UNCLASSIFIED U S Army Medical Center of Excellence

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Army Health System UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Terminal Learning Objective Action: Identify the Army’s operational management of the Health Service Support (HSS) and Force Health Protection (FHP) missions for training, pre-deployment, and post deployment operations. Conditions: Given the role of a unit leader in an operational environment training scenario. Standards: IAW FM 4 -02, Army Health System. UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Enabling Learning Objective A Action: Define the terms Army Health System (AHS), Health Service Support (HSS), and Force Health Protection (FHP) Conditions: As a leader, using an organizational-level leadership perspective in a DL self-paced learning environment, given references, complex scenarios, practical exercises, and discussions. Standards: IAW FM 4 -02, Army Health System Chapter 1. UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE The Army Health System is: • The AHS is a component of the Department of Defense (DOD) Military Health System. • It is responsible for operational management of the Health Service Support (HSS) and Force Health Protection (FHP). • The AHS includes all mission support services arranged by the AMEDD for the Army and as directed, for joint, intergovernmental agencies, and multinational forces. MEDICAL LABORATORY SERVICES COMBAT AND OPERATIONAL STRESS CONTROL MEDICAL TREATMENT (AREA SUPPORT) HOSPITALIZATION MEDICAL MISSION COMMAND MEDICAL EVACUATION PREVENTIVE MEDICINE MEDICAL LOGISTICS A complex “system of systems” VETERINARY SERVICES • Divided into 10 medical functions DENTAL SERVICES • Aligned with medical disciplines and scientific knowledge The Army Health Systems is distributed across 4 Roles of medical care • Interrelated and interdependent UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Principles of Army Health System UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Health Service Support (HSS) Defined as all support and services performed, provided, and arranged by the AMEDD to promote, improve, conserve, or restore the mental and physical well-being of personnel in the Army. This includes casualty care, to include: patient treatment, hospitalization, the treatment aspects of dental care, neuropsychiatric treatment, clinical laboratory services, medical evacuation, and MEDLOG. UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Force Health Protection (FHP) Defined as the measures to promote, improve, or conserve the mental and physical well-being of Soldiers. These measures enable a healthy and fit force, prevent injury and illness, and protect the force from health hazards. This includes the prevention aspects of a number of AMEDD functions: PM support, veterinary services of food inspection and the prevention of zoonotic diseases, COSC, preventive dental services, and laboratory services. UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Distribution of HSS & FHP Battalion Aid Station & Below Medical Company BSMC or MCAS Combat Support Hospital/Field Hospital Definitive Care Role 1 Role 2 Role 3 Role 4 • Immediate lifesaving measures • X-ray, laboratory, and dental support • Self-aid, buddy aid, combat lifesaver • Preventive medicine • Resuscitation, initial wound surgery, and postoperative treatment • Hospitalization • Patient Hold • EMT / ATM • Medic, Physician Assistant • Medical regulating • Advanced Trauma Management • Clinical services • Med Log • Pharmacy • Medical evacuation • Medical Evacuation UNCLASSIFIED • Full spectrum of definitive medical care • CONUS or OCONUS safe havens

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Enabling Learning Objective B Action: Describe the different roles of care in AHS. Conditions: Given the role of a unit leader in an operational environment training scenario. Standards: IAW FM 4 -02 Army Health System, Chapter 1 and 2 UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Roles of Medical Care • A basic characteristic of organizing modern AHS support is the distribution of medical resources and capabilities to facilities at various levels of command, diverse locations, and progressive capabilities, which are referred to as roles of care. • As a general rule, no role will be bypassed except on grounds of medical urgency, efficiency, or expediency. The rationale for this rule is to ensure the stabilization/survivability of the patient through TC 3, advanced trauma management, and far forward resuscitative surgery is accomplished prior to movement between MTFs (Roles 1 through 3). UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Role 1 • First care a Soldier receives- whether injury or illness • Self and Buddy Aid • Combat Lifesaver • Medical Personnel • Emergency Medical Treatment (EMT) • Advance Trauma Management (ATM) • Immediate lifesaving measures • Medical Personnel include: • Physician’s Assistant • Medics UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Role 2 • At this role, care is