4.

3 HEALTH SERVICESUPPORT

4.3.1 IMCOM Health System Functions

The IMCOM Health System (IHS) is composed of eight (8) medical functions that
are grouped under two Army warfighting functions-Force Health Protection (FHP) under
protection and Health Service Support (HSS) under sustainment warfighting functions.
These interrelated and interdependent medical functions are complex in nature and
require medical command and control for synchronization and integration. This ensures
the interrelationships and interoperability of all medical assets and optimizes the
effective functioning of the entire system. To clearly delineate which medical functions
are grouped under which warfighting function, the Army is aligning with the joint
Services in grouping these eight medical functions.

SYSTEM OF SYSTEMS

The IHS is a complex system of systems. The systems which comprise the IHS
are divided into medical functions which align with medical disciplines and scientific
knowledge. These systems are interrelated and interdependent and must be
meticulously and continuously synchronized to reduce morbidity and mortality and to
maximize patient outcome. The ten medical functions are:
 Medical command and control.
 Medical treatment (organic and area support).
 Hospitalization.
 Medical evacuation (to include medical regulating).
 Dental services.
 Operational public health.
 Combat and operational stress control.
 Medical laboratory services (to include both clinical laboratories and environmental
laboratories).

FORCE HEALTH PROTECTION MISSION

The preventive and treatment aspects of medical functions, such as dental, veterinary,
and operational public health services, as well as laboratory services, are included in
the IMCOM force health protection measures, which aim to preserve, enhance, and
promote the physical and behavioral well-being of soldiers. enabling a fit and healthy
workforce, guarding against disease and accidents, and shielding the workforce from
health risks.
HEALTH SERVICE SUPPORT MISSION

The COD MTF provides direct patient care, which includes hospitalization and
medical treatment (organic and area support), medical evacuation, which includes
medical regulating, and medical logistics, which includes blood management, in order to
support, enhance, preserve, or restore the behavioral and physical well-being of
personnel. Support other services, agencies, and organizations as instructed as well.
CBRN patient treatment is a component of health service assistance.

4.3.2 CASUALTY EVACUATION

The transportation of casualties in non-medical vehicles or aircraft without

medical attention while in route is known as casualty evacuation. Additionally known as
CASEVAC. There is a broad range of potential capabilities associated with casualty
evacuation, contingent on the combination of medical providers, medical equipment,
and transport platforms assigned to the task. On the high end of the scale,
nondedicated platforms can be equipped with MEDEVAC assets and the necessary
medical equipment. On the lowest end of the spectrum, CASEVAC is limited to the use
of opportunity platforms to transfer casualties without the use of medical equipment or
providers (the risk of not transferring the victim must be greater than the risk of
evacuating him/her in this way). Good CASEVAC enhances MEDEVAC by offering
more evacuation capability when there is a shortage of

MEDICAL EVACUATION

Medical evacuation is the prompt and efficient transportation of the sick, injured,
or wounded to and from medical treatment facilities using specially designed and
marked medical platforms, with medical staff providing care while in transit. Often
known as MEDEVAC, a patient is a sick, wounded, or injured person who receives
medical attention from professionals with the necessary training.
Ground ambulances, or MEDEVAC platforms, are the components of the Army
MEDEVAC system. In compliance with the law of land warfare and the Geneva
Conventions, these ambulances are only employed to support the medical mission.
They are staffed, equipped, and built to give enroute medical care to patients being
evacuated. A prompt response to requests for medical assistance is made possible by
the MEDEVAC mission's emphasis and the specially equipped vehicles. En route care
aboard medically equipped vehicles or aircraft significantly improves the patient's
chances of making a full recovery and may lower the likelihood of long-term disability by
keeping the patient's condition more stable. The term "enroute care" describes the
medical attention needed to continue the patient's stepwise treatment that was started
before evacuation and to keep them healthy while they are being evacuated.
4.3.3 ROLES OF MEDICAL CARE

One of the fundamental features of current IHS support organization is the

allocation of medical resources and capabilities, also known as responsibilities of care,
to facilities at different levels of command, in different locations, and with progressive
capacities. The term "definitive care " describes the level of medical improvement that
can be achieved in a sick or injured soldier. All forms of medical care, including
treatment and intervention, fall under the umbrella of definitive care. These interventions
can include self-aid, such as a soldier bandaging a bullet wound that just happens to
graze and heal on its own. The options available to wounded soldiers might vary from
medical discharge due to long-term physical restrictions brought on by disease or injury
to return to full duty with no restrictions.

