FM 4-02 FORCE HEALTH PROTECTION IN A GLOBAL ENVIRONMENT (FEBRUARY 2003) - page 5

 

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FM 4-02 FORCE HEALTH PROTECTION IN A GLOBAL ENVIRONMENT (FEBRUARY 2003) - page 5

 

 

FM 4-02
TOE NUMBER
NOMENCLATURE
08855A000
Combat Support Hospital (EAC) (Nonsplit Base)
08856A000
Headquarters and Headquarters Detachment, Combat Support Hospital (Nonsplit Base)
08857A000
Hospital Company, 164 Bed (Nonsplit Base)
08858A000
Hospital Company, 84 Bed (Nonsplit Base)
08949A000
Medical Detachment, Minimal Care
08955A000
Combat Support Hospital (284 Bed) (Corps)
08956A000
Headquarters and Headquarters Detachment, Combat Support Hospital (Corps)
08957A000
Hospital Company (164 Bed) (Corps)
08958A000
Hospital Company (84 Bed) (Corps)
G-4. Force XXI—Tables of Organization and Equipment Numbers and Nomenclature
TOE NUMBER
NOMENCLATURE
08108F300
Brigade Support Medical Company
08158F000
Medical Company (Forward Support Battalion) (Force XXI)
08257F000
Medical Company (Division Support Battalion) (Force XXI)
G-4
FM 4-02
APPENDIX H
ANTITERRORISM, FORCE PROTECTION,
AND FIELD DISCIPLINE
H-1. Protection
Protection is the preservation of the fighting potential of a force so the commander can apply maximum
force at the decisive time and place. Protection is comprised of four components: force protection, field
discipline, safety, and fratricide avoidance. Force protection, the primary component of protection,
minimizes the effects of enemy firepower (including NBC weapons), maneuver, and information. Field
discipline precludes losses from hostile environments (OEH hazards to include TIMs) and disease. Safety
reduces the inherent risk to the soldier’s life, health, and mission accomplishment caused by the operational
environment. Fratricide avoidance minimizes the inadvertent killing or maiming of soldiers by friendly
fires. For an in-depth discussion of protection refer to FM 3-0 and FM 100-14.
H-2. Force Protection
Force protection consists of those actions taken to prevent or mitigate hostile actions against DOD personnel
(to include family members), resources, facilities, and critical information. Force protection does not
include actions to defeat the enemy or protect from accidents, weather, and disease. It includes air, space,
and missile defense; NBC defense; antiterrorism; defensive information operations; and security for
operational forces and resources.
a. Force protection is a complex process in which each action impacts upon many others.
Planning for force protection is a continuous process. Force protection in stability operations and support
operations scenarios can pose significant challenges as interaction with and proximity to the HN civilian
population is greater than in the other types of military operations.
b. The HSS commander is responsible for providing security for his unit and the patients under
his care. In some scenarios, a combat or CS unit may provide security forces to assist in the defense of HSS
units. In other situations, the HSS unit may not be collocated with other types of CSS units and the HSS
commander must then provide completely for his own security.
c.
In stability operations and support operations, medical units may be deployed into a given
geographical area prior to the deployment of combat and CS forces. During FHA and disaster relief
operations, the perceived terrorist threat may be low, but the commander must ensure that his security
measures are adequate for the appropriate threat level. Further, he must ensure he has the capability to
increase these protective measures should the operational scenario change and mission creep occur. If the
political, social, or economic status of the HN or region deteriorates, an increase in the potential for
terrorist activity may also be experienced. The HSS commander must continuously evaluate the potential
for terrorist activity and adjust his force protection plan accordingly. Further, commanders must appreciate
the reality, that deployed US forces are always a target for terrorist attack, as they represent the US
presence abroad.
d. Unit and individual protective measures are discussed in detail in Joint Pub 3-07.3.
H-1
FM 4-02
H-3. Force Protection and the Risk Management Process
a. Assessment of asymmetric threats and vulnerabilities via force protection planning is
fundamental to full spectrum operations. Risk management (Appendix D) integrates force protection
planning into the operations process. Commanders and staffs employ risk management to identify, assess,
and control risks that arise from operational factors. By doing so, they are better able to make an informed
decision and reduce hazards.
b. Force protection adapts the risk management process (FM 100-14) to specific threats and
identifies vulnerabilities and countermeasures. The MDMP integrates force protection simultaneously with
other risk management considerations. Asymmetric threat considerations have direct impact on COA
development and analysis. These vulnerabilities and subsequent countermeasures are integrated into the
operational planning process through risk management assessments and factors at the same time as other
hazards and controls are considered.
c.
Force protection is risk management adapted to the nonbattlefield threat spectrum. It supports
risk management throughout the operations process and directly supports risk management in the MDMP
and troop leading procedures. Protection of critical personnel and resources from asymmetric means,
weapons, and tactics complement the hazard identification and assessment process of risk management.
d. However, force protection differs from risk management, also. Risk management addresses
the potential hazards to US forces described in the field discipline, safety, and fratricide avoidance
components of protection. Force protection employs threat-based assessment and links those threats to
specific vulnerabilities. The force protection component adapts the risk management process and applies it
to threat assessment and countermeasures employment. It specifically addresses asymmetric action by
enemy forces and other groups or individuals against US forces. By specifically addressing potential
asymmetric threats, force protection considerations compliment risk management and assist the commander
in fully visualizing and describing the operation.
H-4. Vulnerability Assessments
a. Vulnerability assessments are essential to force protection planning. They provide the
commander a tool to determine potential vulnerability of a unit. The assessment primarily focuses on the
functions or activities vulnerable to attack by identified threats and critical to success of the mission. There
are two types of vulnerability assessments: internal and external. The internal vulnerability assessment is
conducted by the unit commander and focuses specifically on the unit mission, operations, location, property,
and personnel. An external assessment is normally conducted by a higher headquarters for all of its
subordinate units/elements.
b. Each vulnerability assessment should consider, at a minimum, the following:
• Criticality assessment of facilities and resources.
• Unit security procedures.
H-2
FM 4-02
• Physical and operational security procedures.
• Information systems vulnerability.
• Structural engineering of buildings and facilities.
• Infrastructure vulnerabilities.
• High risk personnel.
• Nuclear, biological, and chemical capabilities/weapons and potential for use by enemy
and/or terrorists.
• Drinking water systems.
• Weapons effects to personnel, facilities, or resources.
H-5. Field Discipline
Field discipline, the second component of protection, guards soldiers from the physical and psychological
effects of the environment. Oppressive environments (adverse terrain, OEH hazards [heat, cold, altitude,
TIMs]), DNBI, and other elements of the medical threat (such as stress, continuous operations, or poisonous
and/or toxic flora and fauna [plants, animals, and arthropods]) can sap soldier strength and morale far more
quickly than enemy action. Commanders take every measure and precaution to keep soldiers healthy and
maintain their morale. This is especially true for HSS commanders as they are responsible for their own
assigned/attached HSS personnel and must also ensure that proactive HSS measures are planned and
implemented (such as medical surveillance activities, PVNTMED programs, COSC programs, and the like
encompassing all AMEDD functional areas) to sustain the health of the command.
H-6. Combatting Terrorism
There are two elements of combatting terrorism—counterterrorism and antiterrorism. Counterterrorism are
those offensive measures taken to prevent, deter, and respond to terrorism. Health service support personnel
do not participate in counterterrorism operations, however, they provide the HSS to the forces conducting
these types of operations. Antiterrorism operations are defensive in nature and the responsibility of each
commander, leader, and soldier.
H-7. Terrorism Considerations
a. As commanders and staffs address terrorism, they must consider several relevant characteristics
of terrorists and their activities. The first consideration is that anyone can be a victim.
(Some terrorists still
operate under cultural restraints, such as a desire to avoid harming women, but the planner cannot count on
H-3
FM 4-02
that.) Essentially, there are no innocents. Secondly, attacks which may appear to be senseless and random
are not. To the perpetrators, their attacks make perfect sense. Acts, such as bombing public places of
assembly and shooting into crowded restaurants, heighten public anxiety and is the terrorists’ immediate
objective. By catastrophic events, such as those occurring on September 11, 2001 with the devastation of
the World Trade Center in New York City and the attack on the Pentagon in Washington, D.C., the
terrorists struck at the pulse of world finance and at the foundations of freedom within the nation. Thirdly,
the terrorists need to publicize their attack. If no one knows about it, it will not produce fear. The need for
publicity often drives the target selection; the greater the symbolic value of the target, the more publicity the
attack brings to the terrorists and the more fear it generates. Finally, a leader planning for antiterrorism
must understand that he cannot protect every possible target all of the time. He must also understand that
terrorists will likely shift from more protected targets to less protected ones. This is the key to defensive
measures.
b. Preventive and protective security measures should be taken by military units and individual
soldiers to protect themselves and their ability to accomplish their mission. The commander develops an
antiterrorism plan to institute passive defense measures. The commander must constantly evaluate security
plans and measures against the terrorist threat in order to effectively identify security requirements. The
commander must conduct an overall vulnerability assessment taking into account the various elements
discussed in paragraph H-4b.
c.
Medical units have specific protections afforded to them under the provisions of the Geneva
Conventions. The HSS commander must understand that these protections probably will not be recognized
nor adhered to by terrorist elements. The HSS commander, in developing his force security plan, should
not rely upon the Geneva Conventions prohibitions as a protection from attack by terrorist elements.
d. Terrorists rely on surprise and the victim’s confusion at the time of the incident. Antiterrorism
involves physical security, OPSEC, and the practice of personal protective measures by all personnel.
Commanders and staffs must plan their response to terrorist threats and incidents. Combatting terrorism is
an aspect of force protection and is the responsibility of commanders at all levels at all times. Properly
planned and executed, the Army antiterrorism program will reduce the probability of surprise while
discouraging attack by raising the risk to the attackers.
H-8. Estimate of the Situation for a Security Assessment
The commander and his staff should complete a thorough estimate of the situation, using METT-TC and
political planning factors, in developing a security assessment. The questions presented in Table H-1 may
assist in formulating the estimate.
Table H-1. Mission, Enemy, Terrain and Weather, Troops and Support Available,
Time Available, and Civil Considerations and Political Planning Factors
MISSION
1. WHAT TYPE OF MISSION IS TO BE CONDUCTED (SUCH AS FHA, MASS CASUALTY SITUATION,
DISASTER RELIEF, PEACEKEEPING, DSO, OR CONVENTIONAL HSS)?
2. WHERE IS THE MISSION TO BE PERFORMED (SUCH AS WITHIN A SECURE COMPOUND, IN
LOCAL VILLAGES/CITIES, OR IN A FIELD ENVIRONMENT)?
H-4
FM 4-02
Table H-1. Mission, Enemy, Terrain and Weather, Troops and Support Available,
Time Available, and Civil Considerations and Political Planning Factors (Continued)
MISSION (CONTINUED)
3.
IS THE ENTIRE UNIT OPERATING TOGETHER (SUCH AS ESTABLISHING A LEVEL II MTF), OR
ARE SEPARATE TEAMS/ELEMENTS BEING DEPLOYED TO REMOTE LOCATIONS (SUCH AS A
TREATMENT TEAM VISITING AN ISOLATED VILLAGE OR ESTABLISHING A CCP)?
