PATIENT EVACUATION
Patient evacuation is quickly and efficiently moving wounded, injured, or ill persons from the battlefield and other locations to MTFs. Medical personnel provide en route medical care during patient evacuation. Precisely planned evacuation plays an important role in the carefully designed treatment sequence from the FLOT rearward. As the echelons of care become more sophisticated from front to rear, so do the means of patient evacuation. The evacuation process continues for each person until he can be RTD or discharged from service. In keeping with the AMEDD mission, every effort is made, consistent with the evacuation policy, to rehabilitate patients and return them to duty at the lowest practicable echelon of care. Patient evacuation is the responsibility of the echelon of care to which patients are evacuated (higher evacuates from lower).
Medical platoons/sections conduct casualty collection and evacuation from the point of injury or illness to the BAS.
Forward and main support medical companies evacuate from a BAS or AOR to a clearing station located in the BSA or DSA, respectively.
Evacuation battalions assigned or attached to corps medical brigades/groups evacuate from clearing stations to MASHs and CSHs and move casualties between MTFs within the corps.
The TA MEDCOM, in conjunction with the TA TRANSCOM, evacuates from the CZ to a field or general hospital in the COMMZ or between MTFs within the COMMZ.
The USTRANSCOM evacuates from the COMMZ to the ZI.
EVACUATION POLICIES
The following factors affect the evacuation policy:
Theater evacuation policy definition. The Secretary of Defense, with the advice of the Joint Chiefs of Staff and upon the theater commander's recommendation, establishes this policy. The policy gives, in number of days, the maximum period of noneffectiveness (hospitalization and convalescence) patients may be held within the theater for treatment. The evacuation period starts when the patient is admitted to the first hospital in the corps or COMMZ hospital. This policy does not mean a patient will be held in the theater for the entire period of noneffectiveness. A patient who is not expected to RTD within the time established in the theater evacuation policy is evacuated to CONUS or some other safe haven as soon as practical. This is done when the treating physicians determine that such evacuation will not aggravate the patient's disabilities or medical condition. For example, a theater evacuation policy of 60 days does not mean a patient is held in the theater for 59 days and then evacuated. Instead, it means that a patient will be evacuated as soon as possible after it is determined he is not projected to RTD within 60 days following admission. The theater evacuation policy is based on,
Nature of tactical operations,duration, magnitude, NBC, and the environment.
Number and types of patients,admission rates versus geographic areas and different types of combat operations.
Evacuation means. What means are available?
Availability of replacements. Can CONUS replace personnel? Small-scale is different from the large-scale conflict.
Availability of in-theater resources. Limiting medical resources greatly impacts the evacuation policy. The greater the limitation, the shorter the evacuation policy.
Corps evacuation policy definition. The corps evacuation policy establishes the maximum duration (expressed in days) of hospitalization authorized in corps medical facilities. The projected hospitalization period for a patient is computed from the date of admission to the first hospital in the medical evacuation chain. The policy does not imply that all patients are held for the maximum time. Patients who are not expected to RTD within the specified period will be evacuated out of the corps as soon as the appropriate medical authority determines that further evacuation will not aggravate the patient's injuries. Because of the impact of the corps evacuation policy on all aspects of support, both in the corps and the theater, the theater commander establishes the corps evacuation policy based on the theater surgeon's advice and the corps commander's recommendation.
Theater evacuation policy analysis. The theater evacuation policy impacts CHS requirements.
Length of the theater evacuation policy affects the number and types of MTFs in the CZ, COMMZ, and in CONUS.
Short corps (intratheater) and long theater evacuation policies mean fewer CZ hospitals and more COMMZ hospitals.
Short theater evacuation policy means fewer theater beds and more CONUS beds.
Long theater evacuation policy means greater accumulation of patients in the theater and, therefore, demands a larger medical force structure.
Medical material and maintenance requirements are affected. The longer the policy, the greater the consumption of medical material and maintenance.
Hospital construction, engineer support requirements, and all aspects of base development for CHS are affected.
Longer evacuation policy demands establishing a larger number of COMMZ hospitals.
Regardless of the numbers, man-hours and material for construction must be considered.
Evacuation requirements will be affected.
Short policy places a greater demand on the US Air Force (USAF) for tactical and strategic evacuation.
Longer policy places greater demand on intratheater (Army) resources.
Replacements for the combat soldiers will vary.
Shorter policy would increase the requirement for replacements for the rapid turnover expected, especially for combat units.
Transportation for inter- and intratheater requirements must be considered.
