from the combatant commander’s guidance and intent and incorporates all missions
and tasks directed by the combatant commander to be accomplished and is synchronized with supporting
8-4
FM 4-02
26 August 2013
Medical Evacuation
and supported units. In some scenarios, Army air and ground evacuation resources may be directed to
provide support to sister Services, multinational partners, and host-nation forces.
8-23. When directed by the combatant commander, Army medical evacuation assets may be tasked to
support other than Army forces engaged in the execution of the joint mission. These additional support
missions will be clearly articulated in the combatant commander’s OPLAN and OPORD. The theater
Army surgeon, with the advice of the senior medical evacuation planner, will coordinate and synchronize
these support operations with the combatant command surgeon, joint task force surgeon, and the other
Services and/or multinational partners as required ensuring that a comprehensive and effective, efficient,
and responsive plan is developed and implemented.
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FM 4-02
8-5
Chapter 9
Medical Logistics
The Army’s MEDLOG system (including blood management) is an integral part of
the AHS in that it provides intensive management of medical products and services
that are used almost exclusively by the AHS and are critical to its success. Also key
to this success is the delivery of a MEDLOG capability that anticipates the needs of
the customer and is tailored to continuously provide end-to-end sustainment of the
AHS mission throughout the range of military operations. Providing timely and
effective AHS support is a team effort which integrates the clinical and operational
aspects of the mission.
SECTION I — MEDICAL LOGISTICS MANAGEMENT IN AN OPERATIONAL
ENVIRONMENT
9-1. The MEDLOG system encompasses planning and executing all Class VIII supply support operations
to include medical materiel procurement and distribution, medical equipment maintenance and repair,
blood management, optical fabrication and repair, and the centralized management of patient movement
items. It also includes contracting support, medical hazardous waste management and disposal, and
production and distribution of medical gases. The appropriate command surgeon provides technical
guidance. The system is anticipatory with select units capable of operating in a split-based mode.
SECTION II — MEDICAL LOGISTICS MISSION COMMAND ORGANIZATIONS
MEDICAL LOGISTICS SYSTEM
9-2. The deployable MEDLOG system consists of the following organizations:
z
Medical logistics management center.
z
Medical logistics company.
z
Medical detachment (blood support).
z
Medical team (optometry).
z
Medical mission command headquarters (to include the MEDCOM [DS], MEDBDE [SPT], and
MMB).
z
United States Army Medical Materiel Agency MEDLOG support team (reachback support for
Army pre-positioned stocks).
MEDICAL LOGISTICS MANAGEMENT CENTER
9-3. The MEDLOG management center provides theater-level centralized management of critical Class
VIII commodities, patient movement items, medical contracting support, and medical equipment
maintenance in accordance with the theater surgeon’s policy. The MEDLOG management center operates
in a split-based mode, with a MEDLOG management center base organization and two forward support
teams (early entry) and two forward support teams (follow-on). The MEDLOG management center is
capable of deploying these teams, while maintaining base operations in CONUS. One forward support
team (early entry) and one forward support team (follow-on) combine to make one complete forward
support team. The forward support teams (follow-on) are not meant to deploy independently of the
forward support team (early entry). One team is deployed per theater. When deployed, the forward
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Chapter 9
support team is subordinate to the MEDCOM (DS) or senior medical mission command headquarters and
collocates with the distribution management center of the theater sustainment command/expeditionary
sustainment command. When so designated, the MEDLOG management center, with the MEDLOG
company, serves as the single integrated MEDLOG manager for joint operations. The MEDLOG
management center also provides technical guidance to medical contracting personnel within the AO.
MEDICAL LOGISTICS COMPANY
9-4. The MEDLOG company provides medical materiel, medical equipment maintenance, optical lens
fabrication and repair, and patient movement items support to BCTs and EAB AHS units operating within
the AO. The MEDLOG company has no organic blood support capability. The MEDLOG company has
the capability for limited self-sustainment during initial operations, meeting the requirement for early entry
into the AO or as part of a task force organization. The company is normally under the mission command
of the headquarters and headquarters detachment, MMB.
MEDICAL DETACHMENT (BLOOD SUPPORT)
9-5. The medical detachment
(blood support) provides collection, manufacturing, storage, and
distribution of blood and blood products for brigade and EAB AHS units and other Services as required.
The detachment receives and stores up to 5,100 refrigerated and/or frozen blood products from CONUS or
other U.S. MTFs and further distributes these products to supported MTFs and AHS units. This unit also
coordinates the movement of blood and blood products and tracks shipments to ensure proper delivery.
The detachment is assigned to the MMB.
MEDICAL TEAM OPTOMETRY
9-6. The medical team (optometry) provides optometry care and optical fabrication and repair support for
brigade and EAB units on an area basis. The detachment consists of six personnel that can be divided into
two teams. Each team is capable of providing optometry support to include routine eye examinations,
refractions, optical fabrication, frame assembly, and repair services. The optometry detachment is assigned
to the MEDCOM (DS) or MEDBDE (SPT) with further attachment to an MMB or BCT.
UNITED STATES ARMY MEDICAL MATERIEL AGENCY MEDICAL
LOGISTICS SUPPORT TEAM
9-7. The MEDLOG support team is a deployable table of distribution and allowances organization
consisting of MEDLOG personnel (military, DA civilians, and contractors) from the U.S. Army Medical
Materiel Agency. The mission of the MEDLOG support team is to deploy to designated locations
worldwide, to provide medical materiel and medical equipment maintenance capabilities and solutions in
support of Army strategic and contingency programs. Upon initial deployment, the MEDLOG support
team is normally under the operational control of the U.S. Army Materiel Command’s Army field support
brigade. The MEDLOG support team supports the reception, staging, onward movement, and integration
of Army pre-positioned stocks, unit sets, and sustainment stocks pre-positioned around the world. After
completing the Army pre-positioned stocks transfer or other assigned mission, the MEDLOG support team
redeploys to CONUS. At the end of the operation, the MEDLOG support team may again deploy to the
AO to support the redeployment of U.S. forces and materiel to follow-on CONUS or outside the
continental U.S. locations.
PRIMARY TASKS
9-8. Table 9-1 describes the primary tasks of the medical logistics function.
9-2
FM 4-02
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Medical Logistics
Table 9-1. Primary tasks and purposes of the medical logistics function
Primary Task
Purpose
Medical materiel procurement
Program funding, develop, acquire, and field the most cost-effective and
efficient medical materiel support to satisfy materiel requirements
generated by doctrinal and organizational revisions to tables of
organization and equipment, as well as user-generated requirements,
state-of-the-art advancements, and initiatives to enhance materiel
readiness.
Class VIII management and
Provide intensive management and coordinated distribution of
distribution
specialized medical products and services required to operate an
integrated Army Health System anywhere in the world in peace and
throughout the range of military operations.
Medical equipment maintenance
Perform appropriate maintenance checks, services, repairs, and tests
and repair
on medical equipment set component equipment items as specified in
applicable technical manuals or manufacturer operating instructions.
Optical fabrication and repair
Fabricate and repair prescription eyewear that includes spectacles,
protective mask inserts, and similar ocular devices for eligible personnel
in accordance with applicable Army policies and regulations.
Blood management (distribution)
Provide collection, manufacturing, storage, and distribution of blood and
blood products to echelons above brigade Army Health System units.
Provide distribution of blood and blood products to Role 2 medical
treatment facilities and forward surgical teams.
Centralized management of patient
Support in-transit patients, exchange in-kind patient movement items
movement items
without degrading medical capabilities, and provide prompt recycling of
patient movement items from initial movement to the patient’s final
destination.
