The transition to Large Scale Combat Operations (LSCO) brings with it a multitude of challenges to the Army Health System (AHS). Awareness of and

ARMY HEALTH SYSTEM MEMORANDUM  

Purpose

To demonstrate an understanding of the Army Health System.

Topic

The transition to Large Scale Combat Operations (LSCO) brings with it a multitude of challenges to the Army Health System (AHS). Awareness of and attention to medical considerations related to LSCO is critical. Identify your medical function and define which of the two warfighting functions you support. Describe how your role in either Force Health Protection or Health Service Support is preparing or is prepared to transition to LSCO. Provide an example supporting your argument.

Resource Requirements

AHS Lesson AHS Smart Book

Expectations

1. Utilizing the DA Letterhead template provided in blackboard, write a MEMORANDUM FOR RECORD for the topic above. Your memorandum must: -follow the guidelines in AR 25-50 (do not sign the document) -be a minimum of 2 body paragraphs -be a maximum of 1 page -include a Point of Contact line -use NCOA-DL for the office symbol

Use your home station address for the letterhead. Do not include a reference paragraph, suspense date, or ARIMS record number. 2. Upload and submit your memo as a MS Word document for grading in blackboard. Verify that you have uploaded the correct document before clicking submit. Only one attempt is authorized for this assignment.

*Your memo will be evaluated on the expectations listed above and the assignment rubric*

1

Army Health System

Doctrine Smart Book 1 JUNE 2020

DISTRIBUTION RESTRICTION:

Approved for public release; distribution is unlimited.

HEADQUARTERS, DEPARTMENT OF THE ARMY

Foreword

As the Army transitions from counterinsurgency operations to large-scale combat operations (LSCO), the United States Army Medical Center of Excellence must redefine its culture. Training, education, and force modernization must focus on operational medicine in support of LSCO instead of hospital- based health care delivery and limited contingency missions. The foundation of Army operations has always been Army doctrine and it is important for this cultural evolution to reinvigorate our use and understanding of doctrine. The Doctrine Smart Book is an effort to consolidate important doctrinal references in one place and make it easier to find the most significant doctrinal concepts. This document captures all of the Army medical doctrine in one abbreviated publication. Leaders have a responsibility to seek self-development and to develop their subordinates; this Doctrine Smart Book is a useful tool to energize Soldiers to seek more detailed information on how we employ medical capabilities in support of Army, joint, and multinational operations. The Army Health System Doctrine Smart Book will be updated frequently when Army Health System doctrine, as well as Army doctrine, is updated and published to the fielded force. The lead agent for this publication is the United States Army Medical Center of Excellence’s Doctrine Division. It invites input and feedback on improvements to this tool. As we are often reminded, doctrine communicates the units and capabilities that currently exist. Doctrine outlines how capabilities can be employed if they were required now or in the near future. Today, Army Medicine is entering not only a period of transition, but also an era of great opportunity. The strategic environment has grown increasingly complex, demanding a more agile force that must adapt in order to operate in a multi-domain operations (MDO) environment. Technological advances have created new ways to communicate, to understand, and to influence others. At the same time, almost two decades of war has reinforced timeless lessons about the centrality of human beings in all aspects of military operations. We must build on these insights to change how we think about, plan for, and conduct all of our operations. Doctrine will be in a relentless state of revision over the next several years as doctrine developers endeavor to keep up with evolving capability developments related to LSCO and MDO. While we cannot predict the future, we can be certain that the Chief of Staff of the Army will continue to call on Army Medicine to preserve Soldier lethality and survivability. Going forward, Army Medicine will continue to transition in support of MDO and in LSCO. Army Medicine will apply the lessons learned from recent combat to peacetime as we prepare for evolving threats. Our doctrine will keep pace in order to provide the framework by which we provide medical support; it is incumbent upon leaders to ensure our doctrine is inculcated into the training, education, and professional development of our units and Soldiers.

DENNIS P; LEMASTER Major General, U.S. Army Commanding

DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited.

