FIELD MANUALNO. 8-10-4

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Preface

Purpose

This manual is directed to medical platoon leaders of combat and combat support battalions and cavalrysquadrons. However, the manual applies equally to other medical platoon members in accomplishment oftheir mission. The tactics, techniques, and procedures provided are not all inclusive. They are presentedas modes of operation. This manual provides a starting point from which users should develop or tailortechniques and procedures to fit their specific units.

Standardisation Agreements

This manual is in consonance with the following International Standardization Agreements:

TITLE NATO STANAG

Procedures for Disposition of Allied Patientsby Medical Installations 2061

Medical and Dental Supply Procedures 2128Camouflage of the Geneva Emblem on Medical

Facilities on Land 2931

Proponent

The proponent of this publication is the Academy of Health Sciences, US Army. Submit changes forimproving this publication on DA Form 2028 (Recommended Changes to Publications and Blank Forms)and forward it to Commandant, Academy of Health Sciences, US Army, ATTN: HSHA-TLD, Fort SamHouston, Texas 78234-6100.

Neutral Language

Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to men.

Use of Trade or Brand Names

Use of trade or brand names in this publication is for illustrative purposes only, and does not implyendorsement by the Department of Defense.

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CHAPTER 1

COMBAT ORGANIZATION

Section I. THE DIVISION

1-1. Background

The division is the largest Army fixed organizationthat trains and fights as a tactical team. It isorganized with varying numbers and types ofcombat, combat support (CS), and combat servicesupport (CSS) units. A division may be armored,mechanized, motorized, infantry, light infantry,airborne, or air assault. It is a self-sustaining forcecapable of independent operations, even for longperiods of time, when properly reinforced. Eachtype of division conducts tactical operations in alow-, mid-, or high-intensity combat environment.Divisions are the basic units of maneuver at thetactical level. The AirLand Battle is won or lost bythe division integrated fight.

1-2. Role of the Division

Divisions plan future operations based on theechelons above corps (EAC) and corps commanders’intent; resources are then allocated based onbattalion- and brigade-size units. Divisions defendagainst three or more assaulting enemy divisions.The defending division commander directs,coordinates, and supports operations of his brigadesagainst assaulting regiments. The divisioninterdicts follow-on regiments to disrupt and delaythose forces as they attempt to join the battle.When attacking, the division commander directs,coordinates, and supports operations of his brigadesagainst enemy battalions and regiments. Thedivision interdicts deeper enemy echelons, reserves,and CS forces.

Section II. TYPE OF DIVISIONS

1-3. Armored and Mechanized Divisions

The heavy division of the US Army (armored andmechanized) provide mobile, armor-protectedfirepower. Because of their mobility andsurvivability, the heavy divisions are employed overwide areas where they are afforded long-range andflat-trajectory fire. They destroy enemy armoredforces and seize and control land areas, includingpopulations and resources. During offensiveoperations, heavy divisions can rapidly concentrateoverwhelming combat power to break through orenvelop enemy defenses. They then strike todestroy fire support, command and control, andservice support elements. Using mobility for rapidconcentration to attack, reinforce, or to block, theydefeat an enemy while economizing forces in otherareas. Heavy divisions operate best in open terrainwhere they can use their mobility and long-range,direct-fire weapons to the best advantage (Figurel-l).

1-4. Infantry Division

The infantry division is a combined arms force ofmaneuver, CS, and CSS units. It does not have themechanized assets to close with the enemy’s heavyforces in terrain suitable for mechanized operations;rather it is more effectively employed in terrainfavoring dismounted operations, such as largeurban areas, mountains, and jungles.

1-5. Light Infantry Division

a. The organization of the light infantrydivision provides the flexibility to accomplishmissions on a global basis on different types ofterrain and against a variety of enemy forces (Figure1-2). It differs from the infantry and other divisionsin both design and concept of employment.

b. The light infantry division is the mostrapidly and strategically deployable of the various

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types of US divisions; it is organized to fight as partof a larger force; in conventional conflicts; orindependently in a low-intensity conflict (LIC). Theability of the light infantry division command andcontrol structure to readily accept augmentationforces permits task organizing for any situationfrom low- to high-intensity conflicts. The factors ofMETT-T (mission, enemy, terrain, troops, and timeavailable) will determine the augmentationsrequired for the division.

c. Although employed as an entity, the lightdivision method of operation is to disperse widely inthe area of operations; conduct synchronized, butdecentralized operations primarily at night or

during periods of limited visibility. Mass isachieved through the combined effects ofsynchronized, small-unit operations and fires.Physical concentration (massing) of light divisionforces only occurs when the risk is low and thepayoff is high.

d. At the tactical level, the optimumemployment option is to employ the light force as adivision under corps control. The corps commandermust ensure that the mission assigned to the lightforce capitalizes on its capabilities. The lightdivision conducts operations exploiting theadvantages of restricted terrain and limitedvisibility.

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1-6. Airborne Division

a. The airborne division (Figure 1-3) isorganized to be rapidly deployed anywhere in theworld—

To conduct combined arms combatparachute assault to seize and secure vitalobjectives behind enemy lines until linking up withother supporting forces.

To exploit the effects of nuclear orchemical weapons.

To rescue US nationals besiegedoverseas.

To reinforce forward-deployed forces(if augmented with transportation).

To serve as a strategic or theaterreserve.

To conduct large-scale tactical raids.

To occupy areas or reinforce friendlyor allied units beyond the immediate reach ofground forces.

To capture one or more intermediatestaging bases or forward operating bases for groundand air operations.

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b. The airborne division conducts airborneassaults in the enemy’s rear to secure terrain or tointerdict routes of resupply or enemy withdrawal.It is ideally suited to seize, secure, and repairairfields to provide a forward operating base forfollow-on air-landed forces. It can conduct airassault operations as well as other missionsnormally assigned to infantry divisions.

c. The airborne division achieves surpriseby its timely arrival on or near the battlefield. Withits aircraft capabilities, the Air Force can deliver theairborne division into virtually any objective areaunder most weather conditions.

d. Because the airborne division is tailoredfor airdrop operations, it can be employed morerapidly than other US divisions. All equipment is airtransportable and, except for aircraft, is air-droppable. All personnel are trained for airborneoperations.

e. Special staff considerations must begiven to attack by enemy armor or motorizedformations. The division does not have sufficientarmor protection to defeat heavier armoredformations at close range. Antiarmor weapons inthe division compensate, but do not completelyoffset this deficiency.

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1-7. Air Assault Division

a. The air assault division combinesstrategic and tactical mobility within its area ofoperations. The air assault division conductscombat operations over extended distances andterrain obstacles using infantry, aviation, CS, andCSS units (Figure 1-4).

b. Airmobile divisions provide the US Armythe operational foundation, experience, and tacticsfor air assault division operations. However, the airassault division no longer merely conductsairmobile operations. It is important to recognizethe distinction between airmobile and air assault.Airmobility is the use of Army aircraft to improveour ability to fight; such as moving troops andequipment from one secure area to another, then

helicopters departing the area of operation.Conversely, air assault operations involve combat,CS, and CSS elements (aircraft and troops)deliberately task organized for tactical operations.Aircraft are the prime movers and are integratedwith ground forces. Additionally, air assaultoperations involve actions under hostile conditions,as opposed to air movement of troops to and fromsecure locations.

c. Once deployed on the ground, air assaultinfantry battalions fight like those of the infantrydivision; however, the task organization of organicaviation permits rapid aerial redeployment. Theessence of air assault tactics is the rapid pace ofoperations over extended ranges. Execution ofsuccessive air assault operations enable the divisioncommander to seize and maintain the tacticalinitiative.

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Section III. THE DIVISION STAFF

1-8. The Division Commander

The division commander is responsible foreverything the division does. He assigns missions,delegates authority, and provides guidance,resources, and support to accomplish the mission.

1-9. Assistant Division Commanders

Within a division there are two assistant divisioncommanders (ADCs). The division commanderprescribes their duties, responsibilities, andrelationships with the staff and subordinate units.Normally the responsibilities are broken down asoperations and training (or maneuver) and support.Thus, commonly a division will have an assistantdivision commander for operations and training

(ADC-OT) (or maneuver, ADC-M) and an assistantdivision commander for support (ADC-S).

1-10. Chief of Staff

The chief of staff directs the efforts of both thecoordinating and special staffs. His authorityusually amounts to command of the staff.

1-11. Staff Sections

The command sergeant major, Gl, G2, G3, and G4function at division level in much the same waytheir counterpart staffs function at battalion andbrigade level (Figures 1-5 and 1-6). The G5 is thecivil-military operations officer. This position isnormally authorized only at division level andhigher. For a detailed discussion of stafforganization and functions, see FM 101-5.

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1-12.

Section IV. THE BRIGADE

Organization of the Armored or Mechanized a. Divisional Brigades.Infantry Brigade

The armored or mechanized infantry brigade is acombination of armored and mechanized battaliontask forces (TFs) and other supporting unitsgrouped under the command of a brigadeheadquarters. It participates in division or corpsoperations according to the principles and conceptsset forth in FM 100-5 and FM 71-100.

(1) Close combat-heavy brigades arethe major subordinate maneuver commands ofarmored and mechanized infantry divisions. Theonly permanent unit assigned to a brigade is itsheadquarters and headquarters company (HHC).The HHC provides direction and control over unitsassigned to, attached to, or supporting the brigade.

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(2) Divisional infantry, armored, and An armored cavalry troop formechanized battalions are attached to brigades: to reconnaissance, security, and economy-of-forcedestroy the enemy; and to seize and hold terrain. operations.Normally, each brigade can control three or fourmaneuver battalions with their CS and CSS units. A direct support FA battalionWhen it is necessary to concentrate forces, control of to provide fire support.more battalions may be necessary. However, thebattalions assigned to a brigade must be limited to a An engineer company fornumber that can be controlled in a very complex combat engineer support.battle situation.

(3) With the addition of light infantrydivisions to the force structure, the divisioncommander may attach light infantry battalions tothe heavy brigade for specific missions and for ashort duration. Use of light forces requires carefulconsideration of key employment and logisticssupport.

(4) While the divisional brigade has nofixed slice of CS and CSS assets, it usually operateswith a proportional share of the division’s assets.Combined arms operations are conducted wheneverappropriate. Normally, brigade support is providedby: a direct support (DS) field artillery (FA)battalion; an air defense artillery (ADA) battery; anengineer company; a forward area signal platoon; amilitary police (MP) platoon; combat intelligenceand electronic warfare (IEW) elements; a tactical aircontrol party (TACP); and a division supportcommand (DISCOM) forward support battalion(FSB). Attack helicopter units may also operatewith the brigade. When sorties are allocated forplanning, United States Air Force (USAF) tacticalair operations support the brigade.

b. Separate Brigades.

(1) Since separate brigades conductoperations under corps command, they areorganized to provide their own support. Unitsorganic to the separate brigade include—

A brigade HHC to providecommand and control (C2) and limited CS assets toinclude MP, chemical, and air defense (AD)elements.

Tank and mechanizedbattalions to fight battles, destroy or disrupt enemyforces, and seize and hold terrain.

A military intelligence (MI)company to assist in collecting, processing, anddisseminating intelligence, and to support EWoperations.

A support battalion organizedto provide CSS in the same way as the DISCOM’sFSB provides CSS to divisional brigades; but withthe added ability to link directly with corps supportcommand (COSCOM) for augmentation.

(2) Additional combat, CS, and CSSunits may be attached to a separate. brigade asrequired by the brigade’s mission and operatingcircumstances. The separate brigade may beattached to a division (less support) but is usuallycontrolled by a corps.

1-13. Organisation of Infantry Brigades

a. Divisional Brigades.

(1) Infantry, airborne, or air assaultbrigades are the major subordinate maneuvercommands of infantry, airborne, or air assaultdivisions.

(2) Normally, there are three or fourbrigades assigned to an infantry division, dependingon operational requirements; however, most oftenthere are three.

(3) Combat support and CSS areprovided to the brigade by the division Normally,field artillery support is provided by a light fieldartillery DS battalion. An engineer company, aforward area signal center platoon, combatelectronic warfare and intelligence elements, anddivision support command forward supportelements also routinely support a brigade. Fromtime to time, attack helicopter units and USAFbombers may operate in support of the brigade.

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b. Separate Brigades.

(1) Since separate brigades sometimesconduct independent operations, they are organizedto provide their own support. Each is generallyorganized with—

A brigade HHC to providecommand and control.

Infantry battalions to destroythe enemy and to seize and hold terrain.

A support battalion withseveral support units to provide CSS.

A combat electronic warfareand intelligence company to assist in collecting,

processing, and disseminating intelligence, and tosupport electronic warfare operations.

A light field artillery battalionto provide fire support.

An engineer company forcombat engineer support.

An armored cavalry troop forreconnaissance, security, and economy of forceoperations.

(2) Additional combat, CS, and CSSunits may be attached to the separate brigade asrequired. The separate brigade may be attached to adivision or placed under the control of a highercommand such as a corps.

Section V. THE BATTALION

1-14. Organization of the Infantry Battalion

a. Organization. An infantry battalion isorganized and equipped to give it the capabilitiesneeded to accomplish its missions. It is large enoughto engage enemy regiments using a full range oforganic and nonorganic weapons and support. Alsoit is small enough that the battalion commander canpersonally lead and immediately influence theaction of his units in battle.

(1) To understand the organizationalstructure of the battalion, one must understand theorganization roles of echelons above and below thebattalion and how the battalion serves as theinterface for these echelons.