Health facilities planning and
Provide a reliable inventory of facilities that meet specific codes and
management
standards, maintains accreditation, and affords the best possible health
care environment for the Soldiers, Family members, and retired
beneficiaries.
Medical contracting support
Ensure the establishment and monitoring of contracts for critical
medical items and services.
Hazardous medical waste
Ensure the proper collection, control, transportation, and disposal of
management and disposal
regulated medical waste in accordance with applicable Army and host-
nation policies and regulations.
Production and distribution of
Ensure the production, receipt, storage, use, inspection, transportation,
medical gases
and handling of medical gases and their cylinders in accordance with all
applicable regulations.
9-9. Refer to JP 4-02, TM 4-02.70, TM 8-227-3, TM 8-227-11, TM 8-227-12, and FM 4-02.1.
SECTION III — MEDICAL LOGISTICS SUPPORT FOR ROLES 1 AND 2
MEDICAL TREATMENT FACILITIES
9-10. The Class VIII supply functions for AHS units/elements operating Roles 1 and 2 MTFs are primarily
the management of medical equipment sets and basic ordering for replenishment. The replenishment
function within the BCT is performed by the brigade medical supply office of the brigade support medical
company. See FM 4-02.1 for information on MEDLOG.
SECTION IV — MEDICAL LOGISTICS SUPPORT FOR ROLE 3 MEDICAL
TREATMENT FACILITIES
9-11. Class VIII support for Role 3 MTFs is a vital part of its mission and includes management of a
commodity that must be adapted to specific theater health care requirements and to the distribution plans
and capabilities provided by sustainment organizations.
9-12. During port operations and reception, staging, onward movement, and integration these AHS units
must be capable of operations immediately upon initial entry of forces. Therefore, MEDLOG support must
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Chapter 9
be included in planning for port opening and early entry operations. Port operations may also include the
issue of AHS unit sets from Army pre-positioned stocks, integration of potency and dated items,
refrigerated, and controlled substances with those assemblages. In almost every operation, lessons learned
reflect that theater MEDLOG units must also provide Class VIII materiel for unit shortages that were not
filled prior to unit deployment.
9-13. Class VIII sustainment of CSHs present the most complex medical materiel requirements and may
consume materiel at a tremendous rate when providing trauma care in support of operations. Specialty care
for burn injuries, orthopedic injuries and surgeries, and neurosurgery often require materiel and equipment
that is not standard and may not have been anticipated or stocked in sufficient quantities prior to
deployment. Combat support hospitals are typically made direct customers of a MEDLOG company/
element that is capable of meeting the unit’s mission requirements.
9-14. Theater hospitalization is provided by CSHs that operate Role 3 MTFs. Army CSHs are located at
EAB. Forward surgical teams deployed from the CSH are dependent on their supporting medical company
for Class VIII resupply, medical equipment maintenance and repair, and blood distribution support.
SECTION V — THEATER LEAD AGENT FOR MEDICAL MATERIEL AND THE
SINGLE INTEGRATED MEDICAL LOGISTICS MANAGER
9-15. The transformation of theater-level MEDLOG will continue though the joint implementation of
DODD 5101.9 designating the Defense Logistics Agency as the executive agent for medical materiel. As
the executive agent, the Defense Logistics Agency is designated as the DOD single point of contact to
establish the strategic capabilities and systems integration necessary for effective and efficient Class VIII
supply chain support to the combatant commander. The executive agent formalizes the roles and
responsibilities necessary to leverage the strategic acquisition framework established by the Defense
Logistics Agency that enables the Services to obtain materiel support from industry sources, rather than a
national depot system. The executive agent will strengthen the combatant commander and Service
collaboration for requirements planning and synchronize the Defense Logistics Agency and Army
MEDLOG capabilities to improve end-to-end supply chain management support in support of joint HSS
and FHP.
9-16. As part of the directive, Army MEDLOG units may be tasked to provide support to all Services and
designated multinational partners (in accordance with applicable contracts and agreements) under the joint
concept of the single integrated MEDLOG manager, as well as emerging concept of theater lead agent for
medical materiel. The theater lead agent is designated by the combatant commander, in coordination with
the Defense Logistics Agency, to provide the operational capability for medical supply chain management
and distribution from strategic to operational levels. In a land AO, the Army will normally be designated
as a theater lead agent for medical materiel, consistent with its traditional designation as a single integrated
MEDLOG manager. Within the AO, these capabilities are provided by modular and scalable operational
units that are task-organized under the control of the MEDCOM (DS).
9-4
FM 4-02
26 August 2013
PART THREE
Force Health Protection
The FHP mission set is a continuous process that begins with the entry of the Soldier
into the military and is continuous throughout his military career. Force health
protection includes establishing and sustaining a healthy and fit force, health
promotion and nutrition programs, the identification of the health threat in all
occupational and environmental health settings
(in both deployed and garrison
settings), the development and implementation of preventive medicine measures to
reduce exposure to health hazards and to mitigate the effects of the adverse impact
of health threats to military personnel.
Force health protection is comprised of a number of AMEDD functions and also
includes the preventive aspects of some medical functions already discussed in Part
Two of this publication. Force health protection encompasses preventive medicine,
veterinary services, area medical laboratory services and support, and the preventive
aspects of dental services and combat and operational stress control. Although
nutrition plays a significant role in maintaining a healthy and fit force, nutrition is
discussed under the casualty care aspects of health service support as an integral
part of the hospitalization function.
This part of the publication discusses the preventive aspects of the medical functions
and the preventive medicine programs and services designed to prevent health
threats to our deployed forces.
Chapter 10
Preventive Medicine
Preventive medicine is the anticipation, communication, prevention, education, and
control of communicable diseases, illnesses, and exposure to endemic, occupational,
and environmental threats. These threats (Table 1-1) include nonbattle injuries, OEH
exposures, combat stress responses, weapons of mass destruction, and other threats to
the health and readiness of the Soldier. Communicable diseases include arthropod-,
vector-, food-, waste-, and waterborne diseases. Preventive medicine measures
include health risk communication, education, field sanitation, medical surveillance,
pest and vector control, disease risk assessment, environmental and occupational
monitoring and health surveillance, preventive medicine measures, health threat
controls for waste (human, hazardous, and medical) disposal, food safety inspection,
and potable water surveillance.
26 August 2013
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10-1
Chapter 10
MISSION
10-1. In past conflicts, disease and nonbattle injury rendered more Soldiers operationally ineffective than
actual battle wounds. Preventive medicine services to counter the health threat and prevent disease and
nonbattle injury are the most effective, least expensive means of providing commanders with the maximum
number of healthy Soldiers. Preventive medicine encompasses those measures to promote, improve, or
conserve the behavioral and physical well-being of Soldiers. These measures enable a healthy and fit
force, prevent disease and nonbattle injuries, and protect the force from health hazards.
PROTECTION WARFIGHTING FUNCTION
10-2. Preventive medicine falls under the protection warfighting function and is concerned with both the
enemy threat and the health threat. The enemy threat produces operational casualties. This threat depends
on the types of weapons used, the will of the enemy to fight, and other operational concerns. The health
threat consists of diseases, OEH hazards, poisonous or toxic flora and fauna, medical effects of weapons,
and physiological and psychological stressors. To counter the health threat, comprehensive medical
surveillance activities, OEH surveillance activities, personal protective measures, preventive medicine
measures, inspection of potable water and field feeding facilities, and field hygiene and sanitation are
instituted and should receive command emphasis.
