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FM 4-02.6
• Security.
• Radiation safety rules.
• Shielding of patients and medical personnel.
• Electrical and mechanical safety rules.
• Procedures for the performance of routine radiographic views.
• Accomplishment of weekly processor tests.
• Establishing quality control procedures.
• Maintenance of equipment records.
• Procedures for disposition of radiographs.
• Dental protocols and procedures.
• Procedures for personal protection (gloves, masks) measures during dental
procedures.
(c)
Patient-holding squad. The following topics should be considered:
• Scope of nursing practice (MOS 91W [M-6]).
• Patient accountability.
• Shift change policies and procedures.
• Holding area staffing.
• Establishment of methods and procedures for documentation.
• Establishment of infection control procedures.
• Care for injection sites and IV treatments.
• Maintenance of equipment.
• Establishment of bedpan and urinal washing procedures.
• Procedures for disinfecting facilities.
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FM 4-02.6
• Infectious waste disposal.
• Procedures for hand washing.
• Location and access to field sinks and latrines for both patients and staff.
• Controlled substance procedures and reports.
• Death procedures to include notifications, as required.
• Preparing required reports.
• Procedures for taking hold patients to field feeding site(s).
NOTE
Patients requiring modified diets are evacuated to corps/COMMZ
hospitals where both patient rations (Medical B Rations) and personnel
trained in providing modified diets (MOS 91M) are available. Patients
held in the holding squad are normally ambulatory and on a regular
diet and may require minimal assistance in obtaining rations.
b. Ambulance Platoon. The following topics should be considered:
• Procedures for inspecting and maintaining medical equipment sets.
• Procedures for the supply/resupply of medical supplies and equipment.
• Treatment protocols for the provision of en route medical care.
• Protocols for the use of pneumatic anti-shock trousers.
• Procedures for the rotation of medication stocks.
• Procedures for the property exchange (litters and blankets).
• Procedures for mass casualty situations, to include the use of ambulance shuttles.
• Procedures for staffing AXPs, if required.
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FM 4-02.6
• Procedures for the evacuation of outpatient treatment to the next echelon care and RTD.
c.
Augmentation.
(1) Surgical.
• Surgical procedures, to include emergency surgeries.
• Operating room staffing, to include duty rosters and on-call rosters.
• Aseptic technique practices.
• Procedures for preparation of the maintenance register.
• Preparation of the patient for surgery.
• Emergency blood requests.
• Sterile instruments and supplies.
• Treatment protocols for medical emergencies, such as for anaphylaxis reaction.
• Provision of immediate postoperative care (inpatient holding area).
(Registered
nurses are part of the augmentation).
• Scrub attire and surgical hand-scrub procedures.
• Environmental safety.
• Medical waste disposal procedures.
• Operating room sanitation.
• Patient deaths, to include notifications requirements.
• Procedures for performing cardiac arrest procedures.
• Procedures for handling contaminated sharps.
• Preparation of required reports.
• Equipment checklists.
• Inventory and maintenance of controlled substances.
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FM 4-02.6
• Infection control procedures.
• Combustibles and cleaning products storage.
• Quality control procedures for equipment.
(2) Combat operational stress control. The following topics should be considered:
• Procedures for segregating battle fatigue casualties from other patients being held.
• Patient accountability procedures.
• Procedures for ensuring sufficient holding capability is available.
• Delineation of responsibilities and actions required of the combat stress control per-
sonnel in the management of their patients.
• Procedures for arranging transportation for battle fatigue casualties (BFC).
d. Temporary Morgue Area.
• Site selection for this area to ensure adequate shielding from other patients.
• Establish procedures for the management of this area and the immediate arrangement for
collection of remains by mortuary affairs personnel.
(See FM 8-10-6, Chapter 4 for initiating the FMC on
decease personnel.)
e.
Mass Casualty Situations. When mass casualty situations occur, all nonessential patient care
activities and support services (such as logistic and personnel) are temporarily suspended. The traffic pat-
terns within the MTF are also temporarily changed and marked in order to move patients to holding and treat-
ment areas based on their medical condition and assigned treatment precedence. Other activities include—
• Establishment of a control cell to coordinate hospital activities.
• Establishment of the triage area.
(Normally a senior NCO or medical officer performs
the triage function.)
• Establishment of a patient decontamination station, if required. (This includes supervising
the patient decontamination process performed by nonmedical personnel.)
• Patient triage and assignment of a treatment precedence.
• Establishment of a litter bearer pool of nonmedical personnel.
(These teams will move
patients from evacuation vehicles to the triage point and within the MTF to the various diagnostic and
treatment areas.)
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FM 4-02.6
• Internal patient movements to appropriate holding and treatment areas based on their
assigned precedence for treatment, monitoring, or observation.
• Internal traffic pattern to ensure a smooth patient flow without having to overlap and/or
retrace traffic patterns.
• Procedures for limiting access to MTF area by visitors or other nonessential personnel.
• Provision of updates on the medical situation periodically and through a central point.
f.
Patient Support Services.
(1) Logistics. The logistics SOP can be addressed in either the CSOP or the TSOP, or it may
be addressed in both with emphasis on the health service logistics portion in the CSOP. Logistics functions
include—
• Inventory control procedures and preparation of requisitions.
• Procedures for maintenance and repairs on medical equipment.
• Coordination for repairs that cannot be accomplished by organic capability.
• Pickup and delivery of medical supplies to include controlled substances.
• Property exchange procedures.
• Coordination for waste disposal, to include medical waste.
• Coordination for pest management support.
• Coordination for laundry and bath services.
(2) Patient administration.
• Procedures for the maintenance of individual field medical records.
• Compilation of medical statistics and preparation of reports.
• Coordination for medical evacuation support.
• Policies regarding the inventorying and safeguarding of patient property and
weapons.
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APPENDIX I
COMMUNICATIONS, AUTOMATION, AND POSITION
NAVIGATION SYSTEMS
Section I. COMMUNICATIONS AND EQUIPMENT
I-1.
General
Communications systems are essential for gathering and disseminating data. Commanders use them to
perform C2 functions and to supervise performance. Effective management of CHS functions depends on
adequate communications to keep abreast of changing situations and requirements. The medical company
relies on both its organic communications assets and the support assets of its parent unit and signal elements
of the division and/or corps.
I-2.
Frequency-Modulated Radios
Frequency-modulated, AM and single-channel tactical satellite (SCTACSAT) radios comprise the family of
radios discussed in this appendix as combat net radios (CNRs). When discussing the operational facility
rules for the medical company, the SINCGARS radios constitute the FM slice; the improved high-frequency
radio (IHFR) and the Harris Corporation commercial radios constitute the AM component; the AN/PSC-5
fills the SCTACSAT requirement; and the near-term digital radio is a TOC to TOC data hauler.
a. Single Channel Ground and Airborne Radio System. The SINCGARS radios (AN/PRC-119
and AN/VRC-87F, -88F, -89F, and -90F) operate in the 30- to 88-megahertz (MHz) frequency range (the
very high-frequency [VHF] band) in 25-kilohertz (kHz) segments for a total of 2,320 channels. They can
operate in either a single-channel or frequency-hopping mode and have embedded communications security
(COMSEC) for secure operations.
b. AN/PRC-119. The AN/PRC-119 is a short-range, manpacked radio designed for dismounted
operations. It consists of a receiver-transmitter (RT), an antenna, a handset, and a battery box. The system
uses rechargeable or nonrechargeable batteries with each lasting approximately 8 hours, depending on
usage.
c.
AN/VRC-88F/87F. The AN/VRC-88F is a short-range, vehicular-mounted radio, which has
an antenna and a battery case as additional components. The radio can be removed from the vehicle and can
be reconfigured as the AN/PRC-119 manpack radio by installing the antenna and the battery case. It
consists of one RT, a radio mount, a mounting adapter, a vehicular antenna, and associated handset and
cabling. The AN/VRC-87F radio is identical, except without the dismounted capability/components. The
radio has an 8-km range. Treatment Team B normally uses this radio.
d. AN/VRC-89F. The AN/VRC-89F radio is a vehicular-mounted, dual configuration radio
consisting of one short-range and one long-range RT mounted in a single vehicular mount. It is basically
two vehicular-mounted, short-range radio sets with an added power amplifier that provides one of the radio
sets with a long-range communications capability up to 35 km. This radio is normally used by the medical
company/troop CP, company/troop commander, and treatment squads.
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FM 4-02.6
e.
AN/VRC-90F. The AN/VRC-90F radio is a vehicular-mounted, single configuration radio,
consisting of a long-range RT (RT plus power amperes) capable of operation up to 35 km. This radio is
especially suitable for ambulance teams, PVNTMED sections, and company/troop commanders who require
unimpeded, long-range communications.
I-3.
Amplitude-Modulated Radios
The AM radios operate in the high-frequency band of 1.5 to 30 MHz. They can be operated in manpacked,
vehicular, base station modes and have ranges from 0 to 2,000 miles. The systems in the AMEDD’s in-
ventory include the AN/GRC-106 (legacy system, not described), the AN/GRC-213, and the AN/GRC-246.
a. AN/GRC-213 (Improved High-Frequency Radio). The AN/GRC-213 is a low-power manpack
or vehicular-mounted configuration of the IHFR system. It provides a reliable high frequency coverage
with voice only capability of 2 to 30 MHz for medical troops/companies. It has the capability to pass secure
medical C2 and CHS information over medium- to long-range distances. It also can be used over varying
terrain features that would normally preclude the use of FM CNRs (SINCGARS).
b. AN/GRC-246. The AN/GRC-246 is a state-of-the-art digital signal processing RT providing
upper sideband, lower sideband, continuous wave for Morse code, and AM equivalent operation over the
1.6- to 30-MHz frequency range. The configurations available are a 20-watt, manpacked version, a 125-
watt vehicular version, and a 400-watt base station. The transceiver provides an impressive list of standard
features, including active squelch, retransmission capability, and NVG compatibility. Built-in options
include a high-speed 2400-baud data modem, a frequency shift keying data modem, automatic link
establishment controller, digitized voice, and full remote control.
c.
AN/PSC-5. The AN/PSC-5 SPITFIRE is a multiservice, nondevelopmental item/commercial
off-the-shelf
(COTS), small, lightweight, manpackable, single-channel, ultrahigh-frequency satellite
communications (SATCOM) radio that includes embedded COMSEC, a 5/25 kHz demand assigned multiple
access capability, line of sight communications, and SATCOM (voice and data). It has an extended
frequency range of 30 to 400 MHz.
I-4.