When a patient receives comprehensive therapy to the fullest extent feasible to

restore their emotional and physical well-being, it is referred to as definitive treatment.
Depending on the type of injury or sickness, it may take on many responsibilities
throughout the continuum of care; it is not linked to any one role or place.
Generally speaking, no function in the provision of care will be disregarded unless there
is a compelling medical need. In order to guarantee the patient's stabilization and
survival through TCCC, far forward resuscitative surgery must be completed before the
patient is moved between MTFs (Roles 1 through 3).

NONMEDICAL PERSONNEL

Combat medics receive assistance in carrying out their tasks from non-medical
people who administer first aid. Combat lifesavers offer advanced first aid, while
individuals apply first aid themselves (self-aid or buddy aid). A nonmedical Soldier
assigned to a unit with the secondary goal of providing advanced first aid is trained to
be a battle lifesaver.

Self-Aid and Buddy Aid

Every soldier has received training in a range of specialized first aid techniques.
These protocols cover assistance for victims of chemical exposure, with a focus on life-
saving measures. With the help of this training, the Soldier or a friend can treat
potentially fatal conditions by administering first aid. To perform first aid duties, each
soldier is given their own first aid gear. First aid, often known as self-aid or buddy aid, is
the term used to describe life-saving actions that can be taken quickly by non-medical
staff for victims or by the victims themselves inthe event that medical personnel are not
immediately accessible.
Combat Lifesaver

A nonmedical soldier chosen by the unit commander for further training beyond
basic first aid protocols is known as a combat lifesaver. Training should be provided to
at least one member of each squad, crew, team, or similar sized unit. This person's
principal responsibility remains unchanged. In addition, before to the arrival of the
combat medic, the combat lifesavers have an additional responsibility to administer
advanced first aid for injuries based on their training. Medical staff typically trains
combat lifesavers while providing direct support to the unit. The commander's appointed
senior medical representative oversees the training program. Combat lifesaver-level first
aid training is provided to members of Special Forces operational detachment units.

ROLE 1

The first medical care a Soldier receives is provided at Role 1 (also referred to as unit-
level medical care). This role of care includes:
 Immediate lifesaving measures.
 Disease and nonbattle injury (DNBI) prevention.
 Combat and operational stress preventive measures.
 Patient location and acquisition (collection).
 Medical evacuation from supported units (POI or wounding, company aid posts,
or
 casualty/patient collection points) to supporting MTFs.
 Treatment administered by specially trained combat medics or squads. (Main
focus is on those actions required for patients to either return to duty or stabilize
them so that they can be evacuated to the next level of care; return to duty is a
patient disposition that returns Soldiers for duty in their unit following medical
evaluation and treatment as needed; these actions include keeping the airway
open, halting bleeding, preventing shock, shielding wounds, immobilizing
fractures, and other emergency measures, as prescribed).
During air evacuation, the combat medic or flight paramedic provides role 1 medical
treatment, whereas in the battalion aid station, the physician, physician assistant, or
health care specialist provides role 1 medical care.
Emergency medical treatment is the prompt administration of medical procedures to the
wounded, injured, or sick by specially qualified medical staff. Role 1 treatment is
performed by Army special operations combat medics, Special Forces medical
sergeants, or physicians and physician assistants at forward operating bases, Special
Forces operating bases, and joint special operations task forces.