Preventive medicine measures can include
immunizations, pretreatments, chemoprophylaxis, and barrier creams. Field hygiene and sanitation
combines with personal protective measures (to include correctly wearing the uniform and using insect
repellent, sunscreen, and insect netting). Soldiers must practice these activities continuously during the
force projection and postdeployment process.
ORGANIZATIONS AND PERSONNEL
10-3. Preventive medicine support consists of preventive medicine units and staff officers. Preventive
medicine detachments and teams provide preventive medicine support and consultation in the areas of
disease and nonbattle injury prevention, field sanitation, entomology, sanitary engineering, and
epidemiology to minimize the effects of environmental injuries, endemic diseases, vectorborne disease, and
other health threats. Echelons above brigade staff support consists of preventive medicine staff officers
organic to the MEDCOM (DS), MEDBDE (SPT), and MMB. These staff officers serve as the
commander’s principal preventive medicine consultants and environmental sciences advisors.
PRIMARY TASKS
10-4. Table 10-1 discusses the primary tasks of the preventive medicine function. See AR 40-5 and DA
Pamphlet 40-11.
Table 10-1. Primary tasks and purposes of the preventive medicine function
Primary Task
Purpose
Disease prevention and control
Prevent and control communicable diseases and provide travel medicine,
population health management, and hospital-acquired infection control.
Field preventive medicine
Provide field sanitation team, preventive medicine measures, individual
Soldier personal protective measures, inspection of potable water and field
feeding facilities, and ice and bottled/packaged water in an operational
environment.
Environmental health
Provide the monitoring of environmental health-related data for the health of,
or potential health hazard impact on, a population and on individual
personnel; pest and disease vector prevention and control; health threat
controls for waste disposal; identification of environmental health hazards and
endemic diseases; incident-specific environmental monitoring; and climatic
injury prevention and control.
10-2
FM 4-02
26 August 2013
Preventive Medicine
Table 10-1. Primary tasks and purposes of the preventive medicine function (continued)
Primary Task
Purpose
Occupational health
Provide medical surveillance examinations and screenings; health hazard
education; surety programs; hearing and vision conservation and readiness;
workplace epidemiological investigations; ergonomics; radiation protection;
industrial hygiene; work-related immunizations; Army aviation medicine;
health hazard assessment of Army materiel and equipment; medical facility
safety; and workplace violence prevention.
Health surveillance and
Provide for the deployment of occupational and environmental health
epidemiology
surveillance, Defense Occupational and Environmental Health Readiness
System, medical surveillance, Medical Protection System, and epidemiology.
Soldier, Family, community
Provide Soldier health (to include Soldier medical and dental readiness),
(public) health, and health
Family and community (public) health (to include childhood lead poisoning
promotion
prevention and Family safety), and health promotion programs and services
(to include tobacco use cessation, substance abuse prevention, and suicide
prevention).
Preventive medicine toxicology
Provide toxicological assessments of potentially hazardous materials, toxicity
clearances for Army chemicals and materiel, and toxicologically-based
assessments of health risks.
Preventive medicine laboratory
Provide laboratory certification and accreditation, quality control and quality
services
management, and the Department of Defense Cholinesterase Monitoring
Program.
Health risk assessment
Provide capabilities and activities necessary to identify and evaluate a health
hazard and to determine the associated health risk (probability of occurrence
and resulting outcome and severity) from potential exposure to the hazard.
Health risk communication
Provide capabilities and activities necessary to identify the personnel affected
by potential or actual health and safety threats, to determine the interests and
concerns that those personnel have about the threats, and to develop
strategies for effectively communicating the complexities and uncertainties
associated with their health risk.
26 August 2013
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10-3
Chapter 11
Veterinary Services
The veterinary mission is to execute veterinary service support essential for FHP and
to project and sustain a healthy and medically protected force; train, equip, and
deploy the veterinary force; and promote the health of the Soldier.
SECTION I — VETERINARY SERVICES
11-1. The U.S. Army Veterinary Service is the executive agent for veterinary support to all DOD Services
with the exception of food inspection on USAF installations. Appropriate veterinary units provide this
support. These units can be task-organized to support food safety and quality assurance and the medical
care mission for military working dogs and other government-owned animals. Services include sanitary
surveillance for food source and storage facilities, procurement, and surveillance and examination of
foodstuffs for safety and quality assurance. The U.S. Army Veterinary Service is responsible for publishing
a directory of approved food sources for the area of operations. Veterinary preventive medicine provides
an effective combat multiplier through monitoring endemic
(animal) disease threats of military
significance. The animal medical care mission provides complete medical care for military working dogs
and other government-owned animals located in the AO. The potential of foodborne disease, the threat of
CBRN contamination of subsistence, the need to assess the zoonotic disease threat, and the need to provide
animal medical care to military working dogs requires a veterinary presence throughout the entire AO.
Comprehensive veterinary medical and surgical programs are required to maintain the health of military
working dogs. See DODD 6400.4 for additional information.
PRIMARY TASKS
11-2. Table 11-1 discusses the primary tasks and purposes of the veterinary services function.
Table 11-1. Primary tasks and purposes of the veterinary services function
Primary Task
Purpose
Animal medical care
Provide medical care for military working dogs and other government-owned
animals.
Food protection
Ensure quality, food safety, and food defense of food sources for deployed
forces.
Veterinary preventive medicine
Reduce transmission of zoonotic diseases transmissible to man.
SECTION II — FOOD PROTECTION MISSION
11-3. The food inspection mission encompasses all services performed to include—
z
Conducting sanitary audits of commercial food establishments to identify approved food sources
for Class A rations.
z
Conducting sanitation inspections audit of food processing facilities for either commercial or
military food production/processing and storage facilities (including block and packaged ice,
bottled water, baked goods, fresh fruits and vegetables, seafood, eggs, poultry, pork, red meat,
and dairy products).
z
Conducting contingency CBRN surveillance of potentially contaminated subsistence, as
directed/required and providing guidance on the disposition of CBRN-contaminated subsistence.
26 August 2013
FM 4-02
11-1
Chapter 11
z
Providing CBRN decontamination instructions for subsistence.
z
Conducting surveillance receipt and inspection at issue of operational and other government-
owned subsistence intended for consumption or use by DOD personnel.
z
Providing basic food microbiological and chemical surveillance of military food supply (to
include performing rapid, presumptive laboratory testing
[screening and surveillance] for
microbial contaminants, pesticides and toxins, and other hidden contaminants
[radioactive
isotopes, polychlorinated biphenyls, petroleum by-products] in the food supply).
z
Providing assessment and guidance on temperature-abused foods.
z
Conducting periodic inspections of government food storage facilities.
z
Participating in foreign humanitarian assistance and other stability tasks as directed.
z
Providing food surveillance inspections of dining facilities for security and storage of food
products.
z
Assisting in foodborne illness investigations.
SECTION III — ANIMAL CARE MISSION
11-4. The animal care mission for government-owned animals is discussed in a similar fashion as are the
roles of medical care used to describe the successive and increasing capabilities to provide care to our
injured and wounded Soldiers in an OE. The major difference is there are very few organic veterinary
assets in the BCT. The majority of veterinary assets in the AO are assigned to EAB veterinary units and
must be projected forward to provide care in the brigade area.
VETERINARY ROLE 1 MEDICAL CARE
11-5. This role of veterinary medical care is provided by an animal care specialist.
ANIMAL HANDLER
11-6. Nonveterinary personnel, such as military working dog, equestrian, livestock, and/or USN marine
mammal handlers perform limited lifesaving and first aid procedures until an animal care specialist or a
veterinarian is available.