(2) Within the context of organizationalroles, platoons normally fight as part of a company.Companies fight using their subordinate platoons asfire or maneuver elements. Battalions providesupport to the companies; ensure the battlefield hasdepth and synchronize the various arms andservices to achieve the maximum effect from theavailable forces. The brigade task-organizes thebattalion, fitting the forces to the ground, mission,and enemy situation. Divisions provide CS and CSS

force multipliers. Corps conducts operational levelwarfare, providing additional CS and CSS assets inaccordance with the corps main effort.

(3) To execute AirLand Battle doctrine,the infantry battalions require: adequate troopstrength; an organic antiarmor capability;supporting arms; optimized task organization basedupon the mission; and adequate support. Theserequirements are met through the organization ofthe infantry battalions and through augmentationand task organization where required.

b. Types of Battalions. There are six basictypes of nonmechanized/nonmotorized infantrybattalions: infantry, air assault, airborne, ranger,light, and mountain (Figures 1-7, 1-8, and 1-9). Thefundamental combat mission of the infantrybattalion, regardless of type, is to destroy orcapture the enemy by fire and maneuver. Toaccomplish specific missions, the battalion isnormally augmented with combat, CS, and CSSassets.

c. Task Organization. Normally, infantrybattalions operate as table of organization andequipment (TOE) units only in garrison. Fortraining and for combat, they are task organized for

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the mission at hand. Task organizing tailors the unit control (OPCON) to the subordinate. Taskto get the most from its capabilities and to minimize organization is made after analyzing theits limitations. It is a temporary grouping of forces considerations of METT-T. When developing thedesigned to accomplish a particular mission. Task task organization, the commander must clearlyorganization involves the distribution of available understand the capabilities and limitations of hisassets to subordinate control headquarters by organic and supporting units; he must consider theattaching or placing assets under operational existing command and control relationships.

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1-15. Organization of the Mechanized Infantry andArmor Battalions

Mechanized infantry battalions and armoredbattalions are organized, equipped, and trained toaccomplish specific missions; each type battalionhas unique capabilities and limitations (Figure 1-10and 1-11).

a. Mission.

(1) The missions of mechanized

configuration are—

(a) The mission of the mechanized

infantry and armored battalions in their pure

infantry battalion is to: destroy or capture theenemy by means of fire and maneuver; or repel hisassault by fire, close combat, and conterattack.

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(b) The mission of the armoredbattalion is to close with and destroy enemy forcesusing fire, maneuver, and shock effect; or repel hisassault by fire and counterattack.

(2) Battalion TFs accomplish missionsand tasks as part of a brigade’s operation.Occasionally, TFs will conduct operations directlyunder a division’s or an armored cavalry regiment’scontrol; such as, participating in the higherheadquarters covering force; acting as a reserve; orforming a tactical combat force in rear areaoperations.

b. Capabilities.

(1) The capability of the armored andmechanized infantry battalions is increased throughtask organization. Based on situational estimates,the brigade commander task-organizes armored andmechanized infantry battalions by cross-attachingcompanies between these units. As a rule, cross-attachment is done at battalion, because it has thenecessary command, control, and supportcapabilities to employ combined arms formations.The brigade commander determines the mix ofcompanies in a TF. Similarly, the TF commandermay cross-attach platoons to form company teamsfor specific missions.

(2) Tank and mechanized infantrybattalion TFs apply their mobility, fire power, andshock effect to—

Conduct sustained combatoperations in all environments.

Accomplish rapid movementand limited penetrations.

Exploit success and pursue adefeated enemy as part of a larger formation.

Conduct security operations(advance, flank, or rear guard) for a larger force.

Conduct defensive, retrograde,or other operations over assigned areas.

Conduct offensive operations.

c. Limitations.

(1) Because of the high density oftracked vehicles, the battalion has the followinglimitations:

Mobility and fire power arerestricted by urban areas, dense jungles and forests,very steep and rugged terrain, and significant waterobstacles.

Strategic mobility is limited bysubstantial quantities of heavy equipment.

Consumption of supply itemsis high, especially Classes III, V, and IX.

(2) Battalions are task-organizedaccording to mission; they are routinely augmentedto improve engineer, fire support, air defense,intelligence, and CSS capabilities.

1-16. Battalion Task Force on the AirLandBattlefield

a. The foundation of AirLand Battledoctrine at the TF level is classical maneuverwarfare. In its simplest form, maneuver warfareinvolves using a part of the force to find, then fix orcontain the enemy, while the remainder of the forceattacks his weakest point—usually a flank or therear. The goal is to mass enough combat power atthe critical place and time to destroy or threaten theenemy with destruction, while preserving freedomfor future action.

b. The TF commander must understand theintent of the brigade and division commander toproperly employ his force. The TF commanderdevelops his intent and concept and accepts risks toachieve decisive results. He seizes the initiativeearly and conducts offensive action aimed atimposing his will on the enemy. The objective of hismaneuver is to position strength against weakness,throw the enemy off balance, and aggressivelyfollow-up to defeat and destroy the enemy.

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Section VI. THE BATTALION STAFF

1-17. Command and Control Responsibilities of theBattalion

The commander establishes a standard commandand control system by defining the functions of keyindividuals, organizations, and facilities. Heorganizes his staff in a manner to accomplish themission. He will develop a basic organizationflexible enough to be modified to meet changingsituations. This section discusses the individual andstaff functions and responsibilities and how they areorganized to facilitate command and control.

1-18. Staff

a. Commander. The commander commandsand controls subordinate combat, CS, and CSSelements that are organic or attached to his unit orunder its OPCON. The commander’s main concernsare to accomplish his unit’s mission and to ensurethe welfare of his soldiers.

(1) The commander cannot win thebattle alone. He must rely on his staff andsubordinate commanders for advice and assistancein planning and supervising operations. He mustcompletely understand their limits and capabilities.He must train subordinate commanders to executehis concept in his absence. Also, he must cross-trainhis staff to continue unit operation when staffelements suffer combat losses.

(2) The staff reduces the demands onthe commander’s time; they assist him by–

Providing information.

Making estimates andrecommendations.

Preparing plans and orders.

Supervising the execution oforders issued by, or in the name of, the commander.

The commander assigns clear-cut responsibility forfunctions to unit staff officers to ensure thatconflicts do not arise. As a rule, staff officers are

delegated the authority to say “yes” to requests bysubordinate unit commanders. They defer tocommand prerogatives when the answer is “no.”The staff must be responsive to subordinate unitcommanders.

b. Executive Officer. The executive officer(XO) is second in command and the principalassistant to the battalion commander. The XO isprepared to assume the duties of the commander.He formulates and announces staff operatingpolicies and ensures the commander and staff areinformed on matters affecting the command. Heensures that —

Required liaison is established.

All staff officers, unless otherwiseinstructed by the commander, inform him of anyrecommendations or information they gave directlyto the commander; or any instructions they receivedirectly from the commander.

He represents the commander, when required, andexercises supervision of the tactical operationscenter (TOC) and its operations.

c. Command Sergeant Major. The commandsergeant major (CSM) is the senior NCO in the unit.He acts in the name of the commander when dealingwith other NCOs in the unit; he is the commander'sprimary advisor concerning the enlisted ranks. He isnot an administrator, but must understand theadministrative, logistical, and operational functionsof the unit to which he is assigned. Since he isnormally the most experienced soldier in the unit,his attention should be focused on operations,training, and how well the commander's decisionsand policies are being carried out. He is the seniorenlisted trainer in the organization, He coaches andtrains first sergeants and platoon sergeants; heworks very closely with company commanders inthis regard. He maintains close contact withsubordinate and attached unit NCOs. The CSM mayact as the commander’s representative insupervising critical aspects of an operation. Forexample, he may help control movement through abreach in an obstacle; at a river crossing, or mayassist in passage of lines. The CSM normally leadsthe advance/quartering party during a major

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movement. He may also help in the CSS effortduring the battle.

1-19. Coordinating Staff

a. S1 (Adjutant).

(1) The S1 has primary responsibilityfor all personnel matters. This responsibilityincludes maintenance of unit strength and personnelservice support. He is responsible for replacementpolicies and requirements; unit strength and lossestimating; morale support; and battalionadministration. The S1 exercises staff supervisionof medical, legal, religious, safety, and civil affairs(including civilian labor) assets. Additionally, hemonitors postal services and public affairs. The S1is responsible for administrative support for enemyprisoners of war, civilian internees, and staffsupervision of casualty evacuation.

(2) The S1 operates from the fieldtrains with the S4. He shares supervisoryresponsibility for logistics operations with the S4.The S1 and S4 must cross-train to be able to conductcontinuous operations. The term "operate” does notmean that the S1 stays at one location at all times;he will move around as necessary to accomplish hismission.

b. S2 (Intelligence Officer). The S2 exercisesoverall staff responsibility for intelligence. Heprepares the intelligence preparation of thebattlefield (IPB) with the commander and S3using—

Higher collection sources.

Ground and aerial reconnaissance.

Observation posts.

Ground surveillance radar.

Target acquisition.

Electronic warfare assets.

In conjunction with the IPB process, he preparesand disseminates intelligence estimates.

c. S3 (Operations and Training Officer). TheS3, as the operations officer, is the commander’sprincipal assistant for coordinating and planningthe battle. The S3–

Monitors the battle.

Makes sure that CS assets areprovided when and where required.

Anticipates developing situations.

He advises the commander on—

Combat and CS matters.

Organization and training.

Operational matters during thebattle.

He prepares the operations estimate and conductsplanning and coordination with other staff sectionsresulting in published operation orders, operationsplans, and training programs. In conjunction withhis planning duties, he is responsible forpsychological operations (PSYOP); electronicwarfare (EW) activities, operations security(OPSEC); deception; and (in conjunction with theS4) tactical troop movement. He establishespriorities for communications to support tacticaloperations and coordinates with XO and battalionsignal officer on the location of the main commandpost (CP).

d. S4 (Logistics Officer). The S4 has primarystaff responsibility for determining CSSrequirements and priorities. His section isresponsible for the procurement, receipt, storage,and distribution of supplies; for transportation ofunits, personnel, and CSS items to their requiredlocations. He designates lines of movement andlocations of CSS elements; prepares and developsCSS plans in concert with the current tactical plan.The S4 is responsible for the preparation,authentication, and distribution of CSS supportplans and orders when published separately. The S4establishes the requirements for civilian labor andthe collection and disposal ofsalvage, and captured material.

excess property,

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e. Battalion Maintenance Officer. Thebattalion maintenance officer (BMO) plans,coordinates, and supervises the maintenance andrecovery efforts of the maintenance platoon andensures that adequate maintenance support isprovided to the TF. Although a staff officer in thebattalion headquarters, he is also the maintenanceplatoon leader. The maintenance warrant officerassists the BMO by providing technical assistanceand supervision of the maintenance platoon. TheBMO supervises the unit maintenance collectionpoint (UMCP) in the armored and mechanizedinfantry battalions only.

1-20. Special Staff

a. S3 Air. The S3 air, the principal assistantto the S3, is normally in the TOC. He assumes theduties of the S3 in his absence. He coordinates theemployment of close air support (CAS) with the firesupport element (FSE) and the TACP, as well as theair defense section leader.

b. Nuclear, Biological, and ChemicalPersonnel. The assistant S3/chemical officer isassigned to the S3 section of combat battalions witha chemical NCO as his assistant. A decontaminationspecialist is assigned to the HHC of airborne and airassault battalions. The chemical officer and NCOtrain and supervise the battalion decontaminationcrew. During combat operations, chemical personnelprovide a 24-hour capability within the S3 section toreceive, correlate, and disseminate information onnuclear, biological, and chemical (NBC) attacks.They consolidate subordinate units’ operationalexposure guide (OEG) radiation status and report tohigher headquarters as required. They providerecommendations concerning mission-orientedprotection posture (MOPP) levels and employmentof supporting NBC reconnaissance and smoke units.If the unit comes under NBC attack, battalion NBCpersonnel organize and establish a battalion NBCcenter, supervise activities of radiological surveyand monitoring teams; chemical detection teams;and coordinate and supervise decontaminationmissions conducted with or without support leveldecontamination assets.

c. Tactical Intelligence Officer. The tacticalintelligence officer works under the supervision ofthe S2; he is part of the two-man battalioninformation coordination center (BICC). The BICC’S

primary responsibility is to manage the unitintelligence collecting, processing, anddisseminating effort for the S2. The BICC developsand initiates the reconnaissance and surveillance(R&S) plan; identifies requirements that cannot bemet by the battalion’s assets; and notifies thebrigade S2.

d. Battalion Communications-ElectronicsStaff Officer. The battalion communications-electronics staff officer (CESO) advises thecommander and staff officers on allcommunications-electronics matters. He plans,manages, and directs all aspects of the unitcommunications systems. The CESO exercises staffsupervision over the communications activities ofsubordinate and attached units; he plans andsupervises the integration of the unitcommunications system into the communicationssystems of higher, lower, and adjacentheadquarters.

e. Surgeon. The surgeon advises and assiststhe commander on matters concerning conservationof the fighting strength of the command to includepreventive, curative, retroactive care, and relatedservices. The surgeon (medical platoon leader), withthe aid of the physicians’ assistant, operates thebattalion aid station (BAS) at the combat trains. Heand medical assistants provide training for themedical platoon; treatment for the wounded andsick; and information on the health of the battalionto the commander. A Medical Service Corps officer,field medical assistant, assisted by the platoonsergeant, handles the administration and logisticsof the medical platoon. Refer to Appendix A fortraining procedures.

f. Chaplain. The chaplain is normally amember of the commander’s personal staff and hasdirect access to the commander. The chaplainexercises the necessary staff authority fordeveloping, coordinating, and executing theReligious Support Plan. The chaplain advises thecommander and staff on matters of religion, morals,and morale, and on the influence of indigenousreligious groups and customs on the commander'scourses of action. Additionally, the chaplainfacilitates soldiers’ free exercise of their religiousrights, beliefs, and worship practices, and makesrecommendations for ethical decision-making andmoral leadership programs (FM 16-1).

