Manual INFANTRY DIVISION OPERATIONS, Tactics, Techniques, and Procedures, FM 71-100-2, Military Manual

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Core Competencies of the 91WP Training for the 91WP Optical Laboratory Specialist 91H It is intended to serve as doctrine and a primary reference publication for medical planners and the medical commander and his staff. Users of this publication are encouraged to submit comments and recommendations to improve the publication.

Comments should include the page, paragraph, and line s of the text where the change is recommended. However, such staffing is subject to change to comply with manpower requirements criteria and can be subsequently changed by your modified table of organization and equipment MTOE. Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to.

Use of trade or brand names in this publication is for illustrative purposes only and does not imply endorsement by the Department of Defense DOD. It is a system that provides medical management throughout all echelons of care. The challenge is to simultaneously provide medical support to mobilizing and deploying forces, establish a CHS system within the theater, and continue to provide health care services to the CONUS base.

Additionally, there will be a requirement to provide medical support to redeployment and demobilization operations at the conclusion of operations. These battlefield rules provide the basis for the development of medical organizations and force structure. Table lists these rules in order of precedence. Table A theater of operations TO is that portion of an area of war necessary for military operations and for the administration of such operations.

The scenario depicts the size of the TO and the US forces to be deployed. The COMMZ begins at the corps rear boundary and extends rearward to include the areas needed to provide support to the forces in the CZ. Combat health support is arranged into five echelons of medical care. Each echelon reflects an increase in medical capabilities while retaining the capabilities found in the preceding echelon. In the TO, CHS is tailored and phased to enhance patient acquisition, treatment, evacuation, and return to duty RTD as far forward as the tactical situation permits. Echelon I. Care is provided by designated individuals or elements organic to combat and combat support CS units and elements of the area support medical battalion ASMB.

Major emphasis is placed on those measures necessary to stabilize the patient maintain airway, stop bleeding, and prevent shock and allow for evacuation to the next echelon of care. This echelon of care includes the following:. Major emphasis is placed on those measures necessary for the patient to RTD, or to stabilize him and allow for his evacuation to the next echelon of care.

These measures include maintaining the airway, stopping bleeding, preventing shock, protecting wounds, immobilizing fractures, and other emergency measures, as indicated. First aid is administered by an individual self-aid or buddy aid and by the combat lifesaver. Each individual soldier is trained to be proficient in a variety of specific first-aid procedures.

These procedures include aid for nuclear, biological, and chemical NBC casualties with particular emphasis on lifesaving tasks. This training enables the soldier or a buddy to apply immediate first aid to alleviate a life-threatening situation. The combat lifesaver is a member of a nonmedical unit selected by the unit commander for additional training beyond basic first-aid procedures.

A minimum of one individual per squad, crew, team, or equivalent-sized unit should be trained. The primary duty of this individual does not change. The additional duty of the combat lifesaver is to provide enhanced first aid for injuries, based on his training before the trauma specialist arrives. The training program is managed by the senior medical person designated by the commander.

Field Manual FM 3 21 8 FM 7 8 The Infantry Rifle Platoon

The trauma specialist is the first individual in the CHS chain who makes medically substantiated decisions based on medical MOS-specific training. Advanced trauma management is emergency care designed to resuscitate and stabilize the patient for evacuation to the next echelon of care. Each squad can split into two trauma treatment teams. When not engaged in ATM, these elements provide routine sick call services on an area basis. Like elements provide this echelon of care in divisions, corps, and EAC units. Echelon II. Care at this echelon is rendered at the clearing station division or corps.

The clearing station can be augmented with a forward surgical team FST , as required, for far forward surgical intervention to stabilize a nontransportable patient for further evacuation. Those patients who can RTD within 1 to 3 days are held for treatment. Emergency medical treatment including beginning resuscitation is continued and, if necessary, additional emergency measures are instituted; but they do not go beyond the measures dictated by the immediate necessities.

The division clearing station has blood replacement capability, limited x-ray and laboratory services, patient-holding capability, and operational dental care. The clearing station also provides Echelon I care to those units without organic medical elements within its area of responsibility AOR. The FSTs not organic to divisions and regiments will be assigned to a medical brigade and normally attached to a corps hospital when not operationally employed. These functions are performed typically by company-sized medical units organic to brigades, divisions, and ASMBs. Echelon III.

The first hospital facility, the corps combat support hospital CSH , is located at this echelon. The CSH is staffed and equipped to provide resuscitation, initial wound surgery, and postoperative treatment. Patients are stabilized for continued evacuation or RTD. For detailed information on theater hospitalization, refer to FM Echelon IV. Those patients not expected to RTD within the theater evacuation policy are stabilized and evacuated out of theater refer to FM Echelon V.

Hospitals in the CONUS sustaining base provide the definitive and rehabilitative treatment capability for patients generated within the theater. Department of Defense hospitals military hospitals of the triservices and Department of Veterans Affairs VA hospitals are specifically designated to provide the soldier with maximum return of function through a combination of medical, surgical, rehabilitative, and convalescent care. The medical threat is a composite of all ongoing or potential enemy actions and environmental conditions that may render a soldier combat ineffective.