1 June 2020 Army Health System Doctrine Smart Book i

1 June 2020

Army Health System Doctrine Smart Book

Contents

Page

PREFACE……………………………………………………………………………………………………… v

PART ONE ARMY HEALTH SYSTEM Introduction ……………………………………………………………………………………………………. 1 Army Health System Operational Framework …………………………………………………….. 1 Operational Environment …………………………………………………………………………………. 2 Roles of Medical Care (Army) (FM 4-02) …………………………………………………………… 4 Army Health System Principles (FM 4-02) …………………………………………………………. 7 Medical Functions (FM 4-02) ……………………………………………………………………………. 9

PART TWO ARMY HEALTH SYSTEM DOCTRINE HIERARCHY AND SUMMARIES Introduction ………………………………………………………………………………………………….. 19 Army Health System Publications …………………………………………………………………… 21

PART THREE ARMY HEALTH SYSTEM UNIT SYNOPSIS Introduction ………………………………………………………………………………………………….. 53 Army Command and Support Relationships …………………………………………………….. 53 Medical Command (Deployment Support) ……………………………………………………….. 57 Medical Brigade (Support) ……………………………………………………………………………… 62 Medical Battalion (Multifunctional) …………………………………………………………………… 67 Combat Support Hospital (248-bed) ………………………………………………………………… 71 Hospital Company (84-bed)……………………………………………………………………………. 73 Hospital Company (164-bed)………………………………………………………………………….. 77 Hospital Center (240-bed) ……………………………………………………………………………… 80 Field Hospital (32-bed) ………………………………………………………………………………….. 87 Hospital Augmentation Detachment (Surgical 24-bed) ………………………………………. 95 Hospital Augmentation Detachment (Medical 32-bed) ……………………………………….. 99 Hospital Augmentation Detachment (Intermediate Care Ward 60-bed) ……………… 103 Medical Detachment, Minimal Care ………………………………………………………………. 106 Hospital Augmentation Team, Head and Neck ……………………………………………….. 109 Forward Resuscitative and Surgical DETACHMENT (FRSD) …………………………… 111 Forward Surgical Team (FST) ………………………………………………………………………. 116 Medical Company (Area Support) …………………………………………………………………. 118 Brigade Support Medical Company (Airborne, Armor, Infantry, and Stryker) ………. 121 121 Medical Company (Air Ambulance) ……………………………………………………………….. 125 Medical Company (Ground Ambulance) ………………………………………………………… 127 Dental Company (Area Support) …………………………………………………………………… 129 Medical Logistics Company ………………………………………………………………………….. 131

Preface

ii Army Health System Doctrine Smart Book 1 June 2020

Medical Detachment (Veterinary Service Support) …………………………………………… 135 Medical Detachment, Combat and Operational Stress Control …………………………. 139 Medical Detachment, Preventive Medicine ……………………………………………………… 141 Medical Detachment, Blood Support ……………………………………………………………… 143 Medical Detachment, Optometry …………………………………………………………………… 146 Medical Logistics Management Center …………………………………………………………… 148 Area Medical Laboratory ………………………………………………………………………………. 151

PART FOUR ARMY HEALTH SYSTEM BY ARMY STRATEGIC ROLE Introduction ………………………………………………………………………………………………… 153 Shape ………………………………………………………………………………………………………… 155 Prevent ………………………………………………………………………………………………………. 165 Large Scale Combat Operations ……………………………………………………………………. 175 Consolidate Gains ……………………………………………………………………………………….. 186

SUMMARY ………………………………………………………………………………………………. 199

GLOSSARY ………………………………………………………………………………………………… 1

Section I – Acronyms and Abbreviations ……………………………………………………….. 1

Section II – Terms …………………………………………………………………………………………. 4

Section III – Army Health System Symbology ………………………………………………… 9

Figures

Figure 1-1. Army Health System Operational Framework ………………………………………………………. 1

Figure 1-2. Army Health System Logic Chart ……………………………………………………………………….. 3

Figure 1-3. Ten Army Health System Medical Functions ……………………………………………………….. 9

Figure 3-1. Medical Command (Deployment Support) OCP …………………………………………………. 61

Figure 3-2. Medical Command (Deployment Support) MCP …………………………………………………. 61

Figure 3-3. Medical Brigade (Support), Early Entry Module ………………………………………………….. 65

Figure 3-4. Medical Brigade (Support), Expansion Module …………………………………………………… 66

Figure 3-5. Medical Brigade (Support) Campaign Module ……………………………………………………. 66

Figure 3-6. Medical Battalion (Multifunctional), Early Entry Element ……………………………………… 70

Figure 3-7. Medical Battalion (Multifunctional), Campaign Support Element …………………………… 70

