Health Service Support (HSS)

Army Health SystemArmy Health System (AHS) – The all encompassing term to describe both the HSS and FHP aspects of AMEDD support. Health Service Support (HSS) Force Health Protection (FHP) Sustainment WFF Component Protection WFF Component • Promotes, improves, conserves, and restores health within a military system. • Employed across the range of military operations. • BLUF: Providing medical care to Soldiers on the battlefield. • Medical portion of Protection WFF. • Preventive measures taken to promote, improve, or conserve the mental and physical well being of Soldiers. • Comprised of preventive aspects of five Army FHP functions. ‘AFTER the boom’ ‘BEFORE the boom’

2 Combat Trains FLOT BSA Field Trains Point of Injury … POI Medical Platoon broken into TMs located at Combat Trains Reference: AMEDD CALL website

Role 1 • First care a Soldier receives – unit-level medical care (concentrated at FLOT and BAS) • Self and Buddy Aid – Life, Limb, Eyesight and prevent shock • Combat Lifesaver • Medical Personnel • Emergency Medical Treatment (EMT) • Advanced Trauma Management (ATM) Medical Personnel may include: - Physician - PAs - Combat Medics -CLS / Buddy Aid • Immediate lifesaving measures • Disease Non-Battle Injury (DNBI) • Combat Stress Preventive Measures • Patient Collection • Medical Evacuation from Supported Units

Role 2 • Includes all the capabilities of Role 1 plus: • Area Support Squad – Lab, Dental, X-Ray • 40 PAX Patient Holding (RTD up to 72 hours) • Preventive Medicine Section • Behavioral Health (COSC) Section • Physical Therapy • Packed red blood cells (liquid) • Brigade Medical Supply Office • (BMSO) • Role 2 assets are located in: • Brigade Support Medical Company (BSMC) • Area Support Medical Company (ASMC)

Role 3 • At Role 3, the patient is treated in an MTF staffed and equipped to provide care to all categories of patients, to include: • Resuscitation • Initial wound surgery • Damage control surgery • Postoperative treatment • Those patients expected to RTD are provided convalescent care and rehabilitative services • At Role 3, those patients not expected to return to duty (RTD) within the theater evacuation policy are stabilized and evacuated to Role 4 facilities • Role 3 is provided by the Combat Support Hospital (CSH)

Role 4 • Role 4 medical care is found in CONUS-based hospitals and other safe havens (OCONUS, VA, National Disaster Medical System (NDMS) Civilian Hospitals) • These hospitals represent the most definitive medical care available in the Army Health System LRMC SAMMC

3. Medical Evacuation CASEVAC-vs.-MEDEVAC CASEVAC MEDEVAC • The transport of casualties on a dedicated evacuation platform. • Does not include en-route care from medical personnel. Only CLS if available. • Vehicle does not have medical capabilities to sustain the casualties while en-route to care. • The transport of casualties on a standard evacuation platform. • Includes en-route care from medical personnel. • Evacuation platform has medical capabilities to sustain the casualties while en-route to care. -vs-

8 EVACUATION FLOW Reference: AMEDD CALL website

PHASE I: Initial Entry and Shaping 1- 74 HBCT Operation Trojan Horse Medical Plan PHASE I Casualty Estimate (daily): 2xKIA / 12xWIA / 6xDNBI • Medical Treatment • Role I: All SM’s treated at respective BAS • Role II: C/290th BSB and 2nd FST at TAA LEE • Role III: • 10th CSH/116th MMB at LSA WABASH • 132nd EMEDS /132nd MASF at LSA GILA • Units review MROE and conduct rehearsals for MASCAL LSA GILA 132 EMEDS/132 MASF PL DENVER LSA WABASH 10 CSH 116MMB • Medical Logistics • Role I: • Units maintain 15 DOS CL VIII • Prep unit aid bags/CLS bags • Role II: • Maintain a 30 DOS CL VIII • BMSO prepares resupply push packets • Maintain 15 DOS emergency CL VIII • Role III: 22nd MEDLOG CO/116th MMB holds 30 DOS at LSA WABASH TAA LEE C/290 + FST 1-74 BSTB 4-49 CAV 4-99 CAB 3-77 CAB 1-391 FA • Preventive Med • Role I: Unit FSTs (BN org) • Role II: C/290th PM officer at TAA LEE • Role III: 223rd Med Det/116th MMB at LSA WABASH TAA LEE Hospitalization Role III: 10th CSH (248 beds) at LSA WABASH PL DENVER • Lab • Role II: Basic DEPMED lab services available at C/290th BSB • Role III: • Full capabilities at 10th CSH and 132nd EMEDS • 8th BSD/116th MMB at LSA WABASH Veterinary Services Role II/III: Available on request, 130th MED DET (VS)/ 116th MMB at LSA WABASH Medical Evacuation PRIMARY: Ground; PREFERRED: Air MEDEVAC: 3 UH60s/ 2 UH60 Chase Air MEDEVAC Call Sign: Dustoff MEDEVAC Freq: P: SC/CT 35.25, A: SC/CT 32.50 Role I: Pushed AXPs to PL Denver Role II: 3 x UH60 with C/290th BSB for MEDEVAC to Role III • Dental • Role I: Palliative treatment only by BAS • Role II: Emergency and essential care provided by C/290th BSB • Role III: • Specialty Care through 198th Dental CO/116th MMB at LSA WABASH • OMFS through 10th CSH at LSA WABASH • COSC • Role I: Unit providers and Chaplains counsel Soldiers • Role II: C/290th BSB BH provider monitors unit MH status and conducts necessary counseling • Role III: 132nd COSC/116th MMB at LSA WABASH • Medical Mission Command • BDE Surgeon at 1-74 HBCT HQ (TAA LEE) • P: BDE Surgeon, A: BN Surgeon 290th BSB, C: BN Surgeon 3-77 CAB, E: BN Surgeon 4-99 CAB • Role I/II: Conduct radio procedure rehearsals • P: FM, A: FBCB2/BFT, C: TACSAT, E: IRIDIUM Satellite Phones • Med Comm: SF 600 • Role III: • Med Comm: MC4.AHLTA-T/DCAM/TC2/AHLTA Warrior/TMDS/JMeWS

PHASE IIA: Decisive Action 1- 74 HBCT Operation Trojan Horse Medical Plan PHASE II Casualty Estimate: 14xKIA / 89xWIA / 14xDNBI • Medical Treatment • Role I: All SM’s treated at respective BAS • Role II: C/290th BSB and 2nd FST at TAA LEE • Role III: • 10th CSH/116th MMB at LSA WABASH • 132nd EMEDS /132nd MASF at LSA GILA I I I I 4 3 99 77 290 C I I … I I I • Medical Logistics • Role I: • Resupply BAS via push packs from BMSO at AXPs • Emergency resupply via air • Role II: • Resupply C/290th BSB from BMSO at TAA LEE • Role III: • Resupply BMSO from 22nd MEDLOG CO at LSA WABASH FST II 4 49 • Preventive Med • Role I: Unit FSTs (BN org) • Role II: C/290th PM officer at TAA LEE • Role III: 223rd Med Det/116th MMB at LSA WABASH Hospitalization Role III: 10th CSH (248 beds) at LSA WABASH • Lab • Role II: Basic DEPMED lab services available at C/290th BSB • Role III: • Full capabilities at 10th CSH and 132nd EMEDS • 8th BSD/116th MMB at LSA WABASH Veterinary Services Role II/III: Available on request, 130th MED DET (VS)/ 116th MMB at LSA WABASH Medical Evacuation PRIMARY: Ground; PREFERRED: Air MEDEVAC: 3 UH60s/ 2 UH60 Chase Air MEDEVAC Call Sign: Dustoff MEDEVAC Freq: P: SC/CT 35.25, A: SC/CT 32.50 Role I: AXPs follow 1-74 HBCT ME across PL Denver Role II: 3 x UH60 with C/290th BSB for MEDEVAC to Role III • Dental • Role I: Palliative treatment only by BAS • Role II: Emergency and essential care provided by C/290th BSB • Role III: • Specialty Care through 198th Dental CO/116th MMB at LSA WABASH • OMFS through 10th CSH at LSA WABASH • COSC • Role I: Unit providers and Chaplains counsel Soldiers • Role II: C/290th BSB BH provider monitors unit MH status and conducts necessary counseling • Role III: 132nd COSC/116th MMB at LSA WABASH • Medical Mission Command • BDE Surgeon at 1-74 HBCT HQ (TAA LEE) • P: BDE Surgeon, A: BN Surgeon 290th BSB, C: BN Surgeon 3-77 CAB, E: BN Surgeon 4-99 CAB • Role I/II: • P: FM, A: FBCB2/BFT, C: TACSAT, E: IRIDIUM Satellite Phones • Med Comm: SF 600 • Role III: • Med Comm: MC4.AHLTA-T/DCAM/TC2/AHLTA Warrior/TMDS/JMeWS

X SPT HHC X X X X X X X X BfSB SUS BTB Combat Health Logistics Planners ASCC XX Sustainment (TSC) Theater Intel Bde (TIB) Theater Signal CMD CA/CMO MEDCOM Corps/Div BCT Surgeon Cell MMB CSH HSS Cell MEDO C-Med -BMSO

Brigade Medical Supply Office X SPT BTB HHC HHC ) ( BMSO Class VIII forward distribution point for the BCT Section located within the BSMC Receives, stores, and issues Class VIII, and provides medical maintenance to organic and attached units of the BCT Has a 100-500 line emergency ASL for 02 Class VIII priorities only PRIMARY DISTRIBUTION: -Ambulance Backhaul & Adding CL VIII to scheduled LOGPACs -Air Delivery available for emergency delivery (ie blood)

*Example from Medical Concept of Support Analysis ***BIG PICTURE*** Medical Forces Available X II I 1 74 1 391 II II II II HHC BSTB BSB 74 … … … … … 4 99 290 174 77 4 49 3 I 174 C 290 1/391 4/49 3/77 4/99 … … .. 2/344 Medical Shortages by Unit 1 459 | | 2 FST Medical Enablers

Medical Platoon, HHC, Combined Arms Battalion Located at FLOT and BAS

Treatment Squad Heavy BCT Stryker BCT Infantry BCT 2x M577 2x M997* 2x CBPS Squad can be divided into 2 x Treatment Teams:1 x 62B (Field Surgeon) or 1 x 65D (Physician Assistant)1 x 68W2O, 2 x 68W1O 1 x MES Tactical Combat Medical Care 1 x MES Chemical Agent PT TX, 1 x MES Chemical Agent PT Decon

Ambulance Squad Heavy BCT Stryker BCT Infantry BCT M113 Maneuver (8 veh, 4 teams) RSTA (8 veh, 4 teams) Fires (M997) (3 veh, 3 Teams) M1133 Maneuver (4 x M1133) RSTA (4 x M1133) Fires (3 x M997) M997/998 Maneuver (8 veh, 4 teams) RSTA (6 veh, 3 teams) Fires (3 veh, 3 Teams) Prepositioned at Casualty Collection Point or Battalion Aid Station

TMT PLT HQ PM COSC CO HQ BMSO Brigade Medical Support Company BSMC EVAC PLT HQ TMT SQD EVAC SQD (AREA) EVAC SQD (FORWARD) AREA TMT SQD Mission: To provide Role II care, ground evacuation, medical supply, preventive medicine, and combat stress control to assigned and attached units of the BCT. -Dental, X-ray, Lab = Role II-40 pax patient hold up who will RTD within 72 hours AREA SPT SQD PT HOLD SQD Located at BSA

Brigade Medical Support Company Med Co PM BH TX TX Dental, PT, Rad, Lab Area Tx

Brigade Medical Support Company TX EVAC EVAC HQ EVAC (AREA) BMSO

Forward Surgical Teams (FST) FST Capabilities: • 100% mobile with 20 Soldiers and fully functional in 90 minutes *cannot ‘jump’ easily • Continuous operations in conjunction with a Medical Company for up to 72hrs (up to 30 patients) • Requires reconstitution of personnel and equipment after 72 hours • Lifesaving resuscitative surgery for patients who would die without immediate intervention • 2 OR Tables (10 Surgeries / 24 Hours) (135 min / PT) • Post-operative patient hold: 8 patients for up to 6 hours • 1x Team Chief (61J), 2x General Surgeon, 1x Orthopedic Surgeon, 3x Med Surgical Nurse, 2x Nurse Anesthetist, 1x OR Nurse, 1x 70B Typically co-located with BSMC or ASMC

Combat Support Hospital (Role III) CSH HHD, 248-Bed Hosp Co B 84-Bed Hosp Co A 164-Bed • Capabilities: • 248 Beds; 485 Soldiers required (243 PROFIS) • 72 hours to establish entire 248 bed hospital • 6 Surgical Tables = 96 table hours per day • GYN, ENT, Urology, Gen Surg, ORTHO, PSYCH • Intensivist, PT, Oral/Maxiofacial • CSH (Corps) capable of split-based capability • B Company (84 Beds) - 100% mobile • A Company (164 Beds) Typically located at LSA

Medical Company (Air Ambulance) Combat Aviation Brigade General Support Aviation Battalion 3 Ship Forward Support MEDEVAC Team (FSMT) acts in Direct Support to BCT if allocated. Typically located vic LSA

Medical Logistics Company Log/Supt Platoon Maint Platoon Med Maint Sect Rcv/Storage Sect Stock Control Sect • Capabilities • Provides Class VIII, single and multi-vision lens fabrication and repair, and biomedical equipment maintenance support • Provides med log support for up to 53K Soldiers in the combat zone, or 77K Soldiers in the COMMZ or 143K Joint Service populations in the theater • Receives, classifies, and issues up to 24 short tons of Class VIII supplies per day • Provides storage for up to 415 short tons of Class VIII supply • Builds and prepositions Medical Resupply Sets • Coordinates for emergency delivery of Class VIII supplies • Provides Single-Integrated Medical Logistics Manager supply and requisition procession mission for all joint forces in the Corps/Theater, as directed Maint Sect Shipping Sect Optical Supt Sect Typically located vic LSA with MMB

Casualty Estimator

“INVERTED - Y” HLZ(FM 90-4) HLZ LANDING CRITERIA (FM 90-4) 1. Clear of debris / obstacles marked 2. Land heading into the wind 3. VS-17 Panels / bean bag lights properly secured 4. Cleared diameter for UH-60 = 50m Cleared diameter for CH-47 = 80m 5. Avoid landing down-slope 6. Do not land on slope >16 degrees *To determine ground slope use the following math computation V x 57.3 H “V” is found by subtracting lowest point on HLZ from highest point “H” is the entire length of the HLZ Left leg light Direction of Flight 7 meters TOUCHDOWN X 14 meters 7 meters Base Directional light 7 meters Direction of Wind Right leg light V = Vertical Distance H = Horizontal Distance EVAC CAPABILITIES (FM 8-10-6) TypeLitterAmb M996 2 6 M997 4 8 M113 4 10 5-ton 12 16 2 ½-ton 12 16 UH-60 (w/o hoist) 6 7 (w / hoist) 3 4 CH-47 24 31 C-130 74 92 C-141 48 170 C-5 70 C-17A 36 54 AAR FORMAT (TC 25-20) 1. What was the plan 2. What actually happened 3. Why did it happen 4. Unit strengths and weaknesses 5. How can we improve FIVE-POINT CONTINGENCY PLAN ( handbook) 1. GOING- Where LDR or element is going 2. OTHERS- Others going 3. TIME- Time to be gone 4. WHAT- What to do if LDR or element does not return in time 5. ACTIONS- Actions on enemy contact, you and me NBC-1 CHEM REPORT (FM 3-3) Line B- Position of observer Line D- DTG of detonation Line E- DTG end of attack Line F- Location of attack Line G- Means of delivery Line H- Type of burst (air or surface) & agent RISK MANAGEMENT (FM 100-14) 1. Identify Hazards 2. Assess Hazards to Determine Risks 3. Develop Controls and Make Risk Decisions 4. Implement Controls 5. Supervise & Evaluate WPNs (FM 7-8) Max E Range(m) M-4/16A2 580 (pt) 800 (area) M-249 600 (pt) 800 (area) M-203 150 (pt) 350 (area) M-136 (AT-4) 300 (pt / area) M-9 (9mm pistol) 50 (pt) M-2 (50 Cal) 1,800 (grazing) EPWs 1. Search 2. Segregate 3. Silence 4. Speed 5. Safeguard Tohelp you- Conserve theFighting Strength MSG Gerald Ecker, ADLER24A - Project Warrior Medical NCO, Jan 00-Jan 04

AMEDD LESSONS LEARNED PRINCIPLES OF CHS (FM 4-02.6) 1. Conformity 2. Continuity 3. Control 4. Proximity 5. Flexibility 6. Mobility 9 – LINE MEDEVAC REQUEST (FM 8-10-6) Line 1- Location of pickup site Line 2- Radio call sign & frequency Line 3- # of patients by precedence a. Urgent b. Urgent (surgical) c. Priority d. Routine e. Convenience Line 4- Special equipment needed a. None b. Hoist c. Extraction equipment d. Ventilator Line 5- # of patients by type L- # of Litter patients A- # of Ambulatory patients Line 6- Security of pickup site (war) N- No enemy troops in area P- Possible enemy troops in area E- Enemy troops in area X- Enemy troops in area Line 6- Number and type of wound injury or illness (peace) Line 7- Method of marking at HLZ a. Panels b. Pyro c. smoke d. None e. Other Line 8- Patient Nationality & Status a. US Military b. US Civilian c. Non US Military d. Non US Civilian e. EPW Line 9- NBC (war) N- Nuclear B- Biological C- Chem Line 9- Terrain description (peace) CHS Leaders’ Reference Card https://lessonslearned.amedd.army.mil/ TROOP LEADING PROCEDURES (FM 7-8) 1. Receive mission 2. Issue warning order 3. Make a tentative plan 4. Start movement 5. Reconnoiter 6. Complete the plan 7. Issue the plan 8. Supervise AMEDD BATTLEFIELD RULES (FM 4-02.6) 1. Maintain medical presence with the soldier 2. Maintain health of the command 3. Save lives 4. Clear the battlefield 5. Provide state-of-the-art care 6. Return soldiers to duty as soon as possible SPOT REPORT S- Size A- Activity L- Location U- Unit/Uniform T- Time E- Equipment AHS FUNCTIONAL AREAS 1. Mission Command (FM 4-02.6) 2. Medical Treatment 3. Evacuation & Med Regulating 4. Hospitalization 5. Combat Health Logistics 6. Dental Services 7. Veterinary Services 8. Preventive Medicine 9. Combat Stress Control 10. Medical Laboratory Services METT-TC ANALYSIS (FM 7-8) 1. Mission 2. Enemy 3. Terrain 4. Troops 5. Time 6. Civilians MILITARY ASPECTS OF TERRAIN (OCOKA) (FM 7-8) 1. Observation & Fields of Fire 2. Cover & Concealment 3. Obstacles 4. Key Terrain 5. Avenues of Approach OPORD FORMAT (FM 101-5) TASK ORGANIZATION: 3. EXECUTION: (Intent) 1. SITUATION: (Enemy/Friendly) Concept of Operation / Concept of Support 2. MISSION: (Task & Purpose) 4. SERVICE & SUPPORT: who, what, when, where, why 5. COMMAND & SIGNAL:

Multi-Functional Medical Battalion (MMB) • Assigned to MED BDE • Can be task organized under MED BDE • Each unit under the MMB is task organized based on mission requirements • Provides specialty medical services, ground evacuation, Role II HSS, and medical logistics to a Sustainment Brigade’s organic, assigned, attached and supported units MMB ASMC VET COSC • What can an MMB do for you? • VET Teams— Military working dog, ‘destroy’ stray dog/cat; inspect food sources to include farms, local vendors, DFAC PRIOR to preparation. • PM Teams – water buffalo inspections, train unit Field Sanitation Team, inspect DFAC DURING preparation and AFTER, site inspection (air quality, sound, water analysis, bug analysis) • COSC—CSF, pre & post deployment, suicide training; therapy dogs, chaplain support • OPTO—Perform annual MEDPROS eye exams, fabricate glasses, fabricate eye-pro inserts. • ASMC—Can schedule en mass PHA with PA MLC PM GA Blood DEN OPTO LOCATED AT: JBLM – 56th MMB Hood – 61st MMB Korea---168th MMB Germany – 421st Bragg – 261st

Health Service Support (HSS)