FM 8-42 COMBAT HEALTH SUPPORT IN STABILITY OPERATIONS AND SUPPORT OPERATIONS (October 1997) - page 6

 

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FM 8-42 COMBAT HEALTH SUPPORT IN STABILITY OPERATIONS AND SUPPORT OPERATIONS (October 1997) - page 6

 

 

FM 8-42
the use of nonmedical vehicles and aircraft (such as from religious groups, volunteer organizations, and
community businesses). When at all possible, the victims who have sustained the more severe wounds
should be evacuated in ground and air ambulances or emergency vehicles. These patients will benefit most
from the provision of en route medical care. The more lightly injured and stable victims and those suffering
from stress can be transported by nonmedical/nonemergency transportation assets without serious risk of
worsening their medical prognosis.
J-7.
Disposition of Remains
In a mass casualty situation, there will be victims who have died before reaching the triage area (dead on
arrival) or who die of injuries before they can be stabilized and further evacuated. A temporary morgue area
should be established away from and out of sight of the triage and treatment areas. If the mass casualty
station is established outside, this area could be established behind a natural barrier such as a stand of trees
or it can be set off by using tentage or tarpaulins. This area is not an actual morgue as it does not have the
required equipment. The holding area requires minimal staffing for security. Remains are identified and
transferred to mortuary facilities as soon as possible.
J-8
FM 8-42
APPENDIX K
UNITED STATES DISASTER ASSISTANCE OPERATIONS
K-1. General
a. During disaster assistance operations, it is important that the CHS response be rapid, well
planned, and thoroughly coordinated. This is accomplished by the development of contingency plans, a
thorough understanding of the FRP and its delineation of duties and responsibilities, and the rapid assessment
of the health care requirements precipitated by the disaster.
b. In these operations, other government agencies may have the lead. An understanding of the
command/coordination arrangements is necessary at all levels to gain unity of effort and to avoid unnecessary
and counterproductive friction.
K-2. Administrative Support
a. To facilitate the management of personnel and resources flooding into the disaster area, it is
essential to establish a central point of administration as soon as possible within the disaster area. Once the
JTF surgeon has been designated and his staff established, the administrative unit is activated. The
headquarters establishing this administrative unit is responsible for preparing an SOP for the operation.
This SOP prescribes formats, reports, submission requirements, and the other myriad of administrative
details required to enhance the management of the operation. As the force deployed may be joint in nature,
or may come from a number of different types of units, such as Active Component, US Army Reserves, or
National Guard, a common reporting system will not exist. One must be established for all relief elements
to use.
b. A common communications system among the various units/forces deployed must be established
early on if effective C2 and administrative functions are to be successful. A system which is not accessible
to a portion of the forces deployed will detract from the overall relief effort.
c.
All units, whether administrative or operational, must provide for their own administrative and
logistical needs. This includes such items as notebooks, paper, pencils/pens, automated equipment (laptop
computers, facsimile machines), typewriters, and such. The local community in the disaster area will not be
able to provide this support.
d. When small teams are deployed, they must thoroughly coordinate support for lodging
and feeding prior to their deployment. The team cannot assume that it will be able to stay in un-
damaged motels/hotels in the disaster or outlying areas. They must be prepared to sleep and eat in a field
environment.
K-3. Priorities of Support
a. In the initial phase of a disaster assistance operation, the priority of support goes to the rescue,
treatment, and evacuation of the disaster victims, to PVNTMED (to include water) concerns, and to food
quality and safety assurance.
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FM 8-42
• Military evacuation assets (especially helicopters) used to augment civilian capabilities
should be carefully deployed to ensure that adequate coverage of the disaster area is effected. Ground
evacuation assets should be employed where the road network is still intact and not blocked by debris or
rubble. The aeromedical evacuation capability should be used in areas inaccessible by road; or where the
criticality of the injury dictates evacuation by air. Existing medical facilities with sustained damage may be
used after they have been inspected to ensure they are structurally sound. Aid station and clearing station
operations can be established in areas where medical assistance is required but the existing medical facilities
are not capable of providing the required support. In addition to independent operations, military medical
personnel may be used to augment the staffing at operational civilian medical facilities.
• Preemptive PVNTMED actions can reduce the incidence of morbidity and mortality due
to preventable causes of disease (control of disease vectors and rodents, disruption of sanitation facilities,
waste disposal, and sewer systems). Additionally, PVNTMED resources are required to ensure the safety of
the water supply in the AO.
• Veterinary resources are required to ensure the wholesomeness and safety of the food
supply in the disaster area. This is of particular importance in an NBC contaminated environment.
b. As the immediate patient work load decreases, emphasis of support can shift from trauma
management to other types of support. Mental health personnel can conduct surveys and provide intervention
as required. Veterinary personnel can tend to injured livestock, pets, and wild animals. Depending upon
regulations governing temporary housing or life support centers, veterinary help may be required with
privately owned pets not allowed to stay with their owners in these facilities. Community health nurses,
dietitians, and physical and occupational therapists can begin to work with disaster victims on activities of
daily living and meeting their day-to-day health care needs.
c.
A goal-oriented approach to disaster assistance must incorporate the reassumption of
responsibility by the local community in the disaster area. Within the medical arena, this may require
assistance in rebuilding the medical infrastructure, repairing and/or replacing facilities, and decreasing the
dependence on military medical assistance. A desired end state should be determined and a time line
established for the withdrawal of military medical assistance. This is, of course, established in conjunction
with the other agencies conducting relief operations.
K-4. Disaster Relief Task List and Status Board
During disaster relief operations, it is essential that the CHS provided be goal-oriented and continually
monitored. It is important, therefore, to establish a task list for the specific operation. Further, a status
board should be maintained to track the progress made toward the resolution of the relief effort.
a. The disaster relief task list will be comprised of different elements for each operation. This
list is developed by the JTF surgeon/staff in coordination with other participants. Factors such as the cause
of the disaster, resources available, time available, and other factors will differ from situation to situation. A
sample task list is provided for a natural disaster. This task list (Table K-1) should not be considered all-
inclusive and should be tailored to the specific operation.
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Table K-1. Sample disaster relief task list
• ESTABLISH COMMUNICATIONS WITH THE DOD CHS COORDINATOR WITHIN THE AOR.
• AUGMENT CIVILIAN HOSPITALS WITHIN THE RESOURCES OF THE DEPLOYED TF STRUCTURE.
• PROVIDE ROUTINE CHS TO US MILITARY FORCES DEPLOYED.
• ESTABLISH CIVILIAN MTFs CAPABLE OF RESUSCITATION AND STABILIZATION.
• PROVIDE MEDICAL SUPPORT TO TEMPORARY FACILITIES PROVIDING SUPPORT TO DISASTER
VICTIMS.
• ASSIST AND ORIENT LOCAL, STATE, AND FEDERAL CHS ORGANIZATIONS CONDUCTING
DISASTER RELIEF OPERATIONS.
• ESTABLISH PVNTMED PROGRAMS FOCUSED ON PEST MANAGEMENT, FIELD SANITATION,
AND PMM FOR VICTIMS OF THE DISASTER AND THE TEMPORARY AREAS ESTABLISHED
FOR HOUSING AND FIELD FEEDING.
• ESTABLISH A SINGLE POINT OF CONTACT FOR CHL.
b. To ensure that the status of each CHS functional component is monitored during the relief
operation, a status board should be prepared. This status board (Figure K-1) should provide a visual update
at a glance. The information can be displayed as a gum-ball chart depicting the civilian community’s
capability to provide its own support. The colors and their definition could be—
• Green for nearly full predisaster capability.
• Amber for some capability (50-75 percent).
• Red for little or no capability; requires significant DOD assistance.
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FM 8-42
PUBLIC HEALTH STATUS OF
FROM
TO
FUNCTIONAL AREA
GREEN
AMBER
RED
PATIENT EVACUATION AND
MEDICAL REGULATING
O
O
O
AREA SUPPORT/EMERGENCY
TREATMENT
O
O
O
HOSPITALIZATION/MEDICAL
TREATMENT FACILITIES/MEDICAL
LABORATORY SUPPORT
O
O
O
PREVENTIVE MEDICINE
O
O
O
VETERINARY SERVICES
O
O
O
COMBAT HEALTH LOGISTICS
(INCLUDING BLOOD MANAGEMENT)
O
O
O
DENTAL SERVICES
O
O
O
MENTAL HEALTH SUPPORT
O
O
O
COMMAND AND CONTROL
O
O
O
COMMUNICATIONS
O
O
O
LEGEND:
GREEN—NEAR FULL PREDISASTER CAPABILITY.