rendered at the Role 2 MTF which is operated by the area support squad, medical treatment platoon of medical companies. Here, the patient is examined and his wounds and general medical condition are evaluated to determine his treatment and evacuation precedence, as a single patient among other patients. • Advanced trauma management and TC 3 including beginning resuscitation is continued, and if necessary, additional emergency measures are instituted, but they do not go beyond the measures dictated by immediate necessities. UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Role 2 Cont. Includes all the capabilities of Role I plus: • Area Support Squad-Lab, Dental, X-Ray • Patient Holding • Mental Health (COSC) Section • Preventive Medicine Section • Physical Therapy • BMSO (Pharmacy) • 100% self-mobile • Holds patients who can return to duty for up to 72 hours • Uses blood/blood products (when FST is attached) UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE 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, and postoperative treatment. This role of care expands the support provided at Role 2. • Patients who are unable to tolerate and survive movement over long distances receive surgical care in a hospital as close to the supported unit as the tactical situation allows. UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Role 3 Cont. • 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 theater evacuation policy are stabilized and evacuated to Role 4 facilities. • It serves as the primary conduit for patient evacuation to CONUS or OCONUS Role 4 facilities. UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Role 4 • Role 4 medical care is found in CONUS-based hospitals and other safe havens. If mobilization requires expansion of military hospital capacities, then the Department of Veterans Affairs and civilian hospital beds in the National Disaster Medical System are added to meet the increased demands created by the evacuation of patients from the AO. • The support-based hospitals represent the most definitive medical care available within the AHS. UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Enabling Learning Objective C Action: Define the 10 Medical Functions of the Army Health System. Conditions: Given the role of a unit leader in an operational environment training scenario. Standards: IAW FM 4 -0 Army Health System Chapters 2 -13 UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE 10 Medical Functional Areas Medical Mission Command Health Service Support Force Health Protection Three Components Preventive Medicine Medical Evacuation Casualty Care Medical Logistics Veterinary Services Combat & Operational Stress Control Hospitalization Medical Treatment Dental Services BH/Neuropsychiatric Treatment UNCLASSIFIED Laboratory Services

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE 1. Medical Mission Command • Medical Command (Deployment Support) – MCDS • Medical Brigade – MED BDE • Multifunctional Medical Battalion UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE 2. Medical Treatment (Organic & Area Support) • The Medical Treatment Function encompasses Role 1 and 2 medical treatment support • Provided by organic medical assets or on an area support basis by: - Medical Companies (Brigade Support or Area Support) - Medical Platoons (Maneuver BN, Fires BN, Supporting BDE HQ) - Medical Sections (BSTB, Aviation BNs) UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Medical Treatment Cont. • The Medical Treatment Function is divided into eight primary tasks: • • • First Aid Tactical combat casualty care Advanced trauma management Forward resuscitative surgery Routine sick call Patient holding Casualty Prevention Measures Medical Evacuation Physical therapy (if augmented) UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE 3. Medical Evacuation • System that provides the vital linkage between the roles of care necessary to sustain the patient during transport • Accomplished by providing en route medical care which enhances the individual’s prognosis and reduces long-term disability • Medical Evacuation occurs at the tactical, operational, and strategic levels and requires the synchronization and integration of service component medical evacuation resources UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Medical Evacuation Cont. Primary tasks and purpose of the medical evacuation function: • Acquire, locate, treat, stabilize, and evacuate • En-route medical care • Area support • Emergency movement of medical personnel, supplies, and equipment • Transfer of patients between MTF’s and mobile aeromedical staging facilities • Medical property transfer • Medical regulating support UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Theater Evacuation Policy • Establishes, in number of days, the maximum period of noneffectiveness (hospitalization and convalescence) that patients may be held within theater for treatment • Established by the Secretary of Defense, with the advice of the JCS, and upon the recommendation of the combatant commander • Doesn’t mean the patient will be held in theater for the entire time • Patients not expected to RTD in time will be treated, stabilized, then evacuated out of theater as soon as medically feasible UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Impact of Evacuation Policy on AHS Requirements A short theater evacuation policy— • • Fewer hospital beds required in theater Greater number of beds required CONUS Creates large demand for intrather Air Force evacuation resources Increases requirements for replacements A longer theater evacuation policy— • Greater accumulation of patients and a demand for a larger AHS structure in theater • Increases the requirements for hospitals, engineer support, and all aspects of base development for the AHS • Greater proportion of patients returned to duty within theater, reduces the loss of experienced manpower • Longer intratheater evacuation policy may decrease demand on evacuation assets and system UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Medical Regulating • Medical Regulating is the management system designed to coordinate the movement of patients from site of injury through successive roles of care to an appropriate MTF. • Entails identifying the patients awaiting evacuation, locating the available beds, locating special care if required, and coordinating the transportation means for movement. • Careful control of patient evacuation to appropriate hospitals is necessary to: • Effect an even distribution of cases • Ensure adequate beds are available for current and anticipated needs • Route patients requiring specialized treatment to the appropriate MTF UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE 4. Hospitalization • The CSH provides essential care within theater to treat and return to duty those patients who can be treated within theater evacuation policy and stabilize and evacuate those patients requiring definitive, convalescent, and rehabilitative care in CONUS or other safe havens • Refers to health care services provided at hospitals on an inpatient basis for all classes of patients whose conditions cannot be managed on an outpatient status: • Inpatient: person admitted to and treated within a hospital and cannot be RTD within the same calendar day • Outpatient: person receiving medical/dental examination / treatment from medical personnel in a status other than being admitted to a hospital • Patient Holding : person treated at Role 2 and is expected to be RTD within 72 hours or is being held for further evacuation to Role 3 Care UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Hospitalization Cont. Primary tasks and purpose of the hospitalization function: • Hospitalization • Forward resuscitative surgery • Clinical Laboratory services • Blood bank • Radiology services • Pharmacy support • Nutritional care • Patient administration • Respiratory care • Optometry • Physical therapy • Preventive medicine UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Hospitalization Cont. • The CSH may be augmented by on or more medical detachments, hospital augmentation teams, or medical teams. MC FST H&N SC Medical Detachment (Minimal Care) – provides minimal/convalescent care, nursing, and rehabilitative services Forward Surgical Team – provides forward resuscitative surgical care (w/ MED CO) Hospital Augmentation Team (Head and Neck) – provides special surgical care for ear, nose, and throat surgery, neurosurgery, and eye surgery (HN tm authorized CT Scanner) Hospital Augmentation Team (Special Care) – provides additional health care providers for stability operations (i. e. pediatrics) PATH Hospital Augmentation Team (Pathology) – provides pathology support to the CSH clinical laboratory, and specialty lab consults from across theater RHD Medical Team (Renal Hemodialysis) – provides hemodialysis care for patients with acute renal failure ID Medical Team (Infectious Disease) – provides infectious disease investigation and control; may work closely with preventive medicine/public health nurse on special care team UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE 5. Dental Services • The mission of the dental service support system is to promote - Promote Dental Health Prevent and treat oral and dental disease Provide far forward dental treatment Provide early treatment of severe oral and maxillofacial injuries • There are three levels of dental support within theater: - Unit Level Dental Care Hospital Level Dental Care Area Dental Support • These levels are defined primarily by the relationship of the dental assets supporting the patient population UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Dental Services Cont. Unit Level Dental Care • Consists of those services provided by dental personnel organic to medical companies/troops • This module provides emergency dental treatment Hospital Level Dental Care • Consists of those services provided by the hospital staff to minimize loss of life and disability resulting from oral and maxillofacial injuries • The Hospital Staff provides operational dental care which consists of emergency and essential dental support Area Dental Support • Provided for units that do not have organic dental assets • This coverage is provided by the: -Dental Company (Area Support) • The DCAS provides operational dental care and has dental assets which can deploy forward to augment / reinforce Med Co assets UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Dental Services Cont. Categories of Dental Care • Within theater, dental service support assets provide Operational Care: • Emergency Dental Care • Essential Dental Care • Another category, normally found only in fixed facilities in the US is Comprehensive Care (restores individual to optimum oral health) UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE 6. Preventive Medicine Services • Preventive medicine encompasses those measures to promote, improve or conserve the physical well-being of Soldiers • These measures enable: • • • A healthy and fit force Prevent disease and non-battle injuries Protect the force from health hazards • Preventive Medicine falls under the Protection Warfighting Function • Concerned with the enemy threat (what kind of injuries will be produced) • Concerned with the health threat (medical surveillance, Occupational and environment health threats, Preventive Med Measurers, etc) UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE 7. Combat and Operational Stress Control COSC are programs developed and actions taken by military leadership to prevent, identify, and manage adverse combat and operational stress reactions in units • Goal is to return Soldiers to duty expeditiously DOD Directive 6490. 02 E – COSC activities will include: • Routine screening of individuals when recruited • Continued surveillance throughout military service • Continual assessment and consultation with medical and other personnel UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Combat and Operational Stress Control Cont. • COSC activities provided at the right place and time will promote Soldier and unit readiness by: • Enhancing adaptive stress reactions • Preventing maladaptive stress reactions • Assisting Soldiers with controlling combat and operational stress reactions • Assisting Soldiers with behavioral disorders • Teaching warrior resiliency skills • In theater, COSC support is provided by: • • Mental Health Sections (BSMC & ASMC) Medical Detachment , Combat and Operational Stress Control (MMB) UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE 8. Veterinary Services • Army Vet Services is the executive agent for veterinary support to all Services • The Vet Services function has three core tasks • Animal Medical Care • Delivered through 4 Roles of Care (1 -3 in theater, 4 CONUS) • Food Protection • Sanitary Surveillance for food sources and storage facilities • Procurement (directory of approved food sources in the AO) • Surveillance and examination of foodstuffs for safety and QA • Veterinary Preventive Medicine • Monitoring zoonotic diseases transmissible to man UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE 9. Medical Logistics • The Medical Logistics system encompasses planning and executing all CL VIII supply support operations: • • Medical material procurement and distribution Medical equipment maintenance and repair Blood management Optical fabrication and repair Centralized management of patient movement items Contract support Medical hazardous waste management and disposal Production and distribution of medical gases UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Medical Logistics Cont. • The deployable MEDLOG System consists of the following organizations: • • • Medical logistics management center. Medical logistics company. Medical detachment (blood support). Medical team (optometry). Medical mission command headquarters United States Army Medical Materiel Agency MEDLOG support team UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE 10. Medical Laboratory Services • The Medical Laboratory Services function is divided into two elements: • Operational Lab (AML) • Identification and field confirmation of suspected CBRN agents, endemic diseases, and occupational & environmental health hazards • Focus is the total health environment of theater, not individual patient care • Clinical Lab (Med Co & CSH) • - Lab capabilities found in Medical Companies and Combat Support Hospitals provide progressive diagnostic capability UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Medical Laboratory Services Cont. Role 2 Laboratory Medical Company (BSMC & ASMC) • Lab element assigned to Area Support Squad of Treatment platoon Laboratory Capabilities • Hematology • Urinalysis • Microbiology • Serology • Receive, maintain, and transfuse blood products Role 3 Laboratory Combat Support Hospital • Lab element assigned to Area Support Squad of Treatment platoon Laboratory Capabilities • Biochemistry • Hematology • Urinalysis • Microbiology • Serology • Blood Banking Services UNCLASSIFIED

UNCLASSIFIED U. S. Army Medical Center of Excellence ADVANCED LEADER COURSE ARMY MEDICINE STARTS HERE Questions UNCLASSIFIED