4.
IS THIS A MMTF MISSION WHERE HSS UNITS ARE DEPLOYED TO AN AREA PRIOR TO
COMBAT AND CS FORCES?
5.
ONCE DEPLOYED, DOES A CHANGE OF MISSION OR MISSION CREEP OCCUR?
ENEMY (OPPOSITION
1.
WHO ARE THE POTENTIAL TERRORISTS?
GROUPS, TERRORIST
2.
WHAT IS KNOWN ABOUT THE TERRORISTS?
FACTIONS)
3.
HOW DO THE TERRORISTS RECEIVE INFORMATION?
4.
HOW MIGHT THE TERRORISTS ATTACK? (THINK LIKE THE TERRORIST. WOULD YOU
AMBUSH OR RAID? WOULD YOU USE SNIPERS, MORTARS, ROCKETS, AIR OR GROUND
ATTACKS, SUICIDE ATTACKS, FIREBOMBS, OR BICYCLE, CAR, OR TRUCK BOMBS?)
5.
WHAT AND/OR WHO ARE POTENTIAL TARGETS? IF YOUR FIRST CHOICE OF THE POTENTIAL
TARGET IS WELL PROTECTED, WHAT WOULD BE AN ALTERNATE TARGET?
6.
WHAT POTENTIAL TACTICS WOULD THE TERRORIST USE (SUCH AS REMOTE CONTROL
DEVICES OR TIMING MECHANISMS; BOMBING A TARGET IN A CONGESTED AREA SO THERE
ARE MANY INJURED AND WOUNDED AND SETTING A SECOND EXPLOSIVE DEVICE TO
DETONATE AFTER FIRST RESPONDERS [SUCH AS EMERGENCY MEDICAL PERSONNEL]
ARRIVE ON THE SCENE; OR DISPERSING ANTIPERSONNEL MINES AND/OR BW AND CW
AGENTS IN HEAVILY POPULATED AREAS)?
7.
DOES THE UNIT HAVE ROUTINES OR PUBLISHED OPERATING HOURS (SUCH AS STATED
CLINIC HOURS FOR THE CARE OF HN PERSONNEL OR HOSPITAL SHIFT CHANGES)?
8.
WILL AN ATTACK GAIN SYMPATHY FOR THE TERRORISTS FROM THE POPULATION BEING
SUPPORTED?
9.
WHAT IS THE PERCEIVED TERRORIST THREAT POTENTIAL FOR VIOLENCE AND THE LEVEL
OF ANTICIPATED VIOLENCE (SUCH AS PERSONAL ATTACKS, AMBUSHES, OR KIDNAPPING
USING SMALL ARMS AND AUTOMATIC WEAPONS VERSUS THE USE OF WMD/NBC
WEAPONRY)?
TERRAIN (AND
1.
WHAT ARE THE STRENGTHS/WEAKNESSES OF THE UNIT AREA AND LOCAL SURROUNDINGS
WEATHER)
(SUCH AS URBAN VERSUS RURAL OR THE EXTENT OF NATURAL BARRIERS AND/OR
SHIELDING [SUCH AS CAVES, RAVINES, AND BASEMENTS])?
2.
WHAT ARE THE AVENUES OF APPROACH (IS TRAFFIC CANALIZED DUE TO MAN-MADE OR
NATURAL TERRAIN FEATURES? DO THE AVENUES OF APPROACH AFFORD COVER AND
CONCEALMENT FOR ENEMY MOVEMENT)?
3.
ARE THERE OBSERVATION AREAS, DEAD SPACES, FIELDS OF FIRE, ILLUMINATION, OR NO-
FIRE AREAS?
4.
ARE THERE TALL BUILDINGS, WATER TOWERS, OR TERRAIN, EITHER EXTERIOR OR
ADJACENT TO THE PERIMETER THAT COULD BECOME CRITICAL TERRAIN IN THE EVENT OF
AN ATTACK?
5.
WHEN TEAMS MUST BE DEPLOYED TO OUTLYING AREAS TO ACCOMPLISH THE MISSION
(SUCH AS PROVIDING FHA TO VILLAGES WITHOUT MEDICAL RESOURCES), WHAT IS THE
CONDITION OF THE ROADS AND TERRAIN THAT MUST BE TRAVERSED (SUCH AS PAVED
ROADS OR UNIMPROVED DIRT TRACKS)? ARE AVIATION ASSETS REQUIRED? WHAT IS THE
POTENTIAL FOR ATTACK WHILE IN TRANSIT?
6.
ARE WEATHER CONDITIONS CONDUCIVE TO THE USE OF BW AND CW AGENTS?
TROOPS
1.
DETERMINE WHAT THE FRIENDLY SITUATION IS.
2.
ARE OTHER US, ALLIED, COALITION, OR HN FORCES AND EQUIPMENT AVAILABLE?
3.
ARE MILITARY POLICE, ENGINEERS, OR OTHER COMBAT/CS RESOURCES AVAILABLE TO
PROVIDE FORCE PROTECTION FOR DEPLOYED MEDICAL UNITS/ELEMENTS?
4.
ARE THERE MWD TEAMS AVAILABLE TO CONDUCT SEARCHES FOR EXPLOSIVE MATERIALS
IN THE UNIT AREA?
5.
WHAT ARE THE HN’S RESPONSIBILITIES, CAPABILITIES, AND ATTITUDES TOWARD
PROVIDING ASSISTANCE?
H-5
FM 4-02
Table H-1. Mission, Enemy, Terrain and Weather, Troops and Support Available,
Time Available, and Civil Considerations and Political Planning Factors (Continued)
TROOPS (CONTINUED)
6. WHAT ARE THE ROE?
TIME
1. WHAT IS THE DURATION OF THE MISSION?
2. ARE THERE TIME CONSTRAINTS?
3. WILL THERE BE SUFFICIENT TIME TO CONSTRUCT FORCE PROTECTION FACILITIES (SUCH
AS BARRIERS AND FENCES AND THE INSTALLATION OF LIGHTS)?
4. WHAT IS THE OPTEMPO (SUCH AS CONTINUOUS OPERATIONS)?
CIVILIAN CONSIDER-
1. ARE THERE HN CONCERNS OR ATTITUDES WHICH WILL IMPACT ON THE SITUATION?
ATIONS AND POLITICAL 2. WILL THE SITUATION BE INFLUENCED BY THE EXISTENCE OF ANY RELIGIOUS, ETHNIC, OR
PLANNING FACTORS
CULTURAL CONCERNS?
3. IS THE ACCOMPLISHMENT OF THE HSS MISSION ALLEVIATING PART OF THE REASON FOR
THE UNREST WITHIN THE COUNTRY (SUCH AS BETTER ACCESS TO HEALTH CARE OR
CURBING MORBIDITY AND MORTALITY RATES FOR CHILDREN)?
4. IS ASSISTANCE AVAILABLE FROM NGOs OR INTERNATIONAL ORGANIZATIONS (SUCH AS
THE UN)?
5. WHAT TYPE OF MEDICAL CARE WILL BE PROVIDED TO HN AND/OR OTHER CIVILIANS (SUCH
AS PERMITTING HN CIVILIANS TO ENTER THE BASE/UNIT AREA FOR MEDICAL ASSESS-
MENTS FOR EMERGENCY CARE TO STABILIZE LIFE-, LIMB-, OR EYESIGHT-THREATENING
MEDICAL CONDITIONS [REFER TO APPENDIX F FOR A DISCUSSION OF ELIGIBILITY FOR
CARE])?
H-6
FM 4-02
APPENDIX I
SPECIAL MEDICAL AUGMENTATION RESPONSE TEAMS
I-1.
Introduction
a. This appendix contains brief descriptions of SMARTs. These teams provide a rapidly available
asset to compliment the need to cover the full spectrum of military medical response locally, nationally, and
internationally. These teams are organized by the USAMEDCOM and its subordinate commands; they are
not intended to supplant TOE units assigned to US Army Forces Command (USAFORSCOM) or other
major commands. The USAMEDCOM, RMCs, USACHPPM, USAMRMC, and US Army Veterinary
Command (USAVETCOM) commanders organize SMARTs using their TDA assets. These teams enable
the commander to field standardized modules in each of the SMART functional areas to meet the
requirements of the mission.
b. The types of SMARTs include—
• Trauma/Critical Care (SMART-TCC).
• Nuclear/Biological/Chemical (SMART-NBC).
• Stress Management (SMART-SM)
• Medical Command, Control, Communications, and Telemedicine (SMART-MC3T).
• Pastoral Care (SMART-PC)
• Preventive Medicine/Disease Surveillance (SMART-PM).
• Burn (SMART-B).
• Veterinary (SMART-V).
• Health Systems Assessment and Assistance (SMART-HS).
• Aeromedical Isolation (SMART-AIT).
c.
These teams provide military support to civil authorities during disasters, CMO, and
humanitarian and emergency services incidents occurring in the US, its territories and possessions, and
OCONUS unified commands AORs.
I-2.
Responsibilities
a. As stated above, the SMARTs will be standardized and formalized within the TDA assets of
the USAMEDCOM and its subordinate commands. The responsibilities for organizing, training, and
equipping these SMARTs are as follows:
I-1
FM 4-02
(1) Headquarters, Department of the Army, The Surgeon General
(HQDASG)/
USAMEDCOM, Assistant Surgeon General, Force Protection has the overall responsibility for the SMART
program and is also responsible for fielding four SMART-HSs.
(2) Each RMC is responsible for fielding one each of the following teams:
• SMART-TCC.
• SMART-NBC.
• SMART-SM.
• SMART-MC3T.
• SMART-PC.
(3) The USAMRMC is responsible for fielding two each:
• SMART-B.
• SMART-HS.
• SMART-AIT.
(4) The USACHPPM is responsible for fielding three SMART-PMs.
(5) The USAVETCOM is responsible for fielding four SMART-Vs.
b. One or more teams may be deployed on a specific mission. The senior medical person
deployed (unless otherwise designated) provides the HSS C2 required. He is also responsible for
coordinating the teams’ effort for mission accomplishment.
I-3.
Requests for Assistance
Requests for assistance may be generated from numerous sources to MEDCOM. These requests are
received using appropriate, recognized, and approved channels. These sources may include—
• Director of Military Support (DOMS).
• United States Joint Forces Command.
I-4.
Team Composition and Specialty-Specific Equipment
a. The USAMEDCOM determines the composition of each team and identifies the specialty-
specific equipment required to accomplish the mission. The composition of the team is task-organized
I-2
FM 4-02
based on the METT-TC and medical risk analysis in order to provide the appropriate level of response and
technical augmentation to civil and military authorities. This information is provided to its subordinate
commands through appropriate command policy statements, directives, or SOPs.
b. These teams may be comprised of active duty military, DOD civilians, or contractors as
determined by the commander.
I-5.
Deployability and Continuous Operations
a. Within 12 hours of notification, the SMARTs will be alerted, issued a warning order
(WARNO), and assembled; within 12 hours of the WARNO the SMARTs will be capable of deploying.
b. The SMARTs are not capable of 24-hour continuous operations. To conduct continuous
operations the deployed SMARTs require augmentation/reinforcement of both personnel and materiel or
support from follow-on medical specialty personnel.
I-6.