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1-21. Other Staff Assets

a. Headquarters and HeadquartersCompany Commander. The HHC commander hasthe responsibility of ensuring that the commandfacilities are provided logistical support (Figure1-12). Normally, he places his XO with the main CPto supervise support, security, and movement. Helocates himself at the field trains to monitor andcoordinate all battalion activities there. He usesland lines and messengers to control all elements in

the field trains and communicates with the combattrains using the administration/logistics net (afrequency modulation (FM) radio net). The HHCcommander is available for other tactical missionsas dictated by the estimate of the situation. Theseroles normally come into play during operationsother than sustained ground combat. They mayinclude coordination and control of thereconnaissance/counter-reconnaissance effort;combat patrols; or any other task designated by thebattalion commander.

b. Fire Support Officer. The integration offire support into the maneuver operation is adecisive factor in the success of battle. Themaneuver commander is responsible for the whole ofhis operation including the fire support plan. Thefire support officer (FSO) is responsible for advisingthe commander on the best available fire supportresources; for developing the fire support plan; forissuing the necessary orders in the name of thecommander and for implementing the approved firesupport plan. The FSO normally locates with thecommander, but it may be necessary to locate wherehe can communicate best.

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c. Air Defense Artillery Officer. The seniorleader of any supporting ADA unit(s) advises thecommander on employment of ADA assets. Duringthe planning process, he is at the main CP to ensurethe integration of air defense into the concept ofoperation. During the execution of the plan, hepositions himself to best command and control theair defense assets. He monitors the command net toremain responsive to the needs of the commander.He also monitors the early warning net to assist inthe acquisition and dissemination of early warninginformation as a member of the Army airspacecommand and control system.

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d. Engineers. The leader of the supportingengineer unit advises the commander onemployment of engineer assets. During the initialplanning, he is at the TOC to advise the cornmanderon employment of his unit. During the battle, theengineer unit provides a representative with a radioat the TOC, if possible, to coordinate the engineereffort. If no representative is available, the TOCperiodically monitors the engineer net. Regardlessof the system used, the engineer leader isresponsible for maintaining constantcommunications with the battalion.

e. Antiarmor Company Commander/Platoon Leader (Light Battalion). This leaderadvises the commander on the tactical employment

of his weapon systems. He may serve as a fourthmaneuver element or as an alternate battalion CPwhen properly task-organized.

f. Scout Platoon Leader. He advises thecommander and the S2 on the employment of hiselement. He is responsible for conducting tacticalreconnaissance in support of the battalion.

g. Battalion Mortar Platoon Leader. Headvises the battalion commander and the FSO ontactical employment of the battalion mortarplatoon; he may assist the FSO with his fire supportcoordinator (FSCOORD) responsibilities. Hisplatoon headquarters may also serve as an alternateCP.

Section VII. THE DIVISIONAL ARMORED CAVALRY

1-22. Mission

The squadron is employed under divisional control.The squadron or any of its troops may betemporarily attached to or placed under the controlof a brigade, although this should not be routine.The squadron will locate itself based on its missionand whom it is supporting. Subordinate elements ofthe squadron are organized for combat and used asdictated by the factors of METT-T. At squadronlevel, this occasionally involves cross-attachment ofplatoons between cavalry troops and augmentationwith armored or mechanized infantry companies.Normally troops operate as organized.

1-23. Divisional Armored Cavalry Squadron

a. Organization. An armored cavalrysquadron assigned to an armored or mechanizedinfantry division contains a headquarters andheadquarters troop (HHT), two armored cavalrytroops, and two air cavalry troops (Figure 1-13).

b. Organization for Combat. The squadronmay be used as organized or reinforced, as is the

regimental armored

SQUADRON

cavalry squadron. Thesquadron is normally under division-d control. Thesquadron or one of its troops may be temporarilyattached to or placed under OPCON of a brigade.Subordinate elements of the squadron are organizedfor combat and used in the same way as subordinateelements of the regimental armored cavalrysquadron. Squadron command and control parallelsthat of the regiment, differing only in scope ofoperations and level of command.

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CHAPTER 2

THE ARMORED CAVALRY

Section I. ARMORED CAVALRY REGIMENT

2-1. Organization

The armored cavalry regiment (ACR) is used by thecorps commander as a reconnaissance and securityforce; it is strong enough to engage in decisivecombat to help achieve his overall goal of destroyingthe enemy’s cohesion and will to fight. The ACR isthe self-contained force around which the coveringforce is built. Further, it provides an economy-of-force structure for use in the main battle area(MBA) for offensive and defensive operations.

2-2. Organization for Combat–Armored CavalryRegiment

The ACR provides the economy-of-force structureupon which to build the covering force organization(Figure 2-l). The ACR is augmented by other corpsand division assets as required. Assets well-suitedto reinforce the ACR are ADA, FA, engineers,attack helicopters, and tactical aircraft. Thecovering force makes maximum use of these assetsbecause of their range; their ability to be appliedquickly to relieve stress;additional pressure as

Section II.

and their ability to applythe battlefield situation

dictates. Armor-heavy maneuver battalions fromthe division may also augment the covering force;however, the combat power available for the MBAmust not be diluted.

REGIMENTAL ARMORED CAVALRY SQUADRON

2-3. Organization-Regimental Armored CavalrySquadron

The regimental armored cavalry squadron containsa HHT, three armored cavalry troops, an armoredcompany, and a self-propelled 155-mm howitzerbattery (Figure 2-2). The squadron usually functionsas part of its parent regiment, but may operateseparately.

2-4. Organization for Combat

a. The regimental squadron may bereinforced with maneuver, CS, and CSS units as isthe regiment. It is usually reinforced by units oneorganizational size lower than provided a regiment.Whereas the regiment is reinforced with one or moremaneuver battalions or TFs, a squadron normallyreceives a company or team.

b. The squadron usually functions as part ofits parent regiment, but may be attached to anotherregiment, a brigade, or higher headquarters. Thesquadron’s mission and location in relation to itsparent regiment are the determining factors. It maybe used as organized or it may be reinforced.

c. The squadron can conductreconnaissance missions; security missions;offensive or defensive missions as an economy force.It can attack autonomously, or can supplement theattack of other maneuver forces. Its mobility andfirepower suit it for exploitation and pursuitmissions. In the defense the cavalry, with itscombined arms organization through troop level, iswell-suited as an economy-of-force element to delayover extended frontages; to defend secondaryavenues of approach; or to fight beside divisional

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FM 8-10-4

units from battle positions (BP) as part of the movement on multiple routes. Further, theseregiment. Its organic systems provide long-range capabilities make the cavalry a potentantiarmor engagement capability. Its tactical counterattack force.mobility facilitates rapid lateral or in-depth

Section III. ARMORED CAVALRY REGIMENT MEDICALCOMPANY DIVISION-LEVEL HEALTH SERVICE SUPPORT

2-5. Mission

The mission of the ACR medical company is toprovide division-level health service support (HSS)within the ACR. This HSS includes medical staffadvice and assistance, and unit-level HSS on an areabasis to all assigned and attached elementsoperating in the regiment area (Figure 2-3).

2-6. Capabilities

This unit provides—

a. Command and control of attachedmedical elements, to include medical planningmedical policies; support operations, as well ascoordinating movement of patients within and outof the regiment area.

b. Advice to the regiment commander andsupport squadron commander on the health of thecommand and medical matters affecting theregiment.

c. Coordination for corps-level medicalsupport operations within the regiment.

d. Development, preparation, andcoordination of the medical portion of the regimentplans and policies.

2-2

e. Allocations of medical resources(personnel and equipment) to all assigned andattached units of the regiment.

f. Triage, initial resuscitation/stabilization,and preparation for further evacuation of sick,wounded, battle fatigued, or injured patientsgenerated in the regiment rear area.

g. Ground evacuation for patients fromEchelon I (unit-level) treatment squads to EchelonII (regiment/division-level) medical treatmentfacilities (MTFs).

h. Treatment squads, for limited periods oftime, to provide support to forces involved in rearbattle combat operations or performingreconstitution/reinforcement operations asappropriate. Regiment (division)-level HSS will bereduced during periods when the treatment squad(s)is used to reconstitute/reinforce appropriate units.

i. Division-level medical supply, medicalequipment maintenance repair parts, and medicalequipment maintenance support to regiment andattached units on an area basis. The regimentmedical supply section (RMSS) maintains a 5-daystock of emergency PUSH packages and individualmedical items. Normal resupply of medical units (forexample, medical platoons/sections) will occur every

FM 8-10-4

five days with PUSH packages until the corpsmedical supply, optical and maintenance unit(MEDSOM) or medical logistics (MEDLOG)battalion is established.

j. Emergency dental care to includetreatment of maxillofacial injuries, sustainingdental care designed to prevent or interceptpotential dental emergencies, and limitedpreventive dentistry.

k. Laboratory and radiology servicescommensurate with the regiment (division)-level ofmedical treatment.

l. Patient holding for up to 40 patientsawaiting evacuation or who will return to dutywithin 72 hours.

m. Outpatient consultation services forpatients referred from unit level HSS facilities.

Section IV. SQUADRON (UNIT) LEVEL HEALTH SERVICE SUPPORTARMORED CAVALRY SQUADRON

2-7. Medical Platoon the squadron surgeon. He is assisted by a MedicalService Corps lieutenant and a warrant officer (WO)

a. The medical platoon sorts, treats, and physicians’ assistant (PA). The squadron surgeon isevacuates the sick and wounded. It stocks medical supervised by the S1. He must understand thesupplies for the squadron and provides all Class scheme of maneuver and the planned disposition ofVIII support. It also performs organizational the units to support the operation. See Figure 2-4 formaintenance and evacuation for all squadron the organizational staffing of the squadron medicalmedical equipment. The medical platoon is led by platoon.

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FM 8-10-4

b. Aidmen attached to troops giveemergency medical treatment and ensure thatpatients who must be evacuated are prepared andpromptly moved. While the troop can establish anaid post, it primarily sorts casualties and evacuatesinjured personnel.

c. An armored ambulance from the medicalplatoon evacuation section normally evacuatespatients requiring further treatment to thesquadron medical aid station.

2-8. Employment

a. The squadron aid station is located as farforward as possible, normally with the squadroncombat trains. It should be in an area providingcover and concealment and near concealedhelicopter landing areas. The squadron aid station issupervised by a physician and a PA. Here, triage isperformed so that the most seriously wounded arecared for first.

b. The platoon has a M577 command postcarrier, which serves as the aid station. Otherplatoon vehicles include two M35A2 cargo trucks, aM998 HMMWV, and eight M113 ambulances. Thetreatment squad may operate as two treatmentteams; however, doing so requires one team to usethe HMMWV. A common configuration places onetreatment team with the M577 in the combat trainsas the primary aid station. The other team operatesnear the forward area rearm and refuel point(FARRP).

c. The medical platoon leader of an armoredcavalry squadron has perhaps the most difficult joba medical platoon leader can have. He must supporta unit which is by nature faster, more autonomous,and more audacious than any divisional unit. Toeffectively meet this challenge requires initiativeand flexibility. Preestablished medical supportconcepts which work for other units may not alwaysbe effective in a cavalry unit. What follows are anumber of general guidelines. The key lies intailoring these concepts and developing new ones.The goal is to develop the best system for eachspecific unit and each anticipated tactical situation.

Aid station/treatment squad.Operate a primary aid station from the M577 in the

combat trains. The physician/platoon leader shouldbe with this team. The PA and his team shouldoperate near the FARRP using the HMMWV fortransportation.

Aidman section. The aidman sectionof a cavalry squadron consists of eleven combatmedics. One medic locates in the troop trainsmoving with either the troop first sergeant orexecutive officer; two medics per troop; two in thearmored company; and two in the howitzerbattalion.

Ambulance section. The medicaloperations officer assisted by the platoon sergeantmanages evacuation operations. He may locate withthe aid station, or forward with the maintenancecollection point/patient collecting point (MCP/PCP).One ambulance is normally positioned with eachtroop, four at the MCP/PCP, and one with eachtreatment team. Alternate configurations include—

Two ambulances with eachtroop, two at the MCP/PCP, and one with eachtreatment team, or

Four ambulances at theMCP/PCP and two with each troop.

There are other configurations which may be used asdictated by the factors of METT-T. Remember,medical company ambulances should be positionedwith the aid station. This fluctuating supportarrangement makes thorough coordinationabsolutely essential. The medical platoon mustknow who will support it during each phase of anoperation. Medical company ambulances positionedforward to support the squadron are essential (acavalry squadron will likely need more ambulancesupport than would an armored or infantrybattalion).

Other considerations. Often, it mustoperate a considerable distance from the regiment’smain body. The squadron frequently disperses overa broad frontage. The following considerationsapply:

The medical platoon must beprepared to handle mass casualty situations. Masscasualties may occur during very mobile, fastmoving situations.

