COMBAT HEALTH SUPPORT
The Army Medical Department (AMEDD) plays a key role in developing and maintaining combat power. Its mission is to maintain the health of the Army to conserve its fighting strength (trained manpower). Commanders need to retain acclimated and experienced personnel to perform their particular mission. In retaining such personnel, the load on the replacement system is diminished, and the requirements for patient evacuation are decreased. On the other hand, accumulating patients within any combat unit restricts its movements. It may also reduce the soldier's willingness to take necessary risks because of a perceived lack of CHS.
CHS SYSTEM
a. Single integrated system. The CHS system is a single integrated system. It begins at the FLOT and ends in CONUS. This system entails the effective medical regulation of sick, injured, and wounded patients in the shortest possible time to the medical treatment facilities (MTFs) that can provide the required treatment. All sick, injured, and wounded patients are regulated and evacuated without regard to lateral or rear boundaries. CHS involves delineating support responsibility by geographic area. The system's effectiveness is measured by its ability to return soldiers to duty.
Organization of the CHS system.
The Army's CHS system in a theater of operations is organized into unit, division, corps, and EAC levels of care that extend throughout the theater. "Echelon of care" is a term used in NATO Standardization Agreement (STANAG) 2068 that can be used interchangeably with the term "level of care."
Each higher echelon of care has the same treatment capabilities as those echelons forward of it. Each echelon adds a new increment of treatment capability that distinguishes it from the lower echelons of care. The echelons of care are referred to as echelons (or levels) I through IV. Zone of interior (ZI) is level V.
The organization for all aspects of CHS is designed to be flexible. It is influenced principally by METT-T.
CHS includes providing support to organizations that do not have an organic medical capability. The CHS units required for this support are allocated based on troop strength and anticipated work load. The units are established where and when requirements indicate.
ECHELONS OF MEDICAL TREATMENT
Echelon I (level I) The first medical care a soldier receives is provided at this echelon. This echelon of care includes,
Immediate lifesaving measures.
Disease and nonbattle injury (DNBI) prevention.
Combat stress control preventive measures.
Casualty collection.
Evacuation from supported units.
Treatment provided by designated individuals or a medical platoon treatment squad (which operates a BAS).
Major emphasis is placed on those measures necessary to stabilize the patient and allow for 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.
Those patients who do not require a higher level of care are RTD. Either an individual (self-aid, buddy aid, combat lifesaver, or combat medic) or personnel in a treatment squad provide medical care. Immediate far forward care consists of those lifesaving steps that do not require a physician's knowledge and skill. The following different skill levels of personnel provide the care required in the forward area:
Self-aid/buddy aid. Each soldier is trained to be proficient in a variety of specific first aid procedures. These procedures include aid for chemical casualties, with particular emphasis on lifesaving tasks. This training enables the soldier or a buddy to apply immediate care to alleviate a life-threatening situation.
Combat lifesaver. The combat lifesaver is a member of a nonmedical unit the unit commander selects for additional training beyond basic first aid procedures. A minimum of one individual per squad, crew, team, or *****alent-sized unit should be trained. This individual's primary duty does not change. He performs the additional duties of the combat lifesaver when the situation permits. The combat lifesaver assists the combat medic by providing immediate care for injuries. Normally, medical personnel assigned to, attached to, or supporting the unit provide the training. The commander designates a senior medical person to manage the training program.
Combat medic (aidman). This is the first individual in the CHS chain who makes medically substantiated decisions based on medical MOS-specific training. The combat medic is trained to emergency medical technician (EMT) level. The combat medic is assigned to the medical platoon or section of the HHC, the HQ and support company, or the troop of the appropriate combat or combat support battalion.
The physician and the physician's assistant (PA) in a medical platoon treatment squad are trained and equipped to perform advanced trauma management on battlefield casualties. This element also conducts routine sick call when the situation permits. Similar elements provide this echelon of care in division, corps, and COMMZ units. The medical platoons/sections of combat and combat support battalions, division medical companies, corps area support medical companies, and other corps medical units provide echelon I CHS.
Echelon II (level II). This echelon of care includes,
Evacuating patients from echelon I medical units.
Providing CHS on an area basis to units without organic medical capability.
Providing care at the clearing station operated by the treatment platoon of a forward, main, or area support medical company. At this echelon of care, the casualty is examined, his wounds and general status are evaluated, and he is treated and RTD, or his priority for continued evacuation is determined. The clearing station provides CHS on an area basis to all forces within that geographic area. The clearing station normally operates in the BSA, DSA, and areas of high troop concentration in the corps rear area and COMMZ.
This echelon of support duplicates echelon I and expands available services by adding dental, laboratory, X-ray, and patient holding capabilities. Emergency care, including beginning resuscitation procedures, is continued. No general anesthesia is available. If necessary, additional emergency measures are instituted; however, they do not go beyond the measures dictated by the immediate need. Those patients who can RTD within 24 to 72 hours are held for treatment. The functions at this level are performed by medical companies organic to,
Separate brigade support battalions.
ACR support squadrons.
DISCOM (heavy division) MSBs and FSBs.
Nondivisional area support medical battalions (corps and COMMZ).
Echelon III (level III). This echelon of care includes,
Evacuating patients from echelon I and II medical units.
Providing care for all categories of casualties in an MTF with the proper staff and equipment.
Providing CHS on an area basis to units without organic medical capability.
This echelon of care expands the support provided at echelon II (division level). Casualties who are unable to tolerate and survive movement over long distances will receive surgical care in a hospital as close to the division rear boundary as the tactical situation will allow. Echelon III characterizes the care provided by the mobile army surgical hospital (MASH) and combat support hospital (CSH). Tactical situations or lack of suitable terrain availability may require these echelon III units to locate in offshore support facilities, third-country support bases, or in the COMMZ. Casualties whose injuries permit additional evacuation without detriment are stabilized and evacuated to a hospital farther to the rear. Those casualties who are expected to RTD within the corps evacuation policy are retrained.
Echelon IV (level IV). This echelon of care includes,
Evacuating patients from echelon I, II, and III medical units.
Treating the casualty in a general or field hospital staffed and equipped for general and specialized medical and surgical care. This echelon of care provides further treatment to stabilize those patients requiring evacuation to CONUS.
Providing CHS on an area basis to units without organic medical capability.
ZI (level V).
In ZI CHS, the casualty is treated in ZI hospitals staffed and equipped for the most definitive care available within the AMEDD CHS system. These hospitals include DOD MTFs, Department of Veteran Affairs (VA) hospitals, and civilian hospitals. Hospitals in the CONUS base represent the final level of CHS.