Trauma/Critical Care Team
The SMART-TCC is capable of providing technical expertise to local first responders in the areas of triage,
assessment, and ATM of mass casualties with severely injured casualties. When required, it may also assist
in providing direct patient care using existing on-site resources and facilities. Further, this team can assess
what follow-on specialty skills are required to enhance the care of the victims, provide guidance to the
management staff on trauma/critical care requirements, provide consultation to other health professionals at
the incident site, and assist in developing a trauma/critical care transition plan for return to normal health
care operations.
I-7.
Nuclear/Biological/Chemical Team
The SMART-NBC provides technical advice and support augmentation to local medical authorities in the
detection, neutralization, and containment of chemical, biological, radiological or associated hazardous
materials in accidental and WMD-related incidents. It also provides assistance to local authorities during
crisis management and consequence management phases of an operation. This team’s capabilities include—
• Technical expertise in response preparation; personal and patient protection measures; patient
decontamination; and initial medical treatment and patient management.
• On-scene technical advice and support augmentation during crisis management and
consequence management operations.
• Assistance to civil authorities in determining and/or acquiring follow-on medical resources,
supplies, and equipment necessary to resolve the incident.
I-3
FM 4-02
• Assistance to authorities in developing a transition plan which facilitates an orderly return to
pre-incident operations.
• Level 1 protection for team members for a 24-hour period.
I-8.
Stress Management Team
The SMART-SM provides augmentation to local medical authorities in the management of stress-related
casualties associated with disaster and mass casualty situations. The capabilities of the SMART-SM are to
provide—
• Technical expertise in stress casualty triage, treatment, and evacuation. This includes providing
initial assessment of stressors, stress responses, and psychological trauma issues; providing initial assessment
of stress and mental health requirements; and, advising commanders or local medical authorities on MH and
stress issues resulting from the incident.
• Assistance to civil authorities in determining follow-on specialty skills and medical resources
required to resolve the incident.
• Assistance to authorities in developing a stress management transition plan which facilitates
the orderly return to pre-incident operations.
I-9.
Medical Command, Control, Communications, and Telemedicine Team
The SMART-MC3T provides command, control, and communications to any deployed SMARTs, as well
as providing telemedicine augmentation (technical advice and support) to local medical authorities in
disaster/mass casualty incidents. The capabilities of this team are to provide—
• Initial on-scene incident assessment.
• Capabilities to task-organize and call forward additional tailored teams, supplies, and
equipment.
• Basic man-portable communications equipment sufficient to communicate intra- and interteam
and back to the home station.
• Technical expertise and man-portable telemedicine equipment sufficient to install, operate,
and maintain a rudimentary, emergency telemedicine capability from a remote site.
• Assistance to civil authorities in communicating emergency patient and provider needs and
providing local authorities with medical situational awareness.
I-4
FM 4-02
I-10. Pastoral Care Team
Upon being alerted, the team assembles and deploys within 12 hours from any of their pre-positioned sites.
This team also provides professional religious augmentation (technical advice and support) to local medical
authorities in the management of events, incidents, and consequences associated with critical events, trauma
ministry, mass casualty ministry, and spiritual assessment.
I-11. Preventive Medicine/Disease Surveillance Team
a. The mission of the SMART-PM is to provide initial disease and OEH threat assessments. This
is accomplished prior to or in the initial stages of a contingency operation, or during the early or continuing
assistance stages of a disaster.
b. Although the basic SMART-PM is standardized, the SMART-PM may be tailored to the
requirements of the specific mission if the Commander, USAMEDCOM, determines additional specialties
are needed. It can—
• Perform on-site initial health threat assessments; perform limited and rapid health hazard
sampling, monitoring, and analysis; and, health risk characterization and needs assessment for follow-on
PVNTMED specialty or other medical treatment support in the AO.
• Prepare PVNTMED estimates.
• Perform analysis of, but not limited to—
Endemic and epidemic disease indicators within the AO.
Environmental toxins related to laboratories, production and manufacturing facilities,
nuclear reactors, or other industrial operations.
Potential NBC hazards.
• Provide medical threat information and characterize the health risk to deployed forces or
civilian populations.
• Provide guidance to and assist local health authorities with surveying, monitoring,
evaluating, and controlling health hazards relative to naturally occurring and man-made disasters.
c.
The SMART-PM may—
• Request information from the AFMIC, WHO, and other agencies with endemic disease
and environmental effects information to prepare their database for the AO.
• Request information from the CDC (in the event of a national disaster) to establish a
baseline for determining the impact of the disaster.
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FM 4-02
• Determine the need for follow-on medical specialty teams or PVNTMED detachments to
definitively characterize the operational force health risks associated with domestic disasters, terrorist
incidents, foreign deployments, or other contingency operations.
• Elect to use telemedicine reach back, or request assistance from appropriate domestic,
foreign, or international response assets after the initial assessment is completed.
• Provide public health and environmental health engineering expertise in the areas of—
Environmental health.
Epidemiology and disease surveillance.
Toxicology.
Entomology.
Health physics (nuclear/radiological).
Industrial hygiene.
Water quality.
Clinical PVNTMED.
Sanitation.
Solid and hazardous waste management.
Food service sanitation.
I-12. Burn Team
The SMART-B provides technical advice and support to local medical authorities in the triage, treatment,
stabilization, care, and evacuation of burn patients associated with disaster/mass casualty incidents. The
capabilities of the SMART-B include providing—
• Technical expertise in burn triage, advanced burn resuscitation, trauma management, and
evacuation.
• Emergency medical care using on-scene facilities and resources and backpack/hand-carried
trauma kits.
• Assistance to civil authorities in determining follow-on specialty skills and medical resources
required to resolve the situation.
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FM 4-02
• Assistance to authorities in developing trauma/critical care transition plan which facilitates an
orderly return to health care delivery.
I-13. Veterinary Team
a. The mission of the SMART-V is to assess the degree of existing destruction and/or impending
risk and to determine recommended follow-on actions relative to animal health and food safety. The
SMART-V also—
• Advises local first responders on food safety and veterinary PVNTMED issues.
• Advises local first responders on triage and treatment of injured animals.
• Provides limited triage and emergency treatment of injured animals including lifesaving
emergency procedures, or when appropriate, euthanasia to prevent undue suffering of those cases
encountered during the assessment process.
• Provides veterinary care for MWDs (such as search and rescue dogs); when authorized,
it also provides care to other government-owned and nongovernmental agencies’ animals participating in the
operation.
b. The SMART-V can—
• Assess food contamination and potential for foodborne illness outbreaks.
• Determine the magnitude of animal involvement in public health and zoonotic disease
threat.
• Make initial assessment and recommend corrective actions.
• Provide liaison with follow-up relief organizations/agencies.
• Assist in establishing control for the AO.
• Coordinate with all known animal medicine/food safety agencies and organizations in the
AO.
I-14. Health Systems Assessment and Assistance Team
The SMART-HS provides augmentation to local medical authorities in health system-wide and facility
infrastructure assessment and reconstitution. The capabilities of this team include—
• Full spectrum health facility medical architecture/engineering advocacy, coordination,
assessment, planning assistance, and action.
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FM 4-02
• Technical expertise in health facility assessment and planning from facility physical plant
damage assessment to health facility and systems reconstitution, repair, and maintenance.
• Assistance to civil authorities in restoring the health care delivery system using hand-carried
equipment and resources.
• Assistance to authorities in developing a health facilities repair/reconstitution transition plan
which facilitates orderly return to pre-incident operations.
I-15. Aeromedical Isolation Team
a. Upon being alerted, the team assembles and deploys within 12 hours from any of their pre-
positioned sites. Provides professional aeromedical augmentation (technical advice and support) to local
medical authorities in the management of events, incidents and consequences associated with transporting
infected/contagious patients.
b. Provides a rapid response evacuation unit to any area of the world to transport a maximum of
two patients simultaneously.
c.
Provides patient care under conditions of biological contamination for soldiers or authorized
civilians exposed to or infected with certain contagious and highly dangerous diseases.
I-8
FM 4-02
APPENDIX J
FORCE HEALTH PROTECTION IN A GLOBAL ENVIRONMENT
FOR THE DIGITIZED FORCE
J-1.
Introduction
a. In a digitized environment, the HSS commander has significantly more information rapidly
available to him to support the warfighter. However, he must ensure that he clearly articulates his
information requirements to ensure that critical information is not lost because of information overloads.
b. One of the most important elements in planning for and conducting HSS operations is a
thorough understanding of the medical threat faced by the deployed force. It is essential, therefore, for the
HSS commander to conduct a comprehensive MIPB. Refer to Appendix B for additional information on
MIPB.
J-2.
Theater Army Medical Management Information System
The Theater Army Medical Management Information System (TAMMIS) is the current information
management system used by the HSL organizations at corps and EAC. The replacement for the logistics
portion of TAMMIS will be a joint system known as the Defense Medical Logistics Standard Support
(DMLSS). The medical maintenance portion of TAMMIS will be replaced by Global Combat Support
System-Army (GCSS-A) maintenance at Levels I through IV at some point and time in the future.
NOTE
Although TAMMIS is currently in use, this system is being phased
out and should be replaced within the next three years. New funding
for the improvement of the current system will no longer be appro-
priated.
a. Controlled accessibility is a TAMMIS feature included both to simplify the system and to
increase security. During system setup, the local manager establishes each user’s accessibility to the system
through system setup files; the user may review only the portion of the system that pertains to his job
responsibilities. The local manager can also adjust his unit’s system to accommodate local requirements and
the operating environment.
b. The TAMMIS has flexible communication capabilities and can relay information between
units in various ways. The preferred medium is via modem; however, direct communication between
computers through a local area network (LAN) or mobile subscriber equipment (MSE) may be used. When
direct electronic communications links are not available, users may pass information by courier via floppy
diskette, tape, or hard copy.
c.
For additional information refer to FM 4-02.1 and FM 8-10-16.
J-1
FM 4-02
J-3.
Medical Communications for Combat Casualty Care
a. The medical communications for combat casualty care (MC4) system is a future system which
is under development and which will lay the foundation for HSS of Force XXI and the Army, 2010 and
beyond. The MRI units were designed to use the enhanced communications and digital enablers that will be
available on the Army XXI battlefield. As the Army moves to the future and as long as soldiers are
involved, the HSS ten functional areas must still be accomplished (Chapter 5).
b. The MC4 system will be achieved by the integration of emerging information management
technologies with existing and emerging digital communications technologies. This new medical information
management system will start with the individual soldier and continue throughout the health care continuum.
The best way to visualize the MC4 system capability is as a piece of the Army digital computer network
where all ten HSS functional areas have been digitized and this HSS information is freely shared with
everyone in the Army network with a need to know. In fact, not only will the MC4 system provide Army
commanders with HSS information, but it will also provide commanders with a seamless transition to the
joint HSS environment. The Theater Medical Information Program (TMIP) is the software program that
will deliver HSS-specific software for the MC4 system, along with standardizing software business practices
DOD-wide.
J-4.
System Description
The MC4 system will be a worldwide, automated HSS system, which provides HSS commanders, health
care providers, and medical support providers, at all levels, with integrated medical information. The
system will provide digital enablers to link, both vertically and horizontally, all ten HSS functional areas.
The MC4 system will receive, store, process, transmit, and report medical C2, medical surveillance,
medical treatment, medical SU, and HSL data across all levels of care. This will be achieved through the
integration of a network of medical information systems linked through the Army data communications
structure. The MC4 system will be developed incrementally through rapid prototyping and the spiral
development process, which will process the system from limited functional capabilities to fully integrated
objective capabilities.
J-5.
Operational Concept
a. Soldier Level.
(1) Soldiers have long required the ability to carry medical information with them for
purposes of individual readiness, continuity of care, medical surveillance, and postdeployment health care
follow-up. Virtually all this critical medical information is currently documented on paper after the fact. In
order to become a part of the soldier’s permanent medical record, the pieces of paper must be physically
transported back to the soldier’s home station and then physically placed in that record. Because of weight,
preparation difficulties (rain, cold, darkness), and storage limitations, it is impossible to maintain a high
level of paper documentation during an operational deployment.
J-2
FM 4-02
(2) With the MC4 system, medical information about each soldier will be entered into a local
database maintained at the supporting BAS, medical company, or other MTF. This information will include
the soldier’s immunization status, medical deployability status, and dental deployability status. A
commander, faced with a deployment, will be able to simply query the database to gain the deployability
status of the entire command. Time previously spent on physically searching paper records will be
available for other tasks.
(3) With the MC4 system, each soldier will be issued a personal automated patient record; it
is an electronic device that will store personal information about the individual soldier. The specifications
for this device are addressed in a specific DOD requirements document, which incorporates Army
operational requirements into this standard joint device. The device will be used to record all of the
soldier’s health care events and the soldier’s readiness status. Each time a soldier receives medical care or
immunizations the medical history on the record will be updated. When a soldier is deployed, his personal
automated patient record will contain baseline clinical data. During processing for deployment the medical
staff will be able to read all of the immunization, medical, dental, and medical history data directly from the
record, greatly speeding up the process. Once in an operational theater, the soldier’s personal automated
patient record will continue to provide a backup record of all medical events that occur during the
deployment. Any medical data generated by a medical event will be entered onto the record as well as
being entered into the MC4 information system. The preservation of medical data will no longer rely on the
safeguarding and transporting of stacks of paper records.
(4) As part of the warrior program under the program manager soldier, a warfighter
physiological status monitor (WPSM) is under development. The WPSM will be a suite of external sensors
that will monitor a soldier’s vital signs. These sensors will feed the vital sign information to a body-worn
computer (also part of the warrior system). An artificial intelligence program on the computer will process
the vital sign information and will generate an alert if the vital signs fall outside of preset ranges. This alert
will be transmitted by the soldier’s warrior radio to the unit platoon leader/platoon sergeant and trauma
specialist, warning that the soldier may have become a casualty. In addition, the warrior system will also
provide a trauma specialist alert button that the soldier can press if he requires medical assistance. The alert
button will transmit a distress call to the platoon leader/platoon sergeant and trauma specialist. When either
alarm is activated, the vital sign information coming from the WPSM will automatically be broadcasted to
the trauma specialist as well as recorded onto the personal automated patient record. The WPSM and
warfighter ensemble are currently being designed for combat troops but a CSS model has been proposed.
b. Databases. With the MC4 system, medical information on soldiers will be stored at different
levels. This will allow commanders and command surgeons at the various levels to access medical
information on their soldiers to find out specific information and to conduct analysis of disease/injury
trends. These lower level databases also provide a means for information redundancy should an information
node be destroyed or a communications outage occur. Personnel (HSS commanders and staff surgeons) at
each level with the MC4 system management functionality will be able to query the database. The HSS
information required by the Combat Service Support Control System (CSSCS) will pass from the MC4
system through GCSS-A or directly to CSSCS.
(1) Personal automated patient record. The device will contain the medical information
relevant to one soldier.
J-3
FM 4-02
(2) Battalion aid station/forward support medical company/division support medical com-
pany/troop medical clinic/area support medical battalion/combat support hospital. Units responsible for
the treatment of soldiers will maintain a database containing medical information relevant to the soldiers that
it supports.
(3) Division surgeon/corps surgeon. The surgeons will maintain a database containing
medical information relevant to the soldiers in that division or corps respectively.
(4) Combatant commander’s surgeon. The combatant commander’s surgeon will maintain a
database containing all medical information relevant to the entire theater. This will be the interim theater
database (ITDB) which provides information to update sustaining base medical information systems such as
the computer-based patient record and medical surveillance system and is used for medical threat and trend
analysis.
c.
Level I.
(1) Trauma specialist. The trauma specialist will be the first point where a casualty interfaces
with the MC4 system. Each trauma specialist will be equipped with a computer capable of reading and
writing to the casualty’s personal automated patient record. Any medical care provided to the casualty by
the trauma specialist will be recorded on the personal automated patient record. Where communication
assets allow, this information will also be transmitted to the supporting BAS. Under the warrior program
trauma specialists assigned to maneuver battalions will have some additional capabilities. A warrior medic
version of the warrior ensemble is being developed with specific medical requirements. The warrior medic
ensemble will include a body-worn computer, a Global Positioning System (GPS) locator, and a warrior
radio. If a soldier’s WPSM/computer system broadcasts an alert or a soldier activates his medic call button,
the trauma specialist will receive these alerts and the flow of vital sign information over his warrior radio.
The trauma specialist’s GPS locator will allow the trauma specialist to quickly locate and reach the casualty.
The trauma specialist’s computer will be able to read vital signs directly from the casualty’s WPSM. All of
these capabilities will enhance the trauma specialist’s ability to quickly detect, reach, and treat a casualty.
In the event of multiple casualties, the flow of WPSM data to the trauma specialist will allow him to
prioritize the casualties using remote triage in order to reach the worst injured first.
(2) Evacuation. If a casualty’s injuries or illness require treatment beyond the trauma
specialist’s abilities, the casualty is evacuated to a higher level of medical care, most often the BAS.
Evacuation is accomplished via dedicated medical evacuation vehicles, wheeled or tracked ambulances, and
air ambulances (helicopters). During evacuation, onboard trauma specialists apply en route treatment and
monitor the casualty. Digital onboard medical equipment eliminates the difficulties with manual vital signs
monitoring which are oftentimes impossible. With the MC4 system, each evacuation vehicle will be
equipped with an onboard computer, which will interface with the casualty’s personal automated patient
record. En route care received will be recorded on the automated patient record, and will also be
transmitted to the destination MTF. Digital linkages to medical C2 units/MROs allow for redirecting the
casualty en route should the need arise. The request for evacuation from the trauma specialist’s site will be
made over Force XXI Battle Command Brigade and Below (FBCB2) utilizing a built-in medical evacuation
request.
J-4
FM 4-02
(3) Battalion aid station. At the BAS, the casualty will receive routine or emergency
resuscitative care. The medical staff will use MC4 computers to read the casualty’s personal automated
patient record, learning what medical care the casualty has already received and any relevant medical
history. This information, along with any information generated by the treatment that the casualty receives
at the BAS, will be recorded onto the local database. The information will also be transmitted to the next
higher level of medical care (the FSMC) and ultimately to the ITDB.
(4) Health service logistics. The present HSL system at Level I is a totally manual system.
Under MC4, the trauma specialist will utilize FBCB2 to request medical supplies from the BAS. This
request will be a built-in report on the FBCB2 system. At the BAS, requests for medical resupply will be
made utilizing the MC4 system. This automation will not only speed the resupply process, but will also
allow the combat commander to maintain visibility of his unit’s HSL status, either through FBCB2 or
through MC4’s link to CSSCS through GCSS-A.
d. Level II.
(1) At the Level II medical units (FSMCs and DSMCs), the MC4 system will provide the
same augmentations to treatment documentation, evacuation, and HSL that will be seen at Level I. Through
the use of the medical detachment, telemedicine (MDT), Level II medical companies will have the ability to
digitize medical data (x-rays, pictures, and so forth) and transmit it to medical experts at echelons above
division. This teleconsultation ability will result in some casualties being treated farther forward in the
theater, will increase the RTD rate, and will reduce overevacuation.
(2) The Medical Materiel Management Branch (MMMB) at the Division Materiel Manage-
ment Center (DMMC) is the Class VIII commodity manager and, using the same automated tools as the
other commodity managers, makes arrangements to fill the request through the battlefield distribution
system. The MC4 system will automate linkage of Class VIII to the transportation system. The management
of the complex MESs along with the quality control of Class VIII material is also automated, improving
efficiency over the current manual system. The joint software design supports the Army support to other
Services mission of Army HSL units.
e.
Levels III and IV. These levels contain hospitals and all of the specialized medical units
required to support the theater. The MC4 system will link all of these medical functions. The MC4 system
will equip corps treatment and evacuation teams with personally carried and mobile computers for the
collection and forwarding of medical information to the FSMC, MSMC, or ASMC. Likewise, COSC
teams, veterinary teams, dental teams, and PVNTMED teams operating in the brigade rear area will be
equipped with personally carried or mobile computers. These MC4 provided devices will be loaded with
the appropriate software functionality. Corps/theater MROs/medical C2 will be able to rapidly and
accurately match treatment capability with the soldier’s need for care. The MC4 corps medical regulating
system (TRANSCOM Regulating and Command and Control Evacuation System [TRAC2ES]) provides this
functionality via Warfighter Information Network (WIN). A seamless Class VIII (including blood)
automated system links the theater to the CONUS sustaining base.
f.
Command and Control. At all levels, the MC4 system will automatically provide information,
such as evacuation status, current fitness for combat, and hazard exposure information, to the commander’s
J-5
FM 4-02
SU system. The MC4 system will provide the commander with the ability to track and record the date and
location of exposure to health hazards, which include environmental, occupational, industrial, and NBC
hazards. This information is critical to the medical force protection health hazard analysis which is required
to identify emerging DNBI problems and trends and to develop PVNTMED measures to counter the
medical threat. Commanders will have real-time information on food source safety/quality, operationally
significant zoonotic diseases, health surveillance/trends, and near real-time health hazard assessment data
for NBC/endemic disease threats and occupational or environmental health threats. This information will
be provided to the HSS commander from the MC4 system functional digital systems through GCSS-A to
CSSCS. Commanders, for the first time, will have a complete picture of the battlefield, which will allow
them to accurately influence current operations while synchronizing HSS with other activities.
g. Level V. All care/exposure information will be digitally stored. The documentation of
immunizations, for example, will eliminate challenges that have surfaced postdeployment for vaccines such
as anthrax and botulism. This information is stored not only in the Level I database supporting the soldier,
but is transmitted to the ITDB and the soldier’s permanent computerized record. The digital documentation
of medical treatment/exposure information will make addressing health exposure issues, as seen in the Gulf
War and more recent deployments, much easier.