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FM 8-10-4

Plans for the use of nonmedicalvehicles (including aircraft) are essential (FM8-10-8).

The cavalry medical platoonmay expend supplies rapidly. Resupply plans mustbe SOP. (See paragraph 3-8 for resupplyprocedures.) Use PUSH packages.

The relationship between theplatoon and the medical company must be clearlyestablished.

The combat lifesaver isessential to effective medical support. The combatlifesaver will be invaluable when the squadronoperates distant from its regimental support units.

Although always a last resort,procedures for abandoning patients must beestablished. The squadron commander makes thisdetermination. If patients are abandoned, somemedical personnel with supplies must remain withthem.

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FM 8-10-4

3-1. Mission

The mission ofstrength, ” istreatment, and

CHAPTER 3

THE HEALTH SERVICE SUPPORT SYSTEM

HSS, to “conserveaccomplished by

the fightingprevention,

evacuation. The- HSS systemprovides medical care as far forward on thebattlefield as the tactical situation will permit,allowing the maximum number of combat soldiersto return to duty (RTD) as early as possible.

3-2. Health Service Support, The Basic Doctrine

a. The objective of the HSS system is toreduce the incidence of disease and nonbattle injury(DNBI) through sound preventive medicineprograms, to provide care and treatment for acuteillness, injury, or wounding, and to promptly returnto duty those soldiers who have recovered.

b. The major tenets of this doctrine are—

Far forward medical treatmentincluding advanced trauma management (ATM).

Selectivity of RTD and nonreturnto duty (NRTD) patients at Echelon III medicalunits.

Standardized Echelon I and IImedical units under the modular medical supportsystem throughout the division, corps, andcommunications zone (COMMZ).

Standardized air and groundevacuation units are integrated under a singlemanager (the medical evacuation battalion [EvacBn]).

Flexible, responsive Echelon III andIV systems provided by four modularly designedhospitals and patient holding units.

Enhanced ancillary and functionalsupport systems with advanced technologies.

A medical system that providescontinuous medical management throughout allechelons of care and evacuation.

3-3. Principles of Health Service Support Opera-tions

a. Conformity. Conformity with the tacticalplan is the most fundamental element for effectivelyproviding HSS. The HSS planner must participatein the development of the commander's operationsplan to ensure adequate HSS at the right time andplace. Medical intelligence data must be consideredin all HSS planning see Appendix C and FM 8-10-8.All HSS planning is forward oriented and makes fulluse of the HSS system. A plan for the rapid rein-forcement/replacement of forward echelons of theHSS structure is essential. For additional infor-mation on planning, refer to FM 8-55.

b. Continuity. The HSS system is acontinuum from the forward line of own troops(FLOT) through the continental United States(CONUS) base; it serves as a primary source oftrained replacements during the early stages of amajor conflict. The medical structure is modular indesign; procedures are standardized for flexibility,rapid reinforcement by identical modules, andsimplified for tailoring a force for varyingsituations. The patient evacuation system(integrated ground and air) is an integral part of theHSS system; it has been organized to optimizeresource use; it is staffed to provide continued careand maintain the physiology of the patient whilebeing transported between MTFs.

c. Control. To ensure that the scarce HSSresources are efficiently employed and support thetactical plan, medical units are under the control of asingle medical manager. Centralized control withdecentralized execution permits the medicalcommander and his staff to rapidly tailor and adjustHSS assets. Assets can be realigned in response tomajor shifts in the location and volume ofcasualties; changes in supported unit compositionand mission, and changes in the intensity of conflict.The modular medical support system provides theflexibility to task organize for any situation, orreplace like units; however, optimum benefits areonly derived through centralized control of allmedical functions and subsystems.

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FM 8-10-4

d. Proximity.

(1) The location of medical assets insupport of combat operations is dictated by the—

METT-T factors.

Requirements for far forwardstabilization of patients.

Early identification andforward treatment of RTD category patients.

Forward orientation ofevacuation resources, thereby reducing responsetime.

Other logistical units/complexes.

(2) Medical commanders and staffs,through constant coordination, ensure that HSSunits are not placed in areas that interfere withcombat operations; or that are subject to directintervention by enemy forces. Conversely, tacticalcommanders must realize the fact that fullycommitted HSS resources with a forwardorientation will optimize their effectiveness.

e. Flexibility. Standardized, like-modulesprovide HSS from the FLOT to the rear boundary ofthe theater of operations (TO). The ability to rapidlyshift HSS resources to areas of greatest need is acornerstone of the modular medical support system.

f. Mobility. The mobility of HSS unitsorganic to maneuver elements must equate to forcesbeing supported. Major medical headquarters (HQ)in the TO (medical group [Med Gp], medical brigade[Med Bde], medical command [MEDCOM])continually assess and forecast echelonment ofmedical units; through collective use of alltransportation resources, they rapidly move units tobest support combat operations.

3-4. System Design

The system is designed to acquire, triage, andprovide medical care for all personnel operating inthe division’s sector. Health service support to thedivision is influenced by many considerations suchas:

3-2

The nature of operations, including theintensity of combat.

The type of threat force to be en-countered.

The geographical area of operations.

The potential for NBC attack.

The climatic conditions and endemicdisease health hazards.

Air superiority.

3-5. Echelons of Health Service Support

Health service support is arranged in echelons(levels) of care (Figure 3-l). Each echelon of carereflects an increase in HSS capabilities whileretaining capabilities found in preceding levels ofcare. The division contains two levels of care: unitlevel and division level. Echelon in HSS is providedby the medical platoon/section organic to combatbattalions and some combat support battalions. Itis supported by first aid in the form of self-aid/buddy aid and the combat lifesaver (CLS).Echelon II HSS is provided by medical companiesof the FSB and MSB of the DISCOM (heavy) or theforward support medical company (FSMC) of themedical battalion (light). This level provides anincreased medical treatment capability plus—

Emergency dental care.

X-ray and laboratory services.

Patient holding facilities.

Preventive medicine.

Mental health services.

Management of Class VIII (medical)supplies, equipment, and repair parts.

Nondivisional units operating in the division sectorreceive medical support on an area basis from thenearest medical treatment facility. For informationon CLS training, see Appendix B.

FM 8-10-4

3-8. The Health Service Support Challenge a. Planning.

The HSS planner must be proactive rather than (1) Mission. Health service supportreactive to changing situations. He must shift planners must understand the tactical commander'smedical resources as the tactical situation changes. plans, decisions, and intent. Health service supportOnly in this way can the Army Medical Department planning is an intense and demanding process. The(AMEDD) “conserve the fighting strength.” The actions of the HSS planner must be proactive, notchallenges for HSS planners at the medical platoon reactive. The planner must know—level include the following elements:

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FM 8-10-4

What each supported elementwill do.

When it will be done.

Where it will be done.

How it will be done.

(2) Requirements. The HSS plannermust plan to meet the requirements of—

Acquisition and treatment ofpatients.

Evacuation.

Health service logistics.

Dental services (available atsupporting medical company).

Veterinary services.

Preventive medicine services.

Mental health consultationservices (available at supporting medical company).

Command, control, andcommunications.

b. Prevention. The most effective, leastexpensive method of providing the commander withsustained combat power is prevention. Preventionbegins with the individual soldier’s awareness of themeans to protect himself through health andpersonal hygiene, stress management, nutrition,physical fitness, and similar measures (soldierhealth maintenance programs). Prevention isenhanced by—

The application of self-aid/buddy aidtraining programs.

The CLS.

Continuous interface with unit- anddivision-level medics.

Division-wide preventive medicine(PVNTMED) programs.

Combat stress control (CSC)programs.

Leadership emphasis at all levels ofcommand.

Ultimately, whether it is individual or collective,prevention is the unit commander’s responsibility.

c. Far Forward Care. Far forward care is theidentification and treatment of battlefield casualtiesas close to the forward edge of the battle area(FEBA)/FLOT as the tactical situation permits. -This includes first aid, in the form of self-aid/buddyaid and the CLS, and unit-level medical support. TheCLS, found in each squad, crew, section, or team, isresponsible for the application of first aid measureswith a higher degree of skill than self-aid/buddy aid.However, the CLS’s primary role is the performanceof his duties as a member of the squad, crew,section, or team, and his first aid duties areperformed as the mission permits. Far forward careis provided to the front-line soldier by the combatmedic attached to the maneuver platoon/company.More comprehensive care is provided by aphysician-directed treatment squad (BAS) capableof administering initial resuscitation andstabilization (ATM) to battlefield casualties. Thiscare maintains the physiology of wounded soldierswho are unlikely to RTD and allows for their rapidevacuation. The BAS treatment squad also treatssoldiers with minor wounds/injuries and returnsthem to duty, A primary goal of unit-level medicalcare is that the combat medic reach the casualty andbegin treatment within 30 minutes of wounding.This rapid application of medical treatment greatlyenhances survivability.

d. Evacuation. Evacuation starts with thecollection of the wounded soldier from the point ofinjury and continues with his rearward movementthrough the HSS system. An important element ofthe evacuation system is the medical care provideden route. Ground ambulances are used in thedivision area and, where indicated, are assisted bycorps air evacuation assets. Normally, groundevacuation will be used for slightly wounded, ill, orinjured soldiers who are expected to return to duty.Air evacuation will be used, when feasible, forseriously wounded, sick, or injured soldiers who arenot expected to RTD. (Remember, air evacuationmay be restricted but only to the extent other

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FM 8-10-4

aviation operations are restricted in the immediatearea.) The responsibility for medical evacuationrests with the next higher echelon of HSS. Forexample, the medical platoon is responsible forevacuating patients out of the forward maneuvercompany/battery/troop area to the BAS. Themedical company is responsible for evacuation fromthe aid station to the division clearing station(DCS). Plans for the use of nonmedical vehiclesshould be established and supplemented whencasualties exceed the capability of medicalevacuation assets. For specific information on theuse of nonmedical vehicles for patient evacuation,see FM 8-10-6.

NOTE

It is the responsibility of unitcommanders to ensure thatwounded personnel areevacuated to establishedpatient collecting points.

3-7. Modular Support System

Health service support to the division is provided bya modular support system (Echelons I and II) thatstandardizes all medical subunits within thedivision. The modular design provides duplicatesystems at each level of care enabling the medicalresources manager at the appropriate level torapidly tailor, augment, or reinforce the battlefieldin areas of most critical need. The system is derivedby recognizing those common medical functionswhich are performed across the division anddesigning like subunits (modules) to accomplishthose tasks. The modular medical support system isbuilt around several modules. The modules areoriented to casualty assessment, collection,evacuation, treatment, and initial surgicalintervention. When effectively employed, theyprovide greater flexibility and mobility, and theability to rapidly tailor the medical force to meetchanges in patient workloads and locations.

a. Combat Medic Module. The combatmedical module consists of one combat medicalspecialist and his basic load of medical supplies andequipment. The combat medic is organic to themedical platoon/section of combat/combat support

battalions/squadrons and is attached to platoons,companies, batteries, or troops.

b. Ambulance Squad. An ambulance squadis comprised of four medical specialists and twoambulances (two teams). The squad providesevacuation of patients throughout the division andensures continuity of care en route. Ambulancesquads are organic to the medical platoon/section incombat battalions; selected combat supportbattalions: medical companies of the FSB and MSB(heavy); and the medical company of the medicalbattalion. Medical company ambulance squads arepositioned to best support the maneuverbattalions/surgeons. The medical platoonambulance squads are likewise positioned tosupport the companies/batteries/troops.

c. Treatment Squad. This squad (BAS)consists of the medical platoon leader (a primarycare physician), a PA, two emergency medicaltreatment (EMT) NCOs, and four medicalspecialists. The squad is trained and equipped toprovide ATM to the battlefield casualty. Tomaintain contact with the combat maneuverelements, each squad has two emergency treatmentvehicles (such as M577s). Each squad can split intotwo trauma treatment teams. The treatment squadis organic to medical platoons/sections in maneuverbattalions and designated combat support units. Itis the basic building block in the medical company.The treatment squad (treatment teams) may beemployed almost anywhere on the battlefield.

d. Area Support Squad. This squad iscomprised of one dentist trained in ATM, a dentalspecialist, an x-ray specialist, and a medicallaboratory specialist. The squad employs light-weight specialized equipment which can be quicklyand easily moved. The squad is organic to themedical company and, if necessary, may be deployedforward with the BAS to support the maneuverbattalion.

e. Patient Holding Squad. This squadconsists of two practical nurses and two medicalspecialists, The squad is capable of holding andproviding minimal care for up to 40 RTD patients;however, in the light division this squad can onlyhold and care for 20 RTD patients. This squad isorganic to the medical companies. A treatment

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FM 8-10-4

squad/team, an area support squad, and a patientholding squad are collocated to form the areasupport section (DCS).

f. Surgical Detachment. This detachment isa corps asset which must be collocated with thepatient holding squad for support. It consists of twosurgeons (a general surgeon and an orthopedicsurgeon), two nurse anesthetists, a medical surgical(intensive care) nurse, two operating roomspecialists, and two practical nurses. Thedetachment is organized to provide earlyresuscitative surgery for seriously wounded orinjured casualties, to save lives, and to preservephysical function. Early surgery will be performedwhenever a likely delay in the evacuation of apatient threatens life or the quality of recovery. TheTF surgical detachment will normally be employedin the division support area (DSA) but may beemployed in the brigade support area (BSA) duringbrigade TF operations.

NOTE

The surgical detachment(squad) is organic to themedical battalion of theairborne and air assaultdivisions.