Ancillary Radio Equipment
The medical company/troop requires two main categories of ancillary equipment associated with its
SINCGARS equipment. These are remote control devices and data fill/variable transfer and storage devices.
a. Control Receiver-Transmitter (C11561). The control receiver/transmitter (CRT) C11561
provides SINCGARS vehicular radios with a remote capability of up to 4 km. It is able to remotely control
all front panel controls on the radio. This CRT C11561 may also be adapted with detachable control panels
for frequency hopping and COMSEC. The COMSEC and data adapter devices may be attached directly to
the CRT for secure communications over the transmission line and optimal interface with digital data
terminals. The CRT C11561 is an incremental change package for the medical company/troop. It will
replace the AN/GRA-39, discussed below.
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FM 4-02.6
b. Radio Set Control Group (AN/GRA-39). The AN/GRA-39, a legacy system is used to remote
single channel radios. It is compatible with integrated and nonintegrated communications radios (integrated
communications with embedded COMSEC and nonintegrated communications with external COMSEC).
The AN/GRA-39 controls only remote keying of radios from a terminal set. The operator must set the
other functions at the location of the radio.
c.
Data Fill Devices. Data fill devices provide the capability to transfer the required frequency
hopping and COMSEC variables from unit to unit. The medical company/troop is authorized the following
two devices for this requirement:
(1) Automated net control device (AN/CYZ-10). The automated net control device (ANCD)
is a handheld device capable of receiving, storing and transferring data between compatible equipment. The
primary application will be the transfer of variable length electronic keying material such as frequency
hopping data, partial or complete SOI information, and other COMSEC variables. The ANCD is sufficiently
programmable to replace and prevent the development of equipment tailored to a unique system. Interaction
between the ANCD and the operator is via the 35-key keyboard and the 2- by 24-character window in the
liquid crystal display. The emergence of ANCD replaces the need for the following fill devices:
• Electronic counter-countermeasure fill device (MX-10579 or MX-18290). The MX-
10579 is used with the nonintegrated communications radio only and the MX-18290 is used with both the
integrated communications radios or the nonintegrated communications radios. The MX-10579 and the
MX-18290 do not provide the capability to store or transfer COMSEC variables and SOI information.
• Electronic notebook (AN/CYZ-7A). The electronic notebook (EN) is a small
handheld data memory device similar to a small calculator. It can be loaded with partial or complete SOI
information and frequency hopping variable. The EN replaces the need for paper SOI, but does not provide
the capability to store and transfer COMSEC variables.
• Cryptographic fill devices (KYX-13 and KYX-15/TSEC). The KYX-13 is a battery
operated fill device that provides storage and transfer of up to 6 COMSEC variables. The KYX-15 is a
battery-operated fill device that provides storage and transfer of up to 16 COMSEC variables, and provides
the capability to create cryptographic variables. The KYX-13 and KYX-15 do not provide the capability to
store or transfer frequency hopping data and SOI information.
(2) Secure voice and FM communications devices. The following are descriptions and
applications of this equipment used by the company in its CNR operations:
(a) Speech security equipment (KY-57). The KY-57 is a half-duplex, tactical wide band
COMSEC device for FM radio equipment. This device permits secure radio transmissions and is required
with legacy VRC-12 systems and nonintegrated communications SINCGARS radios (no internal COMSEC).
Most SINCGARS used today have built in COMSEC (except avionics models) and do not require this
device.
(b) Net control device (KYX-15/TSEC). The net control device (NCD) KYX-15 is a
battery-operated control device that provides for storage and transfer of 1 to 16 COMSEC variables. When
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FM 4-02.6
it is connected to COMSEC equipment, the KYX-15 performs the automatic remote keying function and
other cryptovariable operations. The NCD KYX-15 is required by the NCSs operated by the medical com-
pany’s CP, treatment platoon, and ambulance platoon for secure CNR operation.
I-5.
Mobile Subscriber Equipment
Mobile subscriber equipment is the Area Common-User System (ACUS) for corps and below units. All
medical companies are allocated several MSE telephones such as the DNVT (TA-1042/U); some are
authorized the AN/UXC-7, tactical lightweight digital FAX. The DNVT is a prime subscriber terminal that
provides full-duplex digital voice communications and a voltage reference signal for limited data use.
a. Area Coverage. The MSE system provides ACUS support to a geographic area, as opposed to
dedicated support to a specific unit or customer. The hubs of the system are called nodes and are under the
control of the corps signal officer.
b. Subscriber Terminal (Fixed). The MSE telephone, mobile radiotelephone, FAXs, and data
terminals (as part of the ACUS) are user-owned and operated. The using unit is responsible for running
wire to the designated distribution boxes. Those boxes tie the medical company’s MSE telephones into the
extension switches, which access the system. The subscriber terminals used by the unit are digital, four-
wire voice as well as data ports (DNVTs [TA-1042]) for interfacing with the AN/UXC-7 FAX and the
medical transportable computer unit (MEDTCU).
c.
Wire Subscriber Access.
(1) Wire subscriber access points provide the entry points (interface) between fixed subscriber
terminal equipment and the MSE area system operated by the supporting signal unit. The two types of
interface equipment are—
• The signal distribution panel J-1077 (each panel provides up to 13 subscriber access
points).
• Remote multiplexer combiners (RMCs) that provide access for 8 subscriber access
points.
(2) The medical company/troop is responsible for installing and operating fixed subscriber
terminal instruments (DNVT TA-1042). It must also install and maintain the WF-16 field wire from the
instruments to the interface point (J-1077 distribution panel).
I-6.
Position/Navigation Equipment
a. The medical company, along with other CS, CSS, and combat units has been allocated
sufficient quantities of GPS devices commensurate with their missions. Normally, they are provided for
each vehicle, particularly those deployed in the forward areas.
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FM 4-02.6
b. This is a handheld (may be vehicular mounted), battery-powered position and navigation set
that receives its signal from GPS satellites, performs calculations, and displays position, velocity, time, and
navigational data. These devices provide a very accurate position location capability for determining and/or
reporting self-location; however, it is not a communications device.
c.
The company/troop ambulance teams, treatment teams, and wrecker operators will employ the
GPS device.
Section II. COMBAT NET RADIOS
I-7.
Combat Net Radio Systems
The SINCGARS radio, the IHFR, the Harris Corporation radios, and the PSC-5 SCTACSAT radios
comprise the CNR in the AMEDD inventory. These systems serve as the primary means for voice
transmission of C2 information and as a secondary means to MSE for data transmission.
a. The AM (high frequency) radios provide mid- to far-range communications capabilities. They
interface with other AM high-frequency radios that provide secure voice and data capability, and have push-
button frequency selection. The AN/GRC-246 digital high-frequency radio system from the Harris Corp-
oration provides reliable tactical communications through enhanced digital voice, data performance, and net-
working protocol capabilities. This radio is user friendly, menu-driven, owner-operated, and with a com-
puter interface that makes operation relatively easy. It uses new technology features unavailable in previous
high- frequency radio equipment. The digital radio has automatic link establishment and a serial tone modem
that employs data transport protocols with error detection and correction. The radio uses micro-processor
technology features to overcome nearly all of the limitations (propagation and frequency management)
commonly associated with high frequency beyond line of sight communications. It replaces the need for the
operator to search for the best operating frequency, attempt to establish or maintain communications, and
overcome the problems caused by ever-changing propagation conditions and noise interference.
NOTE
While the radio is easier to use than previous systems, the operator
must still acquire USEABLE frequencies from a frequency manage-
ment office. Not all frequencies between 1.5 and 30 MHz will work
depending on the location of the sender and the receiver, time of day,
and time of year. Commercial software programs are available to
check the propagation of high-frequency radios and are a wise invest-
ment for units planning to use such radios. If high-frequency radios
are critical to your mission, it is recommended the unit acquiring as
many frequencies as possible (10 should be enough) and confirming
the propagation characteristics of each prior to deployment. Frequen-
cy management offices have been known to provide high-frequency
radios that will not propagate for the specific mission requested.
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FM 4-02.6
b. The SINCGARS has a 16-element keypad for push-button tuning for simple and quick
operation. The system is capable of short-range operation for voice or digital data communications. It is
also capable of interfacing with the AN/VRC-12 series or other FM radios. The SINCGARS radios can
operate in a jam-resistant, frequency-hopping mode that can be changed as needed.
(Refer to FMs 11-1,
11-32, and 11-50 for communications operations in the corps, division, and below.). The SINCGARS can
monitor or scan up to five frequencies simultaneously and transmit on the one selected.
c.
The SCTACSAT provides a strategic reach-back and range extension capability. It is primarily
used to transmit voice, but has a limited data capability (limited due to narrow bandwidth). The “reach-
back” capability is critical for deployed forces prior to the ACUS network becoming operational. However,
due to satellite availability, the network is often oversubscribed and presented on a priority basis. The
“range extension” technique provides a retransmission capability for FM radios greatly extending broadcast
ranges.
I-8.
Radio and Wire Nets
The medical company/troop establishes radio nets to maintain an information link for command and
technical control of its elements. It is also essential that this Echelon II unit establishes radio communication
links with supporting corps medical elements and supported medical platoons to ensure that timely CHS is
provided throughout its support area. The medical company/troop, under its parent support battalion/
squadron, employs its SINCGARS radios in three separate FM nets: command net, treatment platoon
medical operations net, and an ambulance platoon medical evacuation net. It also employs an AM (high
frequency) net.
a. Command Frequency-Modulated Net. For C2, the commander establishes a command net
(Figure I-1). The NCS, operated by the unit CP, is normally comprised of the commander’s station,
treatment platoon leader’s station, ambulance platoon leader’s station, MH station, PVNTMED station, and
a wrecker operator/maintenance station. The commander’s station is also deployed in the battalion/squadron
command net. The CP/NCS may be employed in the brigade or regimental administrative/logistics net.
The CP is authorized the NCD KYX-15/TSEC for its NCS operation. The treatment platoon’s NCS may
also serve as the alternate NCS for the command net.
b. High-Frequency Radio Net (Amplitude Modulated). If the unit is a divisional medical company,
it is required to net with the DMOC medical operations net to ensure the external flow of CHL and air/
ground evacuation support. If the unit belongs to a nondivisional brigade or regiment, it will have access to
the supporting medical group medical operations net. Nondivisional medical companies/troops may also
access high-frequency nets of the MEDLOG and medical evacuation battalions. The signal officer of the
parent support battalion/squadron assists the medical company/troop in obtaining adequate SOI to allow it to
access these dedicated medical networks. The unit’s CP operates its high-frequency station (Figure I-2).
c.