ANIMAL CARE SPECIALIST
11-7. Animal care specialists are organic to Army engineer, Ranger, USN, and medical detachment
(veterinary service support) units. The animal care specialist supervises or provides the care, management,
treatment, and sanitary conditions for animals, with a primary responsibility for the prevention and control
of diseases transmitted from animal to man and comprehensive care for government-owned animals.
CAPABILITIES
11-8. Veterinary Role 1 medical care includes—
z
Providing routine daily care for animals in veterinary treatment or research and development
facilities or field units.
z
Obtaining medical history from handlers and measuring and recording animal vital signs.
z
Performing physical examinations to detect obvious abnormalities and reporting findings to the
veterinarian.
z
Positioning and restraining animals for examination and treatment.
z
Calculating doses and administering oral and topical medications as directed by the veterinarian
or established protocol approved by a veterinarian.
z
Maintaining sanitary conditions for all components of the veterinary treatment area (to include
operating room and equipment).
11-2
FM 4-02
26 August 2013
Veterinary Services
z
Assisting the veterinarian in surgical procedures and assisting in performing euthanasia when
instructed by veterinarian. In the event a veterinarian is not present, an animal care specialist is
trained to perform lifesaving measures to stabilize the patient for transport/evacuation and
further care by a veterinarian. Lifesaving measures include maintaining the airway, controlling
bleeding, preventing and controlling shock, and splinting or immobilizing fractures.
z
Cleaning, debriding, and suturing superficial wounds.
z
Collecting, preserving, and preparing blood, urine, feces, skin, and postmortem specimens for
shipment and evaluation.
z
Performing routine diagnostic laboratory tests such as fecal smears, urinalysis, blood counts, and
chemistries and recording laboratory test results.
z
Coordinating and stabilizing military working dogs, horses, livestock, and marine mammals for
evacuation to veterinary field unit or treatment facility. Performing frequent monitoring of vital
signs and collecting of fluids (blood, urine, saliva, and feces) for further evaluation.
z
Conducting minor sick call by the animal care specialist under the indirect supervision of a
veterinarian
(such as teleconsultation or preauthorized protocol). Treatment may include
restoring the airway by invasive procedures; use of intravenous fluids and medications; and
applying splints, bandages, and tourniquets.
z
Preventing disease and nonbattle injury (such as heat/cold injuries, bloat, arthropod/reptile
bites/stings, vomiting/diarrhea, and so forth).
z
Performing routine preventive care for 18 to 24 dogs and emergency care for up to 6 dogs and
kennel inspection support for units in the supported area.
11-9. Veterinary Role 1 medical care is provided by the animal care specialist and veterinarian assigned
individually to various U.S. Army, USAF, U.S. Marine Corps, or USN field units or veterinary service
support teams. Either the animal care specialist or veterinarian will respond to the emergency call of a
military working dog, horse, livestock, or USN marine mammal handler. Depending on the type of
emergency, the animal care specialist or veterinarian will evaluate the traumatized or ill animal to provide
stabilization with basic first aid equipment or medications so that the patient can withstand further
evacuation and treatment at either a forward-deployed veterinary Role 2 veterinary service support team,
veterinary Role 3 medical care performed by a veterinary medicine and surgical team, or veterinary Role 4
medical care at an Army veterinary hospital. An animal handler can be instructed to perform basic
emergency aid procedures and prepare the animal for transport/evacuation to a higher role of veterinary
medical care in the event the animal care specialist or veterinarian cannot provide veterinary Role 1
medical care at the point of injury/illness.
VETERINARY ROLE 2 MEDICAL CARE
11-10. Veterinary Role 2 medical care is provided by a forward-deployed veterinary service support team
veterinarian and an animal care specialist from the medical detachment (veterinary service support) and
includes veterinarian-directed resuscitation and stabilization and may include advanced trauma
management, emergency medical procedures, and forward emergency resuscitative surgery for dogs,
horses, livestock, and USN marine mammals. This role provides care for up to ten military working dogs.
There are five veterinary service support teams in a medical detachment (veterinary service support).
11-11. Veterinary Role 2 medical care includes—
z
Basic veterinary laboratory: microscopic examination, packed cell volume, serum total protein,
and urinalysis.
z
Limited veterinary pharmacy.
z
Limited temporary military working dog holding facilities for basic medical disease treatment.
z
Sick call.
z
Routine preventive care.
z
Nonemergent surgical care.
z
General anesthesia for emergency medical procedures (such as bloat).
26 August 2013
FM 4-02
11-3
Chapter 11
z
Ultrasound.
z
Limited care for large animals under certain conditions of government interest for stability tasks
and defense support of civil authorities tasks.
z
Endemic zoonotic and foreign animal disease epidemiology surveillance and control by
examination of local farm animals in the area, captured wildlife, and stray animals.
11-12. Patients are treated and returned to duty or are stabilized for transport/evacuation to a higher
veterinary role of medical care. At veterinary Role 2 patient holding capability is available for ten military
working dogs and a veterinary medicine and surgical team can care for up to 50 dogs for up to 72 hours
with significant degradation of other aspects of the veterinary mission.
Note. There are no kennels at veterinary Role 2 or Role 3. The military working dog handler is
expected to stay with his dog. Each military working dog handler has a crate for his dog. Dogs
can sleep or rest in their crate on the ground. The horse, livestock, or USN marine mammal
handler is also expected to stay with his animal.
VETERINARY ROLE 3 MEDICAL CARE
11-13. This role of veterinary medical care is provided by the veterinary medical and surgical team which
consists of a clinical and surgical team designed to care for dogs only. No veterinary Role 3 capability is
available in the AO for horses, livestock, or USN marine mammals. If veterinary Role 3 care is required,
the horses, livestock, or USN marine mammals may be transported/evacuated back to CONUS.
11-14. Veterinary Role
3 medical care includes referral for veterinary diagnostic, therapeutic, and
surgical procedures. Veterinary care administered at this veterinary role of care requires advanced clinical
capabilities. At veterinary Role 3, capability exists to provide care for 50 to 200 military working dogs.
There is one veterinary medicine and surgical team per medical detachment (veterinary service support).
11-15. Veterinary Role 3 medical care capabilities include—
z
Patient case consultation and acceptance of referrals.
z
Comprehensive canine veterinary medical/surgical care (such as orthopedic and extensive soft
tissue surgeries).
z
Extensive veterinary laboratory capabilities: complete blood count, chemistry, and urinalysis.
z
Robust veterinary pharmacy.
z
Diagnostic imaging (radiographs and ultrasound).
z
Definitive and restorative military working dog dental care to include endodontic procedures.
z
Area of operations-wide patient tracking of military working dogs to include evacuation.
z
Established AO military working dog evacuation policy and standards of care.
z
Training for veterinarians and animal care specialists.
z
Development of the AO policies for care of government-owned animals.
z
Treatment, return to duty, or hospitalization of military working dogs for continued care or
stabilization of military working dogs for transport/evacuation to veterinary Role 4 medical care.
11-16. The veterinary medicine and surgical team is staffed and equipped to hospitalize up to five
military working dogs in accordance with the military working dog evacuation policy.
VETERINARY ROLE 4 MEDICAL CARE
11-17. Veterinary Role 4 medical care is found in CONUS at the DOD Military Working Dog Center and
outside CONUS at the Dog Center, Europe and the Dog Center, Pacific. Veterinary Role 4 medical care
expands the capabilities available at veterinary Roles 1 through 3 and provides additional specialized
veterinary medical and surgical care, rehabilitative therapy, and convalescent capability.