3-8. Health Care Logistics in the Combat Zone

a. Medical Resupply.

(1) Resupply of the CLS is accom-plished through the normal resupply channels of themaneuver company. Combat lifesavers areresupplied in the same way combat soldiers areprovided camouflage sticks, foot powder, or otherindividual health care items.

(2) Resupply of the combat medic is theresponsibility of the BAS. This mission is handledand supervised by medical personnel. The combatmedic requests his supplies from the BAS. Thisaction is an informal request; it can be oral orwritten. The requests are delivered to the BAS bywhatever means available. Usually this isaccomplished by the driver or the medic in theambulances returning to the BAS with patients.Ambulances then transport the supplies from the

BAS to the combat medics. This system is referredto as backhaul.

(3) Resupply of forward deployed BASSin a heavy division is the responsibility of themedical company of the FSB. In those divisions notunder the MSB/FSB design, resupply of the BAS isthe responsibility of the FSMC of the medicalbattalion. Medical supply personnel operate aresupply point for the BAS of the maneuverbattalions based on supply point distribution.Backhaul of medical supplies using returningambulances, both air and ground, is the preferredmethod of moving medical supplies to the maneuverbattalions. If backhaul is not the method used,coordination for forward movement is theresponsibility of the medical platoon leader of themaneuver battalion.

(4) Resupply of the medical companiesin all divisions is performed by the division medicalsupply office (DMSO). The DMSO has the responsi-bility to provide medical supply support to all unitswithin the division area. In contrast to the formalprocedures normally associated with supportbetween the combat zone (CZ) MEDSOM/MEDLOG battalion and the DMSO, requestssubmitted to the DMSO by division medicaltreatment elements are informal. Requests maycome by message with returning ambulances(ground or air), by land line, or through existingfrequency modulated (FM) command nets withinthe division. Requests for medical supplies fromBASS and medical companies are filled or forwardedto the supporting CZ MEDSOM/MEDLOGbattalion. The line of medical supply flow back tothe requesting units will follow the principle ofbackhaul. Medical evacuation vehicles returning tothe forward areas will be tasked with the transportof medical materiel. The DMSO uses supply pointdistribution at a site that is easily accessible toground ambulances.

(5) Resupply of the DMSO is providedby the CZ MEDSOM/MEDLOG battalion.

(a) The DMSO, located in thedivision’s medical battalion (divisions not underMSB/FSB design) or the MSB (divisions underMSB/FSB design division), is responsible forproviding medical supply and medical maintenance

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FM 8-10-4

support to the medical treatment elements withinthe division. The division health services materielofficer (HSMO) executes health service logisticsplans. He exercises his responsibilities by–

Procuring, storing, andissuing Class VIII supplies for the division.

Coordinating with thesupported elements to determine requirements forClass VIII materiel.

Developing and main-taining prescribed loads of contingency medicalsupplies. These loads should be based upontransportation and storage constraints as well ascharacteristics of the area of operations.

Managing the division’shealth service logistics quality control program.

Supervising unit levelmedical equipment maintenance performed bymedical equipment repairer unit level.

Monitoring the divisionmedical assemblage management program.

Coordinating logisticalplanning for preconfigured Class VIII packages.

Calculating unit re-quirements for preventive medicine items such asfoot powder, water purification supplies, malariapills, and ear plugs.

(b) The reconstitution duties ofthe DMSO include—

Reconciling by brigadethe shortages in each medical company andtreatment platoon as reported by the commander orplatoon leader or the battalion headquarterselement.

Coordinating with themedical battalion commander or the MSBcommander to obtain the number of modularmedical systems required to field an operationallyready treatment facility.

Coordinating with the CZMEDSOM/MEDLOG battalion to monitor thestatus and number of modular systems due in.

Coordinating with thedivision movement control center to move suppliesfrom the MEDSOM/MEDLOG battalion. (TheDMSO directs quick fixes using available assetsand controlled exchanges for medical equipment tomaximize the capability of returning trainedsoldiers to duty.)

Alerting the appropriatecompany when modular systems are arriving.

Allocating modularmedical systems to the unit based on thecommander’s priorities. The DMSO coordinatesthrough the division medical operations center(DMOC) with the division movement control centerto identify backhaul ambulances to transportmodular assemblages to the unit beingreconstituted.

Preparing the criticalitems listing and consolidating the criticalshortages by brigade.

(6) Resupply of the CZ MEDSOM/MEDLOG battalion is received through theCOMMZ MEDSOM/MEDLOG battalion or bydirect shipments from CONUS. The CZMEDSOM/MEDLOG battalion is normally underthe direct command and control of the brigadeheadquarters. It provides medical supply, medicalequipment maintenance, and optical fabricationservices for units in the CZ area. The CZMEDSOM/MEDLOG battalion establishes theClass VIII supply point in the corps area. Shipmentof medical supplies forward is coordinated with thecorps movement control center or accomplished bybackhaul on medical vehicles (air or ground).Emergency resupply can be accomplished by airambulances in the evacuation battalion.

b. Medical Maintenance. Division medicalmaintenance support is provided by DMSO medicalmaintenance personnel.

(1) Division medical equipmentpersonnel provide unit level medical maintenancefor repairs of their own equipment as well as area

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FM 8-10-4

support to units without such capabilities. TheDMSO biomedical equipment maintenance NCOschedules, performs, and coordinates medicalequipment maintenance for the FSMCs. Medicalmaintenance personnel from the DMSO aredeployed forward as necessary to repair essentialmedical equipment. Maneuver BASs turn in theirmedical equipment in need of repair to thesupporting FSMC. The FSMC will send thisequipment to the DMSO when medical maintenancepersonnel are not deployed forward to the BSA.Medical equipment repairs beyond the capabilitiesof the DMSO are sent to the supporting corpsMEDSOM/MEDLOG battalion for repair or theDMSO will request a mobile support team from theMEDSOM/MEDLOG battalion.

(2) The MEDSOM/MEDLOG battalionnormally provides direct and general levels ofmaintenance support but may be directed to providedepot level support. Direct and general levels ofmedical maintenance provide the following services:

Low-density lifesaving diag-nostic equipment and therapeutic equipment-thistype of medical equipment belongs to operatingMTFs and is repaired or replaced immediately. TheMEDSOM/MEDLOG battalion maintains

designated items under the Medical StandbyEquipment Program (MEDSTEP). Direct exchangeof low-density lifesaving diagnostic and therapeuticequipment through the MEDSTEP may beemployed when repair time is determined to beexcessive.

Unserviceable and items,modules, or assemblies that are designed fordiscard-are replaced with serviceable items. Theunserviceable item(s) are disposed of IAWdisposition instructions.

Items that cannot be repairedat the unit level-will be evacuated to theMEDSOM/MEDLOG battalions medicalmaintenance repair element. This element effectsrepairs if within their capability, and returnsrepaired items to user.

Items that cannot be repairedor are not authorized to be repaired at the direct andgeneral support levels-are evacuated to depot.Depot level maintenance is provided by the UnitedStates Army Medical Materiel Agency (USAMMA)or by designated MEDSOM/MEDLOG battalion asnecessary when directed by the appropriatecommander.

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CHAPTER 4

DIVISION-LEVEL HEALTH SERVICE SUPPORT

Section I. DIVISION SUPPORT COMMAND

4-1. Mission

a. The DISCOM provides division-level CSSto all assigned and attached elements of thedivision. The DISCOM can, on a very limited basis,furnish CSS to nondivisional units in the divisionarea.

b. The DISCOM commander is the principalCSS operator of the division and exercises commandauthority over organic units of the supportcommand. The division G4 has coordinating staffresponsibility for logistic planning he developsdivision-level plans, policies, and priorities. Therelationship between the division G4 and theDISCOM commander must be close because of thesimilarities of interests. The G4’s planning role doesnot relieve the DISCOM commander of hisresponsibility; he must advise the division staffduring the formulation of plans, estimates, policies,and priorities.

c. The G3, G4, and the DISCOMcommander normally locate the DISCOM elementsin the DSA and the BSAs. The FSBs of the heavydivisions or the forward area support teams(FASTs) of the light divisions are positioned in theBSAs to best support committed brigades. Theremaining DISCOM elements are located in theDSA to provide area support to divisional units inthe division rear area and backup support to theFSBs/FASTs. Elements of the FSB/FAST may beforward of the BSA and other DISCOM units (MSBand light division equivalents) may have elements inthe BSA.

4-2. Division Support Command Combat ServiceSupport

The DISCOM provides the following CSS:

Support of Class I (to include waterpurification, and limited distribution), II, III, IV,VI, VII, VIII, and IX supplies.

Ammunition transfer points (ATPs)within the division.

Intermediate direct support maintenance(IDSM) and limited backup unit maintenancesupport for all common and missile materiel organicto the division, and aviation intermediatemaintenance (AVIM) support for all aviationmateriel.

Materiel management for the division.

Surface transport for personnel, supplies,and equipment to accomplish division logistic andadministrative missions, to include supplementalground transportation to support emergencyrequirements.

Supervision and coordination ofDISCOM transportation operations.

Automatic data processing (ADP)support for division logistic activities.

Materiel collection and classificationfacilities.

A limited capability to carry reservesupplies.

CSS information and advice to thedivision commander and his staff, except forconstruction.

Division-level and unit-level HSS on anarea basis. This includes medical staff services,intradivision evacuation of patients, and unit-levelmaintenance of medical equipment.

Planning, coordinating, and conductingrear operations within its assigned areas ofresponsibility.

Request, store, and distributeunclassified maps.

Interface and coordination with alliedunits.

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4-3. The Supported Units

a. The maneuver units and their CS are themajor focus of logistics support operations. In thecombat battalion TF area, there are CS unitsperforming many functions–FA, engineers,military intelligence units, and signal teams. Thereare more CS units in the brigade area; for example,air defense elements and FARPs for division andcorps helicopters. Also, there may be moremaneuver and CS formations in the division reararea.

b. All organizations require food, clothing,water, and the other essentials for humansustainment. Most require ammunition and fuel, aswell as maintenance support. All require medicaland personnel service support.

c. When fighting as part of a joint force oras part of a combined force, Army organizations willfrequently support other services or allied forces.This support may range from petroleumdistribution to emergency distribution ofammunition to allied artillery units.

4-4. Support Areas

The BSAs and DSAs are normally located towardthe rear of the units they support (see Figure 4-1). Iflateral and rear boundaries have not been defined,the support area is located as defined by thecommander in coordination with higher andadjacent commands.

a. Brigade.

(1) The BSA is that portion of thebrigade rear occupied by the brigade trains. Whenthe battalion trains are echeloned, the BSA is thearea occupied by the brigade trains and thebattalion field trains. The BSA is generally locatedbetween the DSA and the battalion area; to provideprotection against enemy indirect fire weapons, it islocated approximately 25-30 kilometers behind theFLOT.

(2) Site location considerations for theBSA are the same as those for the battalion supportarea. A brigade does not have organic logisticssupport elements to support the battalion. Logisticssupport elements, located in the BSA, are from the

FSB and selected COSCOM resources as required.The FSB coordinates brigade logistics support withthe brigade S4.

b. Division.

(1) The DSA is that portion of thedivision rear occupied by the DISCOM CP andorganic and attached units. This area may alsocontain CS units and COSCOM elements operatingin support of divisions. The division rear CP willnormally collocate with the DISCOM CP tofacilitate coordination, share area communicationassets, and draw life support and security.

(2) The DSA is normally locatedbetween the division rear boundary and the BSAand adjacent to air-landing facilities and the MSR.The precise location is contingent on—

Tactical plans.

The location of COSCOMlogistics support installations and the MSR.

Terrain in the area ofoperations.

Security considerations.

Accessibility to lines ofcommunications.

(3) All DISCOM units within the DSAare displaced when necessary to maintaincontinuous support to the division. The DISCOMcommander recommends to the division rear CP thenew locations and movement of DISCOM elementsin the DSA: All DISCOM units must be capable ofmoving every 1 to 3 days.

(4) The DISCOM is organized toprovide, within prescribed strength limitations, themost effective and responsive support to tacticalunits. To provide responsive support to the tacticalcommander, logistics, personnel, and HSS must beeffectively organized and positioned where it isrequired. The DISCOM headquarters, along withthe DMMC and the DMOC, ensures the bestposition of logistics support elements operating inthe division area.

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4-5. Division Support Command Headquartersand Headquarters Company

a. The DISCOM headquarters commandsand controls organic and attached units of theDISCOM. It supervises and controls all logisticalsupport and HSS operations within the division. Itadvises the division commander and staffconcerning supply, maintenance, HSS,transportation, and field services functions in thedivision.

b. The headquarters company is responsiblefor providing administrative, supply, maintenance,and food service support for the company, DMMC,and DMOC. It provides administrative, foodservice, and water support to the divisional aviationmaintenance company (AMCO). Supply,maintenance, and food service support is alsorendered to the collocated division rear CP.

4-6. The Division Materiel Management Center

The DMMC is the primary logistics managingelement in the division. The center receives policyand operational guidance from the DISCOMcommander; it advises the commander on materiel(supply and maintenance, less medical)management. Activities include—

Determining supply requirements.

Ordering and directing the distribution ofsupplies received by the division (except ClassVIII).

Developing and supervising the divisionauthorized stockage lists and the prescribed loadlists.

Maintaining the division property bookand Army equipment status reporting data.

Operating an integrated divisionmaintenance management information program.The DMMC maintains maintenance status toinclude problems; maintenance requirements; andunit materiel readiness in the division.

