Army Health System (AHS)

Army Health System

A component of the Military Health System that is responsible for operational management of the health service support and force health protection 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 health service support and force health protection mission requirements for the Army and as directed, for joint, intergovernmental agencies, coalition, and multinational forces. Also called AHS.

Casualty Collection Point (CCP)

A location that may or may not be staffed, where casualties are assembled for evacuation to a medical treatment facility.

Ambulance Exchange Point (AXP)

A location where a patient is transferred from one ambulance to another en-route to a medical treatment facility. This may be an established point in an ambulance shuttle or it may be designated independently. Also called AXP.

Medical evacuation function

Acquire and locate Treat and Stabilize Intra-Theater Medical Evacuation Emergency movement of medical personnel, equipment, and supplies

Clinical laboratory services

Analysis of medical specimens Blood-banking services

Medical laboratory services function

Analytical, investigational, and consultative capabilities Special environmental control and containment Data and data analysis Medical laboratory analysis Deploy modular sections or sectional teams

Veterinary services function

Animal medical care Food protection Veterinary public health

OPERATIONAL CONTROL AND TACTICAL CONTROL

Commanders establish the operational control (OPCON) and tactical control (TACON) command relationships by placing a subordinate unit under the command of another organization for a specified period of time. The OPCON 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. The TACON is a command authority over units made available for tasking that is limited to the detailed direction and control of movements or maneuvers within the operational area necessary to accomplish missions or tasks assigned. The commander establishes these command relationships in an OPORD issued to the subordinate commander and specifies the duration of the relationship in the order. Unless specifically stated in the OPORD, these command relationships do not include ADCON authority and responsibility for the gaining command. Once the duration of the relationship has lapsed, the unit returns to its parent unit.

Dental services function

Comprehensive dental care Operational dental care Emergency dental care Essential dental care Oral maxillofacial surgery

Preventive dentistry

Conduct periodic examination of Soldiers' teeth, gums, and jaw Classify Soldiers' dental conditions in the dental classification system and determine Soldiers' dental readiness status Provide training to Soldiers and units on measures to take to mitigate the adverse impact of dental threats

Conformity

Conformity with the operation order (OPORD) is the most basic element for effectively providing AHS support. In order to develop a comprehensive concept of operations, the medical commander must have direct access to the operational commander. AHS planners must be involved early in the planning process to ensure that we continue to provide AHS support in support of the Army's strategic roles of shape, prevent, LSCO, and consolidate gains. Once the plan is established it must be rehearsed with the forces it supports. In operations with a preponderance of stability tasks, it is essential that AHS support operations are in consonance with the combatant commander's (CCDR's) area of responsibility (AOR) engagement strategy and have been thoroughly coordinated with the supporting assistant chief of staff, civil affairs (CA)

The Principles of Army Health System

Conformity, Proximity, Flexibility, Mobility, Continuity, Control

Continuity

Continuity in care and treatment is achieved by moving the patient through progressive, phased roles of care, extending from the POI or wounding to the CONUS-support base. Continuity of care refers to an attempt to maintain the role of care during movement at least equal to the care provided at the preceding facility. (FM 4-02) Each type of AHS unit contributes a measured, logical increment in care appropriate to its location and capabilities. In recent operations, lower casualty rates, availability of rotary-wing air ambulances, and other mission, enemy, terrain and weather, troops and support available, time available, and civil considerations (METT-TC) factors often enable a patient to be evacuated from the POI directly to the supporting CSH or hospital center. In more traditional operations, higher casualty rates, extended distances, and patient condition may necessitate that a patient receive care at each role of care to maintain his physiologic status and enhance his chances of survival. The medical commander, with his depth of medical knowledge, his ability to anticipate follow-on medical treatment requirements, and his assessment of the availability of his specialized medical resources can adjust the patient flow to ensure each Soldier receives the care required to optimize patient outcome. The medical commander can recommend changes in the theater evacuation policy to adjust patient flow within the deployed setting. A major consideration and an emerging concern in future conflicts is providing prolonged care within all roles of care when evacuation is delayed. The Army's future OE is likely to be complex and challenging and widely differs from previous conflicts. Operational factors will require the provision of medical care to a wide range of combat and noncombat casualties for prolonged periods that exceed current evacuation planning factors

Control

Control is required to ensure that scarce AHS resources are efficiently employed and support the operational and strategic plan. It also ensures that the scope and quality of medical treatment meets professional standards, policies, and United States (U.S.) and international law. As the AHS is comprised of 10 medical functions which are interdependent and interrelated, control of AHS support operations requires synchronization to ensure the complex interrelationships and interoperability of all medical assets remain in balance to optimize the effective functioning of the entire system. Within the AO, the most qualified individual to orchestrate this complex support is the medical commander due to his training, professional knowledge, education, and experience. In a joint and multinational environment it is essential that coordination be accomplished across all Services and unified action partners to leverage all of the specialized skills within the AO. Due to specialization and the low density of some medical skills within the MHS force structure, the providers may only exist in one Service (for example, the United States Army has the only veterinary corps officers in the MHS).