Role 1 includes:
 tactical combat casualty care (immediate far forward care) consists of those
lifesaving steps that do not require the knowledge and skills of a physician. The
combat medic is the first individual in the medical chain that makes medically
substantiated decisions based on medical military occupational specialty-specific
training.
  At the battalion aid station, the physician and the physician assistant are trained
and equipped to provide TCCC to the combat casualty. This element also
conducts routine sick call when the operational situation permits. Like elements
provide this role of medical care at brigade.
 During MEDEVACs, Role 1 treatment is provided by the combat medic (during
ground evacuation) or by the critical care flight paramedic (during air evacuation)
to an MTF. Critical care flight paramedics are trained and equipped to provide
advanced en route care to the combat casualty

ROLE 2
1-41. 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 patients are
examined and their wounds and general medical condition are evaluated to determine
their treatment and evacuation precedence, among other patients. Medical treatment
including trauma management and beginning resuscitation is continued, and if
necessary, additional emergency measures are instituted, but they do not go beyond
the measures dictated by immediate necessities. The Role 2 MTF provides a greater
capability to resuscitate trauma patients than is available at Role 1. Those patients who
can return to duty within 72 hours (1 to 3 days) are held for treatment. This role of care
provides MEDEVAC from Role 1 MTFs and also provides Role 1 medical treatment on
an area support basis for units without organic Role 1 resources. The Role 2 MTF has
the capability to provide packed red blood cells (liquid), limited x-ray, clinical laboratory,
operational dental support, combat and operational stress control (COSC), operational
public health, and when augmented, physical therapy and optometry services.
1-42. Patients who are non-transportable due to their medical condition may require
resuscitative surgical care from an FST or FRSD collocated with a medical company
(refer to Army doctrine on the FST or FRSD). Non-transportable patient is a patient
whose medical condition is such that he could not survive further evacuation to the rear
without surgical intervention to stabilize his medical condition. (ATP 4-02.2). The FST or
FRSD is assigned to the medical command (deployment support) or medical brigade
and attached to a CSH or hospital center when not operationally employed however, the
FST or FRSD is only attached to a medical company for resuscitative surgical care
capability support when employed.
1-43. Role 2 AHS assets are located in the—
 Medical company (brigade support), assigned to modular brigades which include
the armored BCT, infantry BCT, and the Stryker BCT.
 Medical company (area support) which is an EAB asset that provides direct
support to the modular division and support to EAB units.
1-44. The NATO descriptions of Role 2 are—
 A Role 2 Basic MTF can provide reception, triage, resuscitation, and damage
control surgery, short-term holding capacity for at least six and a postoperative
care capability for at least two patients.
  An Enhanced Role 2 MTF can provide enhanced diagnostics and mission
essential specialist care (including in theater surgery). They have at least two
surgical teams, with respective emergency and postoperative care capabilities, x-
ray, laboratory, blood bank, pharmacy, sterilization, dentistry, and a short-term
holding capacity of 25 patients

ROLE 3
1-45. 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. This role includes provisions for—
 Coordination of patient evacuation through medical regulating.
 Providing care for all categories of patients in an MTF with the proper staff and
equipment.
 Providing support on an area basis to units without organic medical assets.

Role 3 AHS assets are located in the— Combat support hospital. Hospital Center.

ROLE 4
Role 4 medical care is found in based hospitals and other safe ports (to include robust
overseas MTFs). 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 operational area. The support-based hospitals represent the most
definitive medical care available within the Army Health System (AHS)

