*FM 4-02
Field Manual
No. 4-02
Headquarters
Department of the Army

Washington, D.C., 17 November 2020

Army Health System

The content of this update remains generally consistent with the 2013 publication on key topics while adopting updated terminology and concepts as necessary. Key topics include AHS, FHP, Health Service Support, ten medical functions, and law of land warfare and medical ethics. The material presented in this publication reflects enduring practices in providing timely AHS support to the tactical commander. This publication depicts AHS operations from the point of injury or wounding through successive roles of care within the area of operations and evacuation to the continental United States-support base. Summary of changes include:  Aligning this publication with Army hierarchy publications including FM 3-0 and FM 4-0.  Aligning this publication with Joint Publication 4-02, Joint Health Services’ FHP and HSS definitions and descriptions.  Reorganizing the order of the publication; FHP is now Part Two while HSS is Part Three.  Revising the definitions of the following terms: Army Health System, force health protection, health service support, definitive care, essential care, and triage.  Replacing the mission command medical function with medical command and control; this is in line with ADP 6-0.  Replacing “field preventive medicine” with “operational public health” according to AR 40-5.  Adding Global Health Engagement information.  Adding hospital center information.  Adding an appendix discussing AHS support to the Army’s strategic roles (shape operational environments, prevent conflict, prevail in large-scale ground combat, consolidate gains).  Adding an appendix derived from FM 3-0 discussing command and support relationships.  Adding a surgeon and surgeon section appendix.  Adding the approved medical symbols appendix. As the Army’s AHS doctrine statement, this publication identifies medical functions and procedures that are essential for operations covered in other Army Medicine proponent manuals. This publication depicts AHS operations from the point of injury or wounding, through successive roles of care within the area of operations, and evacuation to the continental United States (U.S.)-support base. It presents a stable body of operational doctrine rooted in actual military experience and serves as a foundation for the development of Army Medicine proponent manuals on how the AHS supports unified land operations. The AHS mission falls within two warfighting functions-protection and sustainment. To clearly delineate the two AHS missions of force health protection (FHP) and health service support (HSS), this publication is divided into three parts-AHS overview, FHP, and HSS. Field Manual 4-02 consists of three parts and 12 chapters: Part One, AHS, provides a holistic view of the entire AHS and the complexities and interdependence of each medical function in successfully accomplishing the Army Medicine’s mission to conserve the fighting strength. This part of the manual describes and provides operational guidance on the AHS’s echelon above brigade headquarters, as well as the medical aspects of the law of land warfare.  Chapter 1 provides an overview of the AHS to include introduction information on tactical combat casualty care, global health engagement, and the AHS principles.  Chapter 2 discusses AHS command and control, overview of Army echelons, Army command and support relationships, the AHS Team and its primary tasks, medical command and control organizations, and the roles and responsibilities of the medical commander, command surgeon, and commander.  Chapter 3 provides information regarding AHS and the effects of the law of land warfare and medical ethics information.  Chapter 4 discusses Army Health System operations; operational and mission variables; AHS support to decisive action-offensive, defensive, stability tasks, defense support of civil authorities; setting the theater; detainee operations; and maneuver units. Part Two, FHP, encompasses the preventive and treatment aspects of the following medical functions: veterinary services, combat and operational stress control, dental services, operational public health, and laboratory services (area medical laboratory) including the testing of suspect biological and chemical warfare agent samples.  Chapter 5 describes operational public health’s mission, primary tasks, organizations and personnel.  Chapter 6 discusses veterinary services missions and primary tasks, consisting of the food protection mission, animal care mission, and veterinary public health.  Chapter 7 provides information on combat and operational stress control including primary tasks, responsibilities, and programs and resources.  Chapter 8 provides information on the preventive and treatment aspects of dental services.  Chapter 9 discusses environmental and clinical medical laboratory services. Part Three, HSS, encompasses medical treatment, medical evacuation (including medical regulating), and medical logistics (including blood management). Health services support three mission sets include all of the medical functions involved with direct patient care (medical treatment [organic and area support] and hospitalization) to include diagnostic medical laboratories and the medical functions of medical evacuation and medical logistics.  Chapter 10 discusses direct patient activities including medical treatment (organic and area support) and theater hospitalization (combat support hospital and hospital center).  Chapter 11 provides information on medical evacuation to include integrated medical evacuation system, medical regulating, and strategic medical evacuation and patient movement.  Chapter 12 discusses medical logistics to include medical logistics management in an operational environment, medical logistics command and control organizations, medical logistics support for Roles 1 through 3 medical treatment facilities, and as theater lead agent for medical materiel and the single integrated medical logistics manager. The Medical Center of Excellence, Doctrine Literature Division is reorganizing the placement of terms and definitions found in proponent publications within the Army Medicine Doctrine Publication Library. It was determined that some of the terms are best suited in other publications within the Army Medicine Doctrine Publication Library. Based on current doctrinal changes, certain terms for which FM 4-02 is proponent have been added, rescinded, or modified for purposes of this publication. The glossary contains acronyms an defined terms. See introductory table-1, introductory table-2 on page xi for specific term changes. Introductory Table-1. Rescinded Army terms Term Remarks hospital Rescinded. Adopts common English usage. No longer formally defined. preventive medicine Rescinded. Introductory Table-2. Modified Army terms Term Remarks Army Health System Modifies the definition. casualty evacuation Modifies the definition. combat and operational stress control Modifies the definition. continuity of care Modifies the definition. definitive care Modifies the definition. + essential care Modifies the definition. first aid (self-aid/buddy aid) Modifies the definition. Force Health Protection Modifies the definition. Health Service Support Modifies the definition. triage Modifies the definition. This page intentionally left blank.

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 and force health protection missions for training, predeployment, deployment, and postdeployment operations. The Army Health System includes all mission support services performed, provided, or arranged by the Army Medicine to support health service support (HSS) and force health protection (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. Part One of this publication provides a holistic view of the AHS; specifically describing its composition, along with its overarching architecture of its design and functions without regard to the specific warfighting functions under which it operates. This part of the publication— ● Discusses the foundations of the Army Medicine and the fundamental principles which have guided the provision of AHS support on the battlefield throughout its history. It describes the roles of medical care which facilitate providing care at the point of injury (POIPOIProgram of instruction) or wounding and describes the system of phased and incrementally increasing capabilities which enables the wounded or ill Soldier to be stabilized and evacuated to the appropriate medical treatment facility. The goal is then to care for their specific medical condition and to restore them to health, limit long-term disability, and either return then to duty or to their civilian life as a productive member of that community. The term s tabilized patient refers to a patient whose airway is secured, hemorrhage is controlled, shock treated, and fractures are immobilized. (Joint Publication [JP] 4-02) ● Provides an in-depth discussion on the provisions of the Geneva Conventions, the law of land warfare, and medical ethics and their impact on conduct of AHS operations. It describes the primary tasks of the AHS in support of operations characterized by offensive, defensive, stability, and defense support of civil authorities tasks. Further, it discusses AHS support to detainee operations and the roles and responsibilities of the detainee operations medical director. ● Discusses the AHS medical command and control organizations, their functions, and responsibilities. It also provides an in-depth discussion of the Army Medicine team, the medical commander, the command surgeon, and the involvement required of the commander. ● Provides information on the role of the institutional force and the support provided to the operational Army. It also provides a brief description of the Warrior Transition Program for the continued care, convalescence, and rehabilitative treatment of our returning wounded Warriors. ●Provides information on the importance of medical intelligence for the identification of health hazards affecting deployed forces and the medical aspects of intelligence preparation of the battlefield (IPB).