Preventive medicine function

Disease prevention and control Field preventive medicine Environmental health Occupational health Health surveillance and epidemiology Soldier, Family, community (public) health, and health promotion Preventive medicine toxicology Preventive medicine laboratory services Health risk assessment Health risk communication

Hospitalization function

Essential care Triage and emergency care Outpatient services Inpatient care Clinical Laboratory and blood banking Radiology Physical therapy Medical logistics Emergency and essential dental care General and specialty surgery Anesthesia service Pharmacy Nutrition care Behavioral health Patient administration services Consultation

Theater Evacuation Policy

Establishes, in number of days, the maximum period of non-effectiveness (hospitalization and convalescence) that patients may be held within the theater for treatment Established by the Secretary of Defense, with the advice of the JCS, and upon the recommendation of the combatant commander Does not mean the patient will be held in theater for the entire time Patients not expected to RTD in time will be treated, stabilized, then evacuated out of theater as soon as medically feasible

Short theater evacuation policy

Fewer hospital beds required in the theater Greater number of beds required CONUS Creates large demand for intra-theater Air Force evacuation resources Increases requirements for replacements

Medical treatment

First aid Tactical combat casualty care Forward resuscitative surgery Routine sick call Patient holding Casualty prevention measures Medical evacuation Physical therapy

Flexibility

Flexibility is being prepared to, and empowered to, shift AHS resources to meet changing requirements. Changes in plans or operations make flexibility in AHS planning and execution essential. In addition to building flexibility into the OPLAN to support the commander's scheme of maneuver, the medical commander must also ensure that he has the flexibility to rapidly transition from one level of violence to another across the range of military operations. As the current era is one characterized by persistent conflict, the medical commander may be supporting simultaneous actions characterized by different decisive actions, such as offensive, defensive, or stability tasks. The medical commander exercises his command authority to effectively manage his scarce medical resources so that they benefit the greatest number of Soldiers in the AO. For example, there are insufficient numbers of FSTs or FRSDs to permit the habitual assignment of these organizations to each BCT. Therefore, the medical commander, in conjunction with the command surgeon, closely monitors these valuable assets so that he can rapidly reallocate or recommend the reallocation of this lifesaving skill to the BCTs in contact with the enemy and where the highest number of Soldiers will potentially receive traumatic wounds and injuries.

Force Health Protection

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, preventive medicine, and laboratory services. Enabling a healthy and fit force, prevent injury and illness, and protect the force from health hazards.

A longer theater evacuation policy

Greater accumulation of patients and a demand for a larger AHS structure in the theater Increases the requirements for hospitals, engineer support, and all aspects of base development for the AHS Greater proportion of patients returned to duty within the theater, reduces the loss of experienced manpower Longer intra-theater evacuation policy may decrease demand on evacuation assets and system

Behavioral health/neuropsychiatric treatment

Identify and diagnose be-havioral health/neuropsychiatric disorder/disease Stabilize patient

Combat & operational stress control function

Implement combat and operational stress control plan/program Perform combat and operational stress control unit needs assessment Conduct traumatic event management for potentially traumatic event Screen and evaluate Soldiers with maladaptive behaviors to rule out neuropsychiatric/ behavioral health conditions Conduct combat and operational stress restoration and reconditioning programs to include warrior resiliency training Perform command-directed evaluation for Soldier's behavioral health status Screen patients with potential behavioral health issues for signs/symptoms of mild traumatic brain injury

Medical Regulating

Medical Regulating (1) Medical regulating is the actions and coordination necessary to arrange for the movement of patients through the roles of care and to match patients with an MTF that has the necessary HSS capabilities and available bed space. (2) The factors that influence the scheduling of PM include: (a) Patient's medical condition (ability to withstand evacuation). (b) Tactical situation. (c) Availability of evacuation means. (d) Locations of MTFs with special capabilities or resources. (e) Current bed status of MTFs. (f) Surgical backlogs. (g) Number and location of patients by diagnostic category. (h) Location of airfields, seaports, and other transportation hubs. (i) Communications capabilities (to include radio silence procedures). (3) Execution of the medical regulating process at the tactical level is a function of the HQ responsible for coordinating patient evacuation from POI to a Role 2 or higher MTF. This task is often executed by the responsible HQ through the formation of a patient evacuation coordination cell (PECC). (4) Execution of the medical regulation process at the operational level, from MTF to MTF, is conducted by the responsible United States Transportation Command (USTRANSCOM) PM requirements center, in conjunction with the guidance and direction of the affected CCDR

Medical command function

Medical command Communications and computers Task-organization Medical intelligence Technical supervision Regional focus

MEDICAL FUNCTIONS

Medical command and control. Medical treatment (organic and area support). Hospitalization. Medical Evacuation (to include medical regulating). Dental services. Preventive medicine services. Combat and operational stress control (COSC). Veterinary services. Medical logistics (to include blood management). Medical laboratory services (to include both clinical laboratories and environmental laboratories).

Medical logistics function

Medical materiel procurement Class VIII management and distribution Medical equipment maintenance and repair Optical fabrication and repair Blood management (distribution) Centralized management of patient movement items Health facilities planning and management Medical contracting support Hazardous medical waste management and disposal Production and distribution of medical gases

Medical Regulating

Medical regulating is designed to ensure the efficient and safe movement of patients. It is a system that entails identifying the patients waiting evacuation, locating the available beds, and coordinating the transportation means for movement.

Mobility

Mobility is the principle that ensures that AHS assets remain in supporting distance to support maneuvering forces. The mobility, survivability (such as armor plating), and sustainability of AHS units organic to maneuver elements must be equal to the forces being supported. Major AHS headquarters (HQs) in EAB continually assess and forecast unit movement and redeployment. AHS support must be continually responsive to shifting medical requirements in an OE. In noncontiguous operations, the use of ground ambulances may be limited depending on the security threat in unassigned areas and air ambulance use may be limited by environmental conditions and enemy air defense threat. Therefore, to facilitate a continuous evacuation flow, MEDEVAC must be a synchronized effort to ensure timely, responsive, and effective support is provided to the tactical commander. The only means available to increase the mobility of AHS units is to evacuate all patients they are holding. AHS units anticipating an influx of patients must medically evacuate patients they have on hand prior to the start of the engagement.

Principles of the Army Health System

Mobility, proximity, conformity, continuity, and control (FMPC3).

Veterinary services treatment

Preventive care Sick call Combat casualty care Military and contract working dogs hospitalization Medical evacuation

Medical logistics

Provides Class VIII management, requisitioning, and resupply as well as maintenance on medical equipment. Coordinates with supporting medical logistics company and medical detachment (blood support) for required external medical logistics support.

Proximity

Proximity is to provide AHS support to sick, injured, and wounded Soldiers at the right time and the right place and to keep morbidity and mortality to a minimum. AHS support assets are placed within supporting distance of the maneuver forces which they are supporting, but not close enough to impede ongoing operations. To support the operational commander's plan, it is essential that AHS assets are positioned to rapidly locate, acquire, treat, stabilize, and evacuate combat casualties. Peak workloads for AHS resources occur during combat operations.

Roles of veterinary services in a deployed environment

Roles of veterinary services in a deployed environment (includes: 64A (veterinarian), 68T, 68R, and 68S) Veterinary care for military working dogs and other government-owned animals and veterinary preventive medicine capabilities pertaining to zoonotic disease transmissible to man. Medical services provided in the internment facility, to include Veterinary support (food inspection and quality assurance, veterinary preventive medicine, and animal medical care). Mission: The veterinary mission is to execute veterinary service support essential for (FHP) and to project and sustain a healthy and medically protected force; train, equip, and deploy the veterinary force; and promote the health of the Soldier.Primary Task/Purpose: Animal medical care Provide medical care for military working dogs and other government-owned animals.Food protection Ensure quality, food safety, and food defense of food sources for deployed forces.Veterinary preventive medicine Reduce transmission of zoonotic diseases transmissible to man. Capabilities and dependencies Veterinary support for zoonotic disease control, investigation and inspection of subsistence, and animal medical care. Deployment support - falls under chief of staff section Veterinary services personnel serve as the commander's principal consultant and the command's technical advisor for veterinary activities and employment of veterinary assets. This section provides technical supervision of food inspection, animal medical care, and veterinary preventive medicine support. The U.S. Army is the Executive Agent for veterinary services for all Services (DODD 6400.4) (with the exception of food inspection operations on USAF installations). Refer to Table 11-1 for information on veterinary services primary tasks.

Medical Evacuation

System that provides the vital linkage between the roles of care necessary to sustain the patient during transport Accomplished by providing enroute medical care which enhances the individual's prognosis and reduces long-term disability Medical Evacuation occurs at the tactical, operational, and strategic levels and requires the synchronization and integration of service component medical evacuation resources

Army Health System (AHS)

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.

Combat Lifesaver

The combat lifesaver is a nonmedical Soldier selected by his unit commander for additional training beyond basic first aid procedures. A minimum of one individual per squad, crew, team, or equivalent-sized unit should be trained.

OPERATIONAL ENVIRONMENT

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.

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)