The Camp O’ Donnell MTF (COD MTF) is a role 2 MTF capable of providing
health care services to its tenants (TRADOC, ARMOR, PKOC and other subunits.)
Enhancement of the treatment facility will give pave way to modernization of medical
equipment, supplies and capabilities.
Student soldiers undergo rigorous military training for months with numerous
challenges in their overall health (physical, psychological, emotional, and intellectual).
They are trained to fight, think, lead and win in future battles but we need to support
their health through early detection of injuries / illnesses and early consultation to
nearby military treatment facility (MTF).
Equipping our soldiers with proper training and establishing programs that entails
health promotion/prevention such as (flu vaccination, tetanus vaccination and hepatitis
vaccination) would strengthen them to succeed in their military training. Proper
programming of fastmoving medicines for prevalent diseases and injuries would also
enhance proper management of sick student soldiers.
 Early medical evacuation to a higher echelon of care for definitive management
has also important role in health support of our student soldiers. The mission of COD
MTF
1. Provide MED-EVAC of student patients to Army General Hospital or
AFPMC or nearby hospitals within our area of operation
2. Provide primary care and initial stabilization of critically -ill student patient
prior transporting to higher echelon of care
3. Establish Monthly Report on Top 10 most common diseases and injuries
seen in the emergency room for future planning of procurement of medicines
4. Provide Medical Team in high-risk activities and exercises of student
soldiers upon request of schools.
5. Provide medical disposition of student patient after consultation.
6. Provide proper coordination with receiving hospitals regarding transfer of
care of student patients

Upgrading of COD-MTF to a DOH- accredited Station Hospital as an infirmary

level with role 2 capability should be implemented to capacitate the COD-MTF in
providing efficient and effective health care services to all stakeholders within its area of
operation.

4.3.4 Medical Logistic

Military medical logistics is vital in maintaining the health and well-being of
military personnel, especially during missions, conflicts, and humanitarian operations.
Effective logistics guarantee that medical supplies and equipment are available at the
appropriate location and time. This can save lives during emergencies by ensuring
soldiers receive the care they require on the battlefield or in remote regions.
Medical logistics contribute to overall military readiness. A well-managed supply
chain allows military troops to retain operational capacity while avoiding downtime due
to accidents, illness, or a lack of medical treatment. Quick access to medical supplies,
such as trauma kits, blood products, and pharmaceuticals, allows for timely treatment of
victims. This helps to reduce fatality rates and ensures that injured troops are stabilized
before being evacuated or receiving more advanced medical care.
Medical logistics are also important in establishing field hospitals and
implementing evacuation protocols. The capacity to transport medical equipment,
people, and patients in a timely and coordinated manner is critical in high-intensity
circumstances such as battle zones and natural disasters. Preventing illness
transmission is an important part of military operations. Medical logistics provides the
availability of disinfectants, vaccines, personal protective equipment (PPE), and other
supplies required for infection control, hence protecting force health and operational
readiness of military forces.
Military troops are frequently deployed for disaster relief and humanitarian
missions, where medical logistics ensure that necessary supplies, such as medicines
and medical equipment, reaches affected populations in crisis zones promptly and
efficiently. Effective logistics reduce waste, make better use of resources, and
guarantee that medical supplies are managed efficiently. This not only saves money, but
it also lessens the impact of supply shortages or overstocking, improving the overall
effectiveness of military medical operations.

Medical logistics serve specialist forces such as combat medics and military
surgeons, who frequently work in tough or hostile conditions. It guarantees that they
have the necessary instruments and supplies to deliver emergency care, such as
portable surgical kits, diagnostic tools, and evacuation equipment. Military medical
logistics is a major facilitator of operational success, directly impacting military soldiers'
health, preparedness, and morale while also playing an important part in the overall
effectiveness of military and humanitarian missions.

The IMCOM military treatment facilities (MTF) plays a critical role in medical
logistics, ensuring that medical supplies, equipment, and support services are available
for military operations and humanitarian missions. Medical logistics involves the
planning, procurement, distribution, and maintenance of medical supplies and
equipment needed to sustain the health and well-being of soldiers and other personnel
during training, combat, and peacetime operations. The Installation Management
Command should enhance its MTF’s facility and equipment to capacitate them in AFP
Territorial Defense Plan.