MEDICAL LOGISTICS
Medical supply and maintenance. The division main support medical company provides medical supply and medical equipment maintenance for the division and any directed nondivisional units in the division area. The corps medical battalion (logistics) (forward) provides backup support to the division medical companies and provides medical supply and maintenance support to nondivisional units located in the corps rear area. Professional medical officers and trained medical logisticians conduct medical material management because of the unique medical management procedures used in handling class VIII (medical) supplies.
Medical resupply. The BAS resupplies the combat medic. Medical personnel handle and supervise this mission. The combat medic requests his supplies from the BAS. This action is not a formal request so it can be oral or written. The requests are delivered to the BAS by whatever means are available. Usually this is accomplished by the driver or the medic in the ambulance evacuating casualties to the BAS. The ambulance will then transport the requester's supplies forward from the BAS to the combat medic. This system is referred to as backhaul. Commonality of supplies between the combat medic and the ambulance equipment set may allow the ambulance crew to fill the combat medic's request from onboard stock. The ambulance crew can then replenish its stock upon arrival at the BAS. The BAS resupplies the combat lifesaver with class VIII material. Combat lifesavers in nondivisional units will obtain resupply support from the nearest medical unit capable of supporting them.
The forward support medical company resupplies forward-deployed BASs in a heavy division. Medical supply personnel operate a resupply point for maneuver battalion BASs based on supply point distribution. When normal transportation is not available, backhaul transportation of medical supplies using returning ambulances, both air and ground, is an alternative method of moving medical supplies to the maneuver battalions. The maneuver battalion medical platoon leader coordinates forward movement.
The DMSO resupplies heavy or light division forward and main support medical companies. The DMSO also provides medical supply support to all units within the division area as required. Requests may come by message with returning ambulances (ground or air), by land line, or through existing FM command nets within the division. Requests for medical supplies from BASs and medical companies are filled or forwarded to the supporting corps MEDLOG Bn [Forward (Fwd)]. Whenever possible, the DMSO should anticipate demands and push supplies forward based on known operational requirements. The corps MEDLOG Bn (Fwd) resupplies the DMSO.
The medical brigade HQ normally commands and controls the MEDLOG Bn (Fwd). The MEDLOG Bn (Fwd) provides medical supply, medical equipment maintenance, and optical fabrication services for units in the CZ area. It establishes class VIII supply point(s) in the corps area. The MEDLOG Bn (Fwd) coordinates with the CMCC (MCT) for shipping medical supplies forward. Air and ground ambulances can conduct emergency resupply. The MEDLOG Bn (Fwd) receives its resupply from the COMMZ MEDLOG Bn (Rear) or by direct shipments from CONUS.
OTHER CHS
Veterinary services. The US Army is DOD's executive agent for providing veterinary support to all services and other DOD/Federal agencies worldwide. These services include inspecting foods for wholesomeness and quality assurance, sanitary inspection of those facilities supplying foods to DOD components, comprehensive veterinary medical care for Government-owned animals, and preventing and controlling those animal diseases communicable to man. These services are in DS of logistic subsistence organizations, MP units, or civic action programs. Modular veterinary units provide the needed flexibility to meet such broad-based requirements. Other veterinary service personnel in support of battlefield operations may be assigned to civil affairs units, area medical laboratories, units employing military working dogs, or as a veterinary staff officer.
PM services. PM services enhance a unit's effectiveness by reducing the individual soldier's exposure to disease and environmental hazards on the integrated battlefield. These services are provided at all levels of CHS in the CZ. PM services include preventing and controlling disease vectors or pests; controlling waterborne disease, including water quality surveillance of water purification facilities; controlling foodborne disease, including surveillance of ice and dining facility supplies; and technical consultation concerning selecting and developing bivouac sites, cantonment areas, refugee camps, and EPW compounds.
Dental services. Providing dental services as far forward as feasible minimizes the time a soldier is away from his primary duties. Dental service is divided into three categories of care,emergency, sustaining, and maintaining. Emergency care is intended to relieve pain. Examples are using medications and simple procedures such as temporary fillings. Sustaining care provides the level of treatment necessary to keep the soldier functioning in the division area. It consists of procedures such as simple restorations and denture repairs. Maintaining care is more involved and more resource dependent and, therefore, will normally be provided at corps or TA level. Four dental officers are assigned to each division, and one dentist is assigned to each ACR, separate brigade, and special forces group.
Combat stress control. Sustained operations, weapons of mass destruction, and the potential for forces to become intermingled in intense conflict make temporary battle fatigue casualties inevitable. Guerrilla threats count on psychological stress to disable the defender. Mental health sections organic to division medical units are augmented by squads and sections (modules) of a combat stress control company to manage and treat battle fatigue casualties as far forward as the operational situation permits.