AMBER—50–75 PERCENT OF CAPABILITY.
RED—LITTLE OR NO CAPABILITY.
Figure K-1. Sample status board.
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FM 8-42
APPENDIX L
SELECTED SECTIONS OF TITLE 10, UNITED STATES CODE,
PERTAINING TO HUMANITARIAN ASSISTANCE
The information in this appendix is for informational purposes only. Combat health support commanders
should ensure that a legal opinion from the Staff Judge Advocate has been obtained prior to the execution of
any missions that are conducted which are governed by these sections of Title 10, US Code.
L-1. Humanitarian Assistance under Title 10, United States Code, Section 401
a. Humanitarian assistance is governed by Title 10, US Code, Section 401, which specifies:
Humanitarian assistance—
• Must be carried out in conjunction with HN military or civilian personnel.
• Shall complement and may not duplicate any other form of social or economic assistance
that may be provided to the HN by any other department or agency of the US Government.
• May not be provided directly or indirectly to any individual, group, or organization
engaged in military or paramilitary activities.
• May not be provided unless the DOS specifically approves such assistance.
b. Medical humanitarian assistance includes assistance to a HN such as medical, dental, and
veterinary care provided in rural areas of the country.
(A medical mission reconnaissance checklist is
provided in Appendix M.) This assistance complements, but does not duplicate, any other social or
economic assistance that is being provided by other US departments or agencies. These activities serve the
basic economic and social needs of the people of the country concerned; they—
• Support the civilian leadership.
• Benefit a wide spectrum of the community.
• Are self-sustaining (once completed) or supportable by the HN civilian or military
agencies once US assistance is withdrawn.
c.
Department of Defense humanitarian assistance programs promote the—
• Security interests of both the US and HN.
• Specific operational readiness skills of the Armed Forces who participate in the activities.
d. Humanitarian assistance projects or activities in any HN require specific prior approval of the
Secretary of State for such assistance.
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FM 8-42
e.
Expenses incurred as a direct result of providing humanitarian and civic assistance under this
section to a foreign country shall be paid out of funds specifically appropriated for such purposes to include
the following expenses:
(1) Travel, transportation, and subsistence expenses of DOD personnel providing such
assistance.
(2) The cost of any equipment, services, or supplies acquired for the purpose of carrying out
or supporting the activities, including any nonlethal, individual, or small team land mine clearing equipment
or supplies that are to be transferred or otherwise furnished to a foreign country in furtherance of the
provisions of assistance under this section.
f.
The cost of equipment, services, and supplies provided in a fiscal year may not exceed
$5,000,000.
g. Nothing in this section may be interpreted to preclude incurring of minimal expenditures by
the DOD for purposes of humanitarian and civic assistance out of funds other than funds appropriated.
L-2. Transportation for Humanitarian Relief Supplies under Title 10, United States Code,
Section 402
The transportation of humanitarian relief supplies to foreign countries is governed by Title 10, US Code,
Section 402.
a. Notwithstanding any other provisions of law, and subject to subsection (b), The Secretary of
Defense may transport to any country, without charge, supplies which have been furnished by a
nongovernmental source and which are intended for humanitarian assistance. Such supplies may be
transported only on a space available basis.
b. The Secretary may not transport supplies unless the Secretary determines that—
• Transportation of such supplies is consistent with the foreign policy of the US.
• Supplies to be transported are suitable for humanitarian purposes and are in usable
condition.
• Legitimate humanitarian need exists for such supplies by the people for whom they are
intended.
• Supplies will in fact be used for humanitarian purposes.
• Adequate arrangements have been made for the distribution of such supplies in the
destination country.
c.
The President shall establish procedures for making the determinations required under
paragraph b. Such procedures shall include inspection of supplies before acceptance for transportation.
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d. It shall be the responsibility of the donor to ensure that supplies to be transported under this
section are suitable for transport.
(1) Supplies transported under this section may be distributed by an agency of the US
government, a foreign government, an international organization, or a private nonprofit relief organization.
(2) Supplies transported under this section may not be distributed, directly or indirectly, to
any group or organization engaged in a military or paramilitary activity.
L-3. Foreign Disaster Assistance under Title 10, United States Code, Section 404.
Foreign disaster assistance is governed by Title 10, US Code , Section 404.
a. Presidential Direction. The President may direct the Secretary of Defense to provide disaster
assistance outside the US to respond to man-made and natural disasters when necessary to prevent loss of lives.
b. Forms of Assistance. Assistance under this section may include transportation, supplies,
services, and equipment.
c.
Notification Required. Not later than 48 hours after the commencement of disaster assistance
activities to provide assistance under the section, the President shall transmit to Congress a report containing
notification of the assistance provided, and proposed to be provided, under this section and a description of
so much of the following as is then available:
(1) The man-made or natural disaster for which disaster assistance is necessary.
(2) The threat to human lives presented by the disaster.
(3) The US military personnel and material resources that are involved or expected to be
involved.
(4) The disaster assistance that is being provided or is expected to be provided by other
nations or public and private relief organizations.
(5) The anticipated duration of the disaster assistance activities.
L-4. Excess Nonlethal Supplies for Humanitarian Relief under Title 10, United States Code,
Section 2547
The provision of excess nonlethal supplies for humanitarian relief is governed by Title 10, US Code,
Section 2547.
a. The Secretary of Defense may make available for humanitarian relief purposes any nonlethal
excess supplies of the DOD.
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FM 8-42
b. Excess supplies made available for humanitarian relief purposes under this section shall be
transferred to the Secretary of State, who shall be responsible for the distribution of such supplies.
c.
This section does not constitute authority to conduct any activity which, if carried out as an
intelligence activity by the DOD, would require a notice to the intelligence committees under Title V of the
National Security Act of 1947.
d. In this section, the term nonlethal excess supplies means property, other than real property, of
the DOD, that—
(1) Is excess property, as defined in regulations of the DOD, and
(2) Is not a weapon, ammunition, or other equipment or material that is designed to inflict
serious bodily injury or death.
L-5. Humanitarian Assistance under Title 10, United States Code, Section 2551
a. Authorized Assistance. To the extent provided in defense authorization acts, funds authorized
to be appropriated to the DOD for a fiscal year for humanitarian assistance shall be used for the purpose of
providing transportation of humanitarian relief and for other humanitarian purposes worldwide.
b. Availability of Funds. To the extent provided in appropriate acts, funds appropriated for
humanitarian assistance for the purposes of this section shall remain available until expended.
c.
Status Reports.
(1) The Secretary of Defense shall submit to the congressional committees an annual report
on the provision of humanitarian assistance pursuant to this section for the prior fiscal year. The report
shall be submitted each year at the time of the budget submission by the President for the next fiscal year.
(2) Each report shall cover all provisions of law that authorized appropriations for
humanitarian assistance to be available to the DOD.
(3) Each report under this subsection shall set forth the following information regarding
activities during the previous fiscal year.
(a) The total amount of funds obligated for humanitarian relief under this section.
(b) The number of scheduled and completed transportation missions for purposes of
providing humanitarian assistance under this section.
(c) A description of any transfer of excess nonlethal supplies of the DOD made available
for humanitarian relief. The description shall include the date of transfer, the entity to whom the transfer is
made, and the quantity of items transferred.
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FM 8-42
APPENDIX M
MEDICAL MISSION RECONNAISSANCE CHECKLIST
M-1. General
a. The individual medical mission under a humanitarian assistance program requires
comprehensive planning and prior coordination to ensure success. This appendix provides a sample
checklist for completing a reconnaissance of the mission area prior to deployment of a medical team.
b. The terminology used to describe the different levels of the health care delivery system and its
health care professionals in a particular country may vary from that provided in this checklist. This sample
checklist, therefore, should be modified to conform to the health care delivery system in the AO.
M-2. Sample Medical Mission Reconnaissance Checklist
The sample medical mission reconnaissance checklist is provided in Figure M-1.
NAME OF VILLAGE ____________________________
GRID _________________________________________
SHEET # ______________________________________
A.
RESOURCES AVAILABLE IN VILLAGE AND SURROUNDING VICINITY.
1)
COMMUNICATIONS MEANS, ACCESSIBILITY, AND EMERGENCY SERVICES.