J-6
FM 4-02
GLOSSARY
ABBREVIATIONS, ACRONYMS, AND DEFINITIONS
> greater than
< less than
A2C2
Army airspace command and control
A&D
admission and disposition
AAFES Army and Air Force Exchange Service
ABCA American, British, Canadian, and Australian
AC active component/cyanide
ACOS American College of Surgeons
ACR armored cavalry regiment
ACSA Acquisition and Cross Servicing Agreement
adequate care Health care sufficient to provide the lowest possible mortality and morbidity rates for
wounded in action and nonbattle injury casualties in the theater force. Initial resuscitation
should be prompt, adequate, and at the point of injury or as far forward as tactically feasible. Those
soldiers who are wounded in action or suffering from nonbattle injury wil1 be treated and evacuated
as expeditiously as possible to the level of care required for initial wound therapy. Initial wound
surgery will consist of those procedures to stabilize neurological, vascular, bone and joint wounds
and injuries. Initial wound surgery for the less severe injuries may permit return to duty within the
stated theater evacuation policy. If not capable of returning to duty within the evacuation policy,
patients should be evacuated to a level of care capable of providing definitive care.
admin administrator
advanced trauma management (ATM) Resuscitative and stabilizing medical or surgical treatment pro-
vided 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.
AE aeromedical evacuation
AFMIC Armed Forces Medical Intelligence Center
AI area of interest
AIDS acquired immunodeficiency syndrome
AMEDD Army Medical Department
AML area medical laboratory
AO See area of operations.
AOE Army of Excellence
AOR area of responsibility
AR Army regulation
area of operations (AO) That portion of an area of conflict necessary for military operations. Areas
of operations are geographical areas assigned to commanders for which they have responsibility and
in which they have authority to conduct military operations.
ARF acute respiratory failure
ARSOF Army special operations forces
ASBPO Armed Services Blood Program Office
ASCC Army Service Component Command
ASD(HA) Assistant Secretary of Defense (Health Affairs)
ASF aeromedical staging facility
ASMB area support medical battalion
ASMC area support medical company
Glossary-1
FM 4-02
ASMD area support medical detachment
assign To place units or personnel in an organization where such placement is relatively permanent, and/
or where such organization controls, administers, and provides logistical support to units of per-
sonnel for the primary function or a greater portion of the functions of the unit or personnel.
(See
also attached; operational command; operational control; organic.)
ASTS aeromedical staging squadron
ASWBPL Armed Services Whole Blood Processing Laboratory
attach The temporary placement of units or personnel in an organization. Subject to limitations imposed
by the attachment order, the commander of the formation, unit or organization receiving the attach-
ment will exercise the same degree of command and control as he does over units and personnel
organic to his command. However, the responsibility for transfer and promotion of personnel will
normally be retained by the parent formation, unit, or organization.
(See also assign; operational
command; operational control; organic.)
ATM See advanced trauma management.
attn attention
augmentation
(1) The addition of specialized personnel and/or equipment to a unit, aircraft, or ship to
supplement the medical evacuation mission.
(2) The provision of personnel to accomplish task/
mission that organic personnel cannot accomplish in addition to their primary mission (example:
Nonmedical personnel detailed to a medical treatment facility to perform patient decontamination.)
AVSMC aviation support medical company
AXP ambulance exchange point
BAS battalion aid station
battle fatigue (BF) Also referred to as combat stress reaction or combat fatigue. Fatigue by definition is
the distress and impaired performance that comes from doing something (anything) too hard and/or
too long. The term battle fatigue is applied to any combat stress reaction which is treated the way
all fatigue is treated, with the four “Rs”—Reassure of normality, Rest (respite from the work),
Restoration of confidence through talk and activities, and Replenish of nutrition, and hydration,
hygiene and a sense of physical well-being.
bed-to-bed move Movement from a hospital (Level III or IV) to another hospital (Level III, IV, or V)
bed at the same or higher level of care. Requires transportation from the originating hospital to an
aeromedical staging facility, a wait there for an aircraft (or land or sea transportation), loading the
aircraft (or other mode), reception at the destination transportation node, and transportation to the
receiving hospital. Planning assumptions are that an intratheater bed-to-bed move requires up to
24 hours.
BF See battle fatigue.
biological warfare agent A biological warfare agent is a pathogen (microorganism capable of causing
disease) or toxin derived from a living organism that is deliberately used to produce disease or
death in humans, animals, or plants.
BOS battlefield operating system
BSA body surface area
BSMC brigade support medical company
BW biological warfare
C2
See command and control.
Glossary-2
FM 4-02
C3IC coalition coordination, communications, and integration center
C4I command, control, communications, computers, and intelligence
camouflage The use of concealment and disguise to minimize detection or identification of troops,
weapons, equipment, and installations. It includes taking advantage of the immediate environment
as well as using natural and artificial materials.
CASEVAC See casualty evacuation.
casualty evacuation (CASEVAC)
(1) This is the term used by nonmedical units to refer to the movement
of casualties aboard nonmedical vehicles or aircraft. En route medical care is not provided.
(2)
Casualty evacuation is a term used by nonmedical units to refer to the movement of casualties
aboard nonmedical vehicles or aircraft. Casualties transported in this manner do not receive en
route medical care.
CBRNE chemical, biological, radiological, nuclear, and high-yield explosive
cc cubic centimeters
CCAT critical care air transport
CCIR commander’s critical information requirements
CCM critical care management
CCP casualty collecting point(s)
(See also collecting point(s) [patient or casualty].)
CDC Centers for Disease Control and Prevention
chemical warfare agent A chemical substance which, because of its physiological, psychological, or
pharmacological effects, is intended for use in military operations to kill, seriously injure, or
incapacitate humans (or animals) through its toxicological effects. Excluded are riot control
agents, chemical herbicides, and smoke and flame materials. Chemical agents are nerve agents,
incapacitating agents, blister agents (vesicants), lung-damaging agents, blood agents, and vomiting
agents.
CHL combat health logistics
CHPPM Center for Health Promotion and Preventive Medicine
CHS combat health support
CIA Central Intelligence Agency
CJCS Chairman, Joint Chiefs of Staff
CLS See combat lifesaver.
CMO civil-military operations
CMS central material supply
COA course of action
collecting point(s) (patient or casualty) (CCP)
(1) A specific location where casualties are assembled
to be transported to an MTF; for example, a company aid post.
(2) A specific location where
casualties are assembled to be transported to an medical treatment facility. It is usually predesig-
nated and may be either staffed or not. The level designating the point provides the staffing.
combat lifesaver (CLS) Is a nonmedical soldier trained to provide enhanced first aid as a secondary
mission. Enhanced first aid procedures include, but are not limited to, initiating an intravenous
infusion, administering additional nerve agent antidote, and inserting an oropharyngeal airway.
Normally, one member of each squad, team, or crew is trained.
combat operational stress control (COSC) A coordinated program for the prevention, triage and treat-
ment of each level of battle fatigue to maximize rapid return to duty and minimize misconduct
stress reactions and post-traumatic stress disorders. This program is conducted by unit mental
health personnel plus echelon above division combat stress control units.
Glossary-3
FM 4-02
combat service support
(1) The support provided to sustain combat forces, primarily in the fields of
administration and logistics. It may include personnel support, religious support, finance support,
legal service and support, civil affairs, food service, maintenance, health service support, military
police, supply, transportation, and other logistical services. The basic mission of combat service
support is to maintain and support our soldiers and their weapon systems.
(2) The assistance
provided to sustain combat forces, primarily in the fields of administration and logistics. It includes
administrative services, chaplain services, civil affairs, food service, finance, legal services, main-
tenance, combat health support, supply, transportation, and other logistical services.
(3) The
essential capabilities, functions, activities, and tasks necessary to sustain all elements of operating
forces in theater at all levels of war. Within the national and theater logistic systems, it includes but
is not limited to the support rendered by Service forces in ensuring the aspects of supply, mainte-
nance, transportation, health services, and other services required by aviation and ground combat
troops to permit those units to accomplish their missions in combat. Combat service support en-
compasses those activities at all levels of war that produce sustainment to all operating forces on the
battlefield.
(Joint Pub 1-02)
combat support (CS) Fire support and operational assistance provided to combat elements. May include
artillery, aviation, military police, signal, and electronic warfare.
combat zone (CZ)
(1) That area required by combat forces for the conduct of operations. It is the
territory forward of the Army rear area boundary.
(2) That area required by combat forces for
the conduct of operations.
(Joint Pub 1-02)
combatant command A unified or specified command with a broad continuing mission under a single
commander established and so designated by the President, through the Secretary of Defense and
with the advice and assistance of the Chairman of the Joint Chiefs of Staff. Combatant commands
typically have geographic or functional responsibilities.
(Joint Pub 1-02)
combatting terrorism Actions, including antiterrorism (defensive measures taken to reduce vulnerability
to terrorist acts) and counterterrorism (offensive measures taken to prevent, deter, and respond to
terrorism) taken to oppose terrorism throughout the entire threat spectrum.
command and control (C2) The exercise of authority and direction by a properly designated command-
er over assigned and attached forces in the accomplishment of the mission. Command and control
functions are performed through an arrangement of personnel, equipment, communications, facili-
ties, and procedures employed by a commander in planning, directing, coordinating, and control-
ling forces and operations in the accomplishment of the mission.
(Joint Pub 1-02)
command and staff channels These channels clearly identify the official relationship of commands and
staffs and the flow of information as commander to commander, staff to staff, and technical activity
to technical activity.
(See also command channel; staff channel; technical channel; and FM 101-5).
command channel This channel is the direct, official link between headquarters and commanders. All
others and instructions to subordinate units pass through this channel. Within your authority, you
use command channels when acting in the commander’s name.
command post The principal facility employed by the commander to command and control combat
operations. A command post consists of those coordinating and special staff activities and
representatives from supporting Army elements and other services that may be necessary to carry
out operations. Corps and division headquarters are particularly adaptable to organization by
echelon into a tactical command post, a main command post, and a rear command post.
commander in chief A commander of a joint, specific, or unified command with responsibility for
operational and tactical execution of military operations supporting defined national security
Glossary-4
FM 4-02
objectives. Commanders in chief command joint military forces to determine requirements and
develop and execute military plans.
communications zone (COMMZ) Rear part of a theater of operations (behind but contiguous to the
combat zone) which contains the lines of communications, establishments for supply and evacuation,
and other agencies required for the immediate support and maintenance of the field forces.
COMMZ See communications zone.
concept of operations A graphic, verbal, or written statement in broad outline that gives an overall
picture of a commander’s assumption or intent in regard to an operation or a series of operations;
includes, at a minimum, the scheme of maneuver and the fire support plan. The concept of
operations is embodied in campaign plans and operation plans, particularly when the plans cover a
series of connected operations to be carried out simultaneously or in secession. It is described in
sufficient detail for the staff and subordinate commanders to understand what they are to do and
how to fight the battle without further instructions.
continuity of care Attempt to maintain the level of care during movement between echelons (levels) at
least equal to the level of care at the originating echelon (level).
CONUS continental United States
COSC See combat operational stress control.
COTS Committee on Trauma Surgery
country team The executive committee of an embassy, headed by the Chief of Mission, and consisting of
principal representatives of the government departments and agencies present
(for example,
the Departments of State, Defense, Treasury, Commerce, and the US Information Agency, US
Agency for International Development, Drug Enforcement Agency, and Central Intelligence
Agency).
CRTS casualty receiving and transport ship
CS See combat support.
CSH combat support hospital
CSS See combat service support.
CSSCS Combat Service Support Control System
CT computed tomography
CW chemical warfare
CZ See combat zone.
D&D dated and deteriorative
DA Department of the Army
DACMC division air cavalry medical company
DCAS dental company, area support
DD Department of Defense
DE directed energy
DEA Drug Enforcement Agency
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. Doctrinally, definitive care is delivered at the lowest possible level.