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Diseases endemic to the AO. Environmental and occupational health hazards such as toxic industrial material TIM ,. Medical intelligence is the product resulting from the collection, evaluation, analysis, integration, and interpretation of all available general health and bioscientific information. Medical intelligence is concerned with one or more of the medical aspects of foreign nations or AO. For additional information on the medical threat and medical intelligence, refer to FM , FM The extended and nonlinear battlefield stretches CHS capabilities to the maximum. It presents unprecedented challenges to the CHS planner as well as to the tactical commander.

It is imperative that the CHS planner be involved in the initial stages of the planning process. Combat health support planning is an intense and demanding process. The CHS planner must foresee actions beforehand to be able to plan for positive and responsive support to each element supported. To this end, commanders and their staffs must coordinate horizontally and vertically with both medical and nonmedical staffs.

Commanders must be able to reallocate medical resources as the tactical situation changes. On the integrated battlefield, medical units can anticipate situations in which large numbers of patients are produced in a relatively short period of time. Combat health support planning is an intricate process which enables the CHS commander or command surgeon to develop the most effective and flexible plan for providing CHS to the tactical commander. Conformity with the tactical plan is the most fundamental element for effectively providing CHS. Only by participating in the development of the operation plan OPLAN can the CHS planner ensure adequate support at the right time and the right place.

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Combat health support must be continuous since an interruption of treatment may cause an increase in morbidity and mortality. No patient is evacuated any farther to the rear than his physical condition or the military situation requires. Technical control and supervision of medical assets must remain with the appropriate force-level surgeon.

Combat health support staff officers must be proactive and keep their commanders apprised of the impact of future operations on CHS resources. The medical commander must be able to tailor CHS organizations and direct them to focal points of demand throughout his AO. Since these resources are limited, it is essential that their control be retained at the highest CHS level consistent with the tactical situation. The location of CHS assets in support of combat operations is dictated by the tactical situation mission, enemy, terrain, troops, time available, and civilian considerations [METT-TC] factors , time and distance factors, and availability of evacuation resources.

The speed with which medical treatment is initiated is extremely important in reducing morbidity and mortality. Medical evacuation time must be minimized by the efficient allocation of resources and the judicious location of medical treatment facilities MTFs. The MTFs cannot be located so far forward that they interfere with the conduct of combat operations or are subjected to enemy interference.

Conversely, they must not be located so far to the rear that medical treatment is delayed due to the lengthened evacuation time. Further, the location of the MTFs may be affected by the level of conformance to the Geneva Convention protections by the combatants.

Since a change in tactical plans or operations may require redistribution or relocation of medical resources to meet the changing requirements, no more medical resources should be committed nor MTFs established than are required to support expected patient densities.

When the patient load exceeds the means available for treatment MASCAL situation , it may be necessary to give priority to those patients who can be returned to duty the soonest, rather than those who are more seriously injured. Since contact with supported units must be maintained, CHS elements must have mobility comparable to that of the units they support.

Mobility is measured by the extent to which a unit can When totally committed to patient care, a CHS unit can regain its mobility only by immediate patient evacuation. The modular medical support system was designed to standardize all medical subelements in Echelons I and II. This system enables the medical resources manager to rapidly tailor, augment, reinforce, or regenerate CHS units as needed. Combat health support originates in the forward areas divisions with the trauma specialist Echelon I.

Modular Medical Support System. The modular medical support system is built around six modules. These modules are oriented to casualty collection, treatment, and RTD or evacuation. The trauma specialist combat medic module consists of one trauma specialist and his prescribed load of medical supplies and equipment. Trauma specialists are organic to the medical platoons or sections of combat and CS battalions and are attached to the companies of the battalions.

An ambulance squad is comprised of two ambulance teams and two ambulances. This squad provides patient evacuation and en route medical care throughout the theater division, corps, and EAC. This squad consists of a primary care physician, a PA, two health care noncommissioned officers NCOs , and four health care specialists. The squad is trained and equipped to provide ATM to the battlefield casualty or to treat and return him to duty. To maintain contact with the combat maneuver elements, each squad has two vehicles equipped with four field medical equipment set MES : two trauma sets and two sick call sets.

Each squad can split into two treatment teams one team is headed by the physician and the other by the PA. These squads are organic to medical platoons or sections in maneuver and designated CS units, as well as being the basic building block of medical companies, medical troops, and medical detachments. This squad is comprised of one dentist trained in ATM, a dental specialist, a radiology specialist, and a medical laboratory specialist.

This squad consists of one medical-surgical nurse, two health care NCOs, and two health care specialists. It is capable of holding and providing minimal care for up to 40 20 in the light infantry division RTD patients. The area support and patient-holding squads are not capable of independent operations. It is also organic to the airborne and air assault divisions and the armored cavalry regiment ACR. The FST provides a rapidly deployable immediate surgery capability.

It provides surgical support forward in division, separate brigade, and ACR operational areas. This small lightweight surgical module is designed to complement and augment emergency treatment capabilities for the brigade-sized task forces TFs. The team also coordinates through the medical company for its security and redeployment. However, C4I will not be discussed in this chapter; it is included throughout the manual as appropriate.

Within the division, the full spectrum of services is provided by a combination of assigned and attached CHS resources. Medical treatment consists of those measures necessary to recover, resuscitate, stabilize, and prepare the patient for evacuation to the next echelon of care. The medical treatment functional area encompasses Echelons I and II medical treatment.