A)
COMMUNICATIONS MEANS: TELEPHONE ________ TELEGRAPH _______ OTHER __________________
B)
TYPE OF ROAD NETWORK: PAVED _______________ DIRT _______________ PATH ____________________
C)
FIRE/SEARCH AND RESCUE SERVICES (LOCATION): _______________________________________________
D)
POLICE: ____________________________________ MILITIA: ____________________________________________
2)
HEALTH WORKERS.
A)
*HEALTH GUARDIAN: ____________________________________________________________________________
B)
*MIDWIFE: _______________________________________________________________________________________
C)
*HEALTH REPRESENTATIVE: ______________________________________________________________________
3)
OTHER PERSONNEL AVAILABLE.
A)
SCHOOL TEACHER: ______________________________________________________________________________
B)
VILLAGE LEADER: ________________________________________________________________________________
C)
OTHERS:_________________________________________________________________________________________
_________________________________________________________________________________________________
4)
*NEAREST MEDICAL CLINIC.
A)
DISTANCE:_______________________________________________________________________________________
B)
TRANSPORTATION AVAILABLE: __________________________________________________________________
C)
NUMBER AND TYPE OF STAFF (TO INCLUDE SPECIALTIES): ________________________________________
(1)
*NAME OF THE HEAD NURSE: ______________________________________________________________
(2)
*NAME OF THE HEALTH PROMOTER: _______________________________________________________
(3)
OTHERS:___________________________________________________________________________________
___________________________________________________________________________________________
*TERMS FOR THESE INDIVIDUALS OR ORGANIZATIONS MAY VARY BETWEEN HEALTH CARE DELIVERY SYSTEMS.
Figure M-1. Sample medical mission reconnaissance checklist.
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FM 8-42
5)
*NEAREST DISTRICT OR REGIONAL MEDICAL CLINIC.
A)
DISTANCE:_________________________________________________________________________________
B)
TRANSPORTATION AVAILABLE: ____________________________________________________________
C)
NUMBER AND TYPE OF STAFF: _____________________________________________________________
(1)
*NAME OF THE PHYSICIAN (SOCIAL SERVICE): ________________________________________
(2)
OTHERS:_____________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
6)
*NEAREST HOSPITAL (PUBLIC AND PRIVATE) AND TYPE OF HOSPITAL.
A)
*AREA HOSPITAL: ___________________________________ DISTANCE:___________________________
B)
*REGIONAL HOSPITAL: ______________________________ DISTANCE:___________________________
C)
*NATIONAL HOSPITAL: ______________________________ DISTANCE:___________________________
7)
PRIVATE PHYSICIANS.
A)
NAME:_____________________________________________________________________________________
B)
ADDRESS: _________________________________________________________________________________
C)
SPECIALTY: ________________________________________________________________________________
8)
ESSENTIAL DRUG LISTING (MEDICATIONS USED ON HUMANITARIAN ASSISTANCE MISSIONS
SHOULD BE CONSISTENT WITH LOCAL PRODUCTS AND AVAILABILITY). ___________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
9)
MEDICAL LOGISTICS AVAILABILITY (MATERIEL, SERVICES, AND REPAIR CAPABILITY). ______________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
B.
HEALTH INFORMATION.
1)
SIZE OF POPULATION.
A)
ADULTS:____________________________________________
B)
CHILDREN: __________________________________________
C)
INFANTS: ___________________________________________
2)
HOUSING AND ACCESSIBILITY OF HYGIENE AND SANITATION MEASURES.
A)
NUMBER OF HOUSES AND TYPICAL TYPE OF CONSTRUCTION TO INCLUDE HEATING: ________
B)
LATRINES: __________________________________________
C)
WATER PUMP: ______________________________________
D)
WATER SOURCE AND HOW USED (BATHING, LAUNDRY, AND COOKING): ____________________
3)
ENDEMIC DISEASES.
A)
___________________________________________________________________________________________
B)
___________________________________________________________________________________________
C)
___________________________________________________________________________________________
D)
___________________________________________________________________________________________
E)
___________________________________________________________________________________________
F)
___________________________________________________________________________________________
Figure M-1. Sample medical mission reconnaissance checklist (continued).
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FM 8-42
4)
FIVE LEADING CAUSES OF DEATH.
A)
ADULTS:___________________________________________________________________________________
B)
CHILDREN: _________________________________________________________________________________
C)
INFANTS: __________________________________________________________________________________
5)
VETERINARY INFORMATION.
A)
NUMBER OF:
(1)
CATTLE: _____________________________________________________________________________
(2)
HORSES/MULES: _____________________________________________________________________
(3)
GOATS:______________________________________________________________________________
(4)
PIGS: ________________________________________________________________________________
(5)
DOGS/CATS: _________________________________________________________________________
B)
NUMBER OF ANIMALS WHICH DIED IN THE LAST 3 MONTHS: ________________________________
C)
CAUSES OR REASONS OF DEATHS: _________________________________________________________
6)
DENTAL CARE INFORMATION.
A)
GENERAL LEVEL OF ORAL HEALTH: _________________________________________________________
B)
ENDEMIC ORAL DISEASES: _________________________________________________________________
C)
AVAILABILITY OF DENTAL CARE: ___________________________________________________________
D)
*NAMES OF DENTAL CARE PROVIDERS: ____________________________________________________
7)
GENERAL LIVING CONDITIONS.
A)
CLOTHES: ___________________ SHOES: ______________________ BAREFOOT: __________________
B)
HOUSING: _________________________________________________________________________________
C)
ELECTRICITY: ______________________________________________________________________________
D)
NUMBER OF FAMILY RADIOS/TELEVISIONS: ________________________________________________
E)
STORES: ___________________________________________________________________________________
F)
CROPS: ____________________________________________________________________________________
G)
MAIN FOOD SOURCES: _____________________________________________________________________
H)
MAIN SOURCES OF INCOME: __________________ AVERAGE FAMILY INCOME: ________________
I)
AVAILABILITY OF REFRIGERATION: _________________________________________________________
8)
TYPE OF HEALTH CARE TO BE GIVEN: _____________________________________________________________
9)
ESTIMATION ON RELIABILITY OF INFORMATION: __________________________________________________
C.
TRANSPORTATION INFORMATION.
1)
AIR.
A)
PILOTS WHO FLEW ASSESSMENT TEAMS: __________________________________________________
B)
ADEQUATE LANDING ZONE FOR:
(1)
UH-1: ________________________________________________________________________________
(2)
UH-60: _______________________________________________________________________________
(3)
CH-47: _______________________________________________________________________________
(4)
OTHERS:_____________________________________________________________________________
C)
TRAVEL TIME: _____________________________________________________________________________
2)
GROUND.
A)
TYPE OF VEHICLE: __________________________________________________________________________
B)
TRAVEL TIME: _____________________________________________________________________________
Figure M-1. Sample medical mission reconnaissance checklist (continued).
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FM 8-42
C)
SPECIAL REQUIREMENTS (SUCH AS SNOW CHAINS): _______________________________________
D)
OTHERS:___________________________________________________________________________________
D.
SECURITY INFORMATION.
1)
THREAT: _________________________________________________________________________________________
2)
HOST NATION AND US SECURITY FORCES IN THE AREA: __________________________________________
3)
AGENCY RESPONSIBLE FOR PROVIDING SECURITY AND CROWD CONTROL: _______________________
_________________________________________________________________________________________________
E.
DIAGRAM OF MISSION AREA.
1)
DRAW DIAGRAM (PLACE ON BACK OF SHEET). INCLUDE INFORMATION ON VILLAGE OR TOWN,
STREAM FLOW, CATTLE CHUTES, CORRALS, AND CEMETERIES.
2)
EXPLAIN ON-SITE TRIAGE: _______________________________________________________________________
3)
EXPLAIN PATIENT FLOW: _________________________________________________________________________
4)
OTHERS/REMARKS: ______________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
F.
ITEMS REQUIRED TO SUPPORT MISSION: _______________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
G.
PHOTOGRAPHS OF SIGNIFICANT FEATURES AND PEOPLE: (ATTACH TO REPORT)
H.
ASSESSMENT MADE BY:
1)
OIC/NCOIC: ______________________________________________________________________________________
2)
PHYSICIAN/NURSE: ______________________________________________________________________________
3)
OTHERS:_________________________________________________________________________________________
_________________________________________________________________________________________________
I.
EXPECTED DATE OF MISSION: __________________________________________________________________________
Figure M-1. Sample medical mission reconnaissance checklist (continued).