Glossary-5
FM 4-02
(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 level depending on the extent of the service member’s injury or
illness. It embraces those endeavors which complete the recovery of the patient. It is not hampered
by the crisis aspects of resuscitative care.
definitive treatment The final level of comprehensive care provided to return the patient to the highest
degree of mental and physical health possible. Definitive treatment is not associated with a specific
role (level) or location in the continuum of care; it may occur in different roles (levels) depending
upon the nature of the injury or illness. After the definitive treatment period the individual may
undergo rehabilitation before being returned to duty or discharged from the military service.
den dental
dental care There are two categories of dental care—operational care and comprehensive care.
(1) Op-
erational care is provided in the theater of operations and consists of two types of dental care.
(a)
Emergency dental care is given for the relief of oral pain, elimination of acute infection, control of
life-threatening oral conditions (hemorrhage, cellulitis, or respiratory difficulty) and treatment of
trauma to teeth, jaws, and associated facial structures. It is the most austere type of care and is
available to soldiers engaged in tactical operations. Common examples of emergency treatments
are simple extractions, administration of antibiotics, pain medicines, and temporary fillings.
(b) Essential dental care includes dental treatment necessary to intercept potential emergencies.
This type of operational care is necessary for the prevention of lost duty time and preservation of
the fighting strength. It is also intended to maintain the overall oral fitness of soldiers at a level
consistent with combat readiness. Most dental disease is chronic and recurring. A soldier’s oral
health status will deteriorate from the day of deployment if essential dental care is not provided.
The scope of services includes minor oral surgery, definitive restorative, exodontic, periodontal,
and prosthodontic procedures as well as prophylaxis. This is the highest type of dental care pro-
vided within the theater of operations.
(2) Comprehensive care is dental treatment to restore an
individual to optimal oral health, function, and esthetics.
DEPMEDS deployable medical systems
DIA Defense Intelligence Agency
died of wounds (received in action) This term describes battle casualties who die of wounds or other
injuries received in action after having reached a medical treatment facility. These cases differ
from battle casualties who are found dead or who die before reaching a medical treatment facility
(the killed in action group). The criterion is to reach a medical treatment facility while still alive.
All cases counted as DOW received in action are also counted as wounded in action.
direct support (DS) A direct support unit gives priority of support to a specific unit or force. The sup-
porting unit takes support requests directly from the unit or force in need of support. The supporting
unit normally establishes liaison and communications; it also provides advice to the supported unit.
A unit in direct support has no command relationship with the supported unit or force.
directed energy An umbrella term covering technologies that relate to the production of a beam of con-
centrated electromagnetic energy or atomic or subatomic particles. (Joint Pub 1-02)
DIS disease
DISCOM division support command
disease and nonbattle injury casualty (DNBI) A person who is not a battle casualty but who is lost to the
organization by reason of disease or injury, including persons dying of disease or injury, by reason
of being missing where the absence does not appear to be voluntary, or due to enemy action or to
being interned.
(Joint Pub 1-02)
Glossary-6
C1, FM 4-02
DLA Defense Logistics Agency
DMLSS Defense Medical Logistics Standard Support
DMMC division materiel management center
DMSB Defense Medical Standardization Board
DNBI disease and nonbattle injury
(See also disease and nonbattle injury casualty.)
DOD Department of Defense
DODD Department of Defense Directive
DODI Department of Defense Instructions
DOMS Director of Military Support
DOS days of supply
DOTMLPF doctrine, organizations, training, materiel, leadership and education, personnel, and facilities
DS See direct support.
DSB division support battalion
DSMC division support medical company
DSN digital switching network
DSO domestic support operations
DTSMC division troop support medical company
EAC See echelons above corps.
echelons above corps (EAC) Army headquarters and organizations that provide the interface between the
theater commander (joint or combined) and the corps for operational matters, and between the
continental United States/host nation and the deployed corps for combat service support. Opera-
tional echelons above corps may be United States only or allied headquarters, while echelons above
corps for combat service support will normally be United States national organizations.
EEFI See essential elements of friendly information.
EEI essential elements of information
emergency medical treatment (EMT) The immediate application of medical procedures to the wounded,
injured, or sick by specially trained medical personnel.
EMS emergency medical service
EMT See emergency medical treatment.
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.
EPW enemy prisoner(s) of war
essential care
(1) Medical care and treatment within the theater of operations and which METT-T
dependent. 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.
(2) Medical care and treatment within the theater of operations and
which METT-T dependent. 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.
30 July 2009
Glossary-7
C1, FM 4-02
essential care in theater
(1) That care which is required to return soldiers to duty within the theater
evacuation policy or to enable evacuation from the theater as a stable or stabilized patient. In an
immature theater, evacuation of all categories of patients (stable, unstable, stabilized) out of theater
may be required to keep adequate bed capacity available, even though the patients could have been
returned to duty within the theater evacuation policy.
(2) That care received within the theater of
operations which is mission, enemy, terrain, troops, time available, and civilian considerations
dependent. It includes first responder care, forward resuscitative surgery, and en route care as well
as treatment and hospitalization to return the patient to duty or to stabilize for movement to the next
higher level.
(3) Medical treatment and care provided within the theater of operations. This
includes resuscitative care and en route care, as well as care to either return the patient to duty
(within the theater evacuation policy) or begin initial treatment required for optimization of outcome
and/or ensure the patient can tolerate evacuation to the next level of care.
essential elements of friendly information (EEFI) The critical aspects of a friendly operation that, if
known by the enemy, would subsequently compromise, lead to failure, or limit success of the
operation and, therefore, must be protected from enemy detection.
ET endotracheal tube
evac evacuation
evacuation delay Represents the number of days after admission that a patient who has been identified for
evacuation must wait before actually being evacuated. Both patient stabilization requirements
and evacuation transportation availability are taken into account.
evacuation precedence This precedences are somewhat different depending upon the parent Service
The US Air Force precedences are Urgent, Priority, and Routine. The US Army precedences
are URGENT, URGENT-SURG, PRIORITY, ROUTINE, and CONVENIENCE.
FBCB2 Force XXI Battle Command Brigade and Below
FARP forward arming and refueling point
Glossary-8
30 July 2009
FM 4-02
FDA Food and Drug Administration
FEBA forward edge of battle area
FEMA Federal Emergency Management Agency
FFIR friendly forces information requirements
FFP fresh frozen plasma
FH field hospital
FHA foreign humanitarian assistance
FHP force health protection
FHPGE See force health protection in a global environment.
field discipline Field discipline is the component of protection. It guards soldiers from the physical and
psychological effects of the environment. Commanders take every measure and precaution to
keep soldiers healthy and maintain their morale. Such actions include securing equipment and
supplies from loss of damage; providing adequate combat health support, returning minor casualties
to duty as quickly as possible, and providing preventive medicine services. The provide effective
systems for maintenance evacuation and rapid replacement or repair of equipment.
(See also
protection.)
first aid (self-aid/buddy aid) Urgent and immediate lifesaving and other measures which can be per-
formed for casualties (or performed by the victim himself) by nonmedical personnel when medical
personnel are not immediately available.
first responder
(1) This capability can be divided into nonmedical (meaning first aid) and medical first
responders. Medical first responders are able to provide basic trauma management (including
needle thoracostomy and needle cricothyroidotomy) at the point of wounding or injury as well as
limited primary health care and preventive medicine services. It primarily refers to the close
medical support provided to combat troops on operations by members such as combat medics and
combat medical assistants (USMC) but also includes the care provided by the medical evacuation
personnel who retrieve the patient from point of wounding or injury.
(2) Is the first person on
the scene to help a casualty.
FM field manual
FOB forward operating base
force health protection in a global environment (FHPGE) Is executed by the health service support
system and includes all support and services performed, provided, or arranged by the AMEDD to
promote, improve, conserve, or restore the mental or physical well-being of personnel in the
Army and, as directed, in other Services, agencies, and organizations.
force protection Force protection consists of those actions to prevent or mitigate hostile actions against
DOD personnel (including family members), resources, facilities, and critical information. It
coordinates and synchronizes active and passive (offensive and defensive) measures to enable the
force to perform while degrading the opportunities for the enemy. Force protection includes air,
space, and missile defense; NBC defense; antiterrorism; defensive information operations; and
security to operational forces and means. Force protection does not include actions to protect
against accidents, weather, and disease. It is the commander’s responsibility to ensure that force
protection measures are planned for and executed.
(See also protection.)
forward resuscitative surgery The forward resuscitative surgery phase is the urgent initial surgery re-
quired to render a patient transportable for further evacuation to a medical treatment facility
staffed and equipped to provide for his care. Forward resuscitative surgery is performed on
patients with signs and symptoms of initial airway compromise, difficult breathing, and circulatory
Glossary-9
FM 4-02
shock and who do not respond to initial emergency medical treatment and advanced trauma
management procedures.
forward surgical team Is the first medical element capable of performing surgery on life-threatening
wounds. The forward surgical team is employed in direct support of maneuver units. It is
collocated with divisional medical companies and is organic to airborne, air assault, and armored
cavalry divisions/regiment.
fragmentary order An abbreviated form of an operation order used to make changes in mission to units
and to inform them of changes in the tactical situation. Fratricide avoidance Fratricide avoidance
is the fourth component of protection. Fratricide is the unintentional killing or wounding of
friendly personnel by friendly firepower. Commanders seek to lower the probability of fratricide
without discouraging boldness and audacity. Situational understanding, positive weapons control,
control of troop movements, use of identification methods, and disciplined operational procedures
coupled with good leadership can do this.
(See also protection.)
FRP Federal Response Plan
FSB forward support battalion
FSMC forward support medical company
FST forward surgical team
G1
Assistant Chief of Staff (Personnel)
G2
Assistant Chief of Staff (Intelligence)
G5
Assistant Chief of Staff (Civil-Military Operations)
GC Geneva Convention Relative to the Protection of Civilian Persons in Time of War
GCS Glasgow Coma Score
GCSS-A Global Combat Support System-Army
general support A general support unit provides support to the total force, not to any particular sub-
division. Therefore, subdivisions may not directly request support from the general support unit.
Only the supported force headquarters may determine priorities and assign missions or tasks to the
general support unit. A general support unit has no command relationship with the supported unit
or force.
GH general hospital
GI gastrointestional
Global Patient Movement Requirements Center (GPMRC)
(1) A joint activity reporting directly to
the Commander in Chief, US Transportation Command, the Department of Defense single man-
ager for the regulation of movement of uniformed services patients. The Global Patient Move-
ment Requirements Center authorizes transfers to medical treatment facilities of the Military
Departments or the Department of Veterans Affairs and coordinates intertheater and inside conti-
nental United States patient movement requirements with the appropriate transportation component
commands of United States Transportation Command. (Joint Pub 1-02)
(2) The GPMRC is a
joint agency located in the continental United States and established by the US Transportation
Command. The GPMRC receives requests from the TPMRC. The primary role of the GPMRC
is to apportion intertheater assets to the TPMRCs, collaborate and integrate proposed TPMRC
intertheater plans and schedules, and communicate lift and bed requirements. The destination
hospital is determined based on the patient’s medical needs and the available transportation
resources.
(See also Theater Patient Movement Requirements Center.)