4-7. Main Support Battalion

The MSB is organic to the heavy division DISCOMand is commanded by the MSB commander. Thebattalion provides division-level logistics support,HSS to divisional units located in the DSA, andreinforcing support to the FSBs.

4-8. Forward Support Battalions

The FSBs are organic to the heavy divisionDISCOM. These units provide division-levellogistics support for the brigade and other divisionunits located in the BSAs.

4-9. Deployment of Division Support CommandElements

The mission is the basic consideration in thelocation of CSS units and their facilities.Maintenance, supply, medical companies, and otherservice support units must be far enough forward tobe responsive to the supported units. Maintenance,for instance, takes place not only in the BSA butwherever the weapon system is located, if possible.Mechanics and mobile equipment must be there tofix or replace components of the weapon systems.Additional considerations are enemy capability andtheir proximity to logistics support activities andother potential targets.

Section II. DIVISION SUPPORT COMMANDCOMMAND AND CONTROL

4-10. Command and Control over a large area of the battlefield. The C2 processenables commanders to confirm the availability of

command and control is the process through which logistics support resources; and institute accuratethe activities of military forces are directed, control procedures that ensure support is providedcoordinated, and controlled to accomplish the in the right quantities, to the right places, at themission. For the DISCOM commander, the C2 right times.function is a major challenge; his units are dispersed

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FM 8-10-4

4-11. Organization

The division usually consists of six majorsubordinate commands: three maneuver brigades, acombat aviation brigade, the division artillery, anda DISCOM. To accomplish the logistics supportmission, DISCOM units are deployed throughoutthe DSA and BSA. The organization of theDISCOMs is shown in Figures 4-2, 4-3, and 4-4.

4-12. Headquarters and Headquarters CompanyRelationships

a. Relationships used by the HHC and itsstaff are part of the C process. The HHC operates

C2 functions through relationships that include–

Higher organizations.

Lateral organizations.

Subordinate organizations.

b. The DISCOM commander’s higherorganizational relationship are with the divisioncommander and staff. Lateral relationships are withthe brigades and the DIVARTY. Subordinaterelationships are with the MSB, FSB, AMCO,DMOC, and DMMC.

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Section III. DIVISION-LEVEL HEALTH SERVICE SUPPORTARMORED AND MECHANIZED INFANTRY DIVISION

4-13. Structure

a. Division-level HSS (Echelon II) isprovided to all divisional elements by the DISCOMsupport battalions medical companies. This level ofcare stabilizes the wounded soldier and evacuateshim to the appropriate corps hospital. Additionally,they provide Echelon I care on an area basis to allunits that do not have organic medical resources.Division-level HSS may be referred to asprehospital care. The medical companies areassigned to respective support battalions and areunder the C2 of the battalion commander; however,the DMOC retains technical control over allDISCOM medical assets.

b. Echelon II care is provided to divisionalelements operating in brigade areas by medicalcompanies in the FSBs. Normally, one FSB isassigned to support a committed brigade. TheFSMC is usually located in the vicinity of other FSBelements in the BSA. The commanders of theFSMCs are also dual-hatted as brigade surgeons forthe respective brigades.

c. The main support medical company(MSMC) of the MSB provides Echelon I andEchelon II care to all divisional elements operatingin the DSA. The company operates and locates inthe vicinity of other MSB elements in the DSA. TheMSMC contains the centralized divisionalPVNTMED, mental health, optometry services, andClass VIII supply assets. Currently, the division

medical supply office (DMSO) is a MSMC asset.Elements of the MSMC provide limitedreinforcement, reconstitution, and augmentation toFSMCs operating in the BSA.

4-14. Division Surgeon

The division surgeon is the division commander’sprincipal staff advisor on HSS aspects affecting thecommand. The surgeon is a special staff officer andfunctions under the general supervision of the G1.However, the surgeon has direct access to thedivision commander and his staff regarding HSSmatters. The division surgeon also assumestechnical control over all nondivisional medicalunits attached to the division. In coordination withthe division G1, G3, and the DMOC, he developsmedical plans, policies, programs, and proceduresfor the division commander. The duties andresponsibilities of the division surgeon are outlinedin FMs 8-10-5 and 101-5.

4-15. Division Medical Operations Center

The DMOC is a major staff section of the DISCOMHHC (Figure 4-5). The staff of the DMOC managesdivisional medical assets and—

Develops and maintains the medicaltroop basis, revising as required, to ensure taskorganization for mission accomplishment.

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Monitors medical training programs andprovides information to the division surgeon.

Coordinates and directs patientevacuation from division-level medical facilities tocorps-level medical facilities.

In coordination with the division surgeonand DISCOM S3, allocates division medical andcorps augmentation assets to the division asrequired by the tactical situation.

Coordinates (through the DISCOM S1)with the G1 for AMEDD personnel assignmentsand replacements.

Coordinates and prioritizes medicallogistics and logistical aspects of bloodmanagement for the division.

Plans and coordinates division medicalsupport to civil-military and inter-operabilityoperations.

Coordinates and manages disposition ofcaptured medical material.

Plans and coordinates, in coordinationwith the division surgeon, the PVNTMED anddivision mental health/combat stress missions.

Coordinates and manages medicalequipment maintenance programs for the division.

Coordinates medical intelligenceactivities to include collection, limited processing,and dissemination.

Plans and conducts HSS aspects of rearoperations.

Maintains contact with medicalcompanies via FM or AM voice radio.

NOTE

For specific functions of theDMOC, SSS FM 8-10-3.

4-16. The Forward Support Medical Company

The FSMC of the FSB provides Echelon II HSS tothose battalions with organic medical platoons.These companies provide both Echelon I andEchelon II HSS on an area basis to units withoutorganic medical support operating in the BSAs. TheFSMC establishes its treatment facility (clearingstation) in the BSA, normally 15-20 kilometers fromthe FEBA.

4-17. Mission

The FSMC performs the following functions:

Treatment of patients with minordiseases and illnesses, triage of mass casualties,advanced trauma management, and preparation ofpatients incapable of returning to duty for furtherevacuation.

Ground evacuation for patients frombattalion aid stations to the FSMC.

Emergency dental care.

Emergency medical resupply to units inthe BSA.

Medical laboratory and radiologyservices commensurate with division-leveltreatment.

Outpatient consultation services forpatients referred from Echelon I MTFs.

Patient holding for up to 40 patients ableto return to duty within 72 hours.

Limited reconstitution, reinforcement,and augmentation to supported medical platoons.

Echelon I HSS on an area basis to units -without organic medical support.

Tailgate medicine.

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4-18. Organization

The FSMC plays a vital role in manning the force byproviding division- and unit-level HSS to all unitsoperating in the supported brigade area on an areabasis. As shown in Figure 4-6, the company consistsof a company headquarters, treatment platoon, andambulance platoon.

a. Company Headquarters. The companyheadquarters provides C2 of the company andattached medical units. It provides administration,

general and medical supply, NBC defensiveoperations, and communications support. Theheadquarters is organized into command, supply,operations and communication, dining facility, andmotor pool elements. The medical companycommander, a physician, also serves as the brigadesurgeon, As such, he must keep the brigadecommander informed on the medical aspects ofbrigade operations and the health of the command.He regularly attends brigade staff meetings toobtain information to facilitate medical planning.Specific duties of the medical company commanderinclude—

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Assuring implementation of theHSS section of the division SOP.

Determining the allocation of HSSresources within the brigade.

Supervising the technical training ofmedical personnel in the brigade area.

Determining procedures, tech-niques, and limitations in the conduct of routinemedical care, EMT, and ATM.

Informing the division surgeon andthe DMOC of the brigade’s HSS situation.

Supervising activities of sub-ordinate battalion surgeons.

Assuming technical supervision ofall PAs organic to subordinate units in the absenceof their assigned physicians.

Monitoring requests for aeromedicalevacuation from supported units.

During peacetime, a Medical Service Corps officerserves as company commander. He performs all ofthe nonphysician duties of the commander.

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b. Treatment Platoon

(1) The treatment platoon operates theDCS in the BSA. It receives, triages, treats, anddetermines disposition of patients. The platoonconsists of a platoon headquarters, an area supportsection, and a treatment section.

(2) The platoon headquarters is the C2

element of the platoon. It determines and directs thedisposition of patients and coordinates their furtherevacuation.

(3) The area support section operatesthe DCS. It consists of an area support treatmentsquad, an area support squad, and a patient-holdingsquad. These elements operate as a single medicalunit and are not normally used to reinforce orreconstitute other units. The area supporttreatment squad is the base treatment element ofthe DCS. The squad consists of two teams whichprovide troop clinic services and ATM. When theDCS moves, one of the treatment teams along withelements of the holding squad serve as a jumpelement. They set up the new clearing station whileremaining elements close out operations at the oldsite. The area support squad consists of the dentaland diagnostic support elements of the DCS. Thepatient-holding squad operates a 40-bed facility forpatients awaiting evacuation or expected to bereturned to duty within 72 hours. The medicalcompany has a temporary surgical capability whenaugmented by a corps-level surgical detachment.

(4) The treatment section consists oftwo treatment squads. Each squad employstreatment vehicles with medical equipmentsets—two trauma sets and two general sick call sets.These squads provide troop clinic services andATM. This section is oriented toward augmentingor reinforcing supported units medical elements andalleviating mass casualty situations. Each squadmay be split into two treatment teams. (Remember,a treatment team consists of a physician or PA, anEMT NCO, and two medical specialists.) Inexceptional situations, the medical company maydeploy a treatment team forward to support a BAS.

c. Ambulance Platoon. The ambulanceplatoon performs ground evacuation from battalionaid stations to the DCS. It has a platoonheadquarters and five ambulance squads–two with

wheeled ambulances and three with trackedambulances. The headquarters provides C2 andplans for the employment of the platoon. Itcoordinates support with the medical platoons ofthe supported maneuver battalions; plansambulance routes; and establishes ambulanceexchange points (AXPs) for ground and airambulances as required, Each squad splits into twoambulance teams and provides evacuation fromforward areas. Normally, a tracked ambulance teamor squad is positioned with each supportedbattalion.

4-19. Operations

a. Plans. Planning for medical operationswithin the brigade area is done by the medicalcompany commander and support operationssection of the FSB. The company XO is theprincipal assistant to the company commander forthe employment of the company. The basicconsiderations which influence the employment ofmedical assets within the brigade are—

The brigade commander’s plan.

The anticipated patient load.

Expected areas of casualty density.

Medical treatment and evacuationresources available.

On the basis of these factors, planners determine theemployment of ambulances, evacuation routes,AXP locations, and employment of the treatmentteams. Coordination and communication betweenthe medical company cornmander and the maneuverbattalion medical platoon leaders are essential indeveloping an effective HSS plan. The medicalcompany commander will consider all inputprovided by medical platoon leaders. The medicalplatoon leaders must become thoroughly familiarwith the medical company commander’s plan. Theimportance of medical platoon leader-medicalcompany commander communications cannot beoveremphasized.

b. Division Clearing Station Operations.

(1) Elements. The DCS in the BSA isoperated by the medical company treatment

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platoon. In addition, a team from the MSB medicalcompany PVNTMED section and a behavioralscience NCO from the MSB company mental healthsection may operate from the DCS. Also, operatingat the DCS are other elements of the FSMCtreatment section not deployed forward. Duringstatic situations, ambulance teams may bestationed at the DCS to provide routine sick callruns; also to provide emergency standby support tounits operating in and around the BSA.

(2) Functions. The functions performedat the DCS are those discussed for the area supportsection of the treatment platoon. Seriously ill orwounded patients arriving at the DCS are givennecessary treatment and stabilized for movement.Patients with minor injuries and illnesses aretreated within the capability of the attendingmedical and dental personnel. These patients maybe held for up to 72 hours for continued treatment orobservation, returned to duty, or evacuated to acorps MTF. Other functions of the DCS include—

Providing consultation, clinicallaboratory, and x-ray diagnostics for unitphysicians and PAs.

Recording all patients seen ortreated at the DCS and notifying the brigade S1 andXOs/first sergeants of supported CS and CSS units.

Verifying the informationcontained on the field medical card of all patients.

Monitoring patients whennecessary for NBC contamination before medicaltreatment.

Ensuring NBC patients areproperly handled.

(3) Area support. In addition toproviding division-level support for units in thebrigade area, the DCS provides unit-level support tounits in the BSA on an area basis.

(4) Preventive medicine. A PVNTMEDteam from the division PVNTMED section of theMSB ensures that PVNTMED measures areimplemented to protect against food-, water-, andarthropod-borne diseases and environmentalinjuries (such as heat and cold). Specifically, theteam—

Performs environmental healthsurveys and inspections.

Monitors water production anddistribution within the brigade area.

Investigates incidents of food-,water-, arthropod-borne, zoonotic, and othercommunicable diseases.

Helps train unit field sanita-tion teams.

Assists in identification/evaluation of NBC contamination in water supplies.

The team emphasizes preemptive action. In pastconflicts, more soldiers have been renderedineffective from DNBI than from combat wounds,The team cannot wait until problems appear to takeaction. Unit commanders and leaders must plan forand enforce field hygiene and sanitation procedures(FMs 21-10 and 21-10-1).

(5) Mental health. A member of theMSB mental health section functions as the brigadecombat stress control coordinator. As such, headvises the brigade surgeon on mental healthconsiderations. He keeps abreast of the tacticalsituation and plans for battle fatigue/neuropsychiatric (BF/NP) care when maneuverunits are pulled back for rest and recuperation. Atthe DCS, he assists in patient triage and ensuresBF/NP patients are handled properly. Treatment ofbattle fatigue follows these guidelines.