11-4
FM 4-02
26 August 2013
Veterinary Services
SECTION IV — VETERINARY PREVENTIVE MEDICINE
11-18. Veterinary preventive medicine includes the aspects of the prevention and mitigation of the effects
of foodborne disease and the prevention of zoonotic diseases transmissible to man. It also provides
guidance on decontamination for U.S.-owned equipment being retrograded to CONUS and on
multinational forces to prevent the transmission of animal diseases, and advises the commander on foreign
animal disease that may affect redeployment of military equipment back to the U.S. with the Department of
Agriculture, other disease vectors, and other pathogens that pose a hazard to U.S. agriculture or present a
hazard to humans. Specific services include—
z
Support for prevention and control programs to protect Soldiers from foodborne diseases.
z
Evaluation of zoonotic disease data collected in the AO and advice to preventive medicine
elements and higher headquarters on potential hazards to humans.
z
Establishment of animal disease prevention and control programs to protect Soldiers and other
DOD and multinational personnel from zoonotic diseases.
z
Assessment of the presence of animal diseases that may impact the CONUS agriculture system
if contaminated equipment or personnel are allowed to redeploy.
z
Performance of investigations of unexplained animal deaths to include livestock and wildlife.
26 August 2013
FM 4-02
11-5
Chapter 12
Combat and Operational Stress Control
Combat and operational stress control has always been a commander’s program. To
be successful, commanders must fully understand and appreciate the magnitude of a
potentially traumatic event as it affects exposed organizations and individuals. It is a
harsh reality that combat and operational stress affects everyone engaged in unified
land operations. It should be viewed as a continuum of possible outcomes that each
person will experience with a range from positive growth behaviors to negative and
sometimes disruptive reactions. Effective leadership shapes the experience that they
and their Soldiers go through in an effort to successfully transition units and
individuals, build resilience and promote posttraumatic growth, or increased
functioning and positive change after enduring trauma. Combat and operational
stress control does not take away the experiences faced while engaged in military
operations, it attempts to mitigate those experiences so that Soldiers and units remain
combat-effective and ultimately provide the support and meaning that will allow
Soldiers to maintain the quality of life to which they are entitled.
SECTION I — RESPONSIBILITIES
12-1. Combat and operational stress control is a program developed and actions taken by military
leadership to prevent, identify, and manage adverse combat and operational stress reactions in units. This
medical function optimizes mission performance; conserves the fighting strength; and prevents or
minimizes adverse effects of combat and operational stress reaction on Soldiers and their physical,
psychological, intellectual, and social health. Its goal is to return Soldiers to duty expeditiously.
According to DODD 6490.02E, COSC activities include routine screening of individuals when recruited;
continued surveillance throughout military service, especially before, during, and after deployment; and
continual assessment and consultation with medical and other personnel from garrison to the battlefield.
Soldiers who are temporarily impaired or incapacitated with stress-related conditions are diagnosed as BH
disorders. Combat and operational stress control promotes Soldier and unit readiness by―
z
Enhancing adaptive stress reactions.
z
Preventing maladaptive stress reactions.
z
Assisting Soldiers with controlling combat and operational stress reactions.
z
Assisting Soldiers with behavioral disorders.
z
Teaching warrior resiliency skills.
SECTION II — PROGRAM AND RESOURCES
COMBAT AND OPERATIONAL STRESS CONTROL RESOURCES
BRIGADE COMBAT TEAMS
12-2. In the BCTs, COSC support is provided by mental health sections assigned to the brigade support
medical company of the brigade support battalion. If required, these resources can receive direct support
from the BH personnel assigned to the medical detachment (COSC), if augmentation is required.
26 August 2013
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12-1
Chapter 12
MEDICAL COMPANY (AREA SUPPORT)
12-3. At EAB, mental health sections are assigned to the medical companies (area support) that are
normally assigned to the MMB. If required, these resources can be augmented with BH personnel assigned
to the medical detachment (COSC).
MEDICAL DETACHMENT, COMBAT AND OPERATIONAL STRESS CONTROL
12-4. A medical detachment (COSC) is usually assigned to the MMB and provides direct support to the
EAB. In support of an AO, this unit provides support on an area basis and provides additional support to
the BCT as required. The medical detachment (COSC) consists of a detachment headquarters, a main
support section, and a forward support section. The main support section consists of its headquarters and
an 18-Soldier BH team made up of social workers, clinical psychologist, psychiatrist, occupational
therapists, psychiatric nurses, BH specialists, and occupational therapy specialist. The forward support
section consists of an 18-Soldier BH team. Each BH team is capable of breaking into six 3-person
subteams, for battalion/company prevention and fitness support activities. This provides for a total of 12
subteams for each detachment, giving supported commanders more teams and more flexibility in the
utilization of those teams.
PRIMARY TASKS
12-5. Table 12-1 discusses the primary tasks of the COSC function. Table 7-4 discusses the primary tasks
of BH/neuropsychiatric treatment.
Table 12-1. Primary tasks and purposes of the combat and operational stress control function
Primary Task
Purpose
Implement combat and operational stress control
Prevent combat and operational stress reaction.
plan/program
Perform combat and operational stress control unit
Provide command with global assessment of the unit,
needs assessment
with considerations of multiple variables that may affect
leadership, performance, morale, and operational
effectiveness of the organization.
Conduct traumatic event management for
Assist in the transition of units and Soldiers who are
potentially traumatic event
exposed to potentially traumatic events by building
resilience, promoting posttraumatic growth, and/or
increasing functioning and positive changes in the unit.
Screen and evaluate Soldiers with maladaptive
Provide diagnosis, treatment, and disposition for
behaviors to rule out neuropsychiatric/behavioral
Soldiers with neuropsychiatric/behavioral problems.
health conditions
Conduct combat and operational stress restoration
Provide Soldiers rest/restoration within or near their unit
and reconditioning programs to include warrior
area for rapid return to duty and to prevent
resiliency training
posttraumatic stress disorder.
Perform command-directed evaluation for Soldier’s
Determine if a Soldier’s mental state renders him at risk
behavioral health status
to himself or others or may affect his ability to carry out
his mission.
Screen patients with potential behavioral health
Rule out mild traumatic brain injury for Soldiers seeking
issues for signs/symptoms of mild traumatic brain
assistance with behavioral health issues. If appropriate,
injury
refer individuals for follow-up medical examination.
12-2
FM 4-02
26 August 2013
Chapter 13
Dental Services and Laboratory Services
(Area Medical Laboratory Support)
Preventive dentistry incorporates primary, secondary, and tertiary preventive
measures taken to reduce or eliminate conditions that may decrease a Soldier’s fitness
to perform his mission and which could result in the Soldier being removed from his
unit for treatment. The AML includes capabilities in the identification and theater
validation of suspect CBRN agents, endemic diseases, and OEH hazards. Its focus is
the total health environment of the AO, not individual patient care.
SECTION I — DENTAL SERVICES
PREVENTIVE DENTISTRY
13-1. Preventive dentistry measures can effectively prevent the development of tooth decay and oral
disease. The application of fluoride and sealants combined with regular dental checkups and oral
screenings can prevent tooth decay and identify oral disease at its most treatable stages. Therefore,
Soldiers who incorporate good preventive dental hygiene practices are far less likely to become dental
casualties due to disease while deployed. Preventive dentistry incorporates primary, secondary, and
tertiary preventive measures.
13-2. See paragraphs 7-7 through 7-17 of this publication for information on the treatment aspects of
dental services.
PRIMARY TASKS
13-3. Table 13-1 discusses the primary tasks of preventive dentistry. Table 7-3 discusses the remaining
primary tasks and purposes of the dental services function.
Table 13-1. Primary tasks and purposes of preventive dentistry
Primary Task
Purpose
Conduct periodic examination of
Identify dental deficiencies and recommend follow-up courses of action.