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APPENDIX N
COMBAT HEALTH SUPPORT
OF SPECIAL OPERATIONS FORCES
N-1. Special Operations
a. Special operations (SO) are operations conducted by specially trained, equipped, and organized
DOD forces against strategic or tactical targets in pursuit of national military, political, economic, or
psychological objectives. These operations may be conducted during periods of peace or hostilities. They
may support conventional operations or they may be prosecuted independently when use of conventional
forces is either inappropriate or not feasible.
b. Because one of the missions of SO involves training HN military to be self supportive, an
exception to the normal funding source is provided under Section 2011 of Title 10, US Code, permitting the
use of operation and maintenance funds when SO units are practicing their training skills in a HN. The
benefit that the HN derives as a result of this instruction is considered by Congress as a consequential
benefit.
c.
The medical capabilities and requirements for support of each Service’s SO component are
discussed in Joint Pub 3-05.3.
N-2. Department of the Army Special Operations Forces
The five component elements of the Army special operations forces (ARSOF) are:
• Special Forces.
• Rangers.
• Psychological operations (PSYOP).
• Special operations aviation (SOA).
• Special operations support.
N-3. The Threat to Special Operations Forces
The threat to SOF varies with the environment, geographic area, mission, and level of hostilities. The
specific threat to SOF encompasses the same threat facing conventional forces. Further, from the moment
SOF are inserted in small groups into an area by land, sea, or air, they must be able to survive; operate
deep in opposing force-held areas without being detected; and work closely with friendly, indigenous
personnel.
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N-4. Special Operations Forces Missions
a. Special operations forces missions are normally conducted as joint or combined operations
across the full range of military operations.
(1)
In accordance with Section 167, Title 10, US Code, the following are the principal SOF
missions:
• Counterproliferation.
• Special reconnaissance (SR).
• Psychological operations.
• Direct action.
• Foreign internal defense.
• Civil affairs.
• Combatting terrorism.
• Information warfare.
• Unconventional warfare.
(2)
Special operations forces collateral activities are—
• Coalition support.
• Counterdrug operations.
• Countermine operations.
• Humanitarian assistance.
• Security assistance.
• Special activities.
b.
Special operations forces can provide an extra dimension to
the
battlefield
through
their
unique and flexible capacity to affect operations in the deep, close, and rear battle areas.
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FM 8-42
N-5. Command and Control
a. Special operations forces are theater-level assets when deployed into an AO. Operational- and
tactical-level commanders request SOF through the unified CINC. The SOF C2 element is established at
any headquarters, combined or US, employing SOF. This ensures that unique mission requirements and
employment procedures are met.
b. The CINC directs theater SO and the employment of SOF through his subordinate special
operations command (SOC). The theater SOC is a joint command that controls ARSOF, USN, and
USAF SOF. As strategic assets, SOF elements are deployed to the TO and placed under SOC operational
control.
c.
Special operations forces units do not have an organic combined arms capability and are not
designed for sustained combat operations. Special operations forces require the support or attachment of
other combat, CS, and CSS resources (units/elements/personnel). Special operations forces units are
entirely dependent upon the resources of the theater to support and sustain their operations.
N-6. Army Special Operations
a. The SF group is a unique combat arms organization capable of planning, conducting, and
supporting SO activities in all operational environments and in peace, conflict, and war. Special Forces
units are characterized by the quality, motivation, training, and individual skill of their members. These
characteristics produce units with superb collective skills, able to adapt well to dynamic, complex situations.
(1) The SF group consists of a group headquarters and headquarters company, a group
support company, and three SF battalions. The group can operate as a single unit, but normally the
battalions plan and conduct operations from widely separated locations.
(2) The SF company consists of a company headquarters (“B” detachment) and six
operational detachments (“A” detachments or ODAs). The ODA (twelve-man team) is the basic SF unit
and is specifically designed to conduct SO activities in remote areas. This unit can operate for extended
periods with a minimum of external direction and support. The high-grade structure and experience level of
the ODA is required to permit it to develop, organize, equip, train, and advise or direct indigenous military
and paramilitary organizations of up to battalion size. For other SO activities that do not require its full
capabilities, the ODA serves as a manpower pool from which SF commanders organize tailored SF teams to
execute specific missions.
b. The Ranger regiment is a unique light infantry unit capable of planning, conducting, and
supporting SO activities. The Ranger regiment provides the NCA with the capability to deploy a credible
military force quickly to any region of the world. The primary Ranger mission in SO is to conduct direct
action operations best accomplished by light infantry forces using special techniques. Ranger direct action
operations may support or may be supported by other SO activities, or they may be conducted independently
or in conjunction with conventional military operations.
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c.
The SOA regiment is a unique Army aviation unit that provides dedicated combat aviation
support to Army and other SOF. This support is provided in all operational environments and in peace,
conflict, and war. Because of current force structure and contingency requirements, the regiment does not
operate as a single unit. Instead, it tailors the SOA battalion or company task forces to perform specific
missions. The primary mission of SOA assets is to clandestinely penetrate hostile and sensitive airspace to
conduct and support SO activities.
d. United States Army Reserve CA units have public welfare teams with various medical
specialties. These teams can train, advise, and assist US and indigenous forces in the conduct of medical
assistance to command operations and facilitate their integration due to their training.
e.
Psychological operations are planned operations to convey selected information and indicators
to foreign audiences to influence their emotions, motives, and objective reasoning. These operations
ultimately influence the behavior of foreign governments, organizations, groups, and individuals. Army
PSYOP units may be employed by the NCA in pursuit of national security objectives or by a theater-level
commander in pursuit of operational objectives. These PSYOP may be designed to maintain the support of
groups and nations friendly to the US; gain support and cooperation of neutral countries; strengthen or alter
alliances; deter a nation from aggression; and induce the surrender of hostile forces.
N-7. Organic Combat Health Support Capability
The organic CHS capability of SOF units is limited. Consequently, SOF are dependent upon the
conventional CHS structure for medical support in theater. Special operations forces missions rely on
organic assets to perform Echelon I medical care. Echelon II, (division level), Echelon III (corps level),
and Echelon IV (echelons above corps [EAC] level) medical care must be provided to the force.
a. Special Forces.
(1) The SF group has the capability to perform enhanced Echelon I medical care. Individual
care consists of self-aid and buddy aid, combat lifesaver, and aidman (SF medic [MOS 18D]) care. There
are two SF medics assigned to each ODA. The SF medic is extensively trained to act independently, often
as the sole source for medical, veterinary, dental, and PVNTMED care for his ODA and the indigenous
personnel (and their families) with whom his ODA interfaces. The SF medic is also uniquely qualified to
act as a trainer for indigenous and civilian medical personnel. The SF medic and other more specialized
medical assets within the SF group can provide limited support in the following areas:
• Preventive medicine.
• Medical intelligence.
• Veterinary and dental medicine.
• Laboratory support for clinical diagnosis.
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• Minor surgery.
• Short-term trauma management.
• Training for HN health care workers in medical, veterinary, dental, and PVNTMED
skills.
(2) A flight surgeon and physician assistant (PA) are assigned to each SF battalion. At the
forward operating base (FOB), the flight surgeon and PA can perform ATM procedures and provide limited
resuscitative care. Further, the FOB has a PVNTMED noncommissioned officer (NCO) capable of
providing medical threat evaluation and limited direct PVNTMED support.
(3) The Special Forces operating base (SFOB) has a flight surgeon, dental officer, veterinary
officer, medical operations officer, CHL officer, and an environmental science officer assigned. At this
level, the medical officers perform primarily as staff advisors to the group commander and provide medical
staff assistance to the deployed SF battalions. They can also assist in the training of HN medical assets.
(4) The medical platoon of the ARSOF special operations support battalion (SOSB) provides
Echelon I medical care to its supported ARSOF units.
(The full range of Echelon II through Echelon IV
support must be provided to the force.)
• It also provides—
•
Limited ground evacuation of the sick, injured, and wounded.
•
Limited medical intelligence capability.
•
Communications capability.
• The platoon is organized into a headquarters and treatment section, an ambulance
section, and a medical logistics section.
• For additional information, refer to FM 8-10-1.
b. Rangers.
• The Ranger regiment has the capability to perform Echelon I and limited Echelon II care.
Echelon III care must be provided to the force by conventional CHS resources.
• Rangers have organic CHS assets, but they do not have an aid station (treatment squad)
capability.