Figure 3-8. Hospital Center (240-bed) ……………………………………………………………………………….. 84

Figure 3-9. Hospital Center (240-bed) ……………………………………………………………………………….. 84

Figure 3-10. Hospital Center (240-bed) ……………………………………………………………………………… 85

Figure 3-11. Hospital Center (240-bed) ……………………………………………………………………………… 85

Figure 3-12. Hospital Center (240-bed) ……………………………………………………………………………… 86

Figure 3-13. Field Hospital (32-bed) ………………………………………………………………………………….. 93

Figure 3-14. Field Hospital (32-bed) ………………………………………………………………………………….. 93

Figure 3-15. Field Hospital (32-bed) ………………………………………………………………………………….. 94

Figure 3-16. Hospital Augmentation Detachment (Surgical 24-bed) ………………………………………. 98

Figure 3-17. Hospital Augmentation Detachment (Surgical 24-bed) ………………………………………. 98

Figure 3-18. Hospital Augmentation Detachment (Medical 32-bed) …………………………………….. 102

Figure 3-19. Hospital Augmentation Detachment (Medical 32-bed) …………………………………….. 102

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1 June 2020 Army Health System Doctrine Smart Book iii

Figure 3-20. Hospital Augmentation Detachment (ICW 60-bed) …………………………………………. 105

Figure 3-21. Minimal Care Detachment (120-Bed) ……………………………………………………………. 108

Figure 3-22. Complete Forward Resuscitative Surgical Detachment …………………………………… 114

Figure 3-23. Split-Based Forward Resuscitative Surgical Detachment ………………………………… 114

Figure 3-24. Medical Company (Area Support) ………………………………………………………………… 120

Figure 3-25. Brigade Support Medical Company (IBCT) ……………………………………………………. 124

Figure 3-26. Medical Company (Air Ambulance) ………………………………………………………………. 126

Figure 3-27. Medical Company (Ground Ambulance)………………………………………………………… 128

Figure 3-28. Dental Company (Area Support) ………………………………………………………………….. 130

Figure 3-29. Medical Logistics Company …………………………………………………………………………. 134

Figure 3-30. Medical Detachment (Veterinary Service Support) …………………………………………. 138

Figure 3-31. Combat and Operational Stress Control ………………………………………………………… 140

Figure 3-32. Medical Detachment, Preventive Medicine ……………………………………………………. 142

Figure 3-33. Medical Detachment, Blood Support …………………………………………………………….. 145

Figure 3-34. Medical Detachment, Optometry ………………………………………………………………….. 147

Figure 3-35. Medical Logistics Management Center………………………………………………………….. 150

Figure 3-36. Area Medical Laboratory ……………………………………………………………………………… 152

Figure 4-1. Medical Command and Control in Shaping ……………………………………………………… 156

Figure 4-2. Medical Treatment in Shaping ……………………………………………………………………….. 157

Figure 4-3. Hospitalization in Shaping …………………………………………………………………………….. 158

Figure 4-4. Medical Evacuation in Shaping ………………………………………………………………………. 159

Figure 4-5. Dental Services in Shaping ……………………………………………………………………………. 160

Figure 4-6. Preventive Medicine in Shaping …………………………………………………………………….. 161

Figure 4-7. Combat and Operational Stress Control in Shaping ………………………………………….. 162

Figure 4-8. Veterinary Services in Shaping ………………………………………………………………………. 163

Figure 4-9. Medical Logistics in Shaping …………………………………………………………………………. 164

Figure 4-10. Medical Laboratory in Shaping …………………………………………………………………….. 165

Figure 4-11. Medical Command and Control in Prevent …………………………………………………….. 166

Figure 4-12. Medical Treatment in Prevent ………………………………………………………………………. 167

Figure 4-13. Hospitalization in Prevent ……………………………………………………………………………. 168

Figure 4-14. Medical Evacuation in Prevent …………………………………………………………………….. 169

Figure 4-15. Dental Services in Prevent ………………………………………………………………………….. 170

Figure 4-16. Preventive Medicine in Prevent ……………………………………………………………………. 171

Figure 4-17. COSC in Prevent ……………………………………………………………………………………….. 172

Figure 4-18. Veterinary Services in Prevent …………………………………………………………………….. 173

Figure 4-19. Medical Logistics in Prevent ………………………………………………………………………… 174

Figure 4-20. Medical Laboratory in Prevent ……………………………………………………………………… 175

Figure 4-21. Medical Command and Control in LSCO ………………………………………………………. 177

Figure 4-22. Medical Treatment in LSCO ………………………………………………………………………… 178

Figure 4-23. Hospitalization in LSCO ………………………………………………………………………………. 179

Figure 4-23a. Hospitalization in LSCO (hospital center split) ……………………………………………… 179