Treatment Platoon Medical Operations Frequency Modulated Net. For OPCON of its treatment
elements, the treatment platoon establishes a medical operation net (Figure I-3). The platoon headquarters
operates the NCS. The platoon headquarters may also serve as an alternate NCS for the command net, and
the clearing station may serve as the alternate NCS for the treatment platoon. Approaching air ambulances
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FM 4-02.6
for patient pickup also use this net. When treatment squads/teams of the medical company/troop are
deployed in DS, or are attached to supported maneuver battalions/squadrons, they will normally operate in
the medical operations net of the supported BAS/SAS. They must be provided appropriate SOI for support
operations.
Figure I-1. Medical company/troop command frequency-modulated net.
d. Ambulance Platoon (Dedicated) Medical Evacuation Frequency-Modulated Net. The ambu-
lance platoon, under the control of its parent unit, establishes an FM net (Figure I-4) primarily dedicated to
air and ground medical evacuation radio traffic for the supported area. This net, operated by the platoon
headquarters, provides for the control of organic ambulances and for coordination of air and ground patient
evacuation in the supported area. The supported BAS/SAS and supporting corps air and ground ambulances
all operate on this net for the evacuation of patients out of the supported area. Supported aid stations also
use this net for the coordination of CHL support.
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FM 4-02.6
Figure I-2. Medical company/troop medical operations high-frequency net access.
Figure I-3. Treatment platoon medical operations frequency-modulated net.
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Figure I-4. Dedicated medical evacuation frequency-modulated net.
e.
Supported Medical Platoon. This supported Echelon I element employs a medical operations
net (Figure I-5) under the headquarters and headquarters company/troop of the parent maneuver battalion/
squadron. The platoon headquarters serves as the NCS. Its station is also deployed in the administrative/
logistics net. Other stations of this medical operation net include Treatment Team A (battalion/squadron
surgeon’s station), Treatment Team B (PA station), ambulance team stations, and the attached treatment
squad/team from the supporting medical company/troop. The medical platoon is provided appropriate SOI
sufficient to net with both supported and supporting units.
NOTE
Each ambulance team is a separate station and will require separate
call signs.
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FM 4-02.6
Figure I-5. Sample battalion aid station/squadron aid station medical operations
frequency-modulated net.
f.
Internal Wire Communications Net. The medical company/troop employs DNVT MSE for
internal communications. These phones will be replaced by regular garrison desk telephones when the
MSE is replaced by the Warfighter Information Network (WIN) system. The small extension node (SEN)
assigned to the unit will not change much in appearance, but the communications capability upgrade will be
substantial. Figure I-6 depicts a typical wire net for an MSMC and a medical company of a heavy separate
brigade.
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FM 4-02.6
Figure I-6. Sample medical company/troop internal wire net.
Section III. AUTOMATION AND DIGITIZATION
I-9.
Warfighter Information Network
a. The WIN is Force XXI’s communications network that will replace tri-service tactical
communications and MSE (from theater to battalion CP/TOC) and provide a C2 on-the-move capability to
the warfighter. The system uses commercial products and technology; provides wired and wireless
communications to support voice, data, and video information exchange requirements; provides seamless
connectivity among Army Battle Command Systems (ABCS) and weapons platforms within the battle space;
supports multiple security levels (unclassified, secret, and top secret/sensitive compartmented information);
and integrates terrestrial, airborne, and satellite-based transport systems.
b. The WIN is the designated ACUS to replace the MSE system. The terminal equipment will
include COTS desk telephones, COTS FAXs, secure terminal equipment telephones, networked automation
devices and video teleconferencing equipment. The secure terminal equipment telephones are compatible
with secure telephone unit-III telephones in garrison.
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I-10. Tactical High-Speed Data Networks
The tactical high-speed data network is an MSE upgrade providing increased bandwidth to support the video
and high-speed data requirements as an interim step towards the WIN. Components include a high-speed
multiplexer II, an enhanced-trunk group modem order-wire, Cisco routers, forward error correction,
network management, and security to support the data network. The link from a SEN to a node center will
increase in capacity from 16 kilobits per second (kbps) to 512 kbps. An internodal link will increase from
64 kbps to 3,000 kbps.
I-11. Medical Company Automation/Digitization Enablers
The automation and digitization enablers to be made available for the medical company consists of the
MC4; the FBCB2; the GCSS-A; the TC-AIMS), the MTS, and various COTS office computers purchased
by individual units.
a. Medical Communications for Combat Casualty Care. The best way to visualize the MC4
system capability is as a piece of the Army digital computer network where all 10 CHS functional areas
have been digitized and this CHS information is freely shared with everyone on the Army network with a
need to know. The MC4 system will be a theater-automated CHS system that links commanders, health
care providers, and medical support providers, at all echelons, with integrated medical information. Two of
the most significant capabilities that the MC4 system will bring the warfighter are enhanced ability to clear
the battlefield and in-transit visibility of soldiers.
b. Force XII Battle Command Brigade and Below System. The FBCB2 system is a digitized
BCIS that provides on-the-move, real-time and near-real-time battle command information to tactical combat,
CS, and CSS leaders and soldiers. The FBCB2 system, as a key component of the ABCS, seamlessly
integrates with the other components of ABCS at the brigade and battalion level. FBCB2 supports situational
understanding down to the soldier/platform level across all battlefield functional areas and echelons. The
FBCB2 system also provides the means for brigade- and battalion-level commanders to command when
away from their TOCs, interoperating with subordinate commanders and leaders also equipped with FBCB2.
c.
Global Combat Support System-Army. This system ties in all CSS data to C2 and provide CSS
situational understanding. This is the Army’s new automated system that will, over time, replace or
interface with all of the existing CSS automated systems. The title specifies CSS rather than logistics
system, because the new system will encompass personnel, financial, medical, and other nonlogistics CSS
functions. The GCCS-A will be made up of a series of functional modules such as supply, property,
maintenance, and management. Each module will run at any level or organization where the Army
performs that function.
d. Transportation Coordinators’-Automated Information Management System. The TC-AIMS is
a system that provides an integrated information transportation system capability for routine deployment,
sustainment, and redeployment/retrograde operations.
e.
Movement Tracking System. The MTS is a satellite-based tracking/communications computer
found on ambulances and in the company CP. The system’s primary purpose is to maintain visibility of
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vehicles, like ambulances, that move individually and continuously across the battlefield. The system has
the ability to send and receive free text messages for coordination and C2.
NOTE
Army of Excellence division ambulances have the MTS. Force XXI
division ambulances will have FBCB2.
f.
Commercial-Off-the-Shelf Office Automation. The computer devices present in tactical units
essentially mirror the office place automation. Full-sized COTS personal computers and laptops, all with
bubble jet or laser printers, are standard operating equipment. The systems host contemporary office
software with PowerPoint, Word and Excel, to name a few.
Section IV. MEDICAL COMMUNICATIONS FOR COMBAT CASUALTY
CARE SYSTEM CONCEPT
I-12. General
a. The digitized medical companies of the Force XXI division will employ the MC4 system, once
the system becomes operational. They will operate under the CSS Standard Army Management Information
System. The MC4 system is a theater, automated CHS system, which links commanders, health care
providers, and medical support providers, at all echelons, with integrated medical information. The system
provides digital enablers to connect both vertically and horizontally, all 10 CHS functional areas.
b. The MC4 system receives, stores, processes, transmits, and reports medical C2, medical
surveillance, casualty movement/tracking, medical treatment, medical situational understanding, and
MEDLOG data across all echelons of care. This is achieved through the integration of a suite of medical
information systems linked through the Army data telecommunications architecture.
c.
The MC4 system begins with the individual soldier and continues 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 CHS functional areas have been digitized and this CHS information is freely shared
with everyone in the Army with a need to know. Not only will the MC4 system provide Army commanders
with CHS information, but it will also provide them with a seamless transition to the joint CHS environment.
The MC4 system will consist of three basic components: software, hardware, and telecommunications
systems.
(1) Software. The joint TMIP will provide government off-the-shelf (GOTS)/COTS software
and interoperability standards to support joint theater operations. The software provides an integrated med-
ical information capability that will support all echelons of care in a TO with links to the sustaining base.
I-13
FM 4-02.6
Medical capabilities provided by the software to support commanders in the theater will address medical C2
(including medical capability assessment, sustainability analysis, and medical intelligence); MEDLOG
(including blood product management and medical maintenance management); casualty evacuation; and
health care delivery. The MC4 system supports Army-unique requirements and any software needed to
interface with Army information systems such as CSSCS, GCSS-A, FBCB2, warrior programs, and the
MTS.
(2) Hardware systems. The hardware will consist of COTS automation equipment supporting
the above software capabilities. Examples include, but are not limited to, computers, printers, networking
devices, and the EIC.
(3) Telecommunications systems. The MC4 system will rely on current and proposed Army
solutions for tactical, operational, and strategic telecommunications systems to transmit and receive digitized
medical information throughout the theater and back to the sustaining base. There will be no separate
AMEDD communications system. Telecommunications at brigade and below will be accomplished through
the tactical Internet; above brigade level, telecommunications will be accomplished through the WIN
architecture. The MC4 system includes hardware or software required to interface with current and
emerging technologies, supporting manual, wired, and wireless data transmission. At end-state, the MC4
system users will exchange data electronically via the WIN architecture. In the interim, commercial
satellites will be fielded to selected medical units (for example, MDT) receiving the MC4 system to support
high bandwidth requirements until the WIN architecture is fully fielded. Personnel operating satellite assets
are resourced in the MDT TOE and will be located with the MDT. The MC4 system employs a three-block
incremental development approach that incorporates the spiral systems engineering life-cycle methodology
designed to reduce development risk, improve manageability, increase maintainability, and accelerate
benefits to the warfighter. The MC4 system will be the Army’s medical information system to modernize,
digitize, and integrate medical information and make it available for the warfighting commander’s use.
1-13. Medical Digitization of the Combat Brigades
All soldiers have long required the ability to carry medical information with them for purposes of individual
readiness, continuity of care, medical surveillance, and post-deployment health care follow-up.
a. Under the MC4 system, medical information about every IBCT soldier will be entered into a
local database and maintained at the supporting BAS or troop medical clinic. 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.
b. Commanders will have, for the first time, readiness tracking and reporting during all phases of
deployment. The DOD standard automated systems will enhance commanders’ ability to track/report
qualification for worldwide deployment by tracking such items as blood type, dental readiness, immuni-
zations, allergies, flight status, physical profile, eyeglass prescriptions, current medical condition and
medications, thereby ensuring that the commander deploys a fit and healthy force. These digital tools signi-
ficantly enhance theater clearance and manifesting which ultimately streamlines the soldier readiness process.