• A general medical officer and a PA are assigned to each Ranger battalion. The Ranger
regiment, battalion, and company headquarters are each assigned one MOS 18D, SF medical sergeant.
Platoons are each assigned MOS 91B, medical specialists.
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c.
Special Operations Aviation.
• Special operations aviation has a flight surgeon and a psychiatrist assigned at group level.
• Special operations aviation is dependent on area CHS from units it is supporting (typically
the SFOB).
• Special operations aviation units do not have specifically designated medical aircraft with
a primary mission of medical evacuation. Evacuation by nonstandard aircraft is emphasized and
augmentation from supporting Echelon II assets is encouraged.
• Like other SO medical assets, SOA medical personnel can provide limited flight medical
training for HN aviation personnel.
d. Psychological Operations.
• Psychological operations units have no organic CHS. They are dependent on area CHS
from the theater medical command (MEDCOM).
• Psychological operations units also require timely and accurate information on all public
health and HN support initiatives to accomplish their mission.
e.
Civil Affairs. United States Army Reserve CA battalions have public welfare teams with
various skills. Their expertise gives them unique qualifications to provide guidance on the HN health care
infrastructure, as well as PVNTMED issues.
N-8. Planning for Combat Health Support of Special Operations Forces
Special operations forces units require CHS similar to other combat, CS, and CSS units. They also need
medical intelligence to counter the medical threat. The support should include all of the medical functional
areas.
N-9. Patient Evacuation and Medical Regulating
Aeromedical evacuation of SOF is indicated only when it will not compromise the mission. Combat health
support planners must ensure there is adequate medical evacuation capability, both intertheater and
intratheater. If SOF assets are used, as will probably be the case in intratheater evacuation, medical assets
must be on board to provide medical care en route. Combat health support planners must ensure that SOF
have their own evacuation policy to allow return of critical SOF MOSs to their units instead of being
evacuated out of theater. Early coordination must be made with in-theater USAF assets or supporting SOA
assets to ensure timely intertheater evacuation capability. The SOSB has a limited ground evacuation
capability within the staging base. Echelons I through III medical care is a service responsibility. Intratheater
medical regulating of ARSOF is normally an Army function. The transfer of patients from an Echelon III
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Army MTF to an Echelon IV facility is a theater (or joint) function; therefore, intratheater and intertheater
medical regulating is usually a function of the TPMRC and GPMRC. Medical regulating is not an ARSOF
function since units are neither staffed nor equipped to accomplish this mission. It is essential that surgeons
at all levels understand how patients are regulated within and between theaters, and how they can track them
through the system.
N-10. Hospitalization
Special operations forces do not have an organic Echelon III capability. They rely on the theater MEDCOM
hospitalization system for their patients in the combat zone and EAC; in an underdeveloped theater or AO,
SOF may rely on the HN to provide hospitalization. When the sensitivity of a particular mission dictates
strict OPSEC, the SOC must coordinate with the MEDCOM to establish facilities capable of handling
patients on a classified basis.
N-11. Combat Stress Control
a. Combat fatigue cases should be managed as far forward as possible to preclude unnecessary
loss of personnel, hasten RTD, and prevent overburdening the medical evacuation system.
b. Army SOF do not have organic CSC teams; support is required from the theater MEDCOM.
N-12. Preventive Medicine
A major shortfall of SOF CHS is the lack of PVNTMED assets for extensive PVNTMED area support
(such as aerial spraying and larviciding). Although SF medics are trained in the basics of PVNTMED, the
SF group has limited assets and capabilities to plan, coordinate, and supervise PVNTMED programs to the
extent that is required. Other SOF units have even less PVNTMED capabilities. Given the nature of SOF
operations which places personnel at serious risk for disease and environmental injury, a full-time
PVNTMED commitment may be required, necessitating the use of theater PVNTMED support. Education
and thorough indoctrination to the risks, surveillance procedures, and PMM are continually required to
safeguard the health and readiness status of the operational force. The PVNTMED NCOs in the SF
battalions and the SOSB provide technical assistance to the unit field sanitation teams and advise the
commander on the control measures required to protect the force.
N-13. Medical Intelligence
Research specialists are dedicated to researching and compiling medical threat information in all foreign
countries and disseminating this information to all deploying SOF elements. The United States Special
Operations Command (USSOCOM) medical intelligence section is the interface between SOF and AFMIC.
Medical intelligence maintains comprehensive classified and unclassified hard copy and electronic data
bases in support of SOF deployments for training and security assistance commitments. It also maintains
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extensive liaison with intelligence and medical networks within USSOCOM, AFMIC, Defense Intelligence
Agency (DIA), and other agencies. This section compiles new critical elements of information received
from teams operating in the field for dissemination in future deployments. After-action reports (AARs) containing
medical information have proven to be critical in planning operations. The PVNTMED branch and medical
intelligence section work together in recognizing the threat and recommending countermeasures to this
threat.
N-14. Veterinary Services
Special Forces groups have limited veterinary services. When veterinary services are required in more
than one location or when the SOF are larger than two deployed FOBs, veterinary support must be
augmented. Veterinary personnel must perform the majority of the food source inspection mission.
N-15. Medical Laboratory Services
The SF group ODA is the only SOF unit with a limited laboratory capability. The SO medical sergeant
(MOS 18D) is trained to provide basic clinical laboratory tests and procedures in support of UW or FID
missions. Echelon III laboratory support is required from the theater.
N-16. Combat Health Logistics and Blood Management
The medical sections of all SOF units maintain a Class VIII (medical supply) basic load to support initial
operations. The SF group, SOSB, special operations support command (SOSCOM), and battalion medical
sections are the only SOF elements with organic medical supply personnel. The SOSCOM provides the
medical equipment support in SOF. No SOF unit has an organic medical equipment maintenance capability.
These units receive routine CHL through their supporting medical logistics battalion. This support includes
Class VIII supplies, oxygen, resuscitative fluids production, optical fabrication, medical equipment
maintenance support, and blood management. To fill operational requirements in support of UW or FID,
SF medical supply personnel at the SFOB and FOB requisition bulk Class VIII supplies directly from the
supporting MEDCOM medical logistics battalion or installation CHL activity. Army SOF may also
supplement their CHL effort with foreign national medical supplies, particularly during UW operations, if
approved by the Food and Drug Administration (FDA) and theater surgeon.
N-17. Dental Services
The group’s medical section includes a dental team (dental officer and dental assistant) who can provide
emergency or sustaining dental care. The SF medics have limited dental training and equipment and can
provide only emergency dental care.
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N-18. Interrelated Missions
As previously stated, SOF units conduct nine basic missions and have a number of collateral capabilities
(paragraph N-2 above.). Special operations forces elements conduct UW, FID, counterterrorism, direct
action, and SR operations in peace, conflict, and war. Mission priorities vary from theater to theater.
These elements are specifically tailored to organize, equip, train, direct, control, and support indigenous
forces in FID and UW operations. They also perform SR, direct action, and counterterrorism operations
and other missions requiring their collateral capabilities. Although each mission is treated separately, they
are all interrelated. Some situations will dictate that a committed SOF element conduct more than one
mission at the same time.
N-19. Unconventional Warfare
a. Unconventional warfare is a broad spectrum of military and paramilitary operations, normally
of long duration, predominantly conducted by indigenous or surrogate forces who are organized, trained,
equipped, supported, and directed in varying degrees by an external source. Unconventional warfare
includes guerrilla warfare and other direct offensive, low-visibility, covert, or clandestine operations.
Unconventional warfare also includes the indirect activities of subversion, sabotage, intelligence collection,
and evasion and escape.
b. The goals of CHS in support of UW are to conserve the guerrilla force’s fighting strength and
to assist in securing local population support for US and insurgent forces operating within unconventional
warfare operations area (UWOA).
c.
Medical elements supporting the insurgent forces must be mobile, responsive, and effective in
preventing disease and restoring the sick and wounded to duty. There is no safe rear area where the
guerrilla takes his casualties for treatment. Wounded and ill personnel become a tactical rather than a
logistical problem.
d. In a UW situation, indigenous medical personnel may provide assistance during combat
operations by establishing casualty collecting points, thus permitting the remaining members of the insurgent
force to continue to fight. Casualties at these collecting points are later evacuated to the guerrilla base or
guerrilla medical facility. As the operational area develops, more seriously injured or diseased personnel
are evacuated to friendly areas. Clandestine evacuation nets are established if security does not permit using
aeromedical evacuation.
e.
Medical requirements within the UWOA differ from those posed by conventional forces.
Battle casualties are normally fewer and the incidence of disease and malnutrition is often higher.
N-20. Foreign Internal Defense
a. Foreign internal defense is the invited participation by civilian and military agencies of a
government in any of the action programs taken by another government to free and protect its society from
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subversion, lawlessness, and insurgency. These operations which may be international in makeup and
involve more nations than the US are aimed at supporting a friendly government. The purpose of these
operations is to protect internal development efforts that focus on the economic and social aspects of the
nation’s structure. Special operations forces are frequently deployed in regions where FID is a major DOD
mission and, by virtue of their unique skills, language capability, and cultural knowledge, SOF medical
assets are easily integrated into a HN support role. However, FID is not exclusively a SOF mission. It is a
joint and interagency activity in which SOF participate. The primary SOF mission in this interagency
activity is to organize, train, advise, and assist HN military and paramilitary forces.
b. Civil-military operations that focus on the relationship between US military forces and the
indigenous population are critical for FID operations. Combat health support has proven to be one of the
most effective ways to gain support for the HN government. Medical assistance is constructive in nature
and is generally welcomed, rather than feared. Medical assistance programs are requested by the HN
government. They are aimed at—
• Improving basic standards of living and health.
• Involving the local population.
• Enhancing the prestige of local authorities.
c.
Combat health support may include, but is not limited to—
• Providing medical treatment.
• Providing education in basic sanitary procedures, hygiene, and PVNTMED.
• Providing sanitary facilities and waste disposal and controls.
• Improving the quality of drinking water.
• Conducting immunization programs.
N-21. Counterterrorism
a. Counterterrorism operations are offensive measures taken by civilian and military agencies
of a government to prevent, deter, and respond to terrorism. The primary mission of SOF in this
interagency activity is to apply specialized capabilities to preclude, preempt, and resolve terrorist incidents
abroad.
b. Counterterrorism operations are either overt or covert in nature. They are characterized, in
contrast to UW, as being of short duration and specifically targeted. During counterterrorism operations,
tailoring of units and equipment is required. Medical personnel are needed at all levels of the operation,
and medical equipment is selectively chosen for the operation.
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c.
Combat health support planning involves studying the mission and the AO to determine CHS
requirements. Equipment is kept to a minimum to support emergencies and routine illnesses. Special
packing of the equipment is considered, especially for raid-type missions, to make essential items
immediately accessible. Pre-mission medical training concentrates on EMT, ATM, and treatment of mass
casualties.
N-22. Direct Action
a. Special operations forces direct action missions are combat operations conducted or directed
primarily by SOF in hostile or denied areas beyond the operational capability of tactical weapon systems
and conventional maneuver forces. Direct action operations are normally limited in scope and duration, but
they may include long-term stay-behind operations. These operations typically involve the interdiction of
critical LOC or other target systems and the abduction, rescue, or recovery of selected personnel or
sensitive items of material.
b. Combat health support of SOF direct action operations is generally directed toward providing
evacuation and hospitalization. Since the majority of SOF direct action missions are conducted beyond the
forward line of own troops (FLOT), aerial medical evacuation is required to remove casualties from the field
when OPSEC is not endangered. Echelons II and III CHS are required on an area support basis from
the theater MEDCOM.
N-23. Special Reconnaissance
a. Special reconnaissance is an intelligence collection activity conducted beyond the operational
capabilities of tactical collection systems to obtain or verify information about the activities and resources of
a target, organization, or group. Special operations forces SR missions are generally of short duration and
involve small elements (squads, teams, split-teams). Special reconnaissance missions are “deep” operations
conducted beyond the FLOT primarily in support of intelligence requirements of strategic importance.
b. Since SR missions are conducted deep in hostile or denied territory, CHS is limited. As aerial
medical evacuation of SOF casualties would compromise the mission, the units rely on Echelon I (self-aid
and buddy aid, combat lifesaver, and SF medic) until the mission is accomplished and the team is extracted.
c.
Comprehensive medical intelligence is critical for SOF SR missions. The medical threat
requires evaluation of PMM to counter the threat and to protect SR elements from exposure to disease and
injury.
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FM 8-42
APPENDIX O
COMBAT STRESS CONTROL ACTIVITIES
BY PHASE OF THE OPERATION
As in war, the primary mission of the AMEDD CSC assets is to assist leaders with sustaining mission focus
and promoting positive combat behaviors; these behaviors include unit cohesion, vigilance, perseverance,
and good discipline. Leaders must prevent misconduct stress behaviors, since serious misconduct, once
committed, demands firm punitive action. Suicide prevention programs must be continued in stability and
support operations. Sound leadership can prevent BF (or conflict fatigue). Further, should BF occur, strong
leadership assures the soldiers rapid recovery in the unit. However, even soldiers who perform heroically
throughout critical events can develop post-traumatic stress problems months to years later. The stresses of
long deployments disrupt normal habits and family relationships. The CSC mission assists units with
debriefings and management of critical events and with homecoming and reintegration. The DOD (Health
Affairs) may continue to require MH screening of all personnel prior to redeployment from the theater (as in
Operation Joint Endeavor), as part of the PVNTMED surveillance program. Table O-1 provides information on
CSC activities by phase of the operation.
Table O-1. Combat Stress Control Activities
PREDEPLOYMENT
• BRIEF CSC MISSION AND ASSETS TO ALL UNITS.
• GIVE SELECTIVE STRESS MANAGEMENT TRAINING.
• ASSIST AO CULTURAL AND HISTORICAL TRAINING.
• HELP PREPARE FAMILY SUPPORT GROUPS.
IN-COUNTRY ACTIVITIES
• ATTEND COMMAND AND STAFF BRIEFINGS, AS APPROPRIATE.
• VISIT EVERY COMPANY-SIZED UNIT BIMONTHLY.
• CONDUCT ROUTINE UNIT SURVEY INTERVIEWS.
• ASSIST HUMAN DIMENSION TEAMS RESEARCH, WHEN APPLICABLE.
• CONTINUE EDUCATION PROGRAMS.
• EVALUATE AND ASSIST DISTRESSED SOLDIERS.
• PROVIDE RESTORATION TREATMENT, WHEN NEEDED.
CRITICAL EVENT RESPONSE
• ASSIST OR LEAD CRITICAL EVENT DEBRIEFING.
• ADVISE COMMAND, CHAPLAINS, AND MEDICAL PERSONNEL ON
POLICIES AND MEMORIAL SERVICES.
REDEPLOYMENT ACTIVITIES/
• ENCOURAGE END OF TOUR DEBRIEFINGS AND
RETURN TO HOME STATION
CLOSURE BY ALL UNITS.
• ASSIST WITH REUNION ACTIVITIES.
• CONDUCT DOD MH SCREENINGS, AS REQUIRED.
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APPENDIX P
DEVELOPMENT OF MEDICAL ELEMENT TACTICAL
STANDING OPERATING PROCEDURES
P-1. General
a. Combat health support elements employed in stability and support operations often have a high
turnover rate of personnel due to short rotational assignments. To ensure continuity of programs and to
facilitate the orientation of newly assigned personnel, it is important that a TSOP be developed. This TSOP
should be quite detailed and cover all aspects of the CHS element operations, such as—
• Medical procedures and services (can be part of the TSOP or developed as a separate
clinical standing operating procedure [CSOP]).
• Supply and resupply procedures (both medical and nonmedical materiel).
• Unit administration.
• Medical records and administration.
• Mass casualty plans.
• Joint and multinational force and HN coordination requirements.
b. This appendix provides a skeletal outline of topics that should be included in the element’s
TSOP. The CHS element defined in this appendix is task-organized and has a surgical element; not all units
employed in stability and support operations will have this capability or the other full range of functions
defined (such as veterinary services). It may be modified to meet the needs of the unit. The TSOP should
be updated on a regular basis.
c.
Procedures should be formally established within the element (to include an out-briefing by the
departing commander on the adequacy and scope of the TSOP).
P-2. Purpose of the Tactical Standing Operating Procedure
The TSOP prescribes policy, guidance, and procedures for the routine field operations of a specific unit.
It should cover broad areas of unit operations but be sufficiently detailed to provide newly assigned
personnel the guidance required for them to assume their new positions. A TSOP may be modified
by TSOPs and OPLANs/OPORDs of higher headquarters. It applies to the parent unit and all subordinate
units assigned and attached. Should the TSOP not conform to the TSOP of the higher headquarters,
the higher headquarters’ TSOP governs. The TSOP should be periodically reviewed and updated as
required.
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P-3. Format for the Tactical Standing Operating Procedure
a. There is not a standard format for all TSOPs; however, it is recommended that a particular
unit’s TSOP follow the format used by its higher headquarters. The TSOP can be divided into sections
(functional areas or major operational areas). The TSOP can contain one or more annexes, each of which
may have one or more appendixes. The appendixes may have one or more tabs. Appendixes can be used to
provide detailed information on major subdivisions of the annex; tabs can be used to provide additional
information (such as report formats or area layouts) addressed in the appendix.
b. Regardless of the format used, the TSOP should follow a logical sequence in the presentation
of material. As a minimum, it should discuss the—
• Chain of command and/or coordination/cooperation arrangements .
• Major functions and staff sections of the unit.
• Operational requirements, to include ROE.
• Required reports.
• Necessary coordination with higher and subordinate elements, joint or multinational
forces, HN forces and agencies, other US agencies, NGOs, and PVOs for mission accomplishment, as
appropriate.
• Programs (such as command information or PMM).
• Other relevant topics (such as instruction of the culture, customs, and beliefs of the HN
or other countries involved in the mission).
c.
Pagination of the TSOP can be accomplished starting with page 1 and numbering the remaining
pages sequentially. If the TSOP is subdivided into sections, annexes, appendixes, and tabs, a numbering
system that clearly identifies the location of the page within the document can be used. Annexes are
identified by letters and arranged alphabetically. Appendixes are identified by numbers and arranged
sequentially within the specific annex. Tabs are identified by a letter and are listed alphabetically within the
particular appendix. After numbering the initial sections using the standard numbering system (sequentially
starting with page 1 through to the end of the sections); number the annexes and their subdivisions. They
are numbered as the letter of the annex, the number of the appendix, the letter of the tab, and the page
number. For example, page 4 of Annex D is written as “D-4”; page 2 of Appendix 3 to Annex D is written
as “D-3-2”; page 5 of Tab A to Appendix 3 of Annex D is written as “D-3-A-5.” This system of numbering
makes the pages readily identifiable as to their place within the document.
d. In addition to using a numbering system to identify specific pages within the TSOP, descriptive
headings should also be used on all pages to identify subordinate elements of the TSOP.
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(1) The first page of the TSOP should be prepared on the unit’s letterhead. The remaining
pages of the major sections should include the unit identification in the upper right hand corner of the page;
for example, “________Medical Company.”
(2) A sample heading for an annex is “ANNEX C (Administration and Personnel) to
______Medical Company.”
(3) A sample heading for an appendix is “APPENDIX 2 (Personnel Management) to
ANNEX C (Administration and Personnel) to ______Medical Company.”
(4) A sample heading for a tab is “TAB A (Award Recommendations) to APPENDIX 2
(Personnel Management) to ANNEX C (Administration and Personnel) to ______Medical Company.”
e.
As the TSOP is developed, there may be an overlap of material from one annex to another.
This is due in part to similar functions that are common to two or more unit elements. Where overlaps
occur, the material presented should not be contradictory. All discrepancies will be resolved prior to the
authentication and publication of the TSOP.
P-4. Orientation of Newly Assigned Personnel
a. Newly assigned personnel must be adequately oriented to their new positions. On tours of
duty with a duration of 6 months to 1 year, it is important that personnel have ready access to procedures and
guidelines to rapidly assimilate them into the operation. This enhances their effectiveness and maximizes
their contribution to the unit mission. In many stability and support operational missions, US Army Reserve
units may perform their 2 weeks of active duty for training in OCONUS CHS elements. A thorough
orientation on their role and the procedures to be followed enhances the training they receive.
b. Orientation should include—
• Units goals, objectives, and mission.
• Unit history.
• Rules of engagement.
• Existing Status of Forces agreements.
• Cultural, political, and economical considerations of the HN.
• Language requirements and, if personnel are not fluent in the HN’s language, availability
of interpreters and cross-referenced language dictionaries (such as a Spanish-English dictionary). The
element should develop its own cross-referenced training aid with common medical questions and phrases
for use by nonfluent personnel.
(Department of the Army Pamphlet 40-3 provides medical phrases in the
following languages: English, French, Danish, German, Greek, Italian, Dutch, Norwegian, Turkish, and
Portuguese.)
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• Medical threat in the region.
• General threat and individual and force protection measures needed to ensure individual
and unit survivability (including terrorism awareness).
• Standards of conduct (both in the military setting and in the civilian community).
• Administrative, personnel, and finance support.
• Specific job-related information and procedures.
• Population served and eligibility for care.
c.
If facilities are available to make training aids, such as film strips, the portions of the orientation
dealing with topics that remain fairly constant can be standardized. These topics can include the cultural,
economical, and political considerations of the HN and the unit history. If this is not possible, a prepared
briefing and handouts can be used.
P-5. Tactical Standing Operating Procedure (Sections)
The information contained in this paragraph is an outline of the information which may be included in a
TSOP. It is not to be considered an all-inclusive listing. Without supplementation as to specific guidance
and policies, this TSOP cannot be executed as written.
• First section.
(Identifies unit/element it pertains to.)
•
Scope.
•
Purpose.
•
Applicability.
•
References.
•
General information.
• Second section.
(Identifies organizational design.)
•
Organization.
•
Task organization.
•
Organizational charts.
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• Third section.
(Discusses unit functions.)
•
Unit headquarters.
•
Staff responsibilities.
• Fourth section.
(Contains the annexes and provides required procedures/guidance.)
P-6. Tactical Standing Operating Procedure (Annexes)
Annexes are used to provide detailed information on a particular function or AOR. The commander
determines the level of specificity required for the TSOP. Depending upon the complexity of the material to
be presented, the annex may be further subdivided into appendixes and tabs. If the annex contains broad
guidance or does not provide formats for reports, paragraphs may be used and the annex need not be further
subdivided. However, as the material presented becomes more complex, prescribes formats, or contains
graphic material, the annex will require additional subdivision. This paragraph discusses the subdivision of
annexes by appendixes. It does not contain examples of subdividing the information presented in the
appendixes into tabs. Applicable references, such as ARs, FMs, and TMs, should be provided in each
annex. The number of annexes and their subdivisions presented below are not to be considered an all-
inclusive listing. Different commands have unique requirements; therefore, supplementation of the
information presented is permitted.
a. Annex A.
(Organizational Charts).
b. Annex B.
(Command Post). (This annex discusses the operation of the command post, its
staffing, and its functions.)
• General.
• Force protection.
• Security.
• Camouflage (when directed).
• Message distribution.
• Joint/combined liaison.
(This can be a discussion of interpreters, liaison officers/teams,
or other coordination requirements in joint and multinational operations.)
• Journal (duty log), situation map, and information display.
• Combat health support overlays.
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• Nonmedical overlays.
• Communications procedures and security.
c.
Annex C.
(Administration and Personnel).
(This annex outlines procedures relating to
administrative and personnel matters and associated activities.)
• Personnel accountability.
• Personnel management.
• Personnel services.
• Mortuary affairs.
• Public information.
• Maintenance of law and order.
• Enemy prisoners of war/detainees.
d. Annex D.
(Intelligence and Security).
(This annex pertains to intelligence requirements and
procedures and OPSEC considerations.)
• Intelligence.
• General threat.
• Medical threat.
• Weather.
• Captured/detained personnel and captured or abandoned equipment, supplies, and
documents.
• Security.
e.
Annex E. (Operations).
(This annex establishes policy and procedures for unit operations.)
• Operational situation report.
• Operations security countermeasures.
• Development of estimates, OPLANs, and OPORDs.
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• Risk assessment and safety guidance.
• Communications-electronics (to include procedures and security).
• Reporting requirements and formats.
• Briefing requirements, recurring meetings, and readiness reporting.
• Predeployment/deployment operations.
f.
Annex F.
(Unit Layout).
(This annex discusses the establishment and breakdown of the unit
area. The patient treatment areas must be arranged so that patient flow and ambulance turnaround are
unimpeded.)
• Advance party/quartering party.
• Site selection.
• Force protection considerations (to include patient bunkers, listening posts, observation
posts, and individual fighting positions).
• Establishment of treatment areas (which facilitate patient flow).
• Establishment of and safety considerations for x-ray machines.
• Establishment of ambulance turnaround and helicoptering landing areas.
• Establishment of patient decontamination station.
• Establishment of administrative areas, sleeping areas, and motor pool.
• Plan for reconfiguration of triage/treatment areas for mass casualty situations.
• Establishment of field sanitation facilities (latrines, handwashing facilities, soakage pits,
and waste disposal sites/measures).
g. Annex G.
(Nuclear, Biological, and Chemical Defense).
(This annex prescribes policies,
guidance, and procedures for NBC defensive measures. Exposure may result from such activities as an
explosion at a nuclear power plant or as a result of a terrorist attack.)
• Responsibilities.
• Protection measures for unit members and patients under their care.
• Reporting requirements and procedures.
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• Unit decontamination procedures.
• Patient decontamination operations (to include coordination for nonmedical personnel to
perform patient decontamination procedures).
h. Annex H.
(Logistics).
(This annex establishes logistics procedures for the unit. It concerns
both general supply and CHL. Combat health logistics should also be addressed under the MTF operations.)
• General supply and services.
• Property book management.
• Combat health logistics support
(to include emergency resupply measures, blood
management, controlled substance control, and inventory control).
• Power generation equipment/operations.
• Food service.
• Bath and laundry service.
• Transportation and movement requirements.
• Fire prevention and protection.
• Field hygiene and sanitation.
• Motor pool operations.
• Conventional ammunition down- and upload procedures, storage, safety, and issuance.
• Petroleum, oils, and lubricants accounting.
• Maintenance (nonmedical).
• Medical equipment maintenance.
i.
Annex I. (Safety). (This annex establishes minimum essential safety guidance for the unit and
provides guidance on the unit’s risk assessment program.)
j.
Annex J. (Civil-Military Operations).
(This annex discusses participation in CMO activities.
In stability and support operations, this annex takes on an added importance. It should be reviewed often
and revised as necessary.)
• Liaison/interpreters.
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• Status of Forces agreements.
• Customs, beliefs, religious affiliations, and economical, political, and social con-
siderations.
• Type of operation.
(The type of operation will normally dictate the extent of involvement
with the civilian community in the AO.)
• Availability/capability to contract for goods and services.
• Coordination/cooperation requirements with NGOs and PVOs.
• Coordination with the civilian medical infrastructure.
k.
Annex K. (Medical Treatment Facility Operations). (This annex provides the guidance for the
actual medical treatment, evacuation support, and other CHS activities conducted by the unit. It can also be
prepared as a separate CSOP.)
(1) Medical evacuation and medical regulating.
• Request formats.
• Evacuation overlays.
• En route care protocols.
• Ground ambulances.
•
Medical equipment sets.
•
Loading plan.
•
Medical equipment maintenance/calibration.
•
On-board oxygen.
•
Radio procedures.
•
Routes (to include reconnaissance of, obstacles, or other pertinent information).
•
Strip maps.
•
Dispatch of ambulances.
•
Drivers licenses.
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•
Driver briefings.
•
Ambulance shuttle operations.
•
Ambulance exchange point operations.
•
Air ambulances.
•
Army airspace command and control.
•
Weather.
•
Launch authority.
•
Stationing plan.
•
Fuel.
•
Maintenance support.
•
Flying hours program.
•
Crew rest.
•
Flight surgeon support.
•
Billeting and feeding.
•
Landing zone (to include security).
•
Community assistance programs.
•
Medical equipment sets.
•
Responsibilities of each person
(requester,
medical
personnel, or
evacuation
element).
•
Documentation requirements (to include USAF required forms when the unit is the
OMF for USAF evacuation).
• Coordination with other Services when providing area support.
(2) Medical and dental services and clinics.
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(a) A number of standard elements should be covered for all medical and dental services
and clinics. These are—
• Organization and functions.
• Administration (to include policies, goals, objectives, reporting requirements,
duties and responsibilities, location, and hours of operation).
• Examination procedures.
• Treatment protocols.
• Credentialing.
• Combat health logistics supply and resupply procedures, equipment avail-
ability, and maintenance/repair capability.
• Infection control.
• Equipment and supplies listing or locally determined MESs for operations
away from the permanent clinic site.
• Eligibility for care.
• Safety.
• Fire evacuation plan.
• Host-nation coordination requirements.
• In-service education requirements and continuing education programs.
• Standing committees (such as quality assurance, credentialing, or other
medical-specific committees).
• Accident reporting.
• Personal appearance and behavior standards.
• Electrical power requirements and means to support requirements.
(b) Considerations for specific services and clinics are—
• Dental services.
•
Radiographic procedures, and availability of services.
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•
Medical equipment maintenance and repair (to include calibration of
x-ray equipment and safety measures).
•
Personal (universal) protection
(such as gloves, eye protectors, and
mask).
•
Requirements for refrigeration.
•
Recovery of precious metals.
•
Sterilization of instruments (cold sterilization procedures if sterilizer is
not available).
•
Alternate wartime role of dental officers.
• Pharmacy service.
•
Formulary that covers the prescribing procedures, alphabetical listing of
drugs, and a therapeutic category listing.
•
Signature cards.
•
Controlled substance inventory, dispensing requirements, register, de-
struction procedures, discrepancy report, and requisitions.
•
Access letters.
•
Key control.
•
Intravenous admixture program, if applicable.
•
Pharmacy waste disposal.
•
Humanitarian assistance involvement, requirements, and mission.
•
Work report including inpatient and outpatient bulk order and sterile
products, if applicable.
•
Requirements for refrigeration.
•
In-service training requirements.
• Laboratory service.
•
Procedures for preservation and transport of clinical specimens to
supporting laboratories within the theater or to CONUS.
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•
Quality assurance program.
•
Procedures for the preservation and transport of biological specimens for
detection of NBC agents to supporting laboratories.
•
Infection and chemical hazard control.
•
Requirements for refrigeration.
•
Procedures and logistics of blood banking.
•
Blood reports and requisitioning.
•
Currency of reagents.
•
Procedures for hematology laboratory.
•
Procedures for biochemistry and clinical chemistry laboratory.
•
Procedures for bacteriology and parasitology.
•
Medical equipment maintenance and repair.
•
Anesthesia services.
•
Standards.
•
Duty roster and on-call requirements.
•
Master list of clinical procedures.
•
Equipment checklists.
•
Classification of patients.
•
Narcotics control.
•
Infection control in work area.
•
Anesthesia carts.
•
Disposition of syringes and needles.
•
Storage of combustibles and cleaning schedule.
•
Quality control procedures for equipment.
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• Surgical service.
•
Scheduling procedures (to include after-hours and emergency cases).
•
Aseptic (sterile) technique.
•
Maintenance of registry.
•
Scrub attire and surgical hand scrub procedures.
•
Environmental safety.
•
Electrosurgical unit safety.
•
Operating room environmental sanitation.
•
Counts of sponges and sharps.
•
Bullet removal—evidence and property custody document.
•
Death procedures (notifications; autopsy [to include coordination with
HN health officials or compliance with valid agreements]; and disposition).
•
Cardiac arrest procedures.
•
Traffic patterns (transportation of patients to and from the operating
room; transportation of sterile, clean, and dirty equipment; evacuation of personnel and patients during
contingencies.)
•
Handling of contaminated needles and syringes.
• Central materiel supply.
•
Loading and unloading of the sterilizer.
•
Sterilization process monitoring.
•
Shelf life of sterile items (to include labeling).
•
Tray setup and wrapping procedures (to include cleaning and preparing
equipment supplies for sterilization).
• Nursing service.
•
Nursing documentation.
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•
Scope of nursing practices.
•
Standards of nursing practices.
•
Standards of patient care.
•
Assignment of personnel.
•
Special category of personnel.
•
Infection control.
•
Procedures available in radiology.
•
Procedures available in the medical laboratory.
•
Admission and discharge procedures.
•
Procedures for cardiopulmonary resuscitation.
•
Mass casualty plan.
•
Preoperative care of patients.
•
Postoperative care of patients.
•
Care of patients with indwelling catheters.
•
Care of patients with central IV lines.
•
Care of patients with tracheostomies.
•
Care of patients with chest tubes.
•
Death procedures.
•
Ambulatory care procedures.
•
Mass casualty procedures (plan and training requirements; medical cadre
positions and duties; nonmedical personnel positions and duties, including litter teams and perimeter guard,
crowd control, and information personnel; location of services [to include triage, DELAYED, IMMEDIATE,
MINIMAL, and EXPECTANT care areas]).
• Medical equipment repair and maintenance.
•
Maintenance request procedures.
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