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iv Army Health System Doctrine Smart Book 1 June 2020

Figure 4-24. Medical Evacuation in LSCO ………………………………………………………………………… 180

Figure 4-25. Dental Services in LSCO ……………………………………………………………………………… 181

Figure 4-26. Preventive Medicine in LSCO ………………………………………………………………………. 182

Figure 4-27. COSC in LSCO ………………………………………………………………………………………….. 183

Figure 4-28. Veterinary Services in LSCO………………………………………………………………………… 184

Figure 4-29. Medical Logistics in LSCO …………………………………………………………………………… 185

Figure 4-30. Medical Laboratory in LSCO ………………………………………………………………………… 186

Figure 4-31. Medical Command and Control in Consolidating Gains …………………………………… 188

Figure 4-32. Medical Treatment in Consolidating Gains …………………………………………………….. 189

Figure 4-33. Hospitalization in Consolidating Gains …………………………………………………………… 190

Figure 4-34. Medical Evacuation in Consolidating Gains ……………………………………………………. 191

Figure 4-35. Dental Services in Consolidating Gains …………………………………………………………. 192

Figure 4-36. Preventive Medicine in Consolidating Gains …………………………………………………… 193

Figure 4-37. COSC in Consolidating Gains ………………………………………………………………………. 194

Figure 4-38. Veterinary Services in Consolidating Gains ……………………………………………………. 195

Figure 4-40. Medical Laboratory in Consolidating Gains …………………………………………………….. 197

Tables

Table 1-1. Medical command function (primary tasks and purposes) (FM 4-02) ……………………… 10

Table 1-2. Medical treatment (organic and area support) function (primary tasks and purposes) (FM 4-02) ………………………………………………………………………………………………………. 11

Table 1-3. Hospitalization function (primary tasks and purposes) (FM 4-02) …………………………… 12

Table 1-4. Medical evacuation function (primary tasks and purposes) (FM 4-02) ……………………. 13

Table 1-5. Medical logistics function (primary tasks and purposes) (FM 4-02) ………………………… 13

Table 1-6. Preventive dentistry (primary tasks and purposes) (FM 4-02) ……………………………….. 14

Table 1-7. Dental services function (primary tasks and purposes) (FM 4-02) ………………………….. 14

Table 1-8. Preventive medicine function (primary tasks and purposes) (FM 4-02) …………………… 15

Table 1-9. Combat & operational stress control function (primary tasks & purposes) (FM 4-02) .. 16

Table 1-10. Behavioral health/neuropsychiatric treatment (primary tasks & purposes) (FM 4-02) 16

Table 1-11. Veterinary services function (primary tasks and purposes) (FM 4-02) ………………….. 16

Table 1-12. Veterinary services treatment (primary tasks and purposes) (FM 4-02) ………………… 17

Table 1-13. Medical laboratory services function (primary tasks and purposes) (FM 4-02) ………. 17

Table 1-14. Clinical laboratory services (primary tasks and purposes) (FM 4-02) ……………………. 17

Table 3-1. Army command and support relationships ………………………………………………………….. 55

Table 3-2. Army support relationships ……………………………………………………………………………….. 56

Table 4-1. List of abbreviations for Figures 4-1 through 4-40 ………………………………………………. 154

1 June 2020 Army Health System Doctrine Smart Book v

Preface

The Army Health System Doctrine Smart Book is a concise collection of Army Health System summaries that reflects current approved doctrine. Part One provides a summary of the Army Health System and its ten medical functions. Part Two provides a visual representation of the Army Health System’s doctrinal hierarchy and its corresponding Army and joint doctrine. It illustrates the hierarchy as it applies to the Joint Publication 4-02, Joint Health Services; Field Manual 4-02, Army Health System; and Army Health System Army techniques publications. It follows on with one-page synopses of each current approved Army Health System doctrinal publication. Each synopsis contains the characteristics, fundamentals, terms, and ideas as they are discussed in each publication. Part Three consists of doctrinal synopses of each Army Health System unit. Each synopsis contains the table of organization and equipment, task organization, personnel breakdown, and doctrinal employment as they are discussed in various Army Health System doctrinal publications. Part Four discusses the Army Health System by Army strategic role (shape, prevent, large scale ground combat operations, and consolidate gains). The principal audience for this publication is all readers of Army Health System doctrine—military, civilian, and contractor. This publication uses Department of Defense terms where applicable. The proponent and preparing agency of the Army Health System Doctrine Smart Book is the United States Army Medical Center of Excellence (MEDCoE), Doctrine Literature Division. Send questions, comments, and recommendations to Commander, MEDCoE, ATTN: MCCS-FD (Army Health System Doctrine Smart Book), 2377 Greeley Road, Joint Base San Antonio, Fort Sam Houston, Texas 78234- 7731 or by e-mail to [email protected]

1 June 2020 Army Health System Doctrine Smart Book 1

PART ONE

ARMY HEALTH SYSTEM

INTRODUCTION

The Army Health System (AHS) is a component of the Military Health System (MHS) that is responsible for operational management of the health service support (HSS) and force health protection (FHP) missions for training, predeployment, deployment, and postdeployment operations. Army Health System includes all mission support services performed, provided, or arranged by the Army Medicine to support HSS and FHP mission requirements for the Army and as directed, for joint, intergovernmental agencies, coalition, and multinational forces. The AHS is a complex system of systems that is interdependent and interrelated and requires continual planning, coordination, and synchronization to effectively and efficiently clear the battlefield of casualties and to provide the highest standard of care to our wounded or ill Soldiers.

ARMY HEALTH SYSTEM OPERATIONAL FRAMEWORK

1-1. The AHS supports and is in consonance with joint doctrine, as described in Joint Publication (JP) 4-02. Figure 1-1 below depicts the AHS medical command and control (C2) operational framework.

Figure 1-1. Army Health System Operational Framework

Part I

2 Army Health System Doctrine Smart Book 1 June 2020

OPERATIONAL ENVIRONMENT

1-2. The future operational environment (OE) and our forces’ challenges to operate across the range of military operations represents the most significant readiness requirement. The logic chart (Figure 1-2) begins with an anticipated OE that includes considerations during LSCO against a peer threat. Next, it depicts the Army's contribution to joint operations through the Army’s strategic roles. Within each phase of a joint operation, the Army's operational concept of unified land operations guides how Army forces conduct operations. In large-scale ground combat, Army forces combine offensive, defensive, and stability tasks to seize, retain, and exploit the initiative in order to shape OEs, prevent conflict, conduct large-scale ground combat, and consolidate gains. The philosophy of mission command guides commanders, staffs, and subordinates in their approach to operations. The mission command warfighting function enables commanders and staffs of theater armies, corps, divisions, and brigade combat teams (BCTs) to synchronize and integrate combat power across multiple domains and the operational environment. Throughout operations, Army forces maneuver to achieve and exploit positions of relative advantage across all domains to achieve objectives and accomplish missions.

1-3. The logic chart (Figure 1-2) also depicts how the AHS supports the operating force to support FHP and HSS mission requirements for the Army and as directed, for joint, inter-governmental agencies, coalition, and multinational forces during LSCO. For more information on AHS support to the Army strategic roles, refer to Field Manual (FM) 4-02, Appendix B.

Army Health System

1 June 2020 Army Health System Doctrine Smart Book 3

Figure 1-2. Army Health System Logic Chart

Part I

4 Army Health System Doctrine Smart Book 1 June 2020

ROLES OF MEDICAL CARE (ARMY) (FM 4-02)

1-4. A basic characteristic of organizing modern AHS support is the distribution of medical resources and capabilities to facilities at various levels of command, diverse locations, and progressive capabilities, which are referred to as roles of care.

1-5. Definitive care refers to (1) that care which returns an ill or injured Soldier to full function, or the best possible function after a debilitating illness or injury. Definitive care can range from self- aid when a Soldier applies a dressing to a grazing bullet wound that heals without further intervention, to two weeks bed rest in theater for Dengue fever, to multiple surgeries and full rehabilitation with a prosthesis at a continental United States (CONUS) medical center or Department of Veteran’s Affairs hospital after a traumatic amputation. (2) That treatment required to return the Service member to health from a state of injury or illness. The Service member's disposition may range from return to duty to medical discharge from the military. It can be provided at any role depending on the extent of the Service member's injury or illness. It embraces those endeavors which complete the recovery of the patient. (FM 4-02)

1-6. Definitive treatment refers to the final role of comprehensive care provided to return the patient to the highest degree of mental and physical health possible. It is not associated with a specific role or location in the continuum of care; it may occur in different roles depending upon the nature of the injury or illness. (FM 4-02)

1-7. As a general rule, no role of care will be bypassed except on grounds of medical urgency, efficiency, or expediency. The rationale for this rule is to ensure the stabilization/survivability of the patient through tactical combat casualty care (TCCC), and far forward resuscitative surgery is

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