GPMRC See Global Patient Movement Requirements Center.
Glossary-10
FM 4-02
GPS global positioning system
GPW Geneva Convention Relative to the Treatment of Prisoners of War
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
Gy gray
HAZMAT hazardous material
HD sulfur mustard (a blister agent)
health service support (HSS)
(1) The system which executes the force health protection in a global
environment concept and includes all services performed, provided, or arranged to promote,
improve, conserve, or restore the mental or physical well being of personnel in the Army.
(2) The joint medical community also uses the term health service support to describe the joint
military health system.
health threat Refers to an individual soldier’s health. The term can include hereditary conditions which
manifest themselves in adulthood, individual exposure to an industrial chemical or toxin where
others are not exposed, or other injuries and traumas which affect an individuals health rather than
the health of the unit. A health threat may be more individualized in nature and may not be of
military significance.
(See also medical threat.)
Hg mercury
HIV human immunodeficiency virus
HN See host nation.
HNS See host nation support.
hosp hospitalization See hospital.
hospital (hosp) 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.
(Joint Pub 1-02)
host nation (HN) A nation which receives the forces and/or supplies of allied nations and/or NATO to
be located on, or to operate in, or to transit through its territory.
host-nation support (HNS)
(1) Civil and military assistance rendered in peacetime and in wartime to
allied forces and organizations located in the host nation’s territory. The bases of such assistance
are commitments arising from national agreements concluded among host nation(s), international
organizations, and nation(s) having forces operating in the host nation’s territory.
(2) Civil and/
or military assistance rendered by a nation to foreign forces within its territory during peacetime,
crisis or emergencies, or war based upon agreements mutually concluded between nations.
(Joint
Pub 1-02)
HQDASG Headquarters, Department of the Army, The Surgeon General
HSL health service logistics
HSS See health service support.
humanitarian assistance Is provided by DOD forces, as directed by appropriate authority, in the
aftermath of natural or man-made disasters to help reduce conditions that present a serious threat
to life and property. Assistance provided by US forces is limited in scope and duration and is
designed to supplement efforts of civilian authorities that have primary responsibility for providing
such assistance.
Glossary-11
FM 4-02
ICRC International Committee of the Red Cross
ICT integrated concept team
ICU intensive care unit
ICW intermediate care ward
ID identification
IDIV interim division
IDP internally displaced person
IND investigational new drug
information requirements Those items of information regarding the enemy and his environment which
need to be collected and processed in order to meet the intelligence requirements of a commander.
infrastructure In an insurgency, the leadership organization and its system for command and control.
In a broader sense, the systems of communications and the institutions which support the political
and economic functions of a society.
initial point of treatment Any point within the combat health support system at which a soldier is seen
and treated by trained medical personnel.
initial resuscitation The very first state of reviving a patient from apparent death or unconsciousness.
initial surgery Initial surgery renders the casualty transportable via rapid evacuation to a hospital for
reparative surgery. The initial surgery effort at the forward element (forward surgical team), by
definition, is not complete, but rather the initial effort required to save life and limb, prevent in-
fection, and render the casualty transportable.
injury A term comprising such conditions as fractures, wounds, sprains, strains, dislocations, concus-
sions, and compressions. In addition, it includes conditions resulting from extremes of tempera-
ture or prolonged exposure. Acute poisonings, except those due to contaminated food, resulting
from exposure to a toxic or poisonous substance are also classed as injuries.
inpatient Is the term applied to a person admitted to and treated within an Levels III through V hospital
and who cannot be returned to duty within the same calendar day.
intelligence The product resulting from the collection, evaluation, analysis, integration, and interpreta-
tion of all available information concerning an enemy force, foreign nations, or areas of opera-
tions, and which is immediately or potentially significant to military planning and operations.
(See
also medical intelligence.)
intelligence preparation of the battlefield A systematic approach to analyzing the enemy, weather, and
terrain in a specific geographic area. It integrates enemy doctrine with the weather and terrain as
they relate to the mission, and the specific battlefield environment. This is done to determine and
evaluate enemy capabilities, vulnerabilities, and probable courses of action.
interagency operations Any action that combines the human and material resources of two or more
independent organizations, whether they are governmental, international, or private, in the prose-
cution of a common objective.
intertheater evacuation Evacuation of patients between the originating theater and points outside the
theater, to include the continental United States and other theaters. En route care is provided by
trained medical personnel.
(Joint Pub 1-02)
interoperability The ability of systems, units, or forces to provide services to and accept services from
other systems, units, or forces and to use the services so exchanged to enable them to operate
effectively together.
intratheater evacuation Evacuation of patients between points within the theater. En route care is
provided by trained medical personnel.
(Joint Pub 1-02)
Glossary-12
FM 4-02
IPT integrated product team
ISA international standardization agreement
ISB intermediate staging base
ITDB interim theater database
ITO invitational travel orders
IV intravenous
JBPO joint blood program office
JCAHO Joint Commission on the Accreditation of Hospital Organizations
JCS Joint Chiefs of Staff
JFC joint force commander
JFS joint force surgeon
JHSS joint health service support
joint force A general term applied to a force composed of significant elements, assigned or attached, of
two or more Military Departments, operating under a single joint force commander.
(Joint Pub
1-02)
joint force commander A general term applied to a combatant commander, subunified commander, or
joint task force commander authorized to exercise combatant command (command authority) or
operational control over a joint force.
(Joint Pub 1-02)
joint force surgeon A general term applied to an individual appointed by the joint force commander to
serve as the theater or joint task force special staff officer responsible for establishing, monitoring,
or evaluating joint force health service support.
(Joint Pub 1-02)
JRCAB Joint Readiness Clinical Advisory Board
JSOTF joint special operations task force
JTF joint task force
JV Joint Vision
killed in action A casualty category applicable to a hostile casualty, other than the victim of a terrorist
activity, who is killed outright or who dies as a result of wounds or other injuries before reaching
a medical treatment facility. Killed in action cases are not included in the wounded in action
category of the died of wounds category. (Joint Pub 1-02)
lab laboratory
LAN local area network
leapfrog Form of movement in which like supporting elements are moved successively through or by
one another along the axis of movement of supported forces.
levels of care is synonymous with roles of care and echelons of care. The levels of care are charac-
terized by capabilities and not geographical location within the theater of operations. There are
five levels of care—(1) Level I—Unit-level first medical care a soldier receives is provided at this
level. This care includes immediate lifesaving measures, advanced trauma management, disease
prevention, combat operational stress control prevention, casualty collection, and evacuation from
supported units to supporting medical treatment. Level I elements are located throughout the
combat and communications zones. These elements include the combat lifesavers, combat
medics, and battalion aid station. Some or all of these elements are found in maneuver, combat
support, and combat service support units. When Level I is not present in a unit, this support is
Glossary-13
FM 4-02
provided to that unit by Level II medical units.
(2) Level II—Duplicates Level I medical care and
expands services available by adding dental, laboratory, x-ray, and patient-holding capability.
Emergency care, advanced trauma management, including beginning resuscitation procedures, is
continued. No general anesthesia is available; if necessary, additional emergency measures
dictated by the immediate needs are performed. Level II units are located in the combat zone and
the communications zone. Level II medical support may be provided by a clearing station estab-
lished by a forward support medical company; division support medical company, or area support
medical companies located in the corps area and in the communications zone. This is also refer-
red to as division-level medical care.
(3) Level III—This level of support expands the support
provided at Level II. Casualties who are unable to tolerate and survive movement over long
distances will receive surgical care in hospitals as close to the division rear boundary as the tacti-
cal situation will allow. Surgical care may be provided within the division area under certain
operational conditions. Level III characterizes the care that is provided by combat support
hospitals. Operational conditions may require Level III units to locate in offshore support
facilities, third country support base, or in the communications zone.
(4) Level IV—This level of
care is provided in an echelons above corps (communications zone-level) combat support hospital
which are staffed and equipped for general and specialized medical and surgical treatment. This
level of care provides further treatment to stabilize those patients requiring evacuation to conti-
nental United States. This level also provides area health service support to soldiers within the
communications zone.
(5) Level V—In this level of care, the casualty is treated in continental
United States-based hospitals, staffed and equipped for the most definitive care available within
the health service support system. Hospitals in the continental United States base represent the
final level of HSS.
lines of patient drift Natural routes along which wounded soldiers may be expected to go back for
medical care from a combat position.
LOC lines of communication
LR lactated Ringer’s
LZ landing zone
MA mortuary affairs
MASF See mobile aeromedical staging facility.
MASH mobile Army surgical hospital
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 logistical support capabilities.
(Joint Pub 1-02)
MAST Military Assistance to Traffic and Safety
MC Medical Corps
MC4
medical communications for combat casualty care
MCM multicommand manual
MCW minimal care ward
MDMP military decision-making process
MDT medical detachment, telemedicine
med medical
MEDCEN medical center
MEDCOM medical command
Glossary-14
FM 4-02
medical equipment set A chest containing medical instruments and supplies designed for specific table
of organization and equipment units or specific missions.
medical evacuation The process of moving any person who is wounded, injured, or ill to and/or bet-
ween medical treatment facilities while providing en route medical care.
medical intelligence That category of intelligence resulting from collection, evaluation, analysis, and
interpretation of foreign medical, bioscientific, and environmental information which is of interest
to strategic planning and to military medical planning and operations for the conservation of the
fighting strength of friendly forces and the formation of assessments of foreign medical capabili-
ties in both military and civilian sectors.
(Joint Pub 1-02)
medical noneffective rate Is a measure very frequently used in military medicine and measures the
prevalence of noneffectiveness with noneffectiveness being defined as excused from duty for
medical reasons. This rate does not generally include time off for clinic visits and days off, other
than hospitalization, for illness.
medical regulating The actions and coordination necessary to arrange for the movement of patients
through the levels of care. This process matches patients with a medical treatment facility that has
the necessary health service support capabilities, and it also ensures that bed space is available.
(Joint Pub 1-02)
medical regulating officer The medical regulating officer functions as the responsible individual at
command and control headquarters for receiving and consolidating medical evacuation requests.
These requests are initiated by the division medical operations center or subordinate hospitals.
The medical regulating officer also maintains the current patient status, bed status, and surgical
backlog at subordinate hospitals.
medical surveillance The ongoing, systematic collection, analysis, and interpretation of health data
essential to the planning, implementation, and evaluation of public health practice, closely
integrated with the timely dissemination of these data to those who need to know.
(Upon approval
of this revision, this term and its definition will be included in Joint Pub 1-02.)
medical threat
(1) A collective term used to designate all potential or continuing enemy actions and
environmental situations that could possibly adversely affect the combat effectiveness of friendly
forces, to include wounding, injuries, or sickness incurred while engaged in a joint operation.
(Joint Pub 1-02)
(2) A composite of all ongoing potential enemy actions and environmental con-
ditions (diseases and nonbattle injuries) that may render a soldier combat ineffective.
medical treatment facility (MTF) Any facility established for the purpose of providing medical treat-
ment. This includes battalion aid stations, division clearing stations, dispensaries, clinics, and
hospitals.
(2) A facility established for the purpose of furnishing medical and/or dental care to
eligible individuals.
(3) Denotes a facility established for the purpose of providing health services
to authorized personnel.