Medical treatment is provided through the use of modular medical elements paragraph and units designed to perform specific battlefield medical functions. The composition of each module will be identical regardless of where they are employed. This eases the reconstitution burden on the CHS system. Echelon II medical units duplicate these services in addition to providing limited dental, x-ray, and medical laboratory services, and extensive medical ground evacuation services.

Other area medical Medical Evacuation. The systematic evacuation of sick, injured, or wounded soldiers within US forces has been an evolutionary process.

The current organizational design and doctrine are based on years of experience and the assimilation of lessons learned. The policy establishes, in days, the maximum period of noneffectiveness hospitalization and convalescence that patients may be held within the theater for treatment. This policy does not mean that a patient is held in the TO for the entire period of noneffectiveness. A patient who is not expected to be ready for RTD within the number of days established in the theater evacuation policy is evacuated to CONUS or some other safe haven.

For example, a theater evacuation policy of 15 days does not mean that a patient will be held in the TO for 14 days and then evacuated. Rather, it means that a patient is evacuated as soon as it is determined that he cannot be RTD within 15 days following admission. Prior planning to incorporate this requirement into the OPLAN ensures that the use of these assets is integrated with the dedicated medical evacuation platforms. When the use of nonmedical transportation assets is planned, augmentation medical personnel should be requested to provide medical care en route on these vehicles.

Medical Regulating. Medical regulating is the coordination and control of evacuating patients to MTFs that are best able to provide the required specialty care. This system is designed to ensure the efficient and safe movement of patients. Within the division, informal medical regulating is known as patient tracking. Patient tracking within the division is usually operated procedurally so as not to depend solely on communications to effect rapid evacuation. Additional Information. For additional information on medical evacuation and medical regulating, refer to FM and FM Hospitalization is provided as close as practical to the troops requiring it see FMs FM Hospitalization of patients from other Services is provided as directed by higher headquarters.

Hospitalization requirements must be forecasted so that MTFs can be established in advance of the time they are to be occupied. The CONUS-sustaining base hospitals provide the definitive and rehabilitative treatment capability for patients generated within the TO. Refer to paragraph e of this publication, FM Combat health logistics encompasses the planning and execution of medical supply operations, medical equipment maintenance, optical fabrication and repair, contracting services, medical hazardous waste management and disposal, production and distribution of medical gases, and blood banking services for Army operations; when designated, the Army may provide Class VIII support to the other Services, and during interagency and multinational operations.

Within the theater, dental service support provides operational care, which is composed of emergency dental care and essential dental care. These categories are not absolute in their limits; they are the general basis for the definition of the dental service capabilities available at the different CHS echelons of care. Operational Care. Care given for the relief of oral pain, elimination of acute infection, control of life-threatening oral conditions hemorrhage, cellulitis, or respiratory difficulty , and treatment of trauma to teeth, jaws, and associated facial structures is considered emergency care.

It is the most austere type of care and is available to soldiers engaged in tactical operations. Common examples of emergency treatments are simple extractions, antibiotics, pain medication, and temporary fillings. Essential care includes dental treatment necessary to intercept potential emergencies.

This type of operational care is necessary for prevention of lost duty time and preservation of fighting strength. Soldiers in Dental Class 3 potential dental emergencies should be provided essential care as the tactical situation permits. Soldiers in Dental Class 2 untreated oral disease should be provided essential care as the tactical situation and availability of dental resources permit. The scope of operational care includes restoration, minor oral surgery, exodontic, periodontic, and prosthodontic procedures as well as prophylaxis.

Comprehensive Care. Treatment to restore an individual to optimal oral health, function, and esthetics is considered comprehensive care. Comprehensive dental care may be achieved incidental to providing operational care in individuals whose oral condition is healthy enough to be addressed by the category of care provided. This category of care is usually reserved for CHS plans that anticipate an extensive period of reception and training in theater. Veterinary support is also provided upon request and subject to availability of resources for government-owned animals of other federal agencies.

There are no organic veterinary assets within the divisions, separate brigades, and ACRs. Veterinary service within the corps and EAC includes—. Historically, DNBIs have rendered more soldiers combat ineffective than actual battle casualties. Therefore, the medical threat paragraph must be recognized, analyzed, and measures taken to combat its effects.

The medical threat accounts for the vast majority of combat noneffectiveness. The company field sanitation team consists of two soldiers. This team is specially trained by PVNTMED personnel in potable water supply, food service sanitation, waste disposal, pest management, environmental and occupational health hazards, and TIM hazards. The field sanitation team serves as an aid to the unit commander in protecting the health of his command. Combat operational stress control is a system-oriented program to control stressors and stress behaviors. It is coordinated and conducted by MH personnel.

Of primary importance in this effort are the The mission of COSC team is to assist the command in controlling combat operational stress by providing training and consultation in the control of stressors, the promotions of positive combat operational stress behavior, and the identification, handling, and the management of battle fatigue BF soldiers. Combat operational stress prevention programs reduce the incidence of new combat operational stress-related casualties.

These programs promote the early recovery and RTD of stress casualties. They reduce the cases that could otherwise overload the CHS system. Medical laboratory services in a TO are designed to enhance diagnostic capabilities and to identify suspect biological warfare BW and chemical warfare CW agents. Diagnostic medical laboratory assets analyze body fluids and tissues to determine disease processes or to identify microorganisms. The equipment and personnel available are limiting factors in the scope of services provided. The sophistication of laboratory services increases at each successive echelon of care.