The mission sets of the Army Medicine (which historically had been shown under the combat service support battlefield operating system) are under two warfighting functions-the protection and sustainment warfighting functions. This change more closely aligned the Army Medicine mission sets with the overall warfighting functions of the Army. The FHP mission is discussed in Part Two of this publication, while the HSS mission is discussed in Part Three. Although Parts Two and Three discuss the mission sets as separate entities, the medical personnel and staffs that plan, coordinate, and synchronize these operations are responsible for the execution of both mission sets. 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 AHS system. Force Health Protection is a continuous process that begins with the Soldier’s entry into the military and is continuous throughout the Soldier’s military career. Force health protection includes establishing and sustaining a healthy and fit force, health promotion and nutrition programs, the identification of the health threat in all settings (in both deployed and garrison settings), the development and implementation of personnel protective measures to reduce exposure to health hazards and mitigating the adverse effects of the impact of health threats to military personnel. Force health protection are measures that promote, improve, or conserve the behavioral and physical well-being of Soldiers comprised of preventive and treatment aspects of medical functions that include: combat and operational stress control, dental services, veterinary services, operational public health, and laboratory services. Enabling a healthy and fit force, prevent injury and illness, and protect the force from health hazards. Although nutrition plays a significant role in maintaining a healthy and fit force, nutrition is discussed as an integral part of the hospitalization function under the HSS mission.

Health service support pertains to the treatment and MEDEVAC of patients from the battlefield and the required Class VIII supplies, equipment, and services to necessary to sustain these operations. Health service support encompasses three components: direct patient care, MEDEVAC, and MEDLOG. This part of the publication discusses— ●Direct patient care aspects of the AHS mission. It includes medical treatment (organic and area support) and hospitalization. Health Service Support includes the treatment of CBRNCBRNChemical, biological, radiological, and nuclear patients. ●Medical evacuation to include medical regulating, and the provision of en route care to patients being transported. ●Medical logistics inclusive of all functional subcomponents and services to include blood management.

The Army's primary mission is to organize, train, and equip its forces to conduct prompt and sustained land combat to defeat enemy ground forces and seize, occupy, and defend land areas. The Army accomplishes its mission by supporting the joint force in four strategic roles: shape OEs, prevent conflict, conduct large-scale ground combat operations, and consolidate gains. For more information on the Army’s strategic roles, refer to FM 3-0. SHAPE OPERATIONAL ENVIRONMENTS A-1. Shaping activities are continuous within an area of responsibility. The CCDRCCDRCombatant commanders (command authority) uses them to improve security within partner nations, enhance international legitimacy, gain multinational cooperation, and influence adversary decision making. This cooperation includes information exchange and intelligence sharing, obtaining access for U.S. forces in peacetime and crisis, and mitigating conditions that could lead to a crisis. A-2. Army forces conduct operations to shape OEs with various unified action partners through careful coordination and synchronization facilitated by the theater army through the GCC, and when authorized, directly with the partner nation's military forces. Army forces provide security cooperation capabilities area of responsibility-wide, including building defense and security relationships and partner military capacity through exercises and engagements, gaining or maintaining access to populations, supporting infrastructure through assistance visits, and fulfilling EA responsibilities. Military-to-military contacts and exchanges, joint and combined exercises, various long-term persistent military engagements, and other security cooperation activities provide the foundation of the GCC's theater campaign plan. Key medical considerations in support of operations to shape include:  Regionally focused medical command and control to promote unity of purpose of all engaged medical assets.  Medical information management to document health threat exposures and medical encounters, to report health surveillance data and information on the health of the command, and to accomplish medical regulating and patient tracking operations.  Traditional medical support to a deployed force engaged in performing these tasks.  Medical expertise and consultation to enhance building partnership capacity in public, private, and military health sectors of the host nation.  Development of regional theater security cooperation plans aimed at mitigating or resolving the underlying causes of health issues prevalent within the region.  Army Health System support for maintenance and execution of medical support agreements.  Home station medical readiness and training activities, and tailored force generation of medical combat power.  Army medical support to other Services and unified action partners, as well as assessment and release of theater Army prepositioned stocks and other medical logistics support.  Capability gaps and determine mitigation plan.  Theater evacuation policy adjustments.  Coordination with USTRANSCOM for patient movement plans.  Integration and interoperability of theater medical capabilities.  Army Health System support to foreign humanitarian assistance and disaster relief.  Medical preparation of the OE. A-3. See Figure A-1 for an example depiction of AHS support during operations to shape. PREVENT CONFLICT A-4. The intent of operations to prevent is to deter adversary actions and stop further deterioration of a particular situation. Prevent activities enable the joint force to gain positions of relative advantage prior to future combat operations. Operations to prevent are characterized by actions to protect friendly forces and indicate the intent to execute subsequent phases of a planned operation. With the shift from shaping to deterrence, the theater army shifts to refining contingency plans and preparing estimates for land power based on GCC's guidance. The theater army and subordinate Army forces perform the following major activities during operations to prevent:  Execute flexible deterrent options and flexible response options.  Set the theater.  Tailor Army forces.  Project the force. A-5. The AHS support during operations to prevent includes coordination, integration, and synchronization of strategic medical capabilities from the U.S. sustaining base, global health engagements, establishment and maintenance of medical support agreements, as well as the following:  Executing AHS support to other Services when directed.  Recommending theater evacuation policy adjustments.  Providing theater food protection support.  Coordinating with USTRANSCOM for patient movement plans.  Ensuring integration and interoperability of theater medical capabilities.  Conducting medical preparation of the OE.  Maximizing use of host-nation medical capabilities.  Establishing and executing OEH surveillance programs and countermeasures.  Coordinating with the National Center for Medical Intelligence, Centers for Disease Control and Prevention, and other strategic partners for identification and mitigation of regional health threats.  Planning and coordination for AHS support to—  Noncombatant evacuation operations.  Detainee operations.  Reception, staging, onward movement, and integration, and theater opening.  Large-scale casualty events and prolonged care.  Other Services. A-6. See Figure A-2 for an example depiction of AHS support during operations to prevent. CONDUCT LARGE SCALE GROUND COMBAT OPERATIONS A-7. During large-scale ground combat operations, Army forces defeat the enemy. Defeat of enemy forces in close-combat operations is normally required to achieve campaign objectives and national strategic goals after the commencement of hostilities. Planning for sequels to consolidate gains at higher levels should be informed by combat operations and vice versa. However, the demands of large-scale ground combat operations consume all available staff capability at the tactical level. A-8. In large-scale ground combat operations against a peer threat, commanders conduct decisive action to seize, retain, and exploit the initiative. This involves the orchestration of many simultaneous unit actions in the most demanding of operational environments. Large-scale ground combat operations introduce levels of complexity, lethality, ambiguity, and speed to military activities not common in other operations. Large-scale ground combat operations require the execution of multiple tasks synchronized and converged across multiple domains to create opportunities to destroy, dislocate, disintegrate, and isolate enemy forces. A-9. Army forces defeat enemy organizations, control terrain, protect populations, and preserve joint force and unified action partner freedom of movement and action in the land and other domains. Commanders are directly concerned with those enemy forces and capabilities that can affect their current and future operations. Medical command and control gives subordinate medical units at all echelons the freedom to provide a rapid response to acquire wounded, injured, and ill personnel clearing the battlefield of casualties and facilitating and enhancing the tactical commander's freedom of movement and maneuver. A-10. Large-scale ground combat operations place a significant burden on medical resources due to the magnitude and lethality of the forces involved. Medical units must anticipate large numbers of casualties in a short period of time due to the capabilities of modern conventional weapons and the possible employment of weapons of mass destruction. These mass casualty situations can rapidly exceed the capabilities of medical assets. Careful planning and coordination is necessary to minimize the extent to which medical capabilities are overwhelmed. Casualty evacuation must occur concurrently with operations. Units that cease aggressive maneuver to evacuate casualties while in enemy contact are likely to both suffer additional casualties while stationary and fail their mission. Effective management of mass casualty situations depends on established and rehearsed unit-level mass casualty plans. There are a number of other variables which can ensure the success of a unit's mass casualty response. These include, but are not limited to:  Coordination of additional medical support and augmentation of-medical evacuation support, forward resuscitative and surgical detachments, combat support and field hospitals, casualty collection points, ambulance exchange points, and established Class VIII resupply.  Rapid clearance of casualties from the battlefield (independent of MEDEVAC).  Providing effective tactical combat casualty care for the injured.  Continuous flow of casualties to the MTFs at the next higher role of care.  Use of alternative assets when the number of casualties overwhelms the capacity of available medical evacuation systems. A-11. The AHS support during large-scale ground combat operations include but not limited to:  Provide organic Roles 1 and 2 medical treatment and on an area basis.  Provide Role 3 medical treatment.  Medical evacuation and/or CASEVAC from POIPOIProgram of instruction to MTFMTFMilitary treatment facility.  Intra/Intertheater patient movement (between medical treatment facilities).  Provide forward resuscitative surgery to stabilize nontransportable patients for evacuation out of theater.  Emergency movement of Class VIII (to include blood), medical personnel, and medical equipment.  Coordinate medical evacuation plan with the combat aviation brigade for air ambulance support.  Coordinate with United States Air Force for strategic aeromedical evacuation and medical regulating.  Manage patient movement items.  Conduct medical and OEH surveillance.  Conduct health risk assessment and communications.  Provide veterinary medical treatment for MWDs and government-owned animals.  Force rotation (reception, staging, onward movement, and integration).  Sustainment of AHS support operations (possible nontraditional sources of support from other Services, multinational forces, or host nation without habitual support relationships).  Unit reconstitution may be accomplished using modular teams.  Care for detainees (increased requirements for public health support, primary care, care of chronic diseases/conditions). A-12. See Figure A-3 for an example depiction of AHS support during large-scale ground combat operations. CONSOLIDATE GAINS A-13. Army forces provide the joint force commander the ability to capitalize on operational success by consolidating gains. Consolidate gains is an integral part of winning armed conflict and achieving success across the competition continuum. It is essential to retaining the initiative over determined enemies and adversaries. Army forces reinforce and integrate the efforts of all unified action partners when they consolidate gains. A-14. Army forces consolidate gains in support of a host nation and its civilian population, or as part of the pacification of a hostile state. These gains may include the establishment of public security temporarily by using the military as a transitional force, the relocation of displaced civilians, reestablishment of law and order, performance of humanitarian assistance, and restoration of key infrastructure. Concurrently, corps and divisions must be able to accomplish these activities while sustaining, repositioning, and reorganizing subordinate units to continue operations in the close area. Refer to ATPATPArmy Techniques Publications 3-91 and ATPATPArmy Techniques Publications 3-92 for more information. A-15. Upon successful termination of large-scale ground combat operations, Army forces in the close area transition rapidly to the conduct of consolidation of gains activities. Alternatively, they may be relieved in place by another unit. Consolidation of gains activities may encompass a lengthy period of post conflict operations prior to redeployment. This transition to consolidation of gains may occur even if large-scale ground combat operations are occurring in other parts of an AO in order to exploit tactical success. Anticipation and early planning for activities after large-scale ground combat operations ease the transition process. A-16. The joint force commander defines the conditions to which an AO is to be stabilized. The theater army is normally the overseer of the orderly transition of authority to appropriate U.S., international, interagency, or host-nation agencies. The theater army and subordinate commanders emphasize those activities that reduce post-conflict or post-crisis turmoil and help stabilize a situation. Commanders address the decontamination, disposal, and destruction of war materiel. They address the removal and destruction of unexploded ordnance and the responsibility for demining operations. A-17. The consolidation of friendly and available enemy mine field reports is critical to this mission. Additionally, the theater army must be prepared to provide AHS support, emergency restoration of utilities, support to social needs of the indigenous population, and other humanitarian activities as required. (See ADP 3-07 and FM 3-07 for more information on the performance of stability tasks). Army Health System support during operations to consolidate gains includes but not limited to:  Coordinate, integrate, and synchronize AHS resources into the interagency efforts. Provide medical expertise to identify and analyze critical needs emerging within the operational area.  Manage medical information to facilitate medical regulating of victims to facilities outside of the operational area and to document medical treatment.  Assist affected host nation medical infrastructure in saving lives, reducing long-term disability, and alleviating human suffering.  Assist the local government in conducting rescue operations and providing medical evacuation of victims to facilities capable of providing the required care.  Advise local animal, agricultural, and veterinary industry personnel; assess damage of veterinary and animal infrastructure; and provide animal medical care to local animals.  Conduct preventive measures to respond to and resolve emerging health threats caused by the LSCO.  Conduct health risk assessment and communications.  Assist host nation to reestablish its own ability to provide medical services for its population to a reasonable level it possessed prior to hostilities and to support the legitimacy of the host nation.  Continue to assess running estimates and be prepared to provide all aspects of roles of medical care while reducing capacities in support of redeployment operations and downsizing the footprint in theater (for example, reducing the number of intensive care unit and intermediate care ward beds). A-18. See Figure A-4 (on page A-7) for an example depiction of AHS support during operations to consolidate gains. This page intentionally left blank.

This appendix is derived from FM 3-0. It discusses command and support relationships for joint and Army forces. This appendix delineates the four types of joint command relationships, Army command relationships, and Army command support relationships. Command and support relationships provide the basis for unity of command and unity of effort in operations. FUNDAMENTAL CONSIDERATIONS B-1. Establishing clear command and support relationships is a key aspect of any operation. Large-scale combat operations present unique and complex challenges that demand well-defined command and support relationships among units. These relationships establish responsibilities and authorities between subordinate and supporting units. Some command and support relationships limit the commander's authority to prescribe additional relationships. Knowing the inherent responsibilities of each command and support relationship allows commanders to effectively organize their forces and helps supporting commanders understand their unit's role in the organizational structure. JOINT COMMAND RELATIONSHIPS B-2. As part of a joint force, Army commanders and staffs must understand joint command relationships. JP 1 specifies and details four types of joint command relationships:  Combatant command (command authority).  Operational control (OPCON).  Tactical control (TACON).  Support. C OMBATANT C OMMAND (C OMMAND A UTHORITY) B-3. Combatant command is a unified or specified command with a broad continuing mission under a single commander established and so designated by the President, through the Secretary of Defense and with the advice and assistance of the Chairman of the Joint Chiefs of Staff (JP 1). Title 10, United States Code, section 164 specifies this authority in law. Normally, the CCDRCCDRCombatant commanders exercises this authority through subordinate JFCs, Service component commanders, and functional component commanders. O PERATIONAL C ONTROL B-4. Operational control is the authority to perform those functions of command over subordinate forces involving organizing and employing commands and forces, assigning tasks, designating objectives, and giving authoritative direction necessary to accomplish the mission (JP 1). Operational control normally includes authority over all aspects of operations and joint training necessary to accomplish missions. It does not include directive authority for logistics or matters of administration, discipline, internal organization, or unit training. The CCDRCCDRCombatant commanders must specifically delegate these elements of COCOMCOCOMCombatant commander. Operational control does include the authority to delineate functional responsibilities and operational areas of subordinate JFCs. In two instances, the Secretary of Defense may specify adjustments to accommodate authorities beyond OPCON in an establishing directive-when transferring forces between CCDRs or when transferring members or organizations from the military departments to a combatant command. Adjustments will be coordinated with the participating CCDRs. T ACTICAL C ONTROL B-5. Tactical control is the authority over forces that is limited to the detailed direction and control of movements or maneuvers within the operational area necessary to accomplish missions or tasks assigned (JP 1). Tactical control is inherent in OPCON. It may be delegated to and exercised by commanders at any echelon at or below the level of combatant command. Tactical control provides sufficient authority for controlling and directing the application of force or tactical use of combat support assets within the assigned mission or task. Tactical control does not provide organizational authority or authoritative direction for administrative and logistic support; the commander of the parent unit continues to exercise these authorities unless otherwise specified in the establishing directive. S UPPORT B-6. Support is the action of a force that aids, protects, complements, or sustains another force in accordance with a directive requiring such action (JP 1). Support is a command authority in joint doctrine. A supported and supporting relationship is established by a superior commander between subordinate commanders when one organization should aid, protect, complement, or sustain another force. Designating supporting relationships is important. It conveys priorities to commanders and staffs planning or executing joint operations. Designating a support relationship does not provide authority to organize and employ commands and forces, nor does it include authoritative direction for administrative and logistic support. Joint doctrine divides support into the categories listed in Table B-1 (page B-3). ARMY COMMAND AND SUPPORT RELATIONSHIPS B-7. As discussed in Chapter 2, Army command relationships include:  Organic.  Assigned.  Attached.  OPCON.  TACON. B-8. See Table B-1 (on page B-3) for an illustration of Army command relationships. O RGANIC B-9. Organic forces are those assigned to and forming an essential part of a military organization as listed in its table of organization for the Army, Air Force, and Marine Corps, and are assigned to the operating forces for the Navy (JP 1). Joint command relationships do not include organic because a JFC is not responsible for the organizational structure of units. That is a Service responsibility. B-10. The Army establishes organic command relationships through organizational documents such as tables of organization and equipment and tables of distribution and allowances. If temporarily task-organized with another headquarters, organic units return to the control of their organic headquarters after completing the mission. To illustrate, within a BCTBCTBasic combat training, all subordinate battalions are included on the BCTBCTBasic combat training table of organization and equipment. In contrast, within most functional and multifunctional brigades, there is a base of organic battalions and companies and a variable mix of assigned and attached battalions and companies. A SSIGNED B-11. Assign is to place units or personnel in an organization where such placement is relatively permanent, and/or where such organization controls and administers the units or personnel for the primary function, or greater portion of the functions, of the unit or personnel (JP 3-0). Unless specifically stated, this relationship includes administrative control (ADCON).

Organizations from battalion through ASCCASCCArmy service component commander level are authorized a surgeon. Army Medicine leverages the chain of surgeon's cells (staff channels) and medical command and control channels (MEDCOMMEDCOMUnited States Army Medical Command [(DS], MEDBDE [SPT], and [MMB]) to provide AHS support to the deployed force. Integration of these two channels and other warfighting function elements occur at command headquarters (HQs) at different echelons. The surgeon is a member of the commander’s personal and special staff. Through medical command and control, the surgeon coordinates and synchronizes the medical functions within the protection and sustainment warfighting functions and serves as a link between these varied commands and staffs. Surgeons at the ASCCASCCArmy service component commander/theater, corps, division, and brigade level are authorized a surgeon staff. The surgeon’s staff is considered special staff and executes the actions required of the surgeon. The surgeon and the surgeon sections at each echelon work with their commands and staffs to conduct planning, coordination, synchronization, and integration of AHS support. This ensures the consideration of all ten medical functions is included in the command’s running estimates, OPLANs, and OPORDs. SURGEON C-1. The surgeon is a Medical Corps officer and member of the commander’s personal and special staff. The surgeon normally work under the staff supervision of the chief of staff/executive officer. The surgeon is responsible for coordinating health assets and operations within the command. This officer provides and oversees medical care to Soldiers, civilians, and detainees. The surgeon prepares Appendix 9 (Force Health Protection) of Annex E (Protection) and Appendix 3 (Health Service Support) of Annex F (Sustainment) to the operation order or operation plan. If operating in a joint headquarters (Theater/Corps), they have the responsibility of writing Annex Q (Medical Services) to the joint operation order or operation plan (Refer to JP 4-02, Joint Health Services). The surgeon advises the commander and their staff on all medical or medical-related issues. The surgeon’s responsibilities include, but are not limited to:  Advises the commander on the health of the command.  Responsible for the creation of or contribution to the medical common operating picture and medical concept of support.  Provides medical treatment (to include CBRNCBRNChemical, biological, radiological, and nuclear).  Provides status of the wounded.  Coordinates MEDEVAC including Army dedicated MEDEVAC platforms (air and ground).  Determines requirements for the requisition, procurement, storage, maintenance, distribution management, and documentation of Class VIII supplies within the organization.  Plans for and implements operational public health (including initiating measures to counter the health threat, and establishing medical and OEH surveillance).  Advises on the effects of the health threat on personnel, rations, and water.  Advises on health threat requirements including the examination, processing of captured medical supplies, and recommending use of captured medical supplies in support of detainees and other recipients.  Coordinates dental services.  Coordinates COSC.  Ensures the establishment of a viable veterinary services program (including inspection of subsistence and outside the continental U.S. food production and bottled water facilities, veterinary preventive medicine, and animal medical care).  Ensures an area medical laboratory capability or procedures for obtaining this support from out of theater resources are established for the identification and confirmation of the use of suspect biological and chemical warfare agents by opposition forces. This includes the capability for specimens and samples, packaging and establishing handling requirements, and escort and chain of custody requirements.  Coordinates clinical laboratory capabilities, including blood banking.  Advises how operations affect the public health of personnel and the indigenous populations.  Provides recommendations on allocation, redistribution, determining requirements, and assignment of medical personnel.  Coordinates with medical unit commanders (to include leaders of medical platoons and sections) for continuous AHS support.  Provides consultation, mentoring, and technical supervision of subordinate surgeons, physicians, and physician assistants.  Submits to higher HQs those recommendations on professional medical problems that require research and development.  Determines AHS training requirements and provides health education and training.  Ensures field medical records and/or electronic medical records, when available, are maintained on each Solder at the primary MTFMTFMilitary treatment facility according to AR 40-66.  Assessing special equipment and procedures required to accomplish the AHS mission in specific environments such as urban operations, mountainous terrain, extreme cold weather operations, jungles, and deserts, requirements varies depending upon the scenario, and could include:  Obtaining pieces of equipment of clothing not usually carries (piton hammers, extreme cold weather parka, jungle boots, or the like)  Adapting medical equipment sets for a specific scenario to include adding items based on the forecasted types of injuries to be encountered (such as more crushing injuries and fractures in urban operations or mountain operations). In certain scenarios (such as urban operations), some medical supplies and equipment may not be carried into the fight initially (such as sick call materials), but rather brought forward by follow-on forces. In mountain operations, bulky or heavy items (such as extra tentage) may not accompany the force because of the difficulty in traversing the terrain.  Having individual Soldiers carry additional medical items, such as bandages and intravenous fluids. C-2. Through medical command and control, the surgeon coordinates and synchronizes the medical functions within the protection and sustainment warfighting functions and serves as a link between these varied commands and staffs (See Figure C-1; on page C-3). C-3. Although AHS is broken down into two components; FHP which falls in the protection warfighting function and HSS which resides within the sustainment warfighting function, the AHS is functionally aligned with other warfighting fighting functions. Figure C-2 (on page C-3) below builds on Figure C-1 (on page C3) and depicts the 10 medical functions and how they are aligned within three warfighting functions. SURGEON SECTION C-4. The surgeon section works with many personal, special, and coordinating staffs. At different echelons, they work closely with two functional cells, protection and sustainment. At the theater, corps, and division level, there are chiefs of protection and sustainment. At the brigade and battalion level, the S-3 is responsible for protection and the S-4 is responsible for sustainment. Force health protection falls within the chief of protection/S-3’s functional area. Health service support falls within the chief of sustainment’s/S-4 functional area. The responsibility of the entire AHS support structure, which includes both FHP and HSS medical functions, rests with the surgeon. Figure C-3 on page C-4 depicts the coordination and synchronization relationship shared between the surgeon, their staffs, and the chief of the protection/S-3 and chief of sustainment/S-4 cells. C-5. The staff of the surgeon is considered special staff and resides in the sustainment cells within corps, divisions, and brigades HQs. The surgeon staff varies in size depending on the echelon (See Table C-1; page C-5). It assists the surgeon in planning and conducting AHS support operations. Functionally, the surgeon’s staff section “advises the commander” on medical capabilities and capacities necessary to support plans, and interfaces with operations, intelligence, protection cells, civil affairs, sustainment cells, and host nation authorities to coordinate AHS support across the warfighting functions. Specific functions of the surgeon staff include, but are not limited to:  Plans and ensures Roles 1 thru 3 medical support for the command is provided in a timely and efficient manner.  Recommends, develops, and maintains medical troop basis, revises as required, to ensure task organization for mission accomplishment.  Plans and coordinates AHS support operations for the command and attached/OPCON medical assets. This includes reinforcement and reconstitution.  Prepares and presents, as directed by the surgeon, the AHS support portion of the command and operational briefings.  Coordinates with the G-1 (S-1) for tracking critical medical areas of concentration and military occupational specialties.  Assists the G-1 (S-1) in casualty operations and estimates.  Collects and disseminates health threat information and coordinates medical intelligence requirements with the G-2 (S-2).  Facilitates functional integration between AHS and military intelligence staff elements within the command. This supports the G-2/S-2’s intelligence preparation of the battlefield.  Coordinates with the G-3 (S-3) for prioritizing the reallocation of organic and attached/OPCON medical augmentation assets as required by the tactical situation.  Oversees command tactical standard operating procedures (TSOPs), plans, policies, and procedures for AHS support as prescribed by the surgeon.  Oversees individual and collective medical training and provides information to the surgeon and commander.  Coordinates with the G-3 (S-3), G-4 (S-4), and command chemical officer for nonmedical assets for assisting with mass casualties and patient decontamination operations.  Coordinates with the G-3 (S-3) for additional evacuation assets, as required.  Coordinates and prioritizes patient evacuation or movement within the command.  Coordinates patient evacuation from organic MTFs to higher-level roles of medical care.  Coordinates the MEDEVAC of all detainee casualties.  Monitors medical regulating and patient tracking operations.  Coordinates and prioritizes MEDLOG and blood management requirements for the command.  Coordinates and manages the disposition of captured medical materiel.  Coordinates, plans, and prioritizes public health missions.  Monitors disease trends within the command.  Coordinates dental support when the tactical situation permits.  Coordinates with the supporting veterinary element pertaining to subsistence and animal disease surveillance.  Develops and publishes the medical reporting schedule for Force XXI Battle Command Brigade and Below in accordance with FM 6-99 and the commander’s guidance. Initiates other reports as necessary (see Table C-2 on page C-6).  Maintains situational understanding by coordinating for current AHS information with surgeons of the next higher, adjacent, and subordinate headquarters.  Coordinates, monitors, and synchronizes the execution of AHS support for the command for each war-gamed course of action to ensure a fit and healthy force.  The surgeon and their sections are responsible for coordinating with many personal, special, and coordinating staffs. This list is not limited to Table C-3 (on page C-7). These tasks and responsibilities are outlined in FM 3-94 and ATPs 3-91, 3-92, and 3-94. For more information, refer to these doctrinal publications.