Mild cases are given a briefrespite of 1 to 6 hours of comfort and reassuranceand are return to their units.

Moderate cases may beassigned work at a logistics facility in the BSA for 1to 2 days. During this time, however, they must beunder medical supervision; the medical companyremains responsible for such services as feedingthese patients. Moderate cases may also be held atthe holding facility, but separated from otherpatients, if space is available.

Severe cases may be held in theDCS holding facility for up to 48 hours if behavior isnot too disruptive. The combat stress control

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company (CSCC) provides guidance to DCSpersonnel on treating BF/NP patients (see FM 8-51).It also helps the attending physician coordinateRTD of patients fit to perform their duties.

Severe cases beyond the abilityof the DCS to manage are evacuated to the MSBDCS or a corps hospital as conditions permit.Physical restraints are used during transport whennecessary.

(6) Patient weapon and ammunition.The patient’s individual weapon and ammunitionshould be retained by his unit. If weapons orammunition arrive at the DCS, they are collectedand given to the brigade S4 or the supportedCS/CSS unit’s designated representative, or theyare disposed of according to command SOP.

c. Evacuation.

(1) Team locations. Evacuation fromthe BASS is normally provided by the FSMCambulance platoon and a forward air ambulanceteam of the supporting corps air ambulancecompany. These assets also support other units inthe brigade area on an area basis. Typically, oneteam from the ambulance platoon is field sited ateach BAS. The other ambulances of the platoon arelocated at AXPs, designated patient collectingpoints, or at the DCS.

(2) Air ambulance. An air ambulanceteam of the corps air ambulance company may befield sited at the BSA. The team leader is involvedwith planning on employment of air evacuationassets; and obtaining airspace managementinformation. He coordinates aviation supportrequirements and airspace C2 matters with thebrigade S3 (air). The team evacuates urgent patientsfrom as far forward as the tactical situation willallow aviation assets to operate to the BSA/DSADCS.

(3) Alternate evacuation modes. Ifmedical company evacuation assets areoverwhelmed, additional assets may be requestedfrom MSMC or the corps through the DMOC.Another alternative is the use of nonmedical air orground transportation assets. This support isnormally coordinated by the company XO with theFSB S3 section. When possible, nonmedical assets

are augmented with medical personnel and suppliesto provide en route care.

(4) Ambulance shuttle system. To keeptracked ambulances from having to spend too muchtime evacuating patients to the BSA, an ambulanceshuttle system may be setup between the DCS andBASs. Such a system uses ambulance exchangepoints (AXPs). AXPs are positions where patientsare exchanged from one ambulance to anotherusually from tracked ambulances to wheeledambulances. AXPs are normally preplanned andmoved often. Use of AXPs allows ambulances toreturn to their supporting positions more rapidly.This is desirable since the crews are more familiarwith the roads and the tactical situation near theirbases of operations.

(5) Arnbulance relay points. Anotherform of ambulance shuttle system involves the useof ambulance loading points and relay points. Inthis system, ambulances are stationed at loadingpoints ready to receive patients. Ambulances arealso stationed at relay points ready to replaceambulances leaving loading points to evacuatepatients. Control points may also be used atcrossroads or junctions to direct empty ambulancesfrom relay points to loading points.

4-20. Classs VIII Supply

Medical supplies, equipment, and repair parts areprovided through medical logistics channels. Unit-and division-level medical elements carry a 5-daystockage of medical supplies. During combatoperations, the FSB medical company receivespreconfigured medical supply packages from theDMSO. As medical units consume their initial issue,they request resupply from the next higher medicalelement. Medical supplies will normally bebackhauled to the BAS using FSMC ambulances.During combat, a PUSH resupply system should beused. This system is preplanned between themedical platoon and medical company and providesplanned amounts of supplies to the BAS at plannedintervals without a supply request. The PUSHresupply system should be planned and coordinatedbefore combat operations begin. The medicalplatoon leader must ensure that his resupply needsare known by the supporting FSMC, the DMSO,and the DMOC.

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4-21. The Main Support Medical Company medical company is organized with a companyheadquarters, an ambulance platoon, a treatment

The MSMC provides unit- and division-level HSS, platoon, a PVNTMED section, an optometryon an area basis, to units operating in the DSA that section, a mental health section, and a divisionare not otherwise provided this support. The medical supply section. See Figure 4-7.

4-22. Capabilities rear area and those evacuated from medicalcompanies in the brigade area.

The MSMC provides—Facilities for receiving and sorting Ground ambulance evacuation from

patients. medical companies, unit-level medical treatmentFacilities for providing medical elements, and other units operating in the division

treatment for all classes of patients in the division rear area which do not have organic ambulances.

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Emergency dental care, preventivedentistry, and consultation services.

Emergency psychiatric treatment andmental health consultation services.

Division-level medical resupply support;supervision of medical equipment maintenance andmedical equipment repair parts support to alldivision and attached medical units.

A patient-holding facility of 40 cots forpatients who do not require hospital treatment andwho are expected to be returned to duty within 72hours.

Limited laboratory, pharmacy, andradiology services.

Unit-level HSS to units operating in theDSA that are not otherwise provided this support.

Preventive medicine surveillance,inspections, and consultation service.

Optometric support limited to eyeexaminations, spectacle frame assembly usingpresurfaced single-vision lenses, and repair services.

Limited reconstitution, reinforcement,and augmentation to FSMCs.

4-23. Operations

area basis, from unit-level treatment facilities andother units within the DSA to the treatmentplatoon. It may provide ground ambulanceevacuation of patients from the FSMC to theMSMC. Since MSMC evacuation assets are limited,corps ground ambulances are positioned to assist inFSB to MSB evacuations. Ambulances may bypassthe MSMC and evacuate patients directly from theFSMC to a corps hospital. Air and groundevacuation from the DCSs to corps hospitals isprovided by the corps medical brigade/group.

d. Supply. A 5-day level of medical suppliesis maintained by unit- and division-level medicalelements. Battalion aid stations submit routinemedical supply requests to the DMSO. Emergencyrequisitions are submitted to the supportingmedical company; these requests are filled or areforwarded to the DMSO. Requests are filled by theDMSO and shipped to the requestor, or arerequested from the supporting corpsMEDSOM/MEDLOG battalion. Shipment ofmedical supplies forward is coordinated with themovement control officer or accomplished bybackhaul of returning ground and air ambulances.

e. Maintenance. Medical maintenancesupport is provided by the medical equipmentrepairer assigned to the medical company. Higher-level medical maintenance support is provided bythe corps MEDSOM/MEDLOG battalion. Single-vision lens optical fabrication support is providedby the medical company, Multivision lensfabrication support is provided by the corpsMEDSOM/MEDLOG battalion.

The MSMC is located in the DSA.4-24. Organization

a Treatment. The treatment platoonperforms triage and provides medical treatmentwithin its capabilities. It returns patients to duty,transfers them to the holding platoon, or arrangesfor their evacuation to a combat zone hospital.

b. Holding. The holding platoon has a40-cot holding capability. This capability is usedonly if the battle environment is conducive toholding patients at this level and the patient can bereturned to duty within 72 hours.

c. Evacuation. Medical evacuation isprovided for patients by the ambulance platoon ofthe MSMC. This platoon evacuates patients, on an

a. Company Headquarters. The companyheadquarters provides C of the MSMC andattached units. The headquarters consists of acommand element, supply element, motor poolelement, and food service element. The companyheadquarters is staffed with a company commander,a medical operations officer, a first sergeant, and aunit clerk.

(1) Company commander. The companycommander (a physician) plans, directs, andsupervises the operations and employment of thecompany. He is responsible for training, discipline,billeting, and security of the company.

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(2) Medical operations officer. Themedical operations officer coordinates the functionsof the company and assists the commander incompany operations. He coordinates the functionsof the company. During peacetime, a medicaloperations officer commands the company.

b. Ambulance Platoon. The ambulanceplatoon is staffed with a platoon leader, platoonsergeant, aid/evacuation NCO, andambulance aid/drivers. The ambulance platoonemploys five ambulance squads, with only wheeledambulances. The ambulance platoon may providereinforcements or replacements for ambulances ofFSB medical companies.

c. Treatment Platoon. The treatmentplatoon consists of a platoon headquarters, atreatment section, and an area support section.

(1) Platoon headquarters. This officeprovides C2 of the treatment platoon; it providescommunications operations for the company. Itdetermines and directs disposition of patientsreceived from the brigade area. The platoonheadquarters coordinates patient evacuation asrequired. It is staffed with a platoon leader, amedical operations officer, a platoon sergeant,patient administration specialists, a single channelradio operator, and a tactical communicationssystem operator/mechanic.

(2) Treatment section. The treatmentsection of the MSMC employs four treatmentsquads (eight teams) instead of the two squadsfound in the FSMC. The personnel structure of eachtreatment squad is the same as is found in theFSMC and BAS treatment squads.

(3) Area support section. The capa-bilities and personnel structure of the MSMC areasupport section are identical to those of the FSMCarea support section.

d. Optometry Section. The optometrysection provides optometric services, to includeroutine eye examinations and refractions; fabricatespresurfaced, singlevision lenses; and providesoptical repair services. It is staffed with anoptometrist, an optical laboratory specialist, and aneye specialist.

e. Mental Health Section. The mentalhealth section provides division-wide mental healthservices to minimize preventable mental healthproblems and associated personnel losses to thedivision. It is staffed with a psychiatrist, apsychologist, a social worker, and behavioral sciencespecialists.

f. Preventive Medicine Section. This sectionprovides PVNTMED services to the division toinclude environmental health surveillance,inspections, and consultation services. It is staffedwith a PVNTMED officer, an environmental scienceofficer, a PVNTMED NCO, a PVNTMED sergeant,and PVNTMED specialists.

(1) Preventive medicine officer. ThePVNTMED officer plans and directs the divisionPVNTMED program and supervises the activitiesof the PVNTMED section.

(2) Environmental science officer. Thisofficer plans, manages, and supervises theidentification and evaluation of environmentalhealth conditions.

(3) Preventive medicine enlistedpersonnel. The PVNTMED enlisted personnelperform environmental health surveys, inspections,and laboratory procedures, They conduct food-,water-, and arthropod-borne, zoonotic, and othercommunicable disease investigations. They alsoconduct training for unit field sanitation teams.

g. Division Medical Supply Section. Thissection maintains a 5-day stockage level of division-level medical supplies. Requests for medicalsupplies from the FSMCs and BASS are filled orforwarded to the supporting corps MEDSOM/MEDLOG battalion. This section providesmaintenance on medical equipment in the DSA. It isstaffed with a health services materiel officer, amedical supply supervisor, a medical equipmentrepairer, advanced, a pharmacy NCO, and medicalsupply specialists.

(1) Health service materiel officer. TheHSMO supervises and controls medical suppliesand medical equipment maintenance support tounits in the division.

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(2) Medical equipment repairer, medical equipment. He supervises medicaladvanced. This specialist performs periodic equipment repair functions.scheduled services and repairs on all types of

Section IV. DIVISION LEVEL HEALTH SERVICE SUPPORTLIGHT INFANTRY, AIRBORNE, AND AIR ASSAULT DIVISION

4-25. General

Division-level health service is concerned primarilywith evacuating and treating patients from unit-level MTF. It provides unit- and division-level HSS(including tailgate medicine) on an area basis tounits without organic medical support. Throughprovisions of division-level HSS, patients arereturned to duty; held for further treatment if theycan be returned to duty within 72 hours; orevacuated to a corps level medical treatmentfacility. This support is provided in the DSA andBSA by the DISCOM’s medical battalion.

4-26. Organization

a. The DISCOM medical battalion isorganized to provide division-level HSS for theentire division. The battalion provides unit-levelmedical support on an area basis for assigned andattached units operating within the division’s areaof operations, The medical battalion (Figure 4-8) ismodular in design and consists of a headquartersand support company (HSC) and three FSMCs.

b. The division is oriented primarily todefeating light enemy forces in a LIC, whileretaining utility for employment in other scenarios.The medical battalion is designed to be employed inLIC environments. However, the modular designreadily lends itself to quick-fix augmentation. Withsufficient additional organizational support,medical ground evacuation, and medical treatmentmodules, the battalion can support the divisionemployed in other scenarios.

4-27. Mission

The mission of the medical battalion is to maximizethe RTD rate and to conserve the human componentof the division’s weapons system. Its functions arecentered around three basic principles: treat andRTD, treat and hold (up to 72 hours), and treat andevacuate. The battalion provides division-levelHSS; medical staff advice and assistance and unit-level HSS for all assigned and attached units of thedivision. Specific functions of the battalion includethe following

Operates DCSs with limited holdingcapability.

Provides ground ambulance evacuationof patients from unit-level treatment stations.

Provides division-wide medical supplyand medical equipment maintenance service.

Provides unit-level HSS on an area basisto units without organic medical elements.

Provides limited optometry services.

Provides emergency dental service.

Provides limited neuropsychiatric serviceand consultation service for patients referred fromunit-level medical treatment elements.

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FM 8-10-4

Provides PVNTMED service.

Reinforces/reconstitutes unit-level HSSelements to include medical supervision for PAswithout assigned supervisory physician(s).