I-14
FM 4-02.6
c.
Fielding of modular/tailorable CHS units, combined with the digital enablers, allows
optimization of the CHS footprint within a TO minimizing strategic lift and ensuring early deployment of
critical CHS assets. Digital enablers and reach capabilities will also optimize theater assets. Teleconsultation
provides specialty medical information to maximize the effectiveness of deployed personnel.
I-14. The Application of Medical Communications for Combat Casualty Care in Combat Health
Support Echelons of Care
The following paragraphs discuss how MC4 applies at each echelon of CHS in an operation involving the
combat brigade.
a. Echelon I.
(1) The 91W/trauma specialist (combat medic) will be the first point where a casualty
interfaces with MC4. Each 91W/trauma specialist will be equipped (when made available) with an MC4
Type I handheld Personal Digital Assistant (PDA) computing device capable of reading from and writing to
the casualty’s EIC. Medical care provided to the casualty by the 91W/trauma specialist will be recorded on
the EIC. Where communication assets allow, this information will also be transmitted to the supporting
BAS.
(2) If a casualty’s injuries or illness require treatment beyond the 91W/trauma specialist’s
abilities, the 91W/trauma specialist (combat medic) will notify the platoon sergeant who will relay a request
for support/evacuation using the FBCB2 system to the company’s 1SG. The 1SG, who normally has
control over the ambulances operating in DS support of the maneuver company, will dispatch an ambulance
to the location. The casualty will then be evacuated to a higher level of medical care, most likely the BAS.
During this evacuation, an on-board 91W/health care specialist will use digital equipment to monitor the
patient and provide en route care as required. Under MC4, each ambulance will be equipped with an on-
board MC4 computing device, which will interface with the casualty’s EIC. En route care provided by the
91W/trauma specialist will be recorded on the patient’s EIC and will also be transmitted to the destination
medical treatment facility. Digital linkages to medical C2 units/medical regulators allow for redirecting the
casualty en route should the need arise. The request for evacuation from the 91W/trauma specialist’s site
may also be made over FBCB2 system, utilizing a built-in MEDEVAC request.
(3) At the BAS, the medical staff will use MC4 Type II computing devices to read from the
patient’s EIC, ascertaining information on the care that the patient has received demographic information,
and any relevant medical history. Using the MC4 computing device, the BAS medical personnel will
record care provided onto the patient’s EIC. 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 (medical company) and ultimately to the
interim theater database.
(4) The present MEDLOG system at Echelon I is a totally manual system. Under MC4 the
91W/trauma specialist will utilize FBCB2 to request medical supplies from the BAS. This request will be a
built-in report in FBCB2. At the BAS, requests for Class VIII resupply will be made utilizing the MC4
system.
I-15
FM 4-02.6
b. Echelon II.
(1)
At the Echelon II MTFs (for example, the medical company/FST), MC4 will provide the
same augmentations to treatment documentation, evacuation, and MEDLOG that will be seen at Echelon I.
Through the use of the MDT, the medical company will have the ability to digitize medical data (x-rays,
pictures, etc.) and transmit it to medical experts at EAB/EAD. This teleconsultation ability will result
in some casualties being treated farther forward in the theater and will increase the RTD rate and reduce
overevacuation.
(2) The MC4 system will automate linkage of Class VIII to the transportation system. The
management of the complex medical sets along with the quality control of Class VIII materiel is also
automated improving efficiency over the current manual system.
c.
Echelon III. The MC4 will allow reach capability to Echelon III CHS and beyond. Echelon III
contains hospitals and all of the specialized medical units required to support the theater. The MC4 system
will link all of these medical functions. This system will equip corps treatment and evacuation teams with
personally carried and mobile computers for the collection and forwarding of medical information to the
forward, division, or ASMC. Likewise, CSC 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
medical regulators/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’s Regulating and
Command and Control Evacuation System) provides this functionality via WIN. A seamless Class VIII
(including blood) automated system links the theater to prime vendor systems in CONUS.
I-15. Medical Command and Control Application
a. Under MC4, medical information on soldiers will be stored at different levels. This will allow
commanders and command surgeons at the various echelons to access medical information on their soldiers
to find out specific information and to conduct analysis of disease/injury trends. These lower echelon
databases also provide a means for information redundancy should destruction of an information node or
communications outage occur. Each database will feed the databases above it. Personnel (medical
commanders, staff surgeons) at each echelon with MC4 management functionality will be able to query the
database. The CHS information required by the CSSCS will pass from the MC4 system through GCSS-A to
CSSCS.
b. The brigade surgeon will maintain a database containing medical information relevant to the
soldiers in the brigade. This will be the interim theater database that provides information to update
sustaining base medical information systems such as the computer based patient record and health
surveillance system.
c.
At all echelons, MC4 will automatically provide information such as evacuation status, current
fitness for combat, and hazard exposure information to the commander’s situational understanding system.
The MC4 system will provide the commander with the ability to track and record the date and location of
I-16
FM 4-02.6
exposure to health hazards, which include environmental, occupational, industrial, and NBC hazards. This
information is critical to the force health protection hazard analysis necessary to identify emerging DNBI
problems and trends. Commanders will have real-time information on food sources safety/quality,
operationally significant zoonotic disease, 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 commander from the MC4 functional digital systems through GCSS-A
to CSSCS. Commanders, for the first time, will have a complete picture of the battle space, which will
allow them to accurately influence current operations while synchronizing CHS with other activities.
d. The capabilities of the medical assets available to the combat brigade will be optimized with
technological enablers for equipment and supplies, and with digital enablers to include FBCB2, CSSCS,
MC4, TMIP, WIN, and the EIC. Figure I-7 provides an example of the MC4/TMIP database structure.
I-17
FM 4-02.6
Figure I-7. Medical communications for combat casualty care/Theater Medical Information
Program database structure.
I-18
FM 4-02.6
APPENDIX J
CLEARING STATION OPERATIONS ON URBANIZED TERRAIN
J-1.
Employment
In military operations on urbanized terrain (MOUT), the medical company’s/troop’s treatment units may be
required to deploy forward to provide Echelon I augmentation.
J-2.
Site Selection and Unit Layout
Site selection and unit layout requirements of the medical company/troop, as discussed in Chapter 3,
are still valid considerations in MOUT scenarios. However, MOUT-specific issues must also be con-
sidered.
a. Locations Within the City. If the area selected for the medical company to occupy is within the
city, it is important that the site be—
• Adequate for the number of casualties expected.
• That avenues of approach and egress are readily available.
• That there be a smooth flow of traffic within the site.
• That the location is reasonably secure easily defended and that it affords protection from
observation and the direct and indirect fires that are likely to result from that observation.
b. Existing Buildings. Combat in urban environments generally results in serious damage to
existing buildings. This damage may compromise the structural integrity of these buildings and render them
unsafe. If medical company operations must be established within existing battle damaged structures, they
should be inspected by engineers and declared safe for occupation.
c.
Basements. In many areas of the world, basements and subbasements are routine parts of
construction. Although basements afford protection from small arms and automatic weapons fire, they also
pose many potential hazards. Combat in urban areas may damage or destroy gas, water and sewer mains
(distribution systems). As the leaking gas may be heavier than air, it will settle into the low lying spaces
creating poisoning as well as fire and explosion hazards. Another hazard presented by establishing the
MTF in a basement or series of basements is that the building may collapse due to artillery fire or aerial
bombing, trapping medical personnel and patients under the rubble.
d. Fortifying the Building. If ground and upper level floors of a building are used, fortifica-
tions to the building can lower the threat from small arms and automatic weapons fire. This can be
accomplished by barricading windows and using sandbags; observation/firing ports (holes) can be left
open. By covering these observation/firing ports at night, light discipline can be maintained in the MTF
operational area.
J-1
FM 4-02.6
J-3.
Forward Surgical Team
The forward surgical team FST will collocate with the clearing station during MOUT operations. This
element provides forward surgical intervention for nontransportable trauma patients. Once stabilized by the
FST these patients can be evacuated further to the rear for more definitive care.
J-4.
Mass Casualty Operations
Mass casualty situations are chaotic events the throw large numbers of people together under less than ideal
circumstances. When anticipated and prepared for, through detailed planning, coordination, regular
rehearsals and tough realistic training the chaos associated with this type of event can be minimized. These
actions require proactive command level emphasis for units to be able to effectively deal with these
situations
a. Planning. To ensure efficient management of MASCAL situations, the CHS planner must
develop an effective plan and then rehearse it on a periodic schedule.
b. Rehearsal and Training. The response to a MASCAL situation is determined in large part by
how well the unit is prepared before the event occurs. Rehearsals are an invaluable tool for assessing the
strengths, weaknesses and training required to make personnel proficient in their individual and collective
tasks when responding.
c.
Additional Information. For additional information on MASCAL operations, see Appendix C.
J-5.
Forward Deployed Medical Treatment, Preventive Medicine, and Medical Evacuation Assets
a. Medical Treatment. The medical company will augment and/or reinforce aid stations as
needed during MOUT operations. Combat health support planners should consider pushing additional
Class VIII items forward to the aid stations in response to the increased number of casualties that are
generally sustained during MOUT operations. During the initial fight, the focus of the aid station is to treat
and stabilize severe trauma patients for evacuation. As a result, routine sick call services will usually be
passed to the medical company. The medical company/troop must, therefore, provide this support.
b. Preventive Medicine. Throughout history, disease nonbattle injury (DNBI) resulting from
medical threats (including, but not limited to, heat, cold, and disease) have accounted for more losses to
fighting forces than combat-related injuries. The need for effective preventive medicine measures cannot be
overemphasized, especially in MOUT operations. Combat in urbanized terrain by its nature creates some
unique hazards and situations. Despite considerable advances in the technology of war, the medical threat
still presents a significant danger to our forces. For detailed information concerning preventive medicine
refer to FMs 8-10-7 and 21-10.
c.
Medical Evacuation. Conducting medical evacuation operations in the MOUT environment
challenges the CHS planner. He must ensure that the CHS plan includes special or unique materiel
J-2
FM 4-02.6
requirements or improvised use of standard equipment. The plan must be sufficiently flexible to support
unanticipated situations. For detailed information concerning patient evacuation in MOUT operations refer
to FM 8-10-6, Chapters 5 through 10.