Medical intelligence is developed through the leveraging of all-sourced intelligence assessments and products. Medical intelligence results from collection, evaluation, analysis, and interpretation of foreign medical, bioscientific, and environmental information that is of interest to strategic planning and to military medical planning. This information is pertinent to operations for the conservation of the fighting strength of friendly forces and the formation of assessments of foreign medical capabilities in both military and civilian sectors. Military intelligence includes only finished intelligence products produced by an authorized agency. Military Intelligence Soldiers and other intelligence professionals, through the intelligence warfighting function, collect, process and exploit, analyze, disseminate, and evaluate information collected from a variety of sources to generate intelligence. Medical elements require intelligence support in order to not lose the medical personnel's protected status under Article 24 of the1949 Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the field by performing tasks that are inconsistent with their noncombatant role such as intelligence collection. To develop medical intelligence, information is gathered, evaluated, and analyzed on the following subjects:  Endemic, emerging, epidemic and pandemic diseases, public health standards and capabilities, and the quality and availability of medical services.  Foreign military and civilian medical capabilities, including MTFs, medical personnel, emergency and disaster responses, MEDLOG (to include blood processing), and medical pharmaceutical industries.  Integrated databases on all medical treatment, training, pharmaceutical, and research and production facilities.  Environmental risks that can degrade force health or effectiveness including: chemical and microbial contamination of the environment, toxic industrial materials and radiation accidents, and environmental terrorism.  Impact of foreign environmental health issues and trends on environmental security and national policy.  Infectious disease risks that can degrade mission effectiveness of deployed forces.  Foreign and applied biomedical and biotechnological developments of military medical importance.  Foreign scientific and technological medical advances for defense against CBRNCBRNChemical, biological, radiological, and nuclear warfare agents. SIGNIFICANCE OF MEDICAL INTELLIGENCE D-1. At the strategic level, the objective of medical intelligence is to contribute to the formulation of national-based policy. The policy will be based in part on assessments of foreign military and civilian capabilities of the medical or bioscientific community. D-2. At the operational level, the objective of medical intelligence is to support the development of AHS strategies that—  Identify the health threat.  Are responsive to the unique aspects of a particular AO.  Enable the commander to accomplish the operation.  Conserve the fighting strength of friendly forces. SOURCES OF MEDICAL INTELLIGENCE D-3. Medical intelligence is provided to the AHS planner by intelligence organizations. The AHS planner must identify the medical intelligence requirements and provide a request for information and or updated commander's critical information requirements and other requirements to the supporting intelligence element within the command. Up-to-date medical intelligence assessments can be obtained by contacting Director, Defense Intelligence Agency, Attention: Director, National Center for Medical Intelligence, Fort Detrick, Maryland 21702-5000 or via the contact information listed at: https://www.ncmi.detrick.army.mil. The National Center for Medical Intelligence can provide finished all-source intelligence products that assess foreign medical facilities and capabilities; infectious disease/chemical/radiological health threats in the operational environment; foreign CBRNCBRNChemical, biological, radiological, and nuclear medical countermeasures; and emerging and disruptive biotechnology with military applications. The AHS planner should use all available intelligence elements to obtain information and intelligence which supports the military operation. The National Center for Medical Intelligence 24-hour service request for information telephone number is commercial (301) 619-7574 or Defense Switched Network 343-7574. Refer to DODIDODIDepartment of the Defense Instruction 6420.01 for more information. D-4. A supporting intelligence element exists in the AHS unit's chain of command. This element will be the primary source for the AHS planner to access the necessary intelligence for the execution of AHS support operations. MEDICAL ASPECTS OF INTELLIGENCE PREPARATION OF THE BATTLEFIELD D-5. Consideration of the medical aspects of the IPB is a systematic process that is designed to aid AHS planners in analyzing various enemy, environmental, and health threats in a specific AO. Determining the medical aspects of the IPB process occurs during the first step in the mission analysis phase of the military decision-making process. The information derived from conducting a proper assessment of the medical aspects of the intelligence is specific to the geographic region where the AO is located. The Phase I assessments that are part of the medical aspects of IPB are the cornerstone to developing detailed and effective AHS estimates and plans. Some portions of the template will be more or less applicable depending on the assigned mission. For more information on IPB, see ATPATPArmy Techniques Publications 2-01.3/MCRP 2-3A, Intelligence Preparation of the Battlefield/Battlespace. D-6. The Phase I assessments that are part of the medical aspects of IPB are to—  Define the OE.  Describe the operational effects on deployed forces and AHS operations.  Conduct threat integration (enemy, environment, and health) and information consolidation. IDENTIFY SIGNIFICANT CHARACTERISTICS OF THE OPERATIONAL ENVIRONMENT D-7. The first task of the AHS planner is to define the OE. The AHS planner identifies and describes the significant characteristics of the environment to be able to assess the impact on AHS support operations and the health of the command. D-8. The significant characteristics of the OE must be evaluated from both a military perspective and a civilian perspective. The AHS planner must determine what aspects of the OE will impact the delivery of health care to U.S. forces and conversely what impact military medical operations will have on the civilian population in the AO. As the provision of medical care is a humanitarian activity, the patient workload of deployed forces can be affected when forces are deployed in medically underserved areas or in areas where the civilian medical infrastructure has been disrupted or is underdeveloped. The AHS planner can use the memory aid political, military, economic, social, information, infrastructure, physical environment, time (operational variables) or mission, enemy, terrain and weather, troops and support available, time available, and civil considerations factors (mission variables) to frame the analysis of the OE based on the situation. For the AHS planner, the civil considerations must be thoroughly explored and analyzed, even if the immediate mission does not recognize a requirement for the provision of health services to a host-nation population. The AHS planner must be prepared to provide support or have a plan in place in the event a civilian medical emergency should arise and the military forces are directed to provide support. Without prior planning, the diversion of military medical assets to support civilian medical emergencies will adversely impact the AHS support provided to deployed forces and could potentially overwhelm available medical resources. The AHS plan must not only conform to the tactical commander's concept of operation and scheme of maneuver, it must also be in consonance with the CCDRs theater engagement strategy so that any humanitarian activities conducted are not done haphazardly and are part of the regional strategy for the AO. G EOSPATIAL I NFORMATION D-9. Geospatial information includes hydrological data, elevation data, soil composition, and vegetation. G EOGRAPHY AND W EATHER D-10. The geography and weather factors include climate, weather, terrain (to include urban terrain), and altitude. They may also contain information on possible weather/environmental threats such as earthquakes, volcanoes, monsoons, or other such conditions. C LIMATE AND W EATHER E FFECTS D-11. Information contained in the climate and weather effects includes the effects of extreme heat/cold/humidity; effects of the predominant weather patterns (such as monsoons) on AHS operations (such as MEDEVAC effects of heavy rains or snow; the phase of the moon and its effect on operations (such as fullness/brightness when military forces are infiltrating an area); how the weather may affect enemy biological and chemical warfare agents use; and climatic effects on medical supplies and equipment. T ERRAIN A NALYSIS D-12. Terrain analysis includes determining the effect on friendly/enemy maneuver capability; effect on friendly/enemy ability to sustain health care; effects on timely MEDEVAC; and natural lines of patient drift. Lines of patient drift refers to natural routes along which wounded Soldiers may be expected to go back for medical care from a combat position. (ATPATPArmy Techniques Publications 4-02.2). Terrain analysis also impacts on MTFMTFMilitary treatment facility site selection factors; where the mobility corridors are located and their effects on friendly/enemy actions; effects of weather conditions on terrain/mobility; effect of overhead cover (canopy) and vegetation; effect of projected action on terrain/mobility; and where potential sources of potable water are located. A LTITUDE E FFECTS D-13. Altitude effects include effect of high-altitude operations on force capability, rotary-wing MEDEVAC assets, MEDEVAC procedures and methods (higher incidence of litter evacuation and longer evacuation times for manual evacuation), and standard medical treatment protocols. D ESCRIBE THE B ATTLEFIELD E FFECTS D-14. The purpose of this phase of the IPB process is to analyze and integrate various factors of the OE. Conducting a detailed analysis of these factors helps commanders and planners understand how the significant characteristics the OE can affect friendly and threat operations. The AHS planner will focus on identifying the medical aspects of battlefield effects on friendly and threat forces and operations. L IMITS OF C OMMAND D-15. The AO is the geographic area where the commander is assigned the responsibility and authority to conduct military operations. The AHS planner must identify the—  Geographic AO that may include the macroview or the microview depending upon the level of command and the size of the geographic area.  Total population at risk which includes all U.S. and unified action partners, local civilian population, dislocated persons, DOD and other U.S. governmental employees and or contractors, and nongovernmental organizations personnel. In addition to identifying the total population at risk, the planner must also determine what the supported population at risk is (those individuals/groups deemed as eligible beneficiaries for health care provided by United States Army medical assets. The supported population includes:  All supported U.S. units which include sister Services and elements from U.S. governmental agencies and DOD contractors.  All supported multinational units/elements. This paragraph should discuss unit troop strengths, locations, and missions. It may also include organic medical resources and capabilities; multinational medical assets (military, paramilitary, and civilian) which are approved for use for U.S. personnel; identification of multinational (military, paramilitary, and civilian) requirements; identification of unique medical support requirements (such as endemic diseases in the multinational force that are not present in the deployment [host nation] AO); and the current level of health and dental fitness among the supported populations. For veterinary services, the number of military working and contract dogs and other government owned animals that will be used by the multinational force also need to be identified and included in planning.  All personnel in U.S. custody (detainees).  Others as directed. L IMITS OF THE A REA OF I NFLUENCE AND THE A REA OF I NTEREST D-16. The area of influence and the area of interest are geographic areas from which information is required to facilitate planning. The area of influence and the area of interest usually fall outside the AO and may or may not be applicable to a particular operation. Army Health System support outside the AO includes:  Army Health System support provided by organizations/elements outside of the AO. This can include organizations such as CONUSCONUSContinental United States-support base or other safe haven hospitals, MEDLOG support (Defense Logistics Agency or Army Materiel Command), and global patient regulating support (such as the Global Patient Movement Requirements Center).  Location and time/distance factors for medical resources that could be used for augmenting/ reinforcing/reconstituting AHS units/personnel within the AO. This information can include discussions on units/elements in the CONUSCONUSContinental United States-support base or adjacent AOs.  Coordination and synchronization with command and control assets outside the AO which assures the reach capability within the AHS and the ability to rapidly deploy medical specialty care resources as the need arises in the AO.  Follow-on operations or operations being conducted simultaneously outside the AO which can include a range of military activities. D-17. Army Health System planners—  Identify the level of detail required and the time available to conduct the medical aspects of the IPB process.  Evaluate existing information/intelligence of medical significance and identify intelligence gaps. (Sources include: National Center for Medical Intelligence; Defense Intelligence Agency; the Army Public Health Center; The Office of The Surgeon General, Intelligence and Security Division (division or higher staff for intelligence); country studies; supporting intelligence staff officer/assistant chief of staff, intelligence or military intelligence unit; Central Intelligence Agency World Fact Book; open source information system; tourist maps and brochures; public health resources; World Health Organization; Pan American Health Organization; Department of State; and internet, libraries, and other informational sources).  Identify and submit collection requirements to the supporting intelligence staff section/element/unit.  Collect required information to fill gaps. Note. If medical personnel gain information of potential intelligence value through casual observation of activities in plain view while in the performance of their humanitarian duties, they are required to report it to their supporting intelligence staff officer/assistant chief of staff, intelligence. Population Demographics D-18. Population demographics include the effect on the delivery of health care to supported forces and the effect on the AHS if required to support the local populace and nongovernmental organizations. It also includes the political effects of providing care/not providing care to the host-nation populace, nongovernmental organizations, and dislocated persons and the effects of cultural, religious, or language barriers on medical treatment. Other AHS population demographic concerns include:  Condition of the general population (and or supported population) to include an analysis of the health of the general population and the impact of it on deployed forces; analysis of the infant mortality rate as this serves as an indicator of the overall health of the population; leading causes of death; identification of the status of nutrition; and state of advancement of the medical infrastructure.  What effect will clans, tribes, gangs, opposition groups, or paramilitary organizations/groups and organized crime have on the ability to provide AHS support to deployed forces and other eligible beneficiaries?  What effect/additional requirements will dislocated persons and detained personnel have on the AHS system? This is of particular importance for the operational public health arena as camps require sanitation, pest management, and potable water support. Other requirements include the provision of sick call services, outpatient treatment, hospitalization, MEDEVAC, veterinary technical consultation and support, MEDLOG support (to include sorting, repackaging, inventorying, and disseminating donated medical supplies and equipment), and other functional concerns. Threat Forces Capabilities/Effects D-19. The effects of enemy ideology, goals, and missions includes an analysis of the enemy's will to fight; what they are trying to accomplish and why (military objectives); compliance with the Geneva Conventions (to include respect and protection of medical personnel, units, and transports); type of enemy forces (such as paramilitary, conventional, special operations, and or terrorists); philosophy concerning collateral damage, civilian casualties, disruption of utilities (sewage, waste disposal, sanitation, water, electricity, and gas), and generating dislocated persons. Threat forces capabilities or effects encompass the following:  The threat characteristics include the affects enemy doctrine has on deployed forces, to include AHS personnel and units. This information facilitates forecasting what units/elements/ organizations are most likely to sustain heavy casualties.  Enemy force structure and weapons systems include the analysis of the accuracy and range of enemy weapons systems; analysis of the size and composition of the enemy force; and what types of friendly wounds will be generated by enemy weapons systems (such as piercing, blast injuries, concussion, blunt trauma, burns, or combined injuries).  Enemy medical doctrine and capabilities include the analysis of enemy medical doctrine and capabilities; priority and availability of medical care and MEDEVAC; status of the medical infrastructure and training to accomplish the medical mission; and the potential for the enemy to treat their own casualties or to leave them in the care of friendly forces.  Effects of enemy CBRNCBRNChemical, biological, radiological, and nuclear weapons to include an analysis of enemy CBRNCBRNChemical, biological, radiological, and nuclear capabilities; effect of enemy CBRNCBRNChemical, biological, radiological, and nuclear use on friendly forces; the likelihood of its use; whether the enemy can continue the mission in a CBRNCBRNChemical, biological, radiological, and nuclear environment; and whether the enemy's delivery systems are accurate, reliable, and effective.  Military information support operations and unconventional warfare capabilities and effects include an analysis of the probable impact of psychological operations on friendly forces; analysis of unconventional warfare capabilities; probability of unconventional warfare forces targeting friendly areas and AHS assets/resources; and the effect unconventional warfare will have on the delivery of health care. I NFRASTRUCTURE D-20. The infrastructure includes transportation systems (land, sea, and air); communications systems (telephone, cellular, digital, mass media, and electronic means); and, utilities (water, electricity, and sanitation). T RANSPORTATION D-21. Transportation systems include the effect of available transportation systems on timely MEDEVAC or CASEVAC, MEDLOG supply/resupply operations (to include time-sensitive blood distribution and other perishable and dated pharmaceuticals; analysis of likely avenues of approach; effect of the transportation system on mobility and military operations; effect of military operations on the transportation system; and impact of transportation networks on enemy/friendly courses of action). C OMMUNICATIONS S YSTEMS D-22. Communication systems architecture includes the communications networks that are established in the operational area; the level of technology for these systems; and the level of access of the communications infrastructure by the population (for example, if the civilian population does not have telephones, radios, televisions, or computers, other methods for disseminating public health information and health risk communications information must be established). Utilities D-23. Utilities (water, electricity, and sanitation) include the analysis of water quality (portability) and distributions systems; analysis of the reliability of electrical power generation; effectiveness and efficiency of sanitation systems; effects of enemy/friendly military actions on the utilities infrastructure; and the impact a disruption of utilities would have on the health of the general population and/or deployed forces. Industry D-24. Industry includes the types of industry present, their effect on the economy, and the potential threat from toxic industrial materials either used in the manufacturing process or as an end product. Medical Infrastructure D-25. A checklist for assessing the foreign medical infrastructure is provided in Table D-1 (on page D-7). D-26. A checklist for assessing foreign MTFMTFMilitary treatment facility capabilities and services is provided in Table D-2 (on page D-8). D-27. Analysis of local medical supply and equipment sources includes an analysis of local quantity, quality, and availability of medical supplies and equipment; analysis of the availability of blood and blood products; availability of supplies for use for local populace, dislocated persons, and detained persons (to include donated supplies or those of a nongovernmental organization/intergovernmental organization such as the United Nations); availability of supplies approved for use by U.S. forces; analysis of local medical supply production facilities; impact of military operations on the local medical supply infrastructure; and availability and quality of medical gases.