(Joint Pub 1-02)
medically immature theater A theater in which health service support capability is insufficient to sup-
port the operational commander’s operational plan, including the theater evacuation policy, with-
out undue risk of increased morbidity and mortality for soldiers.
medically mature theater A theater in which health service support capability is sufficient to support
the operational commander’s operational plan, within the theater evacuation policy, while minimi-
zing the risk of morbidity and mortality for soldiers.
MEDLOG medical logistics
MEDLOG-D medical logistics-division
MEDMNT medical maintenance
Glossary-15
FM 4-02
MES See medical equipment set.
METT-TC mission, enemy, terrain and weather, troops and support available, time available, and civil
considerations
MH mental health
MHS military health system
MIPB medical intelligence preparation of the battlefield
missing in action This term describes battle casualties whose whereabouts or fate cannot be determined
and who are not known to be in an unauthorized absence status (desertion or absent without
leave).
mission-oriented protective posture (MOPP) A flexible system for protection against NBC contami-
nation. This posture requires personnel to wear only that individual protective clothing and
equipment consistent with the threat, work rate imposed by the mission, temperature, and humi-
dity. There are five levels of MOPP (zero through 4). MOPP 4 offers the greatest protection but
also degrades mission performance the most.
MIW multiple injury wound
mm millimeters
MMMB medical materiel management branch
MMS medical materiel set
MMTF medical multifunctional task force
MOA memorandum(s) of agreement
mobile aeromedical staging facility (MASF) The mobile aeromedical staging facility is a United States
Air Force staging facility employed at forward airfields in the combat zone to provide temporary
staging capability for preparation of patients being evacuated from corps to echelons above corps
hospitals. The mobile aeromedical staging facility is employed to ensure patients are prepared for
aircraft loading with the main focus of reducing aeromedical evacuation aircraft ground time.
mobility The percentage of organic equipment and personnel that can be moved in a single lift using
organic vehicles.
MOOTW military operations other than war
MOPP See mission-oriented protective posture.
MOS military occupational specialty
MOU memorandum(s) of understanding
MPM Medical Planning Module
Mr. Mister
MRE meals, ready-to-eat
MRI Medical Reengineering Initiative
MRO medical regulating office
MROE medical rules of eligibility
Ms. Miss/Mrs.
MS Medical Service Corps
MSB main support battalion
MSCA military support to civilian authorities
MSE mobile subscriber equipment
MSMC main support medical company
MTF See medical treatment facility.
MTW major theater war
Glossary-16
FM 4-02
MV mechanical ventilator
MWD military working dog
MWR morale, welfare, and recreation
NAFI Nonapproriated Fund Instrumentality
NATO North Atlantic Treaty Organization
NBC nuclear, biological, and chemical
NBI nonbattle injury
NCO noncommissioned officer
NDMS national disaster medical system
NEO noncombatant evacuation operations
NGO nongovernmental organization
NICP national inventory control point
nontransportable patient This is a patient whose medical condition is such that he could not survive
further evacuation to the rear without surgical intervention to stabilize his medical condition.
NP neuropsychiatric
NSN national stock number
OCONUS outside continental United States
OEH occupational and environmental health
OMF originating medical facility
OPCON See operational control.
operation order (OPORD) A directive issued by a commander to subordinate commanders for effecting
the coordinated execution of an operation, including tactical movement orders.
operation overlay Is an overlay showing the location, size, and scheme of maneuver/fires of friendly
forces involved in an operation. As an exception, it may indicate predicted movements and
locations of enemy forces.
operation plan (OPLAN) A plan for a military operation. It covers a single operation or series of
connected operations to be carried out simultaneously or in succession. It implements operations
derived from the campaign plan. When the time and/or conditions under which the plan is to be
placed in effect occur, the plan becomes an operations order.
operations security All measures taken to maintain security and achieve tactical surprise. It includes
countersurveillance, physical security, signal security, and information security. It also involves
the identification and elimination or control of indicators which can be exploited by hostile intelli-
gence organizations.
operational command The authority granted to a commander to assign missions or tasks to subordinate
commanders, to deploy units, to reassign forces, and to retain or delegate operational or tactical
control as may be deemed necessary. It does not, of itself, include administrative command or
logistical responsibility.
operational control (OPCON) The authority delegated to a commander to direct forces provided him so
he can accomplish specific missions or tasks that are usually limited by function, time, or location;
to deploy units concerned; and to retain or assign tactical control of these units. It does not include
authority to assign separate employment of components of the units concerned, not does it, of
itself, include administrative or logistics control.
OPLAN See operation plan.
Glossary-17
FM 4-02
OPORD See operation order.
OPSEC See operational security.
OPTEMPO operational tempo
OR operating room
order A communication, written, oral, or by signal, that conveys instructions from a superior to a
subordinate. In a broad sense, the term order and command are synonymous. However, an order
implies discretion as to the details of execution, whereas a command does not.
organic Assigned to and forming an essential part of a military organization; an element normally shown
in the unit’s table of organization and equipment.
(See also assign; attach; operational control.)
OSIS open source information system
OT occupational therapy
outpatient Is the term applied to 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 an
Level II facility [clearing station]) other than a hospital.
PA physician assistant
PAD patient administration
PAH polynuclear aromatic hydrocarbons
PAHO Pan American Health Organization
pam pamphlet
passage of lines Passing one unit through the position of another, as when elements of a covering force
withdraw through the forward edge of the main battle area, or when an exploiting force moves
through elements of the force that conducted the initial attack. A passage may be designated as a
forward or rearward passage of lines.
patient
(1) A sick, injured or wounded soldier who receives medical care or treatment from medically
trained personnel.
(2) A sick, injured, wounded, or other person requiring medical/dental care
or treatment.
(Joint Pub 1-02)
patient decontamination The removal and/or the neutralization of hazardous levels of nuclear, biologi-
cal, and chemical contamination from patients at a medical treatment facility. Patient decontami-
nation is performed under the supervision of medical personnel to prevent further injury to the
patient and to maintain the patient’s health status during the decontamination process. Patient
decontamination serves multiple purposes; it protects the patient from further injury, it prevents
exposing medical personnel to the contamination, and it prevents contamination of the medical
treatment facility.
patient estimates Are derived from the casualty estimate (prepared by the S1/G1) by the combat health
support planner.
(Refer to the definition of casualty as stated above.) Not all classifications of
casualties are medical casualties
(such as killed in action, absent without leave, or detained
persons). Patient estimates only encompass medical casualties.
patient movement The act or process of moving a sick, injured, wounded, or other person to obtain
medical and/or dental care or treatment. Decisions made in this process involve coordination
between the sending medical treatment facility, the gaining medical treatment facility, and the
appropriate Patient Movement Requirements Center.
(Joint Pub 1-02)
patient movement items (PMI) These are the medical equipment and supplies required to support the
patient during evacuation. The patient movement items accompany a patient throughout the chain
of evacuation for the originating medical facility to the destination medical treatment facility.
Glossary-18
FM 4-02
patient movement requirements center A joint activity that coordinates patient movement. It is the
functional merging of joint medical regulating processes, Services medical regulating processes,
and coordination with movement components for patient evacuation. This may be joint, reporting
to the joint task force surgeon; theater, reporting to the joint task force surgeon; theater, reporting
to the theater surgeon; or global, reporting to the United States Transportation Command Surgeon.
(JP 1-02)
(See also Global Patient Movement Requirements Center and Theater Patient Move-
ment Requirements Center.)
PC patient condition code
PCA patient care area
PID pelvic inflammatory disease
PIR priority information requirements
PMI See patient movement items.
PMM preventive medicine measures
POC point of contact
POL petroleum, oils and lubricants
potable water Water that is safe for human consumption. Potable water is free from disease-causing
organisms and excessive amounts of mineral or organic matter, toxic chemicals, and radioactive
materials. The water may not be pleasing to the taste.
POW prisoner of war
preventive medicine (PVNTMED) 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.
PROFIS Professional Filler System
protection This is the preservation of the fighting potential of a force so that commander can apply the
maximum force at the decisive time and place. Protection has four components: force protection,
field discipline, safety, and fratricide avoidance.
(See also force protection, field discipline,
safety, and fratricide avoidance.)
psychological operations (PSYOP) Planned operations to convey selected information and indicators to
foreign audiences to influence their emotions, motives, objective reasoning, and ultimately the
behavior of foreign governments, organizations, groups, and individuals. The purpose of psycho-
logical operations is to induce or reinforce attitudes and behavior favorable to the originator’s
objective.
PSYOP See psychological operations.
PT physical therapy
pub publication
PVNTMED See preventive medicine.
QAP Quadripartite Advisory Publication
QSTAG See Quadripartite Standardization Agreement.
Quadripartite Standardization Agreement (QSTAG) The acronym for American, British, Canadian,
and Australian Organizations standardization agreements. The ABCA member nations are allied
together for military interoperability in both equipment and methods of operations. As each
QSTAG is adopted, it becomes part of each nation’s unilateral procedures and is incorporated into
national doctrinal and procedural publications.
Glossary-19
FM 4-02
rationalization Any action that increases the effectiveness of allied forces through more efficient or
effective use of defense resources committed to the alliance. Rationalization includes consolida-
tion, reassignment of nation priorities to higher alliance needs, standardization, specialization,
mutual support or improved interoperability, and greater cooperation. Rationalization applies to
both weapons/materiel resources and nonweapons military matters.
RBC red blood cell
reconstitution The total process of keeping the force supplied with various supply classes, services, and
replacement personnel and equipment required to maintain the desired level of combat effective-
ness and of restoring units that are not combat effective to the desired level of combat effective-
ness through the replacement of critical personnel and equipment. Reconstitution encompasses
unit regeneration and sustaining support.
resuscitative care
(1) Generally, advanced trauma management care and surgery limited to the minimum
required to stabilize a patient for transportation to a higher level of care.
(2) Resuscitative care is
the aggressive management of life- and limb-threatening injuries. Interventions include emergency
medical treatment, advanced trauma management, and lifesaving surgery to enable the patient to
tolerate evacuation to the next level of care.
return to duty (RTD) A patient disposition which, after medical evaluation and treatment when neces-
sary, returns a soldier for duty in his unit.
RFR radio frequency radiation
RMC regional medical commands
RMW regulated medical waste
ROE rules of engagement
RSI rationalization, standardization, and interoperability
RSO&I reception, staging, onward movement, and integration
RTD See return to duty.
S1
Adjutant, US Army
S2
Intelligence Officer (US Army)
safety Safety is the third component of protection. Operational conditions often impose significant risks
to soldiers’ lives and health and make equipment operation difficult. Command attention to safety
and high levels of discipline lessen those risks, particularly as soldiers reach exhaustion. Safe
operations come from enforcing standards during training. While taking calculated risks, com-
manders assume the obligation to embed safety in the conduct of all operations.
(See also protec-
tion.)
SBCT Stryker Brigade Combat Team
SECDEF Secretary of Defense
SF special forces
SFMS special forces medical sergeant
SFOB special forces operating base
SI seriously ill
SIMLM See single integrated medical logistics manager.
single integrated medical logistics manager (SIMLM) When two or more Services are operating
within the commander’s-in-chief area of responsibility a Service may be designated as the
SIMLM. The SIMLM system encompasses the provision of medical supplies, medical equipment
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