Additionally, the management of blood and blood components are critical tasks requiring medical laboratory and CHL assets. Laboratory tests are limited to manual procedures such as hematocrit, white blood cell count, urinalysis, and gram staining. A full range of laboratory procedures is provided at these echelons. Each has a clinical laboratory to support patient care.

The primary mission of the area medical laboratory AML focuses on the identification and evaluation of health hazards in the AO through accurate field confirmatory laboratory testing of NBC, endemic disease, and occupational and environmental agents. Medical companies are organic to CSS battalions in divisions and separate brigades. A division may be armored, mechanized infantry, light infantry, airborne, or air assault, or it could be comprised of combination of task-organized heavy and light units.

Each type of division conducts tactical operations across the operational continuum. Divisions are the basic units of maneuver at the tactical level. In all divisions, Echelon II medical care is provided by medical companies. These medical companies are assigned to one of the CSS battalions identified above. Armored and mechanized divisions are normally employed for their mobility, survivability, lethality, and psychological effects on the enemy.

These divisions destroy enemy armored forces. They can seize and secure land areas and key terrain. During offensive operations, armored and mechanized divisions can rapidly concentrate overwhelming lethal combat power to break or envelop enemy defenses or offensive formations. These divisions then continue the attack to destroy fire support, command and control C2 , and logistics elements.

Their mobility allows them to rapidly concentrate, attack, reinforce, or block enemy forces. Their collective protection systems enable them to operate in an NBC environment. Armored and mechanized divisions operate best in open terrain where they gain the advantage with their mobility and long-range, direct-fire weapons.

Because of strategic lift requirements, armored and mechanized forces are slow to deploy from home or staging bases into an area of operations AO. They have high consumption rates of supplies, can deploy relatively few dismounted infantry, and have limited use in restrictive terrain. See FM for organizational structure of the division. The digital technological enablers will enhance situational understanding and provide the means for information dominance by enabling friendly forces to share a complete common relevant picture CRP. This provides the commanders a CRP while communicating and targeting in real or near real-time.

Digitization permits the division to conduct operations over an extended battle space by increasing the operational areas of responsibility for all maneuver elements. Digitization will decrease decision-making time by optimizing the flow of information. This information enables Force XXI commanders to quickly mass forces allowing the division to defeat a larger, but less technologically advanced enemy.

It will contribute increased lethality, survivability, and operational tempo while reducing the potential for fratricide. Light Infantry Division. The light infantry division fights as part of a larger force in conventional conflicts and conducts missions as part of a joint force in stability operations and support operations.

Its C2 structure readily accepts any augmentation forces, permitting task organizing for any situation. The optimum use of light forces is as a division under corps control, its mission capitalizing on its capabilities. The division exploits the advantages of restricted terrain and limited visibility. It achieves mass through the combined effects of synchronized small-unit operations and fires, rather than through the physical concentration of forces on the battlefield.

Light division forces physically mass only when risk to the force is low and the payoff is high. The division deploys as an entity; widely dispersed to conduct synchronized, but decentralized, operations primarily at night or during periods of limited visibility. For organizational structure of the light infantry division, see FM Airborne Division. The airborne division can rapidly deploy anywhere in the world to seize and secure vital objectives.

It conducts parachute assaults to capture initial lodgments, execute large-scale tactical raids, secure intermediate staging bases or forward operating bases for ground and air operations, or rescue US nationals besieged overseas. It also can serve as a strategic or theater reserve as well as reinforcement for forward-presence forces. It can seize and repair airfields to provide a forward operating base and airheads for follow-on air-landed forces. It is capable of all other missions assigned to light infantry divisions. The airborne division uses its strategic and operational mobility to achieve surprise on the battlefield.

Its aircraft range and its instrumentation capability enable the Air Force to accurately deliver the airborne division into virtually any objective area under almost any weather condition. All equipment is air transportable; most are airdroppable. All personnel are trained for Engagements with enemy armored or motorized formations require special consideration.

The division does not have sufficient armored protection to defeat heavier armored formations at close range. Antitank weapons in the division compensate for, but do not completely offset, this deficit. For division organizational structure, see FM Air Assault Division.

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The air assault division combines strategic deployability with tactical mobility within its AO. It attacks the enemy deep, fast, and often over extended distances and terrain obstacles. Air assault operations have evolved into combat, CS, and CSS elements aircraft and troops deliberately task-organized for tactical operations. Helicopters are completely integrated into ground force operations. Air assault operations generally involve insertions and extractions under hostile conditions, as opposed to mere air movement of troops to and from secure locations about the battlefield.

Once deployed on the ground, air assault infantry battalions fight like battalions in other infantry divisions; however, normal task organization of organic aviation results in greater combat power and permits rapid aerial redeployment. The rapid tempo of operations over extended ranges enables the division commander to rapidly seize and maintain the tactical initiative. Medium Division. The medium division consists of one armored brigade, one mechanized brigade, and one air assault brigade, and traditional heavy division aviation, CS, and CSS units.

The Army designed this division to provide commanders operational flexibility with armor lethality and light infantry strength in restrictive terrain. They also provide Echelons I and II medical treatment on an area basis to those units without organic medical assets operating in the brigade support area BSA. Also, the FSMCs may deploy its treatment teams that can operate independently from the company for limited periods of time.

The FSMC also provide intervention for combat and operational stress disorders to include BF and preparation of patients for further medical evacuation. Medical surveillance for detection of any health hazards that pose a medical threat. Basic Organization. The composition of each of these components differs depending on the type of division. Forward support medical companies are dependent on appropriate elements of the corps, division, and brigade for patient evacuation including air ambulances , CHS operational planning and guidance, and for legal, finance, and personnel and administrative services.

It is also dependent on the FSB for food service and religious support. The ambulance platoon employs a platoon headquarters with three tracked ambulance squads six ambulances and two-wheeled ambulance squads four ambulances. The company headquarters establishes an FM radio net and an internal wire net for C2. It also establishes an AM net capability for reach-back support. Figure Forward support medical company-heavy TOE L1 , forward support battalion, heavy division.

The ambulance platoon employs a platoon headquarters with four-wheeled ambulance squads eight ambulances. Forward support medical company-light TOE L0 , forward support battalion, light division. The ambulance platoon employs a platoon headquarters with threewheeled ambulance squads six ambulances. Forward support medical company-air assault TOE L0 , forward support battalion, air assault division. The ambulance platoon employs a platoon headquarters with fourwheeled ambulance squads eight ambulances. It also establishes an AM net capability for reach-back support, and its platoons are deployed in the tactical internet for situational understanding of its forward deployed assets.

The company and its forward supporting elements are employed in the tactical internet. For additional information on radios and battlefield automation, see Appendix I. See also Appendix F for information on the digitization of the medical company. Forward support medical company-airborne TOE L0 , forward support battalion, airborne divisions.

These companies provide C2 for organic and attached medical elements. The composition of each of these components differs, depending on the type of division. The ambulance platoon employs a platoon headquarters and five wheeled-ambulance squads 10 ambulances. Main support medical company-heavy TOE L0 , main support battalion, heavy division. The company and its forward support elements FSEs are employed in the tactical Internet. See also Appendix F for information on digitization of medical company. It is organized into a company headquarters section; a DMSO; a PVNTMED section; an optometry section; a MH section; a treatment platoon organized into a platoon headquarters with two independent treatment squads [four treatment teams]; an area support section with an area support squad, an area treatment squad, and a patient-holding squad ; and an ambulance platoon.

The ambulance platoon employs a platoon headquarters and four wheeled-ambulance squads eight ambulances. Main support medical company-light TOE L0 , main support battalion, light division. It employs a treatment platoon that is organized into a platoon headquarters, an area support section composed of an area support squad, an area support treatment squad, an FST see note below , and a treatment squad two treatment teams.

It is normally under the technical control of the division surgeon with tasking through the MSB support operations section refer to FM Main support medical company-air assault TOE L0 , main support battalion, air assault division. It employs a treatment platoon that is organized into a platoon headquarters, an area support section composed of area support squad, an area support treatment squad, an FST see note below , and two independent treatment squads four treatment teams.

It is normally under the technical control of the division surgeon with tasking through the MSB support operations section. Main support medical company-airborne TOE L0 , main support battalion, airborne division. Section II. Both the staffing and the equipping of separate brigades are geared toward semi-independent operations.

They can serve as planning headquarters for larger reserve forces or major contingency operations. Separate brigades normally conduct operations under the corps command. They can also serve as division reinforcement for short periods. The headquarters and headquarter companies of separate brigades include support elements that would normally be found at division. Separate brigades conduct operations like the divisional brigade; they can fight directly under corps control or perform rear operations, flank security mission operations, or covering force operations. They can also serve as the corps reserve, or reinforce a division.

Separate brigades also have their own cavalry troop, engineer company, military intelligence company, military police platoon, artillery battalion, and support battalion for DS CSS with an imbedded medical company. See FM and FM for detailed information on the organization and functions of the different brigades. The medical company-heavy separate brigade is dependent on appropriate elements of the corps for patient evacuation including air and ground ambulance support from the BSA. It is dependent on its brigade and battalion headquarters for CHS operational planning and guidance and for legal, finance, and personnel and administrative services.

It is also dependent on its parent support battalion for food service and religious support. NOTE The company has organic maintenance assets within its company headquarters and should not require unit-level maintenance support. The treatment platoon is organized into a platoon headquarters with three treatment squads six treatment teams , an area support section with an area support squad, an area treatment squad, and a patient-holding squad. The ambulance platoon employs a platoon headquarters, three MA1 tracked ambulance squads six MA1 tracked ambulances and three-wheeled ambulance squads 6-wheeled ambulances with a combined total of 12 ambulances.

For vehicle retrieval and heavy-wheeled maintenance, the company headquarters employs a 5-ton truck wrecker. For tailgate operations and rapid mobility of the clearing station, the treatment platoon employs three 5-ton expansible vans one for the area support squad and two for the area support treatment squad. Medical company-heavy separate brigade TOE L0 , support battalion, heavy separate brigade. The ACR is a self-contained combined arms organization composed of armored cavalry squadrons ACS , an aviation squadron, a support squadron, and separate CS companies and batteries.

Corps CS units and divisional maneuver battalions often reinforce it. The ACR operates independently over a wide area and at extended distances from other units. The ACR is a highly mobile, armored force capable of fighting the fully mechanized threat in the environmental states of war or conflict. Same as a above except it supports the ACR. Same as b above except it has organic mental health and preventive medicine.

The medical troop-ACR is dependent on appropriate elements of the corps and the support squad for patient evacuation including air ambulance , CHS operational planning, guidance, legal, finance, and personnel and administrative services. It is also dependent on the headquarters and headquarters troop of the support squad for food service, religious, and vehicle maintenance support. The Medical Troop-ACR TOE L0 Figure is organized into a troop headquarters section; a treatment platoon that is further organized into a platoon headquarters, an area support element with an area support squad, two area support treatment squads; an FST, and a patient-holding squad.

The troop is also organized with a RMSO and an ambulance platoon. The ambulance platoon employs a platoon headquarters and six-wheeled ambulance squads 12 ambulances. The BCT is a full spectrum, combat force. It has use in all operational environments against all projected future threats, but it is designed and optimized primarily for employment in small scale contingency operations in complex and urban terrain, confronting low-end and mid-range threats that may employ both conventional and asymmetric capabilities. The BCT deploys very rapidly, executes early entry, and conducts effective combat operations immediately on arrival to prevent, contain, stabilize, or resolve a conflict through shaping and decisive operations.

The BCT participates in a major theater war, with augmentation, as a subordinate maneuver component within a division or corps and in a variety of possible roles. The BCT is a divisional brigade that is strategically responsive, rapidly deployable, agile, versatile, lethal, survivable, and sustainable.

It is designed to optimize its organizational effectiveness and seeks to balance the traditional domains of lethality, mobility and survivability with the domains required for responsiveness, deployability, sustainability and a reduced in-theater footprint. It is nontraditional with respect to design, the deployment process, and manner of employment. Its two core qualities are high mobility strategical, operational, and tactical and its ability to achieve decisive action through dismounted infantry assault.

The ASMCs also establish clearing stations and provide Echelons I and II CHS in a wide area normally, an area or sector of the size established and supported by a corps support group or corps support battalion. The mission, assignment, capability, basic organization and dependency of all medical companies were discussed in Chapter 2. This chapter provides information on the organizational design of the medical company and the functions performed by its subordinate elements in support of the mission.

The company headquarters section is organized into a command element; a support element; a unit supply element; a medical supply and medical maintenance element; and an operations and communications element. For communications, the company headquarters employs AM and FM tactical radios, tactical computers, and a manual switchboard. Personnel of this section supervise unit operations, general supply, medical supply, communications, and power-generation operations.

Command Element. The command element is responsible for providing billeting, security, training, administration, and discipline for assigned personnel. This element provides C2 of its assigned and attached personnel. It is typically staffed with a company commander, a field medical assistant, and a first sergeant 1SG. He regularly attends headquarters staff meetings to obtain information to facilitate the execution of medical operations.

He and the company headquarters personnel operate the company command post CP and net control station NCS for both radio and digital traffic. He operates where the commander directs or where his duties require him. Headquarters Support Element. The headquarters support element in the AOE medical company is normally comprised of the signal support, maintenance specialist, decontamination specialist, NBC specialist, and the armorer.

These personnel perform those functions for the company in their areas of expertise. Unit Supply Elements. The unit supply element, under the supervision of the unit supply sergeant, is responsible for managing, requesting, receiving, issuing, storing, and maintaining all classes of supplies and turn-in supplies and equipment for the company.

All blood products for the company are distributed to the treatment platoon area support squad medical laboratory [MEDLAB] element for storage, managing, monitoring, and further distribution in the company or to a supporting FST. The medical maintenance element consist of one medical equipment repairer. The treatment platoon is composed of a platoon headquarters, treatment squads, an area support squad, and an area treatment squad. For communications, the platoon employs up to seven tactical radios.

The digitized medical companies also use FBCB2 and in the future MC4 enablers when fielded for situational awareness and understanding and for functional area operations refer to Chapter 2 and Appendix F. Headquarters Element. The platoon headquarters is the C2 element of the platoon. It determines and directs the disposition of patients and submits requests through the company CP for their evacuation of patients to supporting hospitals.

During hasty displacements the treatment platoon headquarters is used as an alternate company CP. The headquarters element directs, coordinates, and supervises platoon operations. It directs the activities of the clearing station and monitors Class VIII supplies, blood usage and inventory levels, and keeps the commander informed. The headquarters element is responsible for the management of platoon operations, operations security OPSEC , communications, medical administration see Appendices E and K , organizational training, supply transportation, patient accountability, statistical reporting functions, blood situation reporting.

Treatment Squad Elements. The treatment squad element can contain up to four treatment squads, depending on the type company assigned. These squads provide emergency and routine sick call treatment to soldiers assigned to supported units. Each squad has the capability to split and operate as separate treatment teams Teams A and B for limited periods of time.

While operating in these separate modes, they may operate up to four treatment stations. They can be assigned to reinforce or reconstitute similar treatment squads. These squads can operate for up to 48 hours while separated from their parent unit. A treatment squad can be echeloned forward to establish an MTF at a new location. The echeloning of elements allows the old treatment site to remain operational until the new site is established. Area Support Squad Elements. The area support squad elements of the treatment platoon are composed of an area treatment squad, an area support squad, and a patient-holding squad.

The area support squad provides operational dental care that include emergency and essential dental services, limited laboratory and radiological services, and blood support commensurate with Echelon II treatment facilities. The patient-holding squad provides up to 40 cots 40 cots for heavy division and 20 cots for light divisions for patients requiring minimal treatment. Patients held in the patient-holding area are those patients who are expected to be RTD within 72 hours from the time they are held for treatment.

Also, they are normally not used on the area damage control team. The area treatment squad is identical in personnel and equipment as the treatment squads of the treatment section. It is the base medical treatment element of a clearing station. The area support squad includes the dental and diagnostic support elements of the clearing station. It provides for basic services commensurate with Echelon II medical treatment. The dental officer supervises the activities of the area support squad.

The dental element provides operational dental care, which consists of emergency and essential dental care. Essential dental care is intended to intercept potential dental emergencies. The MEDLAB element performs clinical laboratory and blood banking procedures to aid physicians and PAs in the diagnosis, treatment, and prevention of diseases. Laboratory functions include performing elementary laboratory procedures consistent with the Echelon II laboratory capabilities.

This element performs routine clinical radiology procedures to aid physicians and PAs in the diagnosis and treatment of patients. Patient-Holding Squad. The patient-holding squad operates the holding area of the clearing station. The patient holding area is equipped to provide care for up to 40 patients. Normally, only those patients awaiting evacuation or those requiring treatment of minor illness or injuries are placed in the patient-holding area. The patient-holding squad works under the direct super-vision of a physician. The medical-surgical nurse assigned to the patient-holding squad provides nursing care supervision.

Since Echelon II facilities, such as a medical company or troop, do not have an admis-sion capability, patients may only be held at this facility, but are not counted as hospital admissions. If recovery or RTD is not expected within 72 hours, the patients are evacuated to a supporting hospital for admission. Tasking for the FST is accomplished through appropriate command channels. The ambulance platoon headquarters element is staffed with a platoon leader 02, 70B, MS and a platoon sergeant E7, 91W It provides C2 for ambulance platoon operations.

The ambulance platoon headquarters element maintains communications to direct ground ambulance evacuation of patients. The ambulance headquarters element performs route reconnaissance and develops and issues graphic overlays to all its ambulance teams. It also coordinates and establishes AXPs for both air and ground ambulances, as required. Refer to Appendix F for ambulance platoon operations in digitized medical companies.

Ambulance Squads. An ambulance squad consists of two ambulance teams two ambulances, wheel or tracked vehicles. Ambulance squad personnel perform EMT, evacuate patients, and provide for their continued care en route. They also operate and maintain assigned communication and navigational equipment. Ambulance squad personnel provide the EMT that is necessary to prepare patients for movement and also provide en route care.

They perform preventive maintenance checks and services PMCS on ambulances and associated equipment. Ambulance squad personnel maintain supply levels for the ambulance MESs.


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They ensure that appropriate property exchange of medical items such as litters and blankets is made at sending and receiving MTF. NOTE Tracked ambulances are found the armored and mechanized infantry divisions. The airborne air assault and light infantry have only wheeled ambulances organic to their medical companies. The section ensures PVNTMED measures are implemented to protect personnel against food-, water-, and arthropodborne diseases, as well as environmental injuries. The section provides advice and consultation in the area of health threat assessment, force health protection, environmental sanitation, epidemiology, sanitary engineering, and pest management.

Through routine surveillance, they identify actual and potential health hazards, recommend corrective measures, and assist in training IBCT personnel in disease prevention programs d. Also, the prevention of posttraumatic stress disorders is an important objective in both division and corps CSOC programs.

This NCO works for the brigade surgeon under the general supervision of the division psychiatrist. The brigade CSC coordinator routinely circulates throughout the brigade to trained and advise supported personnel see FM Also the MH section serves as a consultant to the commander, staff and others involved with providing prevention and intervention services to unit soldiers and their families.

This is accomplished under the guidance and in close coordination with the brigade surgeon, battalion surgeons, and BSMC physicians. Provide recommendations for prevention or actions required to ensure positive mission-oriented motivation of unit members and unit cohesion.

The governing regulation is AR Also see Appendix K. It is normally staffed with two optometry officers 03, 67F , one of which serves as the section chief; an eye sergeant, 91W20; one optical laboratory specialist, 91H10; and one eye specialist, 91W The two optometrists assigned to this section independently conduct examinations of the eyes using optometric procedures, instruments, and pharmaceuticals, as required.

It assists with site selection for establishment of the units. Improper site selection can result in inefficiency and possibly danger to unit personnel and patients. For example, if there is insufficient space available for ambulances to turnaround, congestion and traffic jams in the MTF AO can result; or, if the area selected does not have proper drainage, heavy rains may cause flooding in the unit and treatment areas.

The optimal land space required for establishment of a medical company is approximately 2, square meters. This area also includes the helipad and parking area requirements. Medical companies are normally established within a base cluster with other corps, division, brigade, or regimental units for security. The senior commander within a base cluster is also the base cluster commander and operates the base cluster operations center BCOC.

The medical company coordinates site selection and obtains approval from the BCOC prior to the establishment of the company area. The medical company will be competing with other CSS units for space and location within the base cluster. It is important, therefore, to stress the unique requirements of the medical mission.

The BCOC provides guidance on security and briefs the medical company on base cluster operating procedures and locations of supported units and elements. Within the base cluster, the MTF should not be placed near hazardous materials such as petroleum, oils, and lubricants POL and ammunition or storage areas , motor pools, and waste disposal sites.

If possible, the MTF should be established toward the center, rather than on the perimeter of the base cluster. The requirements for an area that is only to be used for a short period of time can differ significantly from an area that is expected to be used on an extended basis. On the other hand, if it is anticipated that the unit will be located at one site for an extended period of time, buildings or preestablished shelters, if available, may be used.

Ground evacuation is the principal means of evacuation for patients injured in the forward areas. It should be situated near and be accessible to main road The site should not be so secluded that incoming ambulances have difficulty locating the MTF. To ensure the timely delivery of CHS, the clearing station must be located in the general vicinity of the supported forces or Echelon I facilities supported.

Without proximity to the areas of patient density, the evacuation routes will be unnecessarily long, resulting in delays in both treatment and evacuation. The longer the distance is that must be traveled, the longer it takes for the patient to reach the next echelon of care. Further, this time delay reduces the number of ambulances available for clearing the battlefield as a number of ambulances will be in transit to the clearing station at any given time. Care must be taken to ensure that the site selected is not in or near a dry river or stream bed, has drainage that slopes away from the MTF location and not through the operational area, and that there are not any areas where water can pool.

This is particularly true in extreme cold weather operations where the ground is frozen at night and begins to thaw and become marshy during daylight hours. Further, the area must be able to withstand a heavy traffic flow of incoming and departing ambulances in various types of weather. The site must be large enough to permit dispersal of the unit elements and expansion should augmentation be required. When fully establishing the site, at least 4 acres of land are required for the treatment and administrative areas exclusive of the helipad and motor pool requirements.

See Appendix I for communications considerations and procedures. The area should provide maximum cover and concealment without hampering mission accomplishment or communications capability. Overhead cover is desirable for protection from biological and chemical contamination in the event of an attack. The site selected must have sufficient space available to serve as a landing site for incoming and outgoing air ambulances.

Sufficient space must be allocated for establishing a landing site for contaminated aircraft downwind of the unit and treatment areas. Additional site selection considerations for a landing site are contained in FM The site selected should be easily defendable and maximize the use of available terrain features and defilade for cover and concealment. The extent of perimeter security requirements is dependent upon whether the unit is included in a base cluster or its placement within the base cluster , or if it is solely responsible for its own security. A complete discussion on perimeter security and the Geneva Conventions is contained in Appendix A.

In establishing the traffic patterns within the unit area, three significant areas must be addressed. Using overlapping internal traffic patterns should be minimized. There must be sufficient space allocated for ambulance turnaround once the patient has been delivered to the triage area. Intersections accommodating cross-traffic should be avoided as they present the potential for traffic jams and accidents.

The flow of traffic should be in one direction only. NOTE Two-way traffic can cause confusion, particularly when loading and unloading patients. Certain pieces of equipment require strategic placement within the company area. In selecting the site, the placement of this type of equipment must be considered. For example, trailer-mounted, 10 kilowatt generators must be placed in such a manner as to enhance their safe operation and to reduce their heat signature and noise level, yet be close enough to unit and treatment areas that the limited amount of cable can reach.

It is preferable to maximize the use of natural terrain features within the site to provide a portion of this shielding rather than having to rely solely on the use of sandbags.

The site should be large enough to provide an area for patient decontamination. The specific site selected to establish the decontamination station must be downwind of the unit and treatment areas. The Geneva Conventions Appendix A afford the medical unit a certain degree of protection from attack. The extent to which the combatants and irregular forces on the battlefield are adhering to the provisions of the Geneva Conventions has a bearing on site selection in that it may dictate the degree of required security for the unit refer to Appendix A.

All security precautions and requirements must be met according to higher headquarters operating procedures. Only essential equipment is set up to support the medical company operations. If the failure to camouflage endangers or compromises tactical operations, the camouflage of the MTF may be ordered by a NATO commander of at least brigade level or equivalent. Dispersion of tents and equipment is accomplished to the maximum extent possible. A controlled entry into the medical company area is established. Medical aircraft in the air must display the distinctive Geneva emblem. Camouflage of the red cross means covering it up or taking it down.

The black cross on an olive background is not a recognized emblem of the Geneva Conventions. The command element supervises the establishment of the company. The commander monitors all elements as the company sets up. He ensures that it is established according to the unit layout plan and the TSOP. This is accomplished according to FMs , , and The nonmedical personnel are identified and trained on patient decontamination procedures with medical company personnel. Additional personnel from the base cluster may be trained to transport patients by litter.

All Echelon II medical companies are authorized three chemical patient treatments and two patient decontamination MESs. Each patient chemical treatment MES is stocked with enough supplies to treat 30 patients. Each patient decontamination MES is stocked with enough supplies to decontaminate 60 patients. The 1SG supervises the establishment of the company headquarters and the troop billeting areas and monitors field sanitation team activities. The operations element assists in establishing the company headquarters. He coordinates with the BCOC and monitors the placement of early warning devices for the detection of chemical agents.

He supervises and monitors unit personnel for compliance with correct wear of mission-oriented protective posture MOPP They establish the medical company net control for unit assets. Communications personnel establish the internal wire communications net. They connect to the mobile subscriber equipment MSE area system at the wire subscriber access point operated by the area support signal element.

It ensures that all supplies are secured, properly stored, and protected from the environment. It establishes the unit POL and water points. Medical units are limited by the provisions of the Geneva Conventions in responding defensively to enemy action. Refer to Appendix A for additional information on self-defense and the defense of patients.

Mass Casualty Situations.


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