J-3
FM 4-02.6
APPENDIX K
MANAGEMENT OF INDIVIDUAL HEALTH RECORDS
IN THE FIELD
K-1. General
a. This appendix provides guidance on the maintenance of the soldier’s individual HREC and
CEMRs in the field. The governing regulation is AR 40-66.
b. Health records are maintained by the MTF that provides primary care for the soldier.
c.
Unit commanders will ensure that HRECs are always available to AMEDD personnel who
require such records in the performance of their duties. Unit commanders will also ensure that the
information in the HRECs is kept private and confidential in accordance with law and regulations governing
patient records administration.
d. Health records located at an Echelon I MTFs are maintained by unit medical personnel. The
AMEDD officer-in-charge serves as the custodian of the HRECs and CEMRs. Army Medical Department
officers are in charge of the HRECs and CEMRs for the members of the units and civilian employees for
whom they supply primary medical care. They are also in charge of the HRECs, CEMRs, and the records
of other individuals that are receiving treatment from the MTF. Health records are important for the
conservation and improvement of the patient’s health. Therefore, AMEDD officers will ensure that all
pertinent information is promptly entered in the HRECs/CEMRs in their custody. If any such pertinent
information has been omitted, the AMEDD officer will take immediate action to obtain such information
from the proper authority and include it in the HREC/CEMR.
K-2. Health Records of Deployed Soldiers
a. Health Records. The HRECs (DA Form 3444 or DA Form 8005 Series [Medical and Dental
Treatment Records]) of deployed soldiers and the CEMR of deployed civilians will not accompany them to
the combat area.
(1) The supporting MTF will initiate a DD Form 2766 (Adult Preventive and Chronic Care
Flowsheet), DD Form 2766C (Adult Prevention and Chronic Care Flowsheet Continuation), DD Form
2795 (Pre-Deployment Health Assessment Questionnaire), and DD Form 2796 (Post-Deployment Health
Assessment Questionnaire). If an individual deploys, the DD Form 2766 and DD Form 2766C will be
photocopied prior to deployment and the copy will be kept in the medical record. The original DD Form
2766 and any DD Forms 2766C will accompany the individual to the field. The DD Form 2766 serves as
the treatment folder for the individual that is deployed; other forms, such as DD Form 2766C, DD Form
2795, DD Form 2796, and SF 600 (Health Record-Chronological Record of Medical Care) will be filed on
the fastener inside DD Form 2766. The photocopies of the DD Form 2766 and DD Form 2766C will be
removed and shredded when the originals are placed back into the HREC or CEMR. Forms that had been
filed inside the DD Form 2766 folder will be removed and place in the HREC or CEMR (in the regular
treatment folder).
K-1
FM 4-02.6
(2) When processing individuals for deployment, the MTF and dental treatment facility
(DTF) will audit each individual’s HREC or CEMR and record essential health and dental care information
on DD Form 2766. If a HREC or CEMR is not available, DD Form 2766 will be completed based on
individual interviews and any other locally available data. A HREC may not be available for most
Individual Ready Reserve, Individual Mobilization Augmentees, and retired personnel because these HRECs
may remain on file at the Army Reserve Personnel Command (ARPERSCOM) or the VA.
(3) Upon notification of deployment, all military personnel will complete DD Form 2795.
(a) The individual being screened will fill out the section entitled Demographics on
page 1, and the section entitled Health Assessment on page 2. These sections are self-explanatory.
(b) The health assessment administrator will fill out the boxed area on page 1 entitled
Administrator Use Only, and will answer the user’s questions on filling out the form. The administrator will
document the deployment location as well as the completion date of the pre-deployment evaluation on DD
Form 2766, Block 11, Pre-/Post-Deployment History. This does not apply to classified operations.
(c) The health care provider will fill out the section entitled Pre-Deployment Health
Provider Review on page 2.
(d) A copy of the form will be filed on the fastener inside the DD Form 2766 folder;
one copy will remain in the HREC, and the original form will be sent to the Army Medical Surveillance
Activity, ATTN: MCHB-TS-EDM/Deployment Surveillance, Building. T-20, Room 213, 6825 16th Street
NW, Washington, DC 20307-5000.
(4) Department of Defense Directive 6490.2 and Department of Defense Instruction (DODI)
6490.3 state that to the extent applicable, medical surveillance activities will include essential DOD civilian
and contractor personnel directly supporting deployed forces, consistent with plans established under DODIs
1400.32 and 3020.37. If DD Form 2795 is used for civilians, a copy of the form will be filed on the
fastener inside the DD Form 2766 folder; one copy will remain in the CEMR, and the original form will be
sent to the Army Medical Surveillance Activity.
(5) If the deployed individual is taking part in a classified operation, the pre-deployment
evaluation (DD Form 2795) is still required, but the form will be maintained only in the personnel folder.
(6) The completed DD Form 2766 and a copy of any printout from an automated immuni-
zation tracking system will be provided to the individual’s command, or to the individual if he or she is an
individual replacement, and then handed off to the MTF in the AO responsible for providing primary
medical care to that individual. That MTF will maintain the DD Form 2766 as an outpatient field file for
reference as needed. The MTF will ensure that the ABO/Rh blood type from a verified blood bank typing
is recorded in Block 10. The field file will consist of, in part, DD Form 2766, DD Form 2795, and possibly
DD Form 2766C, DD Form 2796, SF 600, SF 558 (Medical Record-Emergency Care and Treatment),
SF 603 (Health Record-Dental), or DD Form 1380. These forms will be filed on the fastener inside
the DD Form 2766. For detailed information on how to complete the DD Form 1380, see Appendix C, FM
8-10-6.
K-2
FM 4-02.6
(7) If DD Form 2766 is not available, the individual’s field file may be managed as a “drop”
file (forms not attached) and integrated into the DD Form 2766 when it is available.
b. Forwarded Deployed Force. If time permits, follow guidance in a(1), (2), and (3) above. If
not, consolidate HREC in-country and process when time permits.
c.
Limited Contingency Operations. Retain the HREC at the MTF and DTF providing primary
care. If the servicing primary care facility closes, forward the HREC to the MTF or DTF indicated by the
servicing MEDDAC and dental activity. If full mobilization occurs, follow guidance in a(1), (2), and (3) above.
d. Units That Do Not Process Through a Mobilization Station. Units that do not process through
a mobilization station before deployment or otherwise do not have access to an MTF or DTF will follow the
procedures in b above.
K-3. Use of Field Files/DD Form 2766
a. If a member’s primary MTF changes, the field file/DD Form 2766 should be moved to the
gaining MTF.
b. If a member requires admission to the hospital, every attempt will be made to forward the field
file/DD Form 2766. The file will be returned to the member’s primary MTF if disposition is RTD.
K-4. Storage of Health Records and Civilian Employee Medical Records
Forward deployed (Echelon I and Echelon II) MTFs will secure field chest or field file containers in
quantities sufficient for the troop and civilian employee population supported. They will maintain the DD
Form 2766 for each individual receiving primary medical care from their MTF.
K-5. Establishment and Management of the Field File in the Operational Area
a. A DD Form 2766 and the medical records identified above will be maintained by medical
companies operating an Echelon II MTF or the medical platoon/section that operates an Echelon I MTF, or
will be handed off to the MTF providing their primary care.
b. Supported units will be required to provide the primary care MTF a battle roster of personnel
assigned. This roster should be provided when personnel assignment changes are made or upon request.
c.
The MTF, when possible, will attempt to ensure that the HREC or CEMR accompanies the
medically evacuated individual.
d. If an individual’s primary MTF changes, the HREC or CEMR will be transferred to the
gaining MTF.
K-3
FM 4-02.6
e.
If an individual requires hospital admission, every attempt will be made to forward the HREC
or CEMR to the admitting hospital.
f.
When the MTF determines that an individual was evacuated without the DD Form 2766 and
other medical records in the file, then the individual’s DD Form 2766 and other medical records are
forwarded to the medical C2 headquarters responsible for regulating patients out of the AO. The medical
C2 headquarters forwards the outpatient field file to the hospital where the patient was evacuated. The
hospital patient administration section will attach the file to the inpatient chart and the file is evacuated with
the patient out of the AO or theater.
K-6. Health Assessments after Deployment
a. All military personnel will complete DD Form 2796 prior to leaving the AO.
(1) The individual being screened will fill out the section entitled Demographics on page 1
and the section entitled Health Assessment on page 2. These sections are self-explanatory.
(2) The health assessment administrator will fill out the boxed area on page 1 entitled Admin-
istrator Use Only and will answer the user’s questions on filling out the form. The administrator will
document the deployment location (if this information is missing) and the completion date of the post-
deployment evaluation on DD Form 2766, Block 11, Pre-/Post-Deployment History. This does not apply to
classified operations.
(3) The health care provider will fill out the section entitled Post-Deployment Health Provider
Review on page 2.
b. If a situation does not allow this health screening prior to departure, the individual’s commander
will ensure that the health assessment is completed and submitted to the local MTF commander within 30
days of the individual’s return. The local MTF commander will ensure that a procedure is in place for
submitting the original DD Form 2796 to the Army Medical Surveillance Activity and for filing a copy in
the HREC.
c.
If the DD Form 2796 is completed prior to leaving the AO, a copy of the form will be filed in
the DD Form 2766 folder until it can be integrated into the HREC. The original DD Form 2796 will be
submitted to the Army Medical Surveillance Activity, ATTN: MCHB-TS-EDM/Deployment Surveillance,
Building. T-20, Room 213, 6825 16th Street NW, Washington, DC 20307-5000.
d. The post-deployment assessment of Reserve Component personnel must be completed prior to
release from active duty if not completed before redeployment. Reserve Component personnel who have
been deployed will also complete DD Form 2697 (Report of Medical Assessment) according to AR 40-501.
Reserve Component personnel who are called to active duty but never actually deployed will only complete
DD Form 2697.
e.
If DD Form 2796 is used for civilians, the form will be completed prior to leaving the AO. If
a situation does not allow this health screening prior to departure, the individual’s commander will ensure
K-4
FM 4-02.6
that the health assessment is completed within 30 days of the individual’s return. If the DD Form 2796 is
completed prior to leaving the AO, a copy of the form will be filed in the DD Form 2766 folder until it can
be integrated into the CEMR. The local commander will ensure that a procedure is in place for submitting
the original DD Form 2796 to the Army Medical Surveillance Activity and for filing the copy in the CEMR.
f.
If the deployed individual is taking part in a classified operation, the post-deployment evaluation
(DD Form 2796) is still required, but the form will be maintained only in the personnel folder.
K-7. Field Record Administration after Hostilities Cease
a. Field files/DD Form 2766 will be integrated with the HREC or CEMR after demobilization at
the home station or at mobilization stations.
(1) On return to the MTF (post-deployment), forms, such as SF 600, will be removed from
the DD Form 2766 folder and placed with the other SF 600 in the medical record.
(2) DD Form 2795 and DD Form 2796 will be removed from the DD Form 2766 folder and
placed as shown in Figures 5-1, 5-2, or 7-1 of AR 40-66. If a previously photocopied DD Form 2795 is
contained in the record, only one of the DD Forms 2795 will be kept; the other will be removed and
shredded.
(3) The photocopies of the DD Form 2766 and DD Form 2766C will also be removed and
shredded when the originals are placed back into the record. Field files/DD Form 2766 will be forwarded
to ARPERSCOM for those members who’s HREC is maintained at ARPERSCOM.
b. Each CONUS MTF must request records from ARPERSCOM for those members who remain
on active duty and are assigned for support upon demobilization.
c.
Field files will be integrated with the HREC maintained at home station or mobilization
station. Field files will be forwarded to Army Reserve Personnel Center (ARPERCEN) for members who’s
HREC is maintained at ARPERCEN.
d. Each CONUS MTF must request records from ARPERCEN for those soldiers who remain on
active duty and are assigned for support upon demobilization.
K-5
FM 4-02.6
APPENDIX L
CLINICAL GUIDELINES FOR COMBAT CASUALTY CARE
Section I. CLINICAL GUIDELINES FOR PHYSICIAN-LEAD, PHYSICIAN
ASSISTANT-LEAD, AND NURSING-LEAD TREATMENT MODULES
L-1. General
a. This appendix provides guidelines for use of personnel providing combat casualty care within
the medical company. It focuses on the clinical aspects of the unit’s operations.
b. The phased concept of combat casualty care, unique to war, permits the medical company, an
Echelon II MTF, to do what must be done to render casualties transportable to an Echelon III MTF for
continued treatment, or to treat and care for them for a limited period of time until they are able to RTD.
L-2. Field Surgeon (62B00 MC)
The credentialed physician (field surgeon) commanding trauma treatment elements examines, diagnoses,
and treats or prescribes course of treatment for the initial phase of battlefield disease and injury. He
provides resuscitative and definitive care for injured and wounded soldiers within the capability of the unit’s
medical element. This physician is also credentialed in Advance Trauma Life Support (ATLS®). Accord-
ingly, he establishes and practices techniques and procedures in accordance with ATLS® protocols. The
field surgeon also provides guidance to assigned clinical personnel and ensures the efficacy of their capability
in handling the sick and wounded/trauma casualty. He also ensures his team readiness and continued
training in tactical emergency medical care.
L-3. Physician Assistant (65D00 SP)
Physician assistants leading emergency medical treatment elements are ATM certified. The ATM is
composed of ATLS® and military specific/unique ATM and resuscitative skills. They practice techniques
and procedures in accordance with established ATM protocols. The PA also provides clinical guidance to
assigned medical personnel and insures the efficacy of their capability in handling of the sick and wounded/
trauma casualty.
L-4. Medical-Surgical Nurse (66H00 AN)
The medical-surgical nurses leading patient holding elements provide professional nursing care and health
care promotion for the assigned unit and the broader military community. Their responsibilities include
ambulatory, medical-surgical, emergency, and critical care nursing. The medical-surgical nurse duties
include supervision of holding squad personnel and technical training for 91W personnel of the unit. The
medical-surgical nurse also provides nursing care for those patients that overflow the FST’s recovery area.
L-1
FM 4-02.6
L-5. Forward Surgical Team
This physician-lead 20-person Echelon II trauma treatment module employs three clinical functional areas:
triage-trauma management, surgery, and recovery.
Section II. HEALTH CARE SPECIALISTS TREATMENT AND
EVACUATION MODULES
L-6. The 91W Health Care Specialist
Health care specialists assigned to treatment teams, holding squad, and ambulance teams of the medical
company/troop serve as integral members of the warfighting team by combining the skills of soldier and
medical caregiver. The 91W performs emergency and evacuation care under the medical direction of a
physician or other credentialed providers. Serves as a clinical technician in inpatient and outpatient areas of
MTFs. Performs basic force health protection care for individual soldiers and small units. Is trained for
combat and other operational environments. Conducts casualty triage and provides medical care for
patients in all operational environments to include enroute care during ground and air ambulance evacuations.
The 91W is certified to the national standards of emergency medical technician-basic (EMT-B) and
augmented by the national EMT-intermediate curriculum.
L-7. Core Competencies of the 91W
The 91Ws of medical company/troop must be trained/credentialed in several areas of core competencies.
These core competencies are examples of specific skills that establishes the scope and depth of clinical
practice that are outlined in Tables L-1 through L-3 below.
Table L-1. Core Competency for Emergency Medical Care
CORE COMPETENCY IN EMERGENCY CARE FOR THE 91W IS INCLUSIVE OF THE FOLLOWING:
• BATTLEFIELD AND OPERATIONAL FOCUS
• FAR FORWARD PRIMARY CARE
• SKILLS TO SUPPORT UNIT READINESS AND OPERATIONAL NEEDS
• SKILLS IN CONTEXT OF TACTICAL/OPERATIONAL ENVIRONMENT
EXAMPLES:
A. ALL EMT-BASIC SKILLS
1. ABCs (AIRWAY, BREATHING, CIRCULATION), CPR (CARDIOPULMONARY RESUSCITATION), OXY-
GEN THERAPY, SUCTION, AND SO FORTH.
2. BLEEDING CONTROL, BANDAGING, SPLINTING
3. BLS (BASIC LIFE SUPPORT) CARE FOR A BROAD ARRAY OF EMERGENCIES
4. DOCUMENTATION OF MEDICAL CARE
L-2
FM 4-02.6
Table L-1. Core Competency for Emergency Medical Care (Continued)
B. ADVANCED AIRWAY MANAGEMENT (INTUBATION, CRICOTHYROTOMY)
C. DECOMPRESSION OF TENSION PNEUMOTHORAX
D. VASCULAR ACCESS: INTRAVENOUS, INTRAOSSEOUS
E. FLUID RESUSCITATION
F. NBC MEDICAL PROCEDURES
G. LIMITED MEDICATIONS
1. CONTROLLED MEDICATIONS (SUCH AS MORPHINE)
2. CEPHALOSPORIN (ANTIBIOTIC)
3. ATROPINE (NERVE AGENT ANTIDOTE)
4. PRALIDOXIME (NERVE AGENT PROPHYLAXIS)
5. NITRITES, SULFATES (CYANIDE ANTIDOTE)
6. ALBUTEROL (PULMONARY AGENTS)
7. EPINEPHRINE, BENADRYL (ANAPHYLAXIS)
8. OTHER MEDICATIONS AT THE DISCRETION OF THE ATTENDING PHYSICIAN
H. ASSIST WITH AND MAINTAIN MEDICAL INTERVENTIONS INITIATED IN ECHELONS I, II, AND III DURING
TRANSPORTATIONS. ASSIST IN THESE PROCEDURES:
1. NASOGASTRIC INSERTION
2. FOLEY CATHETER INSERTION AND MAINTENANCE
3. CHEST TUBE(S) INSERTION AND MAINTENANCE
I. TRIAGE/MASCAL
J. ALL EMERGENCY CARE SKILLS ARE TRANSFERABLE TO INPATIENT/PATIENT HOLDING SETTING
Table L-2. Core Competency for Primary Medical Care
CORE COMPETENCY IN PRIMARY CARE FOR THE 91W IS INCLUSIVE OF THE FOLLOWING:
• SICK CALL NEEDS OF FAR-FORWARD UNITS
• ACUTE DENTAL, PSYCHOLOGICAL, AND OTHER PRIMARY CARE NEEDS
• PROTOCOL-DRIVEN COMMON FIELD CLINICAL PROBLEMS
EXAMPLES:
A. HEADACHE, COUGH, SORE THROAT AND OTHER MINOR COMPLAINTS
B. SPRAINED ANKLE, BRUISES, CUTS AND OTHER MINOR INJURIES
C. MINOR WOUND CARE AND CLOSURES (STAPLES/SUTURES)
D. LIMITED OVER-THE-COUNTER (OTC) MEDICATIONS
1. ACETAMINOPHEN (HEADACHE)
2. IBUPROFEN (ACHES AND PAINS)
3. ANTACIDS (DYSPEPSIA)
4. KAOPECTATE (DIARRHEA)
5. BENADRYL (ITCH)
6. CALAMINE LOTION (POISON IVY)
7. OTHER AVAILABLE OTC MEDICATIONS APPROVED BY A PHYSICIAN
E. REHABILITATION OF HEAT EXHAUSTION, FATIGUE, COLD EXPOSURE, AND SO FORTH
F. ASSIST PHYSICIAN/PA IN SICK CALL PROCEDURES
G. APPROPRIATE DOCUMENTATION (PATIENT CHARTING AS APPROPRIATE)
H. CONDUCT BASIC AMBULATORY CARE—TRIAGE
L-3
FM 4-02.6
Table L-3. Core Competency for Medical Evacuation
CORE COMPETENCY IN PATIENT EVACUATION AND RETRIEVAL FOR THE 91W IS INCLUSIVE OF THE FOLLOWING:
• EXTRACTION OFF THE BATTLEFIELD
• EXTRICATION FROM ALL TYPES OF COMBAT VEHICLES AND AIRCRAFT
• ONGOING EVACUATION CARE
• REQUESTING AIR/OR GROUND EVACUATION
EXAMPLES:
A. EXTRACTION OFF THE BATTLEFIELD
B. MANUAL AND LITTER CARRIES
C. EVACUATION PLATFORM LOADING/UNLOADING
D. EXTRICATION FROM VEHICLES/AIRCRAFT
E. OPERATING TACTICAL GROUND AMBULANCES (TRACKED AND WHEELED)
F. BASIC EN ROUTE MEDICAL CARE ONGOING FOR UP TO 48 HOURS
G. APPLICATION OF TACTICAL MEDICAL EVACUATION PROCEDURES AND RADIO COMMUNICATIONS
L-8. Medical Training
Tables L-4 through L-6 contains the critical tasks to be used by the commander in the development of unit
medical training program for assigned or attached 91W personnel. The training will be conducted under the
auspices of a licensed physician. The 91W will be certified to the national standards of EMT-B and
augmented by the national EMT-intermediate curriculum. The commander (medical company/troop) will
coordinate with the senior medical officer for consultation as needed, supervision of the unit’s continuing
education program, and to serve as the medical liaison between the unit and other services/facilities.