4-28. Command and Technical Relationships

The medical battalion commander exercises C2 overthe battalion, and operational control over corpsmedical units attached to the division. As divisionsurgeon, he exercises technical supervision over allHSS elements of the division.

a. The HSC commander exercises C2 overall elements assigned to his company, lessoperational control of the battalion headquarterselement.

b. The FSMC commander exercises C2 overall elements of the FSMC. As brigade surgeon, heexercises technical supervision over all HSSelements of the brigade.

c. The commander exercises C2 oversubordinate elements. He makes all fundamentaldecisions in his area of responsibility. Whentactically feasible, he consults with subordinatecommanders before making decisions.

d. The medical battalion staff provides thecommander with timely information, it prepares,analyzes, estimates, and recommends courses ofactions. The staff translates the commander’sdecisions into instructions and orders, issues theorders, and supervises their execution. Staffmembers resolve problems and makerecommendations within their functional areasbased on the commander’s guidance/SOP. Thecommander, however, identifies goals, announcesthe goals and takes the initiative. Once thecommander decides what must be done, the staffsupports the decision and ensures that it is carriedout.

e. Medical company commanders areworking physicians. They command their companyfrom a location where they can best access andinfluence the HSS operation. These commanders useverbal orders, radio and wire communicationsbetween themselves, their platoon leaders, andsupported elements.

f. The medical battalion is under the C2 ofthe DISCOM commander. The medical battalioncommander (division surgeon) is the primarymedical staff officer of the DISCOM. Thebattalion’s S2/S3 assumes the planning andoperations functions that have traditionally beenassociated with the division surgeon’s section. Themedical battalion commander, his staff, andsubordinate commanders employ direct channels ofcommunications on technical matters.

g. The commander of the support companyprovides technical advice to supported units in theDSA. Commanders of FSMCs provide technicaladvice to respective brigade commanders and serveas brigade surgeons.

h. A request for HSS flows from therequesting unit to the supporting medical company,and from medical companies to the medicalbattalion S2/S3 section.

4-29. Communications

For rapid response to changing threats, the HSSsystem employs AM/FM voice and data linkcommunications, together with automatic dataprocessing and line communications to themaximum extent available. These systems arerequired for the effective control of medical units,patient evacuation, and medical regulating.

4-30. Medical Battalion Command/Operations Net

Communications are essential for gathering data,planning operations, and supervising missionperformance. Effective management depends oncommunications to keep abreast of changingsituations and HSS requirements. The medicalbattalion headquarters and its companies depend onboth AM and FM radios and area communicationssystems to conduct operations. The medicalbattalion commard/operations FM radio net isshown in Figure 4-9. Stations in this net arediscussed below. The battalion headquarters andsupport medical company’s wire net is shown inFigure 4-10.

a. Station A. This station is the S2/S3operations center which acts as the net control

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FM 8-10-4

station. The S3 uses this station to control the d. Stations D, E, F, G and H. These stationsentire operations of the medical battalion on a are used by the battalion commander and his staffroutine basis. to maintain contact with subordinate companies.

b. Station B. This station is the com- e. Station I. This station is used by themander’s communications means for C2, and for division PVNTMED officer.division surgeon’s traffic with divisionheadquarters.

c. Station C. This station is the S2/S3officer’s means of controlling battalion operationswhile traveling.

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FM 8-10-4

4-31. Long-Range Communications Service Support (CSS) Computer System (TACCS),the wire telecommunications systems, and a high

The medical battalion employs long-range frequency (AM) radio system with voice and data-communications systems to facilitate patient link capability. The supporting corps medicalmanagement, air and ground evacuation, and brigade/group and the battalion are linked by thesemedical regulating within and out of the division. systems. The medical battalion’s high frequencyThese systems include the Tactical Army Combat AM radio net is shown in Figure 4-11.

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FM 8-10-4

4-32. Support Company Communications

The Support Company employs AM and FM radios.These radios are used to maintain an informationlink for C2; to provide information on patientevacuation and to maintain the command net. TheFM short-range radio nets are used for C2 within thecompany and for communication with supportedunits. The high frequency radio (long-range) net isrequired for medical regulating and aeromedicalevacuation coordination. The Support Company’sradio net is shown in Figure 4-12. Its wire net isshown along with the battalion headquarters inFigure 4-10.

4-33. Forward Support Medical Company Com-munications

The three FSMCs have identical TOEs. Each FSMCemploys AM and FM radios. Communicationrequirements for the FSMC are similar to those ofthe headquarters support medical company.Additionally, the FSMC is required to establish andmaintain tactical communications with forwardHSS elements of the maneuver brigade it supports.The FSMC radio and wire nets are shown in Figures4-13 and 4-14.

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FM 8-10-4

4-34. Battalion Headquarters Element Organi-zation and Functions

a. The battalion headquarters is a majorfunctional element organized under the HSC (Figure4-15). For mutual administrative and logisticalsupport, it is collocated with the support companyelement in the DSA (with division trains). Thebattalion headquarters is comprised of the followingsubelements:

(1) Command Section.

(2) S1 Section.

(3) S2/S3 Section.

(4) S4 Section and Division MedicalSupply Office.

(5) Preventive Medicine Section.

(6) Optometry Section.

(7) Mental Health Section.

(8) Battalion Maintenance Section.

b. This headquarters provides C2 forsubordinate units; staff functions for the medicalbattalion; special staff functions for the division;and HSS for all divisional units. It providesadministrative and logistical support for thebattalion and plans for its employment. Thisheadquarters provides C2 or OPCON for attachednondivisional medical elements. Staff functions andrelationships specified for battalion level organiza-tion in Chapter 4 of FM 101-5 are applicable to themedical battalion headquarters.

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FM 8-10-4

NOTE

To avoid degrading thebattalion’s support to organicunits, provisions must be madefor additional logistics supportto attached nonmedical ele-ments.

4-35. Command Section

The battalion command section (Figure 4-16)consists of the battalion commander and hisimmediate staff. These personnel supervisefunctions of the battalion headquarters elements.

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a. Battalion Commander. The battalioncommander plans, directs, and supervises battalion

FM 8-10-4

activities; he prescribes policy, procedures, mission,and standards. His duties and responsibilities as thedivision surgeon are discussed in FM 8-10-5.

b. Battallion Executive Officer. The XO isthe principal assistant to the battalion commander.He supervises and coordinates the functions of thebattalion staff; and directs the rear battle defenseprogram. The XO is also the battalion’s materielreadiness officer.

c. Battalion S1. The S1 advises thecommander on administrative and personnelmatters. He develops and issues instructions forsubmission of records and reports. The S1 alsoauthenticates and supervises the preparation anddistribution of orders and instructions (other thanoperations orders).

d. Battalion S2/S3. The S2/S3 is theoperations, intelligence, and training officer. Thisofficer advises and assists the battalion commanderin planning and coordinating battalion operations.He supervises planning, operations,, security, NBC,intelligence, communications and training activitiesof the battalion. He also authenticates andsupervises the preparation and distribution ofoperations orders.

e. Battalion S4. The S4 directs the logisticalactivities of the battalion; he advises and assists thebattalion commander in logistic matters. Hecoordinates with the S3 in planning andimplementing damage control measures. The dutiesand functions of the S4 are discussed in detail in FM10-14-2.

f. Command Sergeant Major. The CSM isthe battalion commander’s principal enlistedassistant. He maintains liaison between thecommander and first sergeants of subordinate units.The CSM advises and assists noncommissionedofficers in accomplishing their assigned missions.He assists the commander in the inspection ofsubordinate units and other activitiescommensurate with his position.4-36. Battalion S1 Section

The S1 section (Figure 4-17) assists the commanderand staff in administrative and personnel matters.

The activities of this section includes thesupervision of correspondence, personnel liaison,mail distribution, and dissemination of commandinformation. The S1 section uses the battalionadministration AM radio network and TACCS tocommunicate with FSMCs and corps-level HSSelements.

4-37. Battalion S2/S3 and Division Surgeon Sec-tion

The S2/S3/division surgeon section (Figure 4-18)performs two functions. It serves as the mainoperations planning element for the battalion; alsoas the staff HSS planning and operations elementfor the division. This section is responsible for—

a. Formulating battalion plans.

b. Publishing battalion operations order.

c. Maintaining communications with andmonitoring movement of battalion units.

d. Providing rear area security and damagecontrol for HSS elements.

e. Training battalion units.

f. Supervising and gathering medicalintelligence.

g. Planning for division-level HSS.

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FM 8-10-4

4-38. Plans and Operations Branch

a. The plans and operations branch (Figure4-18) of the battalion S2/S3 is responsible for—

Planning and coordinating intelli-gence and security matters.

Processing, interpreting, anddisseminating information pertaining to the effectsof METT-T and civilian population on thebattalion’s mission.

Supervising the collection anddisposition of medical intelligence,

Disseminating technical intelli-gence.

Developing plans, policies, pro-grams, and procedures pertaining to the medicalbattalion’s operations and functions.

Planning, supervising, andinspecting the tactical and technical training ofsubordinate units.

Planning and coordinating theaugmentation or reconstitution of medical battalionunits.

Coordinating and providing currentoperational information to supporting corps HSSelements operating within the division.

Planning, coordinating, andsupervising the battalion’s support of civil-militaryoperations, psychological and unconventionalwarfare operations.

Regulating (informal) patientswithin and out of the division.

Planning and supervising defenseagainst nuclear, biological, and chemical attack airdefense; and unconventional and psychologicalwarfare operations.

Preparing the rear operationsdefense plan for the battalion headquarters andsupport company’s immediate area of(base cluster). See FM 90-14.

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FM 8-10-4

Advising the medical battalioncommander and staff on all aspects of the activitiesdiscussed above.

NOTE

This branch supervises theexecution of the rearoperations defense plan underthe direction of the battalionXO.

b. The field medical assistant (assistantS2/S3) in the battalion S2/S3 and the divisionsurgeon’s staff element coordinates all functionspertaining to health service plans, organization,operations, intelligence, and training.

4-39. Division Surgeon Branch

This branch focuses on the division surgeon’sfunctions, It is assisted by the plans and operationsbranch and the battalion S1. The staff officers(Figure 4-12) who provide for the functions of thedivision surgeon’s branch manage other majoractivities within the battalion. These officers(division PVNTMED officer, division dentalsurgeon, division psychiatrist, and health servicesmateriel officer) may act for the surgeon in matterspertaining to their area of expertise. This branchacts independently of the S2/S3 and is responsibleto the surgeon for—

Preparing the HSS portion of the divisionstaff estimate.

Preparing the HSS annex to the divisionOPLAN, and preparing of the HSS annex to thedivision SOP.

Coordinating and planning division-wideHSS.

Preparing and coordinating MEDSOM/MEDLOG plans.

Coordinating with division staff officers(and corps medical staff officers as required) on–

Controlling critical HSS items ofequipment and supplies.

Preparing AMEDD personnelassignments; medical logistical support; medicalrecords and reports; and augmentation andreconstitution of divisional HSS elements.

a. Division Preventive Medicine Officer.The division PVNTMED officer serves as theassistant division surgeon. He is located with thedivision PVNTMED section.

b. Division Dental Surgeon. The divisiondental surgeon serves as the special staff advisor tothe division surgeon for all matters pertaining todental support and planning. This officer alsomanages the area support squad of the supportcompany he is located with that element. Heprovides emergency dental care and supervisesother dental personnel in performing their duties.

c. Division Psychiatrist. The divisionpsychiatrist is located with the division mentalhealth section. His staff duties and responsibilitiesare discussed in FM 8-51.

d. Division Health Services MaterielOfficer. The division HSMO has staff responsibilityfor planning and managing of medical materiel andsupplies for the division. He is located with the S4section/DMSO.

4-40. Communications Branch

a. Functions. The communications branch(Figure 4-18) develops, executes, and supervises thebattalion signal communications SOP. Thisbranch—

Secures, maintains, and issues thecommand’s Security Operations Instructions (S0I)booklet to battalion users.

Implements the DISCOM signalcommunications SOP.

Assures communications systemsinterface between the battalion and higherheadquarters, and between the battalion and itssubordinate units.

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FM 8-10-4

Operates the battalion switchboardand control stations for the battalion’scommand/operations (FM voice) net and theadministrative/logistical (AM voice) net.

Provides for technical training tobattalion users of communication-electronics (CE)equipment.

b. Tactical Communications Chief. Thetactical communications chief serves as the signaladvisor for the battalion. He is the principal advisorto the commander and the battalion S2/S3 in CEmatters. The chief supervises the communicationbranch he advises on selecting a site for thebattalion command post. He also works with theDISCOM communications officer to ensureintegration of the battalion’s communicationssystems.

4-41. Battalion S4 Section/Division MedicalSupply Office

The S4 section and DMSO is comprised of twoseparate functional elements which are shown inFigure 4-19.

4-42. S4 Element

This office is responsible for planning, coordinating,and supervising unit-level general supply andservices functions of the battalion. It is assisted bypersonnel in the DMSO. The S4 element also–

Determines logistic requirements,maintains a property book, and provides generalsupply support to assigned and attached units ofthe battalion.

Requisitions and issues general classes ofsupplies and equipment for units of the battalion.

Assists in preparing plans for areadamage control.

4-43. Division Medical Supply Office

This office is organized to provide Class VIII supplyand unit-level medical equipment maintenance forthe division. The functions of the DMSO includedevelopment and maintenance of prescribed loads ofmedical supplies; management of the medicalquality control program and supervision of unit(organizational) medical maintenance support. Thisoffice also monitors the division medical assemblagemanagement program and coordinates LOG PLANrequirements for preconfigured Class VIIIpackages.

4-44. Medical Supply Operