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RIMPAC 2014 Military Medicine Overview THIRD Fleet Surgeons Office

RIMPAC 2014 Military Medicine Overview THIRD Fleet Surgeons Office. UNCLASSIFIED. Objectives. RIMPAC 2014 Background Military Medicine (MILMED) Task Organization MILMED Firsts in RIMPAC 2014 MILMED Objectives Real-World Medical Planning Medical Exercise Events

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RIMPAC 2014 Military Medicine Overview THIRD Fleet Surgeons Office

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  1. RIMPAC 2014Military Medicine OverviewTHIRD Fleet Surgeons Office UNCLASSIFIED

  2. Objectives • RIMPAC 2014 Background • Military Medicine (MILMED) Task Organization • MILMED Firsts in RIMPAC 2014 • MILMED Objectives • Real-World Medical Planning • Medical Exercise Events • Multinational MILMED Symposium • MILMED Subject Matter Expert Exchange (SMEE) • Hospital Ship Engagements • People’s Republic of China (PRC) Participation • Humanitarian Assistance / Disaster Relief (HA/DR) • MILMED Schedule of Events (SOE) Summary • Challenges • Talking Points

  3. RIMPAC 2014 Theme and Objective Theme Capable, Adaptive, Partners Objective To enhance the interoperability of the combined RIMPAC force across the full spectrum of military operations and to improve individual warfighting competencies Source: Senior Leadership Summit - Jan 13

  4. RIMPAC 2014 Exercise Focus Areas (1) • Integration of new participants • A multi-threat environment to enable the coordination and employment of: • Air assets to conduct OCA, DCA, and SEAD • Air, surface and sub-surface assets for AW, T/ASW, and ASUW • MIO/MSO, ISR, Fires, EOD AND salvage • Air and surface assets, and SPMAGTF, in amphib/land operations • NECC forces • Air, surface and sub-surface assets for MIW • Special Force operations • Multi-national personnel in key C2 positions within component staffs (afloat/ashore) • Conduct Humanitarian Assistance / Disaster Relief, and Search and Rescue Operations Source: Concept Development Conference - Apr 13

  5. RIMPAC 2014 Exercise Focus Areas (2) • Live weapon firing opportunities • ROE decision making • Integrated logistics and combat service support • Integrated certification and experimentation activities into the exercise where appropriate (without impacting on national training objectives) • Professional exchanges and social interaction to strengthen international relations and establish closer military bonds • Observer program for non-participating nations overview of exercise operations. • Tactical and operational level planning in support of the exercise scenario • Distinguished/VIP Visitor program • Environmental stewardship • Medical interoperability of all participating nations New Focus Area 2014

  6. RIMPAC 2014 Participants • Repeat Participants (21): • - Australia, Canada, Chile, Colombia, France, Indonesia, India, Japan, Malaysia, Mexico, Netherlands, New Zealand, Norway, Peru, Philippines, Republic of Korea, Singapore, Thailand, Tonga, United Kingdom and United States • New Participants (2): • Brunei, People’s Republic of China • Invited Observer Nations (8): • Bangladesh, Brazil, Cambodia, Denmark, Germany, Italy, Maldives, PNG, Vietnam 23 Nations Invited

  7. RIMPAC 2014 Nations 23 Participating Nations: 46 Ships, 6 Submarines, 16 Land Forces, 28 MPRA Assets, 200+ Aircraft = 25000+ people

  8. Crawl Walk Run Harbor Phase Relationship building Can’t surge trust Reinforce protocols - Safety, environment, warfighting Confirm connectivity and weapons systems National command and control Final review of overall plan prior to execution Understanding C2 processes Force Integration Training Basic air, surface, subsurface warfare at the task group level More advanced warfighting with sinkex, air-to-air engagements Amphibious rehearsal Humanitarian assistance and disaster relief Practice C2 processes Exercise Progression Scenario Development and Complexity • Advanced FIT & Freeplay • Task Force integration and training at theatre level • Photo exercise • Amphibious assault • Apply C2 processes • Freeplay phase over 96 hours Time

  9. RIMPAC Execution Schedule • NLT 25 Jun Forces arrive Hawaii • 26 Jun – 07 Jul Harbor Phase • 08 – 24 Jul Force Integration Phase • 08-09 Jul Ship’s sail • 08-19 Jul Serialized training • 20-24 Jul Advanced integration training • 25 Jul PHOTEX • 26 – 29 Jul Freeplay / Scenario Phase • 30-31 Jul Replenishment / return to port • 01 Aug Closing Briefs / Reception • Post 04 Aug Forces depart Hawaii

  10. Medical Interoperability Focus Area

  11. Combined Surgeon Staffs CCTF Surgeon CAPT Tim Hinman CCTF Medical Cell CCTF Medical Planner: AUS CCTF Corpsmen: HMCM Dell (US) Assistant Corpsmen: CAN Engagement Planner 1: US Engagement Planner 2: NZ Deputy CCTF Surgeon LCDR Jonathan Milliner CFLCC Surgeon: US Corpsmen: US CFACC Surgeon: US Corpsmen: US CFMCC Surgeon: CAN Deputy Surgeon: US Medical Planner: CAN Medical Planner: NZ CFSOCC None Medical Anchor Desk Anchor 1: CAN Anchor 2: AUS Anchor 3: US Anchor 4: US Anchor 5: NZ

  12. CFMCC Task Organization CFMCC CANFLTPAC (PWC, Ford Island) USNS MERCY C2: TACON – CTF178 10-12 Jul 25-27 Jul USNS MERCY C2: TACON – CTF175 12-25 Jul PLA(N) PEACE ARK C2: TACON – CTF175 15 Jul – 1 Aug USNS MERCY C2: TACON – CTF176 27 Jul – 1 Aug MOC (PWC, Ford Island) CTF 175 MIO (USCG) USCGC WAESCHE CTF 177 MIW (NMAWC) PWC, Ford Island CTF 173 SUPPORT FORCES (CTF-33) PWC, Ford Island CTF 171 NEF (EODGRU1) Hickam AFB CTF 178 HADR/MIO PWC, Ford Island CTF 176 ESG (COMWAR) USS PELELIU CTF 170 CSG (CCSG-9) USS RONALD REAGAN CTF 172 MPRA (CTF-32) Kaneohe Bay CTF 174 TASWC (CTF-34) Joint Base Pearl Harbor D/CFMCC (PWC, Ford Island) CTG 176.1 CATF (PHIBRON 3) USS PELELIU CTG 176.2 ESG SCC (CDS-31) USS CHOSIN CTG 176.9 CLF USS PELELIU CTG 170.1 SCC (MTS-71) ROKN SEOAE RYU SUNGYONG

  13. RIMPAC MILMED Objectives • Develop robust Health Service Support (HSS) system to provide real-world medical care to all RIMPAC participants • Increase familiarity of partner nation military medicine practices, capabilities and experiences through military medicine exchange in order to foster multinational relationships and enhance coalition medical interoperability (Symposium & SMEE Events) • Conduct medical exercises (MEDEXs) during HA/DR exercise, Forced Integration Phase and Free Play/Scenario Phase to enhance casualty management interoperability between partner nations

  14. Challenges • Late addition of USNS MERCY • Limited contact / planning with PLA(N) • Limited contact with participant nations • Design of MILMED Symposium • Creating multilateral events

  15. Real-World HSS • HSS Plan • Annex Q (generic/standing) – complete • Appendices 1-3 (biennial supplementation) – complete • HSS CONOPS – complete • Site survey and stakeholder relationships built - complete • Way Ahead • CAN Providers – Credential verification (Plan of Supervision in NHCL HI) • SA on medical protocols at HI military ranges • Guard Ship watchbill for acute care during Harbor Phase • Assignment of MERCY’s Command Element • Medical Anchor Desk battle-books & patient tracking tool • RIMPAC Transit Personnel Unit (TPU) • Medical welcome package • Release message requiring attendance at Medical Orientation

  16. Health Service Support Assets • Real-World • Role 1: Unit medical departments • Role 2: HN Clinics: Makalapa Clinic, Kaneohe Clinic • Role 2E: USS PELELIU, USS RONALD REAGAN, USNS MERCY, PEACE ARK • Role 3: HN Hospitals: Tripler Army Medical Center (TAMC), Queens Medical Center, Hilo Medical Center, Wilcox Medical Center, • Role 4: Home nation hospital • Constructive • Role 3: USNS MERCY, PEACE ARK • Additional Host Nation Support • - Recompression Chamber • Mobile Dive Salvage Unit 1 • - Fleet Liaisons to assist with patient tracking and AME out of HI OPAREA RIMPAC 2014 MEDICAL LAYDOWN RIMPAC 2014 Roles of Care Role 1: First aid, triage, resuscitation and stabilization Role 2: Role 1 extended to receive casualties from other units, treat & hold until RTD or evacuated Role 2E: Role 2 extended by limited surgical and holding capability Role 3: Role 2 extended by surgery, intensive & post-op care, medical, dental, nursing & diagnostics Role 4: Definitive care Wilcox Kauai PEACE ARK Kaneohe Tripler Makalapa Queens Hickam AFB Hilo USS PELELIU Big Island USNS MERCY USS RONALD REAGAN

  17. EXERCISE NARRATIVE • CONCEPT OF HEALTH SERVICE SUPPPORT • *Note: Ship locations will change throughout exercise • REAL-WORLD GUIDANCE • - Casualties may skip Role 2E and evacuate directly to HN hospital, if appropriate • Casualties in the vicinity of Oahu should be evacuated to Tripler Army Medical Center (TAMC) • Injuries on military ranges should follow range medical protocols • Patients getting treatment on outer islands should be transferred to TAMC as soon as safely possible • Patients not expected to return to duty will be evacuated out of HI OPAREA at earliest opportunity • CFMCC • Deploy forces to Combined Joint Operations Area (CJOA) with 30 days of supply. Focus on Force Health Protection • Test comms with afloat medical assets, HN hospitals, RIMPAC Battle Watch, Medical Anchor Desk and Liaisons • Posture forces to provide Role 2-3 medical care afloat • Ensure units have tactical CASEVAC plans consistent with RIMPAC Annex Q • BPT support CASEVAC with lift assets. • BPT provide Role 2E and 3 HSS for amphibious landing and surface engagements • CFLCC • Deploy forces to CJOA • Test comms with HN hospitals, RIMPAC Battle Watch, Medical Anchor Desk & Liaisons • Ensure units have tactical CASEVAC plans consistent with RIMPAC Annex Q • Sync medical plans with CFMCC assets in support of amphibious landing • CFACC • Ensure MEDEVAC/CASEVAC assets are identified on the Air Tasking Order (ATO) • BPT provide strategic evacuation out of CJOA. • Host Nation Coordination • Will provide Role 3 medical support. • Will provide dive chamber support. • Will provide liaisons to assist with patient tracking and Strategic Evacuation out of HI OPAREA. Wilcox Note: MEDEVAC/CASEVAC via helo from Big Island to Oahu will require fuel stop. Kauai Kaneohe Tripler Makalapa Queens Hickam AFB Hilo STRAT AME to HN Big Island

  18. Pt evaluated by unit’s medical & recommends MEDEVAC. Role 1 POI Key SMDR: Senior Medical Dept Rep CRTS: Casualty Receiving Treatment Ship LHD: Large Amphibious Ship CVN: Aircraft Carrier TAH: Hospital Ship TAMC: Tripler Army Med Center POI: Point of Injury Unit’s SMDR consults with their applicable CTF Surgeon, who concurs with MEDEVAC Possible to treat on & move pt to CRTS (LHD, CVN, TAH)? Role 2/2E YES NO CTF Surgeon consults/informs CFMCC Surgeon/Medical Anchor Desk. Hospital determined. Role 3 CTF Surgeon approves MEDEVAC to CRTS & notifies Medical Anchor Desk Organic lift available? YES NO CTF Surgeon coordinates pt movement & informs Medical Anchor Desk when completed. Unit submits MEDEVAC request (9-line) to Medical Anchor Desk/CFMCC Battle Watch Medical Anchor Desk ICW CFMCC Battle Watch identifies lift for MEDEVAC Unit submits formal MEDEVAC report via CoC & includes updates in daily MEDSTATREPs Once lift is identified, Medical Anchor Desk coordinates pt movement with unit. Unit’s SMDR coordinates with accepting physician. Medical Anchor Desk coordinates pt arrival with TAMC or civ hospital. Fleet Liaison is also notified who will track pt & provide updates. CCTF Surgeon/CFMCC Surgeon will work with nation liaisons for repatriation. Role 4

  19. Medical Orientation Day • When: 27 Jun 14 • Location: Sharky’s Theatre • Participants: All RIMPAC medical personnel • Purpose: Promulgate real-world HSS guidance to all participating medical personnel • Agenda Topics (Draft) • Morning • Welcome by CCTF Surgeon • Introductions • Medical leadership overview • Annex Q overview • NHCL HI & Fleet Liaison • Medical Guard Ship • Event timeline • Afternoon • Component Surgeons group sessions with CTF Surgeons and SMDRs • Introductions, expectations, MEDEVAC scenarios, tactical plans • Photo

  20. Medical Exercise Events When: FIT & Free Play/Scenario Phases Participants: USN, USA, USMC, USCG, Canada, Australia, New Zealand, Republic of Korea, Japan, Mexico, PRC Training Objectives • Medical staff integration - multinational CCTF and CFMCC staffs • Capitalize on real-world MEDEVACs to train & interoperate • Historically 30-50 real-world MEDEVACs • Utilize Role 2E/3 medical facilities afloat for medical exercise casualties • C2, communication, pt movement(helo, boat), pt tracking, interoperating • Casualty management and evacuation during amphibious landing • Concept of HSS / Medical CONOPS • ESG / CPR medical staff submit Concept of HSS for amphibious assault • FHP plans to mitigate emerging disease risks from natural disaster

  21. MILMED Symposium When: 1-2 July 2014 Location: USS PELELIU Target Audience: All military medical personnel attending RIMPAC, local military medical personnel supporting RIMPAC, special invitee from supporting institutions, agencies and nations. (~150 personnel) Objective • Increase familiarity of partner nation military medicine practices, capabilities and experiences through military medicine exchange in order to foster multi-national relationships and enhance coalition medical interoperability • Engage wide range of speakers/nations • Clinical topics of relevance to RIMPAC participants • Enhance understanding of partner nation capabilities Forums • Presentations • Panel discussions • Tours of ship medical departments

  22. MILMED Symposium Topics (Draft)

  23. MILMED Symposium Topics (Draft)

  24. MILMED Symposium Topics (Draft)

  25. MILMED Symposium Topics (Draft)

  26. MILMED SMEE Events When: Harbor Phase Location: Various locations Target Audience: Partner nation medical personnel Objective • Increase familiarity of partner nation military medicine practices, capabilities and experiences through military medicine exchange in order to foster multi-national relationships and enhance coalition medical interoperability • Clinical topics of relevance to RIMPAC participants • ATLS Course • PHTLS Course

  27. RIMPAC SMEE Events

  28. RIMPAC SMEE Events

  29. RIMPAC SMEE Events

  30. USNS MERCY Participation • USNS MERCY Training Objectives • Conduct integrated HA/DR medical response as a Role III CRTS • Exercise HA/DR C2 interoperability within multilateral/interagency construct • Participate in multilateral HA/DR SMEE events • Conduct mass casualty receiving, stabilization, patient movement operations • Perform flight deck operations for casualty receiving and patient movement to next role of care • Perform casualty receiving treatment support as an afloat Role III HSS platform ISO Fleet integrated exercise events • Exercise communications/combined medical operations ISO amphibious operations, MIO and other naval operations

  31. USNS MERCY SOE (1) • Transit to HI OPAREA • 16 Jun: MERCY underway, SESEF range and embark HSC-8 • 17 Jun: MERCY RAS-F • Depart SOCAL ICW CTF 35.9.3 (PEL ARG) to arrive NLT 0800 25 June • 25 Jun: MERCY and PEACE ARK berth JBPHH (Kilo 3/5 and Kilo 8) • Harbor Phase Participation (27 Jun – 9 Jul) • 27 Jun: Medical Orientation Day • 30 Jun: Opening briefs • 1-2 Jul: Multinational MILMED Symposium – Canada lead • 2 Jul: Proposed reception ICW MILMED Symposium hosted aboard MERCY • 27 Jun - 7 Jul: Tours, sports events, planning syncs, support to Medical Guard Ship • 3, 7-9 Jul: Medical SMEE events hosted aboard MERCY and PEACE ARK • HA/DR Exercise Participation (3-12 Jul) • 8-12 Jul: MERCY medical LNOs to HA/DR key nodes • 10 Jul: Chop to CTF-178 • 10-12 Jul: Support HA/DREX from Kilo 3/5 pier (notionally at anchor off Griffon) • 12 Jul: Chop to CTF 175 • 14 Jul: HA/DR TTX aboard PEACE ARK

  32. USNS MERCY SOE (2) • Force Integration Phase Participation (8-25 Jul) • 15 Jul: U/W 0900 (MERCY) • 15-25 Jul: Resuscitative surgical support for real-world casualties • 15-24 Jul: CRTS ISO of MIO and other naval operation exercise events • 15-24 Jul: Exchange medical ship-riders with PEACE ARK for medical SMEE • 22 Jul: PHOTOEX of two hospital ships • 25 Jul: RIMPACPHOTOEX then chop to CTF 178 • Free Play Phase Participation (26-29 Jul) • 26-31 Jul: Resuscitative surgical support for real-world casualties • 27 Jul: CRTS ISO of a mass casualty exercise event then chop to CTF-176 • 27-28 Jul: CRTS ISO of combined forcible entry exercise events • 1 Aug: RTP Pearl Harbor for closing ceremony and reception • 2 Aug: Depart Pearl Harbor en route San Diego • 8 Aug: Arrive San Diego

  33. USNS MERCY Ship-rider Opportunities • Opportunities for Additional Medical Personnel from RIMPAC countries • 29 June – 1 August (Full RIMPAC)– Side-by-side peer exchanges for physicians, nurses, corpsmen/medics, and technicians during including HA/DR events, SMEE, underway casualty receiving exercise events and training. • 29 June – 13 July (Harbor Phase)- Side-by-side peer exchanges for physicians, nurses, corpsmen/medics, and technicians during the Harbor Phase of RIMPAC. Includes participation in HA/DR events including casualty receiving of simulated casualties and participation in SMEE events. • Ship-rider cross-decks –Three day medical ship-rider exchanges with PEACE ARK and other RIMPAC ships (where feasible) • 14-18 July– Side-by-side peer exchanges during underway operations including casualty receiving operations and training. Designed for physicians, physician extenders, and nurses. • 18-21 July– Side-by-side peer exchanges during underway operations and training. In addition to this physician, physician extender, and nurse-level training experience, MERCY will offer portions of Pre-Hospital Trauma Life Support training for physician extenders, first responders, and EMS providers. • 21-24 July– Side-by-side peer exchanges in biomedical repair, laboratory, radiology, and shipboard preventive medicine. Experience will be designed for technicians in biomedical repair, laboratory, radiology, and preventive medicine including medics and corpsmen. Physicians and other qualified providers will participate in Advanced Trauma Life Support Provider Course

  34. PLA(N) PEACE ARK Participation Harbor Phase Participation (27 Jun – 9 Jul) 27 Jun: Medical Orientation Day 30 Jun: Opening briefs 1-2 Jul: Multinational MILMED Symposium 2 Jul: Proposed reception aboard MERCY 3, 7-9 Jul: Medical SMEE events hosted aboard MERCY and PEACE ARK HA/DR Exercise Participation (3-12 Jul) 10-12 Jul: Observe DMAT 14 Jul: HA/DR TTX aboard PEACE ARK Force Integration Phase Participation (8-25 Jul) 15 Jul: U/W 0800 15-24 Jul: CRTS ISO of MIO and other naval operation exercise events 15-24 Jul: Exchange medical ship-riders with MERCY for medical SMEE 22 Jul: PHOTOEX of two hospital ships 25 Jul: RIMPAC PHOTOEX Free Play Phase Participation (26-29 Jul) 27 Jul: CRTS ISO of a mass casualty exercise event

  35. HA/DR ExerciseMedical Participation

  36. HA/DR Exercise • When: 3-12 July • Location: Ford Island and other various locations • Medical HA/DR Training Objectives • Exercise HA/DR C2 to identify & provide military HSS from maritime assets • CRTS response to HA/DR operations (ships and medical personnel ashore) • Identify & mitigate risk of emerging diseases resulting from natural disaster • Information flow via medical lines of communication • TAMC, HAH, DMAT and HI Hospital Certifications

  37. HA/DR Timeline

  38. HA/DR Medical SOE • 6 Jul: MERCY provides caps/lims brief to CJTF (Japan) • 7 Jul: CTF 178 ships get underway (Note: MERCY remains pier-side) • 8 Jul: MERCY provides LNO to CMCC and CTJT staff • 10 Jul: MERCY chops to CTF 178 and supports HA/DR • - Remains pier-side, but notionally anchored off Griffon • HN DMAT set up on Ford Island • TAMC Drash set up on Ford Island • MEDEVACs via tender boat to MERCY • MERCY & other nations provide medical augment to HN DMAT • USA 25th CAB conducts flights to local hospitals to drop off supplies • 11 Jul: MEDEVACs via helo and ambulance bus to local hospitals • 12 Jul: MEDEVACs via tender boat to MERCY • MEDEVACs via helo to CTF 175 ships • - USNS MERCY, JS ISE, HMNZS CANTERBURY • 14 Jul: TTX onboard PEACE ARK • - TTX scenario will be RIMPAC HA/DR scenario

  39. Overall Summary of MILMED SOE (1)

  40. Overall Summary of MILMED SOE (2)

  41. Overall Summary of MILMED SOE (3)

  42. Overall Summary of MILMED SOE (4)

  43. MILMED Firsts in RIMPAC 2014 • Medical interoperability is a RIMPAC Focus Area • Multinational MILMED Symposium • Numerous medical SMEE events • Medical exercises throughout FIT & Free Play Phases • T-AH participation (USNS MERCY, PEACE ARK) • MILMED as approved warfare area for PRC engagements • Leveraging partner nations to plan major events (e.g., Symposium – Canada has lead) • US Army providing lift support during all phases (e.g., dedicated MEDEVAC helos with en-route care) • Credentialing Canadian providers to work side-by-side USN providers at NHCL HI

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