Table L-4.
91W10/20 Critical Task List
1. PERFORM AN INITIAL CASUALTY ASSESSMENT
TRAUMA/MEDICAL ASSESSMENTS (RESPONSIVE AND UNRESPONSIVE), BOTH ADULT AND PEDIATRIC (VS),
HISTORY (HX), SUBJECTIVE OBJECTIVE PROCEDURE NOTES, AUSCULTATE BREATH/BOWEL SOUNDS, MENTAL
STATUS, GLASGOW COMA SCALE, PRIORITIZE INJURIES OF INDIVIDUAL CASUALTY/PATIENT, COMPLETE
SPECIFIC FORMS
2. PERFORM ONGOING CASUALTY MANAGEMENT
VS DEFICITS AND TX, ONGOING MEDICAL MANAGEMENT IN BOTH LIMITED AND UNLIMITED RESOURCE
ENVIRONMENTS, PROVIDE CARE FOR COMPLICATIONS WITHIN AIR/GROUND EVACUATIONS, TRIAGE
CASUALTIES
3. PERFORM A CASUALTY RESUSCITATION
UNRESPONSIVE AND RESPONSIVE CASUALTIES, CARDIOPULMONARY RESUSCITATION (CPR), AIRWAY
ADJUNCTS, AIRWAY DEVICES, ADMINISTRATION OF OXYGEN (O2), HEAD POSITIONS, COMPLETE SPECIFIC
FORMS
L-4
FM 4-02.6
Table L-4.
91W10/20 Critical Task List (Continued)
4. ESTABLISH AN AIRWAY
ESTABLISH AIRWAY, USING AIRWAY ADJUNCTS, CONFIRM PLACEMENT, USE AMBU BAG AND TRACHEAL
SUCTION AS REQUIRED. USE MEDICATIONS FOR CONTROL OF THE INTUBATED PATIENT
5. MANAGE AN AIRWAY
FOCUSED ASSESSMENT, ADMINISTRATION OF O2 MASKS, PULSE OXIMETER, SUCTIONING, INTUBATION
6. TREAT A CASUALTY FOR A BURN INJURY
FOCUSED ASSESSMENT (BURN SURFACE AREA/DEPTH), AIRWAY MANAGEMENT, STABILIZING TX, PAIN
MANAGEMENT, WOUND CARE. (INCLUDE KNOWLEDGE ON CHEMICAL AND ELECTRICAL BURNS), PREPARE
FOR EVACUATION
7. TREAT A CASUALTY FOR A MAXILLOFACIAL AND NECK INJURY
FOCUSED ASSESSMENT, AIRWAY MANAGEMENT, MANAGE AREA-SPECIFIC BLEEDING, TX TEETH INJURIES,
AND PAIN MANAGEMENT, EAR INJURY
8. TREAT A CASUALTY FOR AN OCULAR INJURY
FOCUSED ASSESSMENT (HX, INCIDENT, COMPLAINTS, ACUITY, PUPIL, ORBITAL RIM, CHEMICAL), IRRIGATE
EYES, SUPERFICIAL FOREIGN BODY REMOVAL, EXTRUSIONS OF THE EYE, BURNS AND CONTUSIONS, APPLICA-
TION OF BANDAGES, PREPARE FOR EVACUATION
9. TREAT A CASUALTY FOR HEAD INJURY
FOCUSED ASSESSMENT, OPEN AND CLOSED INJURIES, TX FOR SPECIFIC INJURY, PREPARE FOR EVACUATION
10. TREAT A CASUALTY FOR A CHEST INJURY
FOCUSED ASSESSMENT, OPEN/CLOSED CHEST INJURES, NEEDLE DECOMPRESSION, FLAIL CHEST, EMPHY-
SEMA, TENSION PNEUMOTHORAX, ADMINISTRATION OF O2, PAIN MANAGEMENT, PREPARE FOR EVACUATION,
BLAST INJURY
11. TREAT A CASUALTY FOR AN ABDOMINAL INJURY
FOCUSED ASSESSMENT (BOWEL SOUNDS), TX OPEN AND CLOSED INJURIES (BANDAGES AND POSITION), IV
FLUID MANAGEMENT, PREPARE FOR EVACUATION
12. TREAT A CASUALTY WITH A WOUND
FOCUSED ASSESSMENT (OPEN/CLOSED), TX FOR LACERATIONS AND FRACTURES (FX), APPLICATION OF
DRESS-INGS/BANDAGES, SLINGS, SPLINTS, SUPERFICIAL REMOVAL OF FOREIGN BODY(IES), WOUND CARE,
ESTABLISH A STERILE/CLEAN FIELD, PERFORM SIMPLE SKIN CLOSURE TECHNIQUES, PAIN MANAGEMENT,
PREPARE FOR EVACUATION
13. TREAT A CASUALTY WITH AN EXTREMITY INJURY
FOCUSED ASSESSMENT (INCLUDE NERVE INJURIES AND OPEN/CLOSED INJURY), TX DISLOCATIONS AND FX,
APPLICATION OF SPLINTS/SLINGS AND FX DEVICES, PAIN MANAGEMENT, PREPARE FOR EVACUATION
14. TREAT A CASUALTY WITH A MANGLED BODY PART
FOCUSED ASSESSMENT, TX CRUSHED, PARTIAL AND COMPLETE AMPUTATIONS AND AVULSIONS, IV FLUID
MANAGEMENT, PAIN MANAGEMENT, USE OF TOURNIQUET, APPLY DRESSINGS, PREPARE FOR EVACUATION
15. TREAT A CASUALTY WITH AN IMPALED OBJECT
FOCUSED ASSESSMENT, TX ABDOMINAL AND EXTREMITY IMPALEMENTS, PAIN MANAGEMENT, PREPARE FOR
EVACUATION
L-5
FM 4-02.6
Table L-4.
91W10/20 Critical Task List (Continued)
16. CONTROL BLEEDING
FOCUSED ASSESSMENT, APPLY DIRECT PRESSURE, PRESSURE POINTS, HEMOSTATIC DRESSINGS (WHEN
AVAILABLE) PRESSURE DRESSINGS, TOURNIQUET, IV THERAPY (INSERTION AND MANAGEMENT)
17. TREAT FOR SHOCK
FOCUSED ASSESSMENT (VS FOR EBL), DECISION IV FLUID MANAGEMENT/THERAPY, USE OF ALBUMIN, ASSESS
URINE OUTPUT, FOLEY INSERTION
18. PROVIDE TREATMENT FOR BITES AND STINGS
FOCUSED ASSESSMENT (TYPE OF INSECT/SNAKE AND SO FORTH), TX INJURY AND COMPLICATIONS, IN-
STRUCT PREVENTIVE MEASURES
19. TREAT FOR ANAPHYLAXIS
FOCUSED ASSESSMENT (TYPE OF INCIDENT-FOOD, DRUGS, AND BITES/STINGS); ADMINISTER EPINEPHRINE
AND OXYGEN, AIRWAY MANAGEMENT
20. PROVIDE TREATMENT FOR A TOXIC EXPOSURE
FOCUSED ASSESSMENT (INGESTED, CONTACT, INHALED) ADMINISTER IPECAC, CHARCOAL, AIRWAY MANAGE-
MENT (CPR), PREPARE FOR EVACUATION
21. MANAGE A SEIZING CASUALTY
FOCUSED ASSESSMENT (INCLUDE HX AND INCIDENT OF ONSET), AIRWAY MANAGEMENT, USE OF DRUGS/
NARCOTICS, PREPARE FOR EVACUATION, POSITION PATIENT
22. TREAT A CASUALTY FOR A COLD INJURY
FOCUSED ASSESSMENT (MINOR TO SEVERE), PROVIDE TX FOR EACH (TEMP CONTROL, REWARMING, AND SO
FORTH), INSTRUCT PREVENTIVE MEASURES, AND PREPARE FOR EVACUATION
23. TREAT A CASUALTY FOR A HEAT INJURY
FOCUSED ASSESSMENT (MINOR TO SEVERE), PROVIDE TX FOR EACH (TEMP CONTROL, COOLING, AND SO
FORTH), INSTRUCT PREVENTIVE MEASURES, ORAL AND IV FLUID MANAGEMENT, PREPARE FOR EVACUATION
24. MANAGE A BEHAVIORAL CASUALTY
FOCUSED ASSESSMENT (INCLUDE DEPRESSION, SUICIDE, STRESS, AND SO FORTH), INITIATE CARE OR
PREVENTIVE MEASURES, PREPARE FOR EVACUATION, STRESS MANAGEMENT PRINCIPLES
25. EXTRACT A CASUALTY
PROVIDE SUPPORT DEVICES, SPINE PRECAUTIONS/IMMOBILIZATIONS, REMOVE FROM GROUND, VEHICLE,
TANK, FIXED FACILITY, AIRCRAFT, PROVIDE GROUND SURVEILLANCE FOR LAND MINES/SCENE SAFETY.
26. PERFORM CASUALTY TRIAGE
MASCAL-CORRECTLY TRIAGE CASUALTIES INTO DELAYED, IMMEDIATE, MINIMAL, OR EXPECTANT
27. EVACUATE A CASUALTY BY GROUND
ASSESS AND TRIAGE CASUALTY/IES FOR TYPE OF ROUTE APPROPRIATE FOR INJURY, LOAD AND UNLOAD A
CASUALTY, LITTER CARRIES
28. EVACUATE A CASUALTY BY AIR
ASSESS AND TRIAGE CASUALTY/IES FOR TYPE OF ROUTE APPROPRIATE FOR INJURY, LOAD AND UNLOAD A
CASUALTY, LITTER CARRIES
29. MANAGE MEDICAL COMMUNICATIONS
REQUEST FOR CASUALTY EVACUATION, WRITTEN FORMS OF COMMUNICATION, 9 LINE, USE OF VARIOUS
EQUIPMENT, TELEMEDICINE, GUIDE COMBAT LIFE SAVERS
L-6
FM 4-02.6
Table L-4.