4.3.5 Area Medical

The IMCOM Health Facility will adopt the concept of Forward Treatment Unit
(FTU) and Field Hospital (FH) in response to AFP Territorial Defense Plan. FTU is a
modular, and deployable medical/surgical system of equipment that can be utilized to
provide forward surgical care capability and/or forward resuscitative care capability
during military operations or disaster response. It has 3 major elements or subsets that
can be deployed individually (by subsets) or as full complement (whole set) depending
on the type of mission.
The FTU will be used primarily to support Combat Operations and Humanitarian
Assistance and Disaster Relief (HADR) Operations. c. The mission of the FSMC utilizing
the FTU is to provide far forward Damage Control Resuscitation (DCR) and Damage
Control Surgery (DCS) to stabilize patients for further medical evacuation to the next
higher role of medical care. The FTU provides critical care Role 2 (Forward
Resuscitative Care Capability) in support to units conducting operations. Role 2 care
provides Advance Trauma and Emergency Management at the Brigade Support Areas
(BSA).
The FTU shall be allocated to the Infantry Divisions and mainly as an organic
equipment of the Forward Support Medical Company (FSMC), Service Support
Battalion (SSBn). It is a forward deployed medical facility that is capable of Forward
Resuscitative Care Capability (Role 2) that collects, registers, and treats casualties for
further evacuation to Field Hospitalization Capability (Role 3) or to Definitive Care
Capability (Role 4).

The FTU has five (5) major component system that can be deployed dependently
or inter-dependently depending on the type of mission given to the FSMC, as follows:
1) Mobile Resuscitative and Surgical Care Unit (MRSCU);
2) Treatment Facility System – medical tentages with lighting and water
system and with the bare minimum medical requirements to perform basic trauma care
to a maximum of 32 patients. It is composed of four (4) tents: a triage area, treatment
area, patient holding area, and evacuation area;
3) Forward Resuscitative and Critical Care Equipment with Medical
Equipment Dais (FoRCCEMED);
4) Billeting Unit with dining and wash area composed of three (3) tents; and
5) Command and Administration Section composed of (1) tent with pertinent
Office and Admin Equipment.
Field hospitals will serve as critical medical support in both relief scenarios,
where conventional healthcare facilities may be unavailable or incapacitated. These
units are tasked with:
1. Triage and Stabilization: Immediate evaluation, stabilization, and care for
casualties and patients in emergencies or military operations, ensuring that
life-saving interventions are provided in a timely manner.
2. Comprehensive Medical Treatment: Delivery of primary and secondary
medical care, including trauma management, surgical interventions, intensive
care, and post-operative care. Field hospitals are equipped with the
capabilities to handle a wide range of medical conditions under challenging
conditions.
3. Evacuation Coordination: Coordination of patient evacuation to more
established medical facilities when necessary, ensuring continuity of care
while maintaining optimal resource utilization.

The concept of operation of a field hospital and forward treatment unit around
rapid deployment, flexibility, scalability, and the provision of life-saving medical care in
challenging environments shown in Diagram below. These facilities are essential for
military operations and disaster relief efforts, offering critical care, triage, and
stabilization services. Their ability to deploy quickly and operate efficiently in austere or
combat environments ensures that they remain a vital component of military and
humanitarian medical operations.

Concept of operation of FTU and FH

Shown in the picture, the Field Hospital (FH) is situated in the rear side providing
role 3 medical care within the division area. While the BSMC (Brigade Support Medical
Company) and FSRD ( Forward Surgical and Resuscitative Detachment) served as
Forward Treatment Unit within the battalion and brigade level providing role 2 medical
care.

References :

1. Field Manual Operations 3-0, US Army Headquarters , Department of the Army,

October 2017.
2. FM 4-02 US Army Health System, Nov 2020
3. HPA Letter Directive on Activation of the Forward Support Medical Company
(FSMC) of Infantry Division and Medical Platoons of Infantry Battalions dated
March 2012; and

4. SOP Nr 3, GHQ, AFP dated 23 April 2018 with subject: AFP Health Service
Support System

5. AFP Modernization Program – Forward Treatment Unit Modernization Project;