E-1. The Army Medicine has a long tradition of providing world-class medical care across global operational areas, OEs, and under austere and challenging conditions to the joint force. Wherever an injured or ill Service member is located, the United States Army will project its resources to locate, acquire, treat, stabilize, and evacuate our wounded Service members to MTFs capable of providing world-class health care to enhance the prognosis, mitigate disability, and empower them to lead full and productive lives. E-2. Historically, Army Medicine has provided acute trauma care, curative, restorative, rehabilitative, and convalescent care within the AO. Soldiers were not evacuated for care in the CONUSCONUSContinental United States-support base unless their recovery time exceeded the theater evacuation policy (in some cases up to 60 days). E-3. With the advent of technological innovations in transportation and medicine the last few years, Soldiers can be stabilized and rapidly evacuated from austere OEs to world-class fixed MTFs in CONUSCONUSContinental United States or other safe havens in a matter of hours to days from the time of injury or wounding. These advancements have—  Enabled the essential care in the operational area concept to be implemented.  Reduced the medical footprint present in a deployed setting without reducing the quality of medical care provided to our Soldiers.  Optimized the use of scarce medical resources.  Enabled wounded and ill Soldiers to more rapidly be reunited with their Families and personal support structures to facilitate and enhance the healing process. MISSION FOCUS E-4. The mission of the institutional force is to generate and sustain operational Army capabilities. The Army does not organize the institutional force into standing organizations with a primary focus on specific operations. Rather, when the institutional force capabilities perform specific functions or missions in support of and at the direction of joint force commanders, it is for a limited period of time. Upon completion of the mission, the elements and assets of those institutional force capabilities revert to their original function. E-5. All elements of the Army, whether the institutional force or operational Army, perform functions specified by U.S. law. The Army executes Title 10 and Title 32 USCUSCUnited States Code directives, to include organizing, equipping and training forces for the conduct of prompt and sustained combat operations on land; accomplishing missions assigned by the President of the United States, Secretary of Defense and CCDRs; and changing the force to meet current and future demands. Below is the list of USCUSCUnited States Code Title 10, Armed Forces, Subtitle B, Army functions:  Recruiting.  Organizing.  Supplying.  Equipping (including research and development).  Training.  Servicing.  Mobilizing.  Demobilizing.  Administering (including morale and welfare of personnel).  Maintaining.  Constructing, maintaining, repairing buildings structures, utilities, and acquiring real property and interests in real property necessary to carry out the responsibilities specified in this section. E-6. The Army Medicine serves as a critical link between medical formations in the operational and institutional force to leverage capability and capacity across the Total Army. The Army Medicine and joint force medical formations Service members receive the best health care anywhere in the world. THE SURGEON GENERAL E-7. According to General Order 2020-01, para 37, The Surgeon General is the principal military adviser to the Secretary of the Army and the Chief of Staff of the Army on the health and medical aspects of manning, training, and equipping the Army and serves as the principal military adviser to the Assistant Secretary of the Army (Manpower and Reserves Affairs) for health affairs. E-8. The Surgeon General is responsible for—  Assisting the Assistant Secretary of the Army (Manpower and Reserves Affairs) in developing policies and programs for the Army system for health and planning and supervising the execution of those policies and programs.  Representing Army health policies and military health readiness requirements to DOD, executive departments, Congress, and nongovernmental organizations.  Providing technical advice and assistance to the Secretariat and Army Staff for matters on public health, readiness of the force, warrior transition care, medical force structure and equipping, force development, medical materiel and research and development, medical training and education, medical evacuation, and medical military construction.  Developing and directing the Army’s Planning, Programming, Budgeting, and Execution process for the Defense Health Program.  Assessing Assistant Secretary of Defense for Health Affairs and DHA health affairs policies and programs. DEFENSE HEALTH AGENCY E-9. The DHA is a Tri-Service, integrated combat support agency that enables the United States Army, Navy, and Air Force to provide a medically ready force and ready medical forces to the combatant commands in support competition continuum. The DHA supports the delivery of integrated, affordable, and high quality health services to beneficiaries of the Military Health System and is responsible for driving greater integration of clinical and business processes across the Military Health System. The DHA leads the Military Health System's integrated system of readiness and health to deliver increased readiness, better health, and lower cost. In support of a cohesive, globally integrated, affordable, and high quality Military Health System, the DHA directs the execution of ten joint directorates and manages and administers the following Enterprise Support Activities:  TRICARE Health Plan.  Pharmacy Programs.  Health Information Technology.  Education and Training.  Public Health.  Medical Logistics.  Facility Management.  Budget and Resource Management.  Research, Development, and Acquisition.  Procurement and Contracting. E-10. The DHA's administration of the TRICARE Health Plan provides worldwide medical, dental, and pharmacy programs for over 9.4 million members of the uniformed Services, retirees, and Family members. SUPPORT TO THE TACTICAL COMMANDER E-11. The institutional force fulfills numerous critical roles with regards to supporting the Soldiers deployed in an operational area. Army Medicine organizations conduct operational development activities and medical research and development to discover and field advanced technologies to mitigate the health threat faced by our deployed forces. Army Medicine institutional forces facilitate and enhance medical readiness of Soldiers through the promotion of fitness and healthy lifestyles, the Performance Triad, and the prevention of diseases and injuries. Army Medicine institutional forces provide mobilization and predeployment support to ensure that Soldiers are mentally and physically ready to be deployed (immunizations, predeployment health assessments, dental, vision, and hearing readiness testing and treatment, and health risk communications on health hazards in the operational environment. During deployments, they provide reach back support through medical specialty areas and can deploy teams comprised of physicians, scientists, technicians, and other health care providers to provide solutions to unique health threats or medical conditions and issues occurring during the deployment. EDUCATION E-12. Educational requirements within the health care professions are significantly more complex than in other branches of the Army. Formal accredited schooling is required for fields within Army Medicine and professional education is received in civilian educational and DOD medical organizations. Medical education is a lengthy process, which is often accomplished in phases (such as, medical school, internship, and residency). Medical professionals require credentialing and licensure before they can practice medicine. Credentials are most often obtained from non-DOD affiliated civilian organizations. Health professions also require continuing education to maintain certification. Headquarters, Department of the Army, Office of The Office of The Surgeon General facilitates this process by providing global opportunities to fulfill the continuing education requirements health care professionals across the Total Army. TRAINING E-13. All medical military occupational specialties require school training. Medical skills are perishable and require continual practice and refresher training. The MEDCoE provides military occupational specialty-specific training for award of medical military occupational specialties and provides refresher training for some low-density for Reserve Component forces and United States Army National Guard when mobilized. Additionally, the MEDCoE develops and fields collective training materials and distance learning programs. In some medical specialty areas, the didactic portion is completed at the MEDCoE while the resident phase is conducted at Role 4 MTFs. ARMY MEDICAL ACTION PLAN E-14. Military personnel are treated at DOD MTFs in conjunction with the Department of Veterans Affairs, and civilian medical facilities to provide world-class health care and services for their dedication and sacrifices to the nation. In support of this plan, the Chief of Staff of the Army approved the actions to be implemented to include:  Establish and institutionalize a command and control structure for Service members undergoing long-term definitive, rehabilitative, and convalescent care.  Prioritize mission support and create ownership of actions and processes.  Flex housing policies and focus on Family support issues.  Develop training and doctrine to facilitate and ensure a system which provides timely and effective support.  Create full patient visibility throughout the Army and Military Health Systems continuum of care and facilitate medical information sharing across agencies to improve patient outcomes.  Improve the medical evaluation board process and eliminate delays in the process. E-15. The intent of this action plan is for the Army to provide a continuum of integrated care and services from POIPOIProgram of instruction or wounding, illness, or disease to return to duty or transition from active duty. It is vital that the Army coordinates execution of the necessary changes at the strategic, operational, and tactical level to ensure a simultaneous transformation of care and services over all lines of operations to achieve the desired end state. THE ARMY RECOVERY CARE PROGRAM E-16. The Army Recovery Care Program (ARCP) (formerly the Warrior Care and Transition Program) serves as the proponent for the case management and transition of the Army's seriously wounded, ill, and injured Soldiers. The program provides oversight, guidance, and advocacy for wounded, ill, and injured Soldiers, Veterans, and Families through a comprehensive recovery plan aimed at successful reintegration back into the force or into the community with dignity, respect, and self-determination. The ARCP includes an oversight and policy headquarters (a staff directorate of the U.S. Army Medical Command) and 14 Soldier Recovery Units. E-17. The Soldier Recovery Units (see Figure E-1) are strategically postured at 14 installations aligned to division and corps headquarters with the capacity to manage care for 2,800 active, U.S. Army Reserve and Army National Guard Soldiers. The ARCP provides a total force solution for wounded, ill, and injured Soldiers and the program utilizes multi-component cadre designed to meet the needs of the population. More than 80,000 Soldiers have entered the ARCP, with a population peak of nearly 12,500 Soldiers in 2008. The program's motto, "Recover and Overcome," helps inspire Soldiers that their condition does not define them or their legacy. The health, humanity, dignity and respect of each individual Soldier remains paramount as the program remains scalable to meet future Army requirements. The foundation of the program includes:  Single entry criteria for all components concentrating medical and administrative resources on Soldiers with complex case management requirements.  Program and policy that supports goals and requirements based on individual Soldier requirements and point of recovery.  Advocacy and non-clinical case management through transition to Veteran status and beyond.  A comprehensive recovery plan supported by an interdisciplinary team including military leaders, transition coordinators, adaptive reconditioning specialists, and behavioral health professionals to help Soldiers realize their transition or career goals. SOLDIER RECOVERY UNITS E-18. The Soldier Recovery Unit is a total force solution open to Soldiers, regardless of mechanism of injury (in the line of duty), who meet the single entry criteria. The Soldier Recovery Unit is comprised of four platoons: Headquarters platoon, Complex Care platoon, Veteran Track platoon, and Return to Duty platoon. Each platoon is designed to meet the case management requirements of Soldier Recovery Unit Soldiers, and Soldiers are assigned to platoons depending on the primary stage of their recovery. This organization enables the Soldier Recovery Unit to concentrate personnel and services in accordance with each Soldier's individual recovery requirements. Two critical components of the Soldier Recovery Unit are the Triad of Leadership (TOL) and Triad of Care. E-19. The TOL consists of senior commanders/command sergeants major, MTFMTFMilitary treatment facility commander/MTFMTFMilitary treatment facility ASCCs commanders/command sergeants major, and Soldier Recovery Unit commanders/command sergeants major. Soldier Recovery Unit entry packets are reviewed by the TOL but the senior commander on a Soldier Recovery Unit installation is the final decision authority for Soldier Recovery Unit entry. E-20. The triad of care consists of the Soldier Recovery Unit Medical Provider, nurse case manager, and platoon sergeant/squad leader. The TOL and Triad of Care work together in conjunction with the interdisciplinary team to ensure advocacy for Warriors, continuity of care, and a seamless transition into the force or return to a productive civilian life. This page intentionally left blank.

This appendix depicts and describes a variety of symbols and control measures related to AHS tactical mission tasks. The appendix does not attempt to produce all conceivable combinations for AHS symbols or control measures, but rather, it shows several examples of each type as a starting point. Readers should refer to MIL-STD 2525D and ADP 1-02 for more information about military symbols. F-1. Military symbols are governed by the rules in MIL-STD 2525D. Army Doctrine Publication 1-02 is the Army proponent publication for all military symbols and complies with MIL-STD 2525D. F-2. Army Doctrine Publication 1-02 provides a single standard for developing and depicting hand drawn and computer-generated military symbols for situation maps, overlays, and annotated aerial photographs for all types of military operations. A military symbol is a graphic representation of a unit, equipment, installation, activity, control measure, or tactical task relevant to military operations that is used for planning or to represent the common operational picture on a map, display, or overlay. Chapters 4–7 of ADP 1-02 also provide an extensive number of icons and modifiers for building a variety of framed symbols. Refer to Table F-1 for medical main icons.

This glossary lists acronyms and terms with Army or joint definitions. Where Army and joint definitions differ, (Army) precedes the definition. Terms for which FM 4-02 is the proponent are marked with an asterisk (*). The proponent publication for other terms is listed in parentheses after the definition.

Entries are by paragraph number unless indicated otherwise.

C-15, C-16, C-22, C-23, D-18 P principles of the Army Health System, 1-22, 1-23, 1-50, 2-114, 3-2, 3-51, Chapter 5 Intro R return to duty, 1-28, 1-39, 1-41, Table 6-2, 6-19, Table 7-1, 8-7, 8-9, Table 10-1, 11-5, 11-6, C-8, E-15 roles of care, 1-20, 1-30, 1-32, 2-163, 2-172, 2-176, Table 6-2, 8-5, 8-12, 10-1, 11-1, 11-2, 11-19 T tactical combat casualty care, 1-12, 1-14, 1-15, 1-35, 1-57, 2-148, 3-42, 4-20, 4-46, 4-48, 6-10, Table 6-2, 6-14, Table 10-1, 10-1, A-10, C-23 theater sustainment command, 2-16, 2-18, 2-21—24, 2-26, 2-27, 2-38, 2-41, 12-3 This page intentionally left blank. FM 4-02,C2 08 August 20 25 By Order of the Secretary of the Army: RANDY A. GEORGE General, United States Army Chief of Staff Official: MATTHEW L. SANNITO Acting Administrative Assistant to the Secretary of the Army 2521833 DISTRIBUTION: Active Army, Army National Guard, and United States Army Reserve. Distributed in electronic media only (EMO). This page intentionally left blank. PIN: 080588-002