Soldiers’ teeth, gums, and jaw
Classify Soldiers’ dental conditions
Determine Soldiers dental classification and dental readiness status.
in the dental classification system
and determine Soldiers’ dental
readiness status
Provide training to Soldiers and
Provide training/education to Soldiers and unit leaders on identifying
units on measures to take to
dental threats, taking preventive measures to mitigate or eliminate the
mitigate the adverse impact of
dental threat, and ensuring Soldiers are practicing good oral hygiene.
dental threats
26 August 2013
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13-1
Chapter 13
SECTION II — AREA MEDICAL LABORATORY
SPECIALIZED THEATER LABORATORY
13-4. The AML is the Army’s specialized theater laboratory that deploys worldwide as a unit or by task-
organized teams to perform surveillance, analytical laboratory testing and health hazard assessments of
environmental, occupational, endemic, and CBRN threats in support of Soldier protection and weapons of
mass destruction missions.
13-5. The AML tests air, water, soil, food, waste, and vectors (insects, animals) for a broad range of
microbiological, radiological, and/or chemical contaminants under two basic scenarios:
z
As a public health Level 4 field laboratory (theater validation) in support of theater operations.
The AML provides—
„ Theater validation level of identification to enable commanders and health care providers to
make data-based decisions.
„ Support to multiple medical detachments
(preventive medicine) with surveillance/
surveillance oversight, sample collection/sample management, and rapid laboratory analysis and
validation.
z
In contingency operations (for example, after use of weapons of mass destruction), the AML
provides—
„ Immediate hazard identification (presumptive or field confirmatory level of identification)
in high risk environments with chemical or biological agent contamination, epidemic disease, or
industrial contamination.
„ Rapid laboratory analysis and theater validation level of identification to assist commanders
in making operational decisions.
13-6. The AML is organized into three teams consisting of the following:
z
The staff (headquarters) section provides mission command and communications support for the
unit and accomplishes all required administrative functions of the unit.
z
The analytical chemistry (CBRN) section conducts analytical chemistry support by providing
identification of chemical agents in the environment to include food, water, plants, soil, and
explosives.
z
The microbiology
(endemic) section conducts biological agents analysis using multiple
methodologies, provides identification of endemic disease agents, and supports animal
pathology and endemic disease surveillance.
z
The occupational and environmental health surveillance (CBRN) section provides identification
for environmental samples and clinical specimens using multiple methodologies. This section
also provides diagnostic capability to identify outbreaks of regionally specific endemic diseases
and serves as a resource of information for higher-level command medical personnel. This
section also provides the operational commander the immediate hazard identification
(presumptive or field confirmatory level of identification) of CBRN.
PRIMARY TASKS
13-7. Table 13-2 discusses the primary tasks of the operational medical laboratory function performed
by the area medical laboratory. The primary tasks of the clinical laboratory function are discussed in
Table 7-5.
13-2
FM 4-02
26 August 2013
Dental Services and Laboratory Services (Area Medical Laboratory Support)
Table 13-2. Primary tasks and purposes of the operational medical laboratory function
performed by the area medical laboratory
Primary Task
Purpose
Analytical, investigational, and
Identify chemical, biological, radiological, and nuclear threat agents in
consultative capabilities
biomedical specimens and other samples from the area of operations.
Assist in the identification of occupational and environmental health
hazards and endemic diseases.
Special environmental control and
Evaluate biomedical specimens for the presence of highly infectious or
containment
hazardous agents of operational concern.
Data and data analysis
Support medical analyses and operational decisions.
Medical laboratory analysis
Support the diagnosis of zoonotic and significant animal diseases that
impact on military operations.
Deploy modular sections or
Interface with preventive medicine teams, veterinary teams, forward-
sectional teams
deployed Army Health System units, biological integrated detection
system teams, and chemical company elements operating in the area of
operations.
26 August 2013
FM 4-02
13-3
Source Notes
This is the source used for historical purposes that is cited in this publication. It is
listed by page number.
7-1
FM 3-0, Operations, (Washington, DC: Department of Defense, 27 February 2008).
26 August 2013
FM 4-02
Source Notes-1
Glossary
This glossary lists acronyms and terms with Army or joint definitions. Where Army
and joint definitions differ, (Army) precedes the definition. Terms for which this
publication is the proponent are marked with an asterisk
(*). The proponent
publication for other terms is listed in parentheses after the definition.
SECTION I — ACRONYMS AND ABBREVIATIONS
ABCA
American, British, Canadian, Australian, and New Zealand
(Armies)
ADP
Army doctrine publication
ADRP
Army doctrine reference publication
AHS
Army Health System
AMEDD
Army Medical Department
AML
area medical laboratory
AO
area of operations
AR
Army regulation
ATTN
attention
BCT
brigade combat team
BH
behavioral health
CA
civil affairs
CBRN
chemical, biological, radiological, and nuclear
CONUS
continental United States
COSC
combat and operational stress control
CSH
combat support hospital
DA
Department of the Army
DD
Department of Defense
DOD
Department of Defense
DODD
Department of Defense directive
DODI
Department of Defense instruction
EAB
echelons above brigade
EPW
enemy prisoner of war
FHP
force health protection
FM
field manual
FST
forward surgical team
GC
Geneva Convention Relative to the Protection of Civilian
Persons in Time of War
26 August 2013
FM 4-02
Glossary-1
Glossary
GPW
Geneva Convention Relative to the Treatment of Prisoners of
War
GTA
graphic training aid
GWS
Geneva Convention for the Amelioration of the Condition of the
Wounded and Sick in Armed Forces in the Field
GWS SEA
Geneva Convention for the Amelioration of the Condition of the
Wounded, Sick, and Ship-wrecked Members of the Armed
Forces at Sea
HSS
health service support
JP
joint publication
MEDBDE (SPT)
medical brigade (support)
MEDCOM (DS)
medical command (deployment support)
MEDLOG
medical logistics
MHS
Military Health System
MMB
medical battalion (multifunctional)
MTF
medical treatment facility
NATO
North Atlantic Treaty Organization
NCO
noncommissioned officer
OE
operational environment
OEH
occupational and environmental health
OPLAN
operation plan
OPORD
operation order
POW
prisoner of war
S-1
personnel staff officer
S-2
intelligence staff officer
S-3
operations staff officer
S-4
logistics staff officer
S-6
signal staff officer
SJA
staff judge advocate
SOP
standard operating procedure
STANAG
standardization agreement
TC3
tactical combat casualty care
TM
technical manual
TOE
table of organization and equipment
U.S.
United States
USAF
United States Air Force
Glossary-2
FM 4-02
26 August 2013
Glossary
USAMEDCOM
United States Army Medical Command
USAMEDDC&S
United States Army Medical Department Center and School
USN
United States Navy
SECTION II — TERMS
*advanced trauma management
Resuscitative and stabilizing medical or surgical treatment provided to patients to save life or limb and
to prepare them for further evacuation without jeopardizing their well-being or prolonging the state of
their condition.
*Army Health System
A component of the Military Health System that is responsible for operational management of the
health service support and force health protection missions for training, predeployment, deployment,
and postdeployment operations. Army Health System includes all mission support services performed,
provided, or arranged by the Army Medical Department to support health service support and force
health protection mission requirements for the Army and as directed, for joint, intergovernmental
agencies, coalition, and multinational forces.
*casualty evacuation
Nonmedical units use this to refer to the movement of casualties aboard nonmedical vehicles or
aircraft without en route medical care.
*collection point(s) (patient or casualty)
A specific location where casualties are assembled to be transported to a medical treatment facility. It
is usually predesignated and may or may not be staffed.