91W10/20 Critical Task List (Continued)
30. PROVIDE POSTMORTEM CARE
PREPARE AND WRAP BODY, GRAVES REGISTRATION
31. PROVIDE TREATMENT FOR A BIOLOGICAL EXPOSED CASUALTY
FOCUSED ASSESSMENT, TRIAGE, APPROPRIATE TX PER PROTOCOL
32. PROVIDE TREATMENT FOR A NUCLEAR EXPOSED CASUALTY
FOCUSED ASSESSMENT, TRIAGE, APPROPRIATE TX PER PROTOCOL
33. PROVIDE TREATMENT FOR A CHEMICAL AGENT CASUALTY
FOCUSED ASSESSMENT, TRIAGE, APPROPRIATE TX PER PROTOCOL
34. DECONTAMINATE A CASUALTY
FOCUSED ASSESSMENT, APPROPRIATE DECONTAMINATION PROCEDURES
35. PERFORM MEDICAL SCREENING
ADMINISTER IMMUNIZATIONS, PERFORM SICK CALL PROCEDURES UTILIZING THE ALGORITHM DIRECTED
TROOP MEDICAL CARE, PERFORM EMERGENCY INCIDENT REHABILITATION
36. PROVIDE BASIC CARE
BED BATH, BLOOD DRAWS (NEEDLE/VACUTAINER), MAINTAIN BLOOD/FLUID PRECAUTIONS
37. PREVENT THE SPREAD OF DISEASE
PERFORM BASIC FIELD SANITATION, INSTRUCT ON PERSONAL HYGIENE IN REMOTE ENVIRONMENTS,
PREVENT NOSOCOMIAL INFECTIONS, WASH HANDS, DISPOSE OF INFECTIOUS WASTE, BODY SUBSTANCE
ISOLATION
38. TREAT A CASUALTY FOR SPINE INJURY
FOCUSED ASSESSMENT, C-SPINE AND NERVE INJURIES, APPROPRIATE IMMOBILIZATION
39. TREAT CARDIOPULMONARY SYMPTOMS
FOCUSED ASSESSMENT, CHEST PAIN, HA, ABDOMINAL PAIN, SITE OF BURN; DIFFERENTIAL DIAGNOSIS OF
CHEST PAIN
40. TREAT GASTROINTESTINAL SYMPTOMS
FOCUSED ASSESSMENT, ACUTE ABDOMINAL PAIN, N/V/D
41. TREAT GENITOURINARY SYMPTOMS
FOCUSED ASSESSMENT, UTIs, STDs (UNDER TREAT INFECTIOUS DISEASE), VAGINAL DELIVERY (ISOLATED
ENVIRONMENT IN EMERGENCY CASES ONLY)
42. TREAT NEUROLOGICAL SYMPTOMS
FOCUSED ASSESSMENT, TX PER PROTOCOL
43. TREAT METABOLIC/ENDOCRINE SYMPTOMS
FOCUSED ASSESSMENT, ASSIST WITH TX OF HYPOGLYCEMIA PER PROTOCOL
44. TREAT INFECTIOUS DISEASE IMMUNOLOGICAL SYMPTOMS
FOCUSED ASSESSMENT, TRIAGE, APPROPRIATE TX PER PROTOCOL
45. TREAT SKIN DISORDERS
FOCUSED ASSESSMENT, TRIAGE, APPROPRIATE TX PER PROTOCOL
46. VAGINAL DELIVERY (EMERGENCY CASES ONLY)
FOCUSED ASSESSMENT, MANAGE AIRWAY, MANAGE AREA BLEEDING, PAIN MANAGEMENT, FETAL ASSESS-
MENT, UMBILICAL CORD MANAGEMENT
L-7
FM 4-02.6
Table L-5.
91W30 Critical Task List
EVACUATE A MEDICAL CASUALTY
• THE MEDICAL EVACUATION SYSTEM INCLUDES PROPERTY EXCHANGE, MEDICAL SUPPORT OF
OFFENSIVE/DEFENSIVE OPERATIONS
• ESTABLISH GROUND AND AIR AXP
• COMMUNICATE WITH FORWARD SUPPORT AIR AMBULANCE TEAM, ESTABLISH LZ
• EVACUATION OF PRISONERS OF WAR
• EVACUATION IN SPECIFIC ENVIRONMENTS INCLUDES MOUNTAIN, JUNGLE, DESERT, AND OTHER
OPERATIONS
• USE OF SMOKE IN GROUND/AIR EVACUATION MISSIONS (IAW GENEVA CONVENTIONS)
PERFORM MEDICAL FORCE PROTECTION
EMPLOY PREDEPLOYMENT MEDICAL SURVEILLANCE REQUIREMENT
• CONDUCT MEDICAL SOLDIER READINESS PROCESSING
• IDENTIFY AND COORDINATE WITH PVNTMED ASSETS
• CONDUCT INSPECTIONS OF UNIT FIELD SANITATION PRACTICES
• CONDUCT INJURY PREVENTION CLASSES
• CONDUCT A MEDICAL THREAT ASSESSMENT
EMPLOY MEDICAL SURVEILLANCE REQUIREMENTS DURING DEPLOYMENT
• CONDUCT MEDICAL SURVEILLANCE DATA COLLECTION ACTIVITIES
• CONDUCT MEDICAL SURVEILLANCE DATA ANALYSIS ACTIVITIES
• REPORT MEDICAL SURVEILLANCE DATA ANALYSIS FINDINGS
EMPLOY MEDICAL SURVEILLANCE REQUIREMENTS DURING REDEPLOYMENT
• COORDINATE WITH PVNTMED FOR DEBRIEFING
• CONTINUE MONITORING POTENTIAL DISEASE SYMPTOMS FROM DEPLOYMENT
CONDUCT MEDICAL FORCE PROTECTION RISK ASSESSMENT
• IDENTIFY THE 5 STEPS OF CONTINUOUS RISK MANAGEMENT IAW FM 100-14
• UTILIZE RISK ASSESSMENT FORM FOR MEDICAL OPERATIONS
• CONFINED SPACES
• PERSONAL PROTECTIVE MEASURES
SUPERVISE A MEDICAL TREATMENT AREA
• ESTABLISH BAS, TREATMENT TEAM; MINIMAL CARE WARD, AND SO FORTH
• ESTABLISH NBC DECONTAMINATION STATION, BAS, TREATMENT TEAM/PLATOON IAW FM 8-10-7
• SUPERVISE FIELD/FIXED TREATMENT FACILITIES (WARDS, CLINICS)
• COORDINATE MEDICAL COMPETENCY BASE TRAINING.
• NATIONAL REGISTRY OF EMERGENCY MEDICAL TECHNICIAN STANDARDS
• REFRESHER COURSE
• CPR/OTHER REQUIREMENTS
APPLY MEDICAL LOGISTICS
• CLASS VIII MEDICAL RESUPPLY SYSTEM
• MEDICAL EQUIPMENT MAINTENANCE
• BLOOD STORAGE AND DISTRIBUTION
• NEW TECHNOLOGY SUCH AS O2 GENERATION, RESUSCITATIVE FLUIDS DEVELOPMENT, BLOOD
SUBSTITUTES AND FROZEN BLOOD AND HEMOSTATIC DRESSINGS
ASSIST WITH ADVANCED TRAUMA MEDICAL PROCEDURES
• CRICOTHYROTOMY
• NEEDLE CRICOTHYROTOMY/PERCUTANEOUS TRANSTRACHEAL JET VENTILATION
• CHEST TUBE INSERTION
• DIAGNOSTIC PERITONEAL LAVAGE
• CENTRAL VENOUS CANNULATION
• VENOUS CUTDOWN
• PERICARDIOCENTESIS
• RESUSCITATIVE THORACOTOMY
• ESCHAROTOMY FOR BURNS
L-8
FM 4-02.6
Table L-6.
91W40 Critical Task List
ASSESS MEDICAL CAPABILITIES
• CONSIDER RECONFIGURING ASSETS (PERSONNEL, EQUIPMENT) FOR STABILITY OPERATIONS AND SUP-
PORT OPERATIONS
• DEVELOP VIABLE HEALTH CARE PROGRAM FOR DISASTER ASSISTANCE, COMMUNITY AND ENVIRON-
MENTAL ASSISTANCE, AND LAW ENFORCEMENT SUPPORT
• INDIGENOUS MEDICAL CAPABILITIES
• RESEARCH AND IDENTIFY MEDICAL INTELLIGENCE
• ECHELONS OF CARE FOR JOINT OPERATIONS
MEDICAL REGULATING
• RESPONSIBILITIES AND COORDINATION WITH OTHER SERVICES (INTRACORPS, INTRATHEATER, AND
INTERTHEATER MEDICAL REGULATING).
• REGULATING WITHIN THE CZ
• ORIGINATING MEDICAL FACILITY’S RESPONSIBILITIES
• ESTIMATING MEDICALLY SIGNIFICANT CASUALTIES
• ESTIMATING ECHELON III HOSPITAL BED REQUIREMENTS
MANAGE INFECTIOUS AND REGULATED MEDICAL WASTE
• IDENTIFY PROPER DISPOSAL TECHNIQUES FOR REGULATED MEDICAL WASTE
• IDENTIFY SOURCE REDUCTION TECHNIQUES FOR REGULATED MEDICAL WASTE
APPLICATION/UTILIZATION OF MEDICAL TECHNOLOGY
REQUIRES FURTHER REFERENCES FROM AMEDD CENTER & SCHOOL, ATTN: MCCS-FC, FT SAM HOUSTON,
TX OR THE DCDD WEBSITE: http://dcdd.amedd.army.mil/index1.htm
PREPARE THE MEDICAL ANNEX TO AN OPERATION ORDER
• PREPARE HEALTH SERVICES ANNEX INCLUDING SERVICE SUPPORT, PATIENT EVACUATION, TREAT-
MENT AND HOSPITALIZATION.
• MISCELLANEOUS—CP LOCATIONS, COMMUNICATIONS, JOINT INTERNATIONAL OR HOST AGREEMENTS.
ALSO INCLUDED ARE: OVERLAYS AND PVNTMED.
L-9. Semiannual Combat Medic Skills Validation Test
a. The Army Surgeon General has directed that all 91W health care specialists validate their skill
proficiency semiannually. The Semiannual Combat Medic Skills Validation Test (SACMS-VT) will be
administered at least twice a year with a minimum of 4 months separating record of events. Commander
may administer the SACMS-VT more than twice a year, but must indicate beforehand when results are for
record purposes.
b. The SACMS-VT documents the 91W’s level of proficiency in critical medical skills and
provides the impetus for sustainment training to maintain readiness. Commanders will find that this test
facilitates the EMT-B civilian biannual certification process and ties in additional critical battlefield treatment
modalities. Detailed information for the test is provided in soon-to-be published Training Circular (TC)
8-800, Semiannual Combat Medic Skills Validation Test. The TC can be obtained by accessing the 91W
website: http://www.cs.amedd.army.mil/91w/default.htm.
L-9
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