*combat and operational stress control
A coordinated program for the prevention of and actions taken by military leadership to prevent,
identify, and manage adverse combat and operational stress reactions in units.
*combat lifesaver
A nonmedical Soldier trained to provide enhanced first aid as a secondary mission. Normally, one
member of each squad, team, or crew is trained.
*continuity of care
Attempt to maintain the role of care during movement between roles at least equal to the role of care at
the originating role.
*definitive care
(1) That care which returns an ill or injured Soldier to full function, or the best possible function after
a debilitating illness or injury. Definitive care can range from self-aid when a Soldier applies a
dressing to a grazing bullet wound that heals without further intervention, to two weeks bed-rest in
theater for Dengue fever, to multiple surgeries and full rehabilitation with a prosthesis at a continental
United States medical center or Department of Veterans Affairs hospital after a traumatic amputation.
(2) That treatment required to return the Service member to health from a state of injury or illness.
The Service member’s disposition may range from return to duty to medical discharge from the
military. It can be provided at any role depending on the extent of the Service member’s injury or
illness. It embraces those endeavors which complete the recovery of the patient.
*definitive treatment
The final role of comprehensive care provided to return the patient to the highest degree of mental and
physical health possible. It is not associated with a specific role or location in the continuum of care; it
may occur in different roles depending upon the nature of the injury or illness.
26 August 2013
FM 4-02
Glossary-3
Glossary
*emergency medical treatment
The immediate application of medical procedures to the wounded, injured, or sick by specially trained
medical personnel.
*en route care
The care required to maintain the phased treatment initiated prior to evacuation and the sustainment of
the patient’s medical condition during evacuation.
*essential care
Medical care and treatment within the theater of operations and which is mission, enemy, terrain and
weather, troops and support available, time available, and civil considerations-dependent. It includes
first responder care, initial resuscitation and stabilization as well as treatment and hospitalization.
Forward care may include stabilizing surgery to ensure the patient can tolerate further evacuation as
well as en route care during evacuation. The objective is to either return the patient to duty within the
theater evacuation policy, or to begin initial treatment required for optimization of outcome.
*first aid (self-aid/buddy aid)
Urgent and immediate lifesaving and other measures which can be performed for casualties (or
performed by the victim himself) by nonmedical personnel when medical personnel are not
immediately available.
*force health protection
(Joint) Measures to promote, improve, or conserve the mental and physical well-being of Service
members. These measures enable a healthy and fit force, prevent injury and illness, and protect the
force from health hazards. (JP 4-02)
(Army) Force health protection encompasses measures to
promote, improve, conserve or restore the mental or physical well-being of Soldiers. These measures
enable a healthy and fit force, prevent injury and illness, and protect the force from health hazards.
These measures also include the prevention aspects of a number of Army Medical Department
functions (preventive medicine, including medical surveillance and occupational and environmental
health surveillance; veterinary services, including the food inspection and animal care missions, and
the prevention of zoonotic disease transmissible to man; combat and operational stress control; dental
services [preventive dentistry]; and laboratory services [area medical laboratory support]).
*forward resuscitative surgery
Urgent initial surgery required to render a patient transportable for further evacuation to a medical
treatment facility staffed and equipped to provide for the patient’s care.
*health service support
(Joint) All services performed, provided, or arranged to promote, improve, conserve, or restore the
mental or physical well-being of personnel. These services include, but are not limited to the
management of health services resources, such as manpower, monies, and facilities; preventive and
curative health measures; evacuation of the wounded, injured, or sick; selection of the medically fit
and disposition of the medically unfit; blood management; medical supply, equipment, and
maintenance thereof; combat and operational stress control and medical, dental, veterinary,
laboratory, optometry, nutrition therapy, and medical intelligence services. (JP 4-02)
(Army) Health
service support encompasses all support and services performed, provided, and arranged by the Army
Medical Department to promote, improve, conserve, or restore the mental and physical well-being of
personnel in the Army. Additionally, as directed, provide support in other Services, agencies, and
organizations. This includes casualty care (encompassing a number of Army Medical Department
functions—organic and area medical support, hospitalization, the treatment aspects of dental care and
behavioral/ neuropsychiatric treatment, clinical laboratory services, and treatment of chemical,
biological, radiological, and nuclear patients), medical evacuation, and medical logistics.
*hospital
A medical treatment facility capable of providing inpatient care. It is appropriately staffed and
equipped to provide diagnostic and therapeutic services, as well as the necessary supporting services
required to perform its assigned mission and functions. A hospital may, in addition, discharge the
functions of a clinic.
Glossary-4
FM 4-02
26 August 2013
Glossary
*inpatient
A person admitted to and treated within a Role 3 and 4 hospital and who cannot be returned to duty
within the same calendar day.
*lines of patient drift
Natural routes along which wounded Soldiers may be expected to go back for medical care from a
combat position.
mass casualty
Any large number of casualties produced in a relatively short period of time, usually as the result of a
single incident such as a military aircraft accident, hurricane, flood, earthquake, or armed attack that
exceeds local logistic support capabilities.
(JP 4-02)
*medical evacuation
The process of moving any person who is wounded, injured, or ill to and/or between medical treatment
facilities while providing en route medical care.
medical regulating
The actions and coordination necessary to arrange for the movement of patients through the roles of
care and to match patients with a medical treatment facility that has the necessary health service
support capabilities, and available bed space. (JP 4-02)
*medical treatment facility
(Joint) A facility established for the purpose of furnishing medical and/or dental care to eligible
individuals.
(JP 4-02)
(Army) Any facility established for the purpose of providing medical
treatment. This includes battalion aid stations, Role 2 facilities, dispensaries, clinics, and hospitals.
*nontransportable patient
A patient whose medical condition is such that he could not survive further evacuation to the rear
without surgical intervention to stabilize his medical condition.
*outpatient
A person receiving medical/dental examination and/or treatment from medical personnel and in a
status other than being admitted to a hospital. Included in this category is the person who is treated
and retained (held) in a medical treatment facility (such as a Role 2 facility) other than a hospital.
*patient
A sick, injured or wounded Soldier who receives medical care or treatment from medically trained
personnel.
*patient estimates
Estimates derived from the casualty estimate prepared by the personnel staff officer/assistant chief of
staff, personnel. The patient medical workload is determined by the Army Health System support
planner. Patient estimate only encompasses medical casualty.
*patient movement
The act of moving a sick, injured, wounded, or other person to obtain medical and/or dental care or
treatment. Functions include medical regulating, patient evacuation, and en route medical care.
*preventive medicine
The anticipation, prediction, identification, prevention, and control of communicable diseases
(including vector-, food-, and waterborne diseases), illnesses, injuries, and diseases due to exposure to
occupational and environmental threats, including nonbattle injury threats, combat stress responses,
and other threats to the health and readiness of military personnel and military units.
*resuscitative care
Advanced trauma management care and surgery limited to the minimum required to stabilize a patient
for transportation to a higher role of care.
*return to duty
A patient disposition which, after medical evaluation and treatment when necessary, returns a Soldier
for duty in his unit.
26 August 2013
FM 4-02
Glossary-5
Glossary
*stabilized patient
(1) Patient may require emergency intervention, but not surgery, within the next 24 hours. The
patient’s condition is characterized by a secure airway, control or absence of hemorrhage, shock
adequately treated, vital signs stable, and major fractures immobilized. Stabilization is a precondition
of extended duration evacuation (up to 24 hours). This includes, but is not limited to: (a) Ventilator.
(b) Physiologic monitors.
(c) Skull free of air or functioning drains in place.
(d) Chest tube functional
or x-ray free of pneumothorax.
(e) Oxygen requirement is acceptable.
(f) Functioning nasogastric
tube or absence of ileus.
(g) Bone fixator is acceptable.
(h) Plaster bi-valved.
(i) Pulses present after
vascular repair. Despite these definitive example characteristics, there are patients who do not fit these
descriptions, and yet may be considered stabilized—as always, this clinical decision is decided on
between the originating and receiving physicians.
(2) Patient whose condition may require emergency
interventions within the next 24 hours. The patient’s condition is characterized by a minimum of a
secured airway, control or absence of hemorrhage, treated shock, and immobilized fractures.
Stabilization is a necessary precondition for further evacuation.
(3) A patient whose airway is secured,
hemorrhage is controlled, shock is treated, and fractures are immobilized.
strategic aeromedical evacuation
That phrase of evacuation that provides airlift for patients from a theater to another theater or the
continental United States. (JP 4-02)
*tailgate medical support
An economy of force device employed primarily to retain maximum mobility during movement halts
or to avoid the time and effort required to set up a formal, operational treatment facility (for example,
during rapid advance and retrograde operations).
*theater evacuation policy
A command decision indicating the length in days of the maximum period of noneffectiveness that
patients may be held within the command for treatment. Patients that, in the opinion of a responsible
medical officer, cannot be returned to duty status within the period prescribed are evacuated by the
first available means, provided the travel involved will not aggravate their disabilities.
*triage
The medical sorting of patients. The categories are: MINIMAL (OR AMBULATORY)— those who
require limited treatment and can be returned to duty; IMMEDIATE—patients requiring immediate
care to save life or limb; DELAYED—patients who, after emergency treatment, incur little additional
risk by delay or further treatment; and EXPECTANT—patients so critically injured that only
complicated and prolonged treatment will improve life expectancy.
Glossary-6
FM 4-02
26 August 2013
References
SOURCES USED
These are the sources quoted or paraphrased in this publication.
GENEVA CONVENTIONS
These publications are available online at:
http://www.icrc.org/Web/Eng/siteeng0.nsf/htmlall/genevaconventions.
Convention (I) for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the
Field, 12 August 1949.
Convention (II) for the Amelioration of the Condition of Wounded, Sick and Shipwrecked Members of
Armed Forces at Sea, 12 August 1949.
Convention (III) relative to the Treatment of Prisoners of War, 12 August 1949.
Convention (IV) relative to the Protection of Civilian Persons in Time of War, 12 August 1949.
DOCUMENTS NEEDED
These documents must be available to the intended users of this publication.
This publication is available online at: http://www.dtic.mil/doctrine
JP 1-02, Department of Defense Dictionary of Military and Associated Terms, 8 November 2010.
This publication is available online at: http://armypubs.army.mil/doctrine/ADP_1.html.
ADP 1-02, Operational Terms and Military Symbols, 31 August 2012.
READINGS RECOMMENDED
These sources contain relevant supplemental information.
NORTH ATLANTIC TREATY ORGANIZATION STANDARDIZATION AGREEMENTS
These publications are available online at: https://nsa.nato.int/protected (password required).
2060, Identification of Medical Material for Field Medical Installations, Edition 4, 27 March 2008.
2068, Emergency War Surgery, Edition 5, 12 September 2005.
2087, Medical Employment of Air Transport in the Forward Area, Edition 6, 30 October 2008.
2131, Multilingual Phrase Book for Use by the NATO Medical Services - Allied Medical Publication-
5(B), Edition 4, 2 March 2000.
2132, Documentation Relative to Medical Evacuation Treatment and Cause of Death of Patients,
Edition 2, 7 August 1974.
2228, Allied Joint Medical Support Doctrine - Allied Joint Publication-4.10(A), Edition 2, 3 March
2006.
2454, Road Movements and Movement Control - Allied Movement Publication-1(A), Edition 3,
27 January 2005.
2931, Orders for the Camouflage of Protective Medical Emblems on Land in Tactical Operations,
Edition 3 - Allied Tactical Publication-79, Edition A, 12 March 2013.
2939, Minimum Requirements for Blood, Blood Donors and Associated Equipment, Edition 5,
8 February 2010.
3204, Aeromedical Evacuation, Edition 7, 1 March 2007.
Allied Joint Publication-4.10(A), Allied Joint Medical Support Doctrine, March 2006.
26 August 2013
FM 4-02
References-1
References
AMERICAN, BRITISH, CANADIAN, AND AUSTRALIAN ARMIES PUBLICATION AND STANDARD
These documents are available online at: http://www.abca-armies.org (password required).
256, Coalition Health Interoperability Handbook, Edition 2, 15 July 2009.
815, Blood Supply in the Area of Operations, Edition 1, 21 October 1991.
UNITED STATES CODE
This document is available online at: http://www.gpoaccess.gov/uscode/index.html
Title 10, United States Code, Armed Forces.
Title 32, United States Code, National Guard.
DEPARTMENT OF DEFENSE PUBLICATIONS
This document is available at: http://www.afhsc.mil/policyJCS
Joint Chiefs of Staff Memorandum MCM 0028-07, Procedures for Deployment Health Surveillance,
2 November 2007
These publications are available online at: http://www.dtic.mil/whs/directives/.
DODD 2310.01E, The Department of Defense Detainee Program, 5 September 2006.
DODD 2311.01E, DOD Law of War Program, 9 May 2006.
DODD 5101.9, DOD Executive Agent for Medical Materiel, 23 August 2004.
DODD 6400.4, DOD Veterinary Services Program, 22 August 2003.
DODD 6490.02E, Comprehensive Health Surveillance, 8 February 2012.
DODI 2310.08E, Medical Program Support for Detainee Operations, 6 June 2006.
DODI 3000.05, Stability Operations, 16 September 2009.
DODI 6000.16, Military Health Support for Stability Operations, 17 May 2010.
These publications are available online at: http://www.dtic.mil/doctrine/new_pubs/jointpub.htm.
JP 3-63, Detainee Operations, 30 May 2008.
JP 4-02, Health Service Support, 26 July 2012.
MULTISERVICE PUBLICATIONS
These publications are available online at: http://www.apd.army.mil
AR 190-8/Office of the Chief of Naval Operations Instruction 3461.6/Air Force Joint Instruction
31-304/Marine Corps Order 3461.1, Enemy Prisoners of War, Retained Personnel, Civilian
Internees and Other Detainees, 1 October 1997.
FM 3-24/Marine Corps Warfighting Publication 3-33.5, Counterinsurgency, 15 December 2006.
*TM 4-02.70/Navy Medical Publication-5120/Air Force Manual 41-111_IP, Standards for Blood
Banks and Transfusion Services, 15 March 2011.
*TM 8-227-3/Navy Medical Publication-5101/Air Force Manual 41-119(I), The Technical Manual of
AABB (Formerly American Association of Blood Banks), 1 August 2011.
These publications are available online at: http://armypubs.army.mil/med/index.html
TM 8-227-11/Navy Medical Publication-5123/Air Force Instruction 44-118, Operational Procedures
for the Armed Services Blood Program Elements, 1 September 2007.
TM 8-227-12/Navy Medical Publication-6530/Air Force Handbook 44-152_IP, Armed Services Blood
Program Joint Blood Program Handbook, 1 December 2011.
ARMY PUBLICATIONS
These publications are available online at: http://www.apd.army.mil
ADP 3-0, Unified Land Operations, 10 October 2011.
ADP 3-07, Stability, 31 August 2012.
References-2
FM 4-02
26 August 2013

 

 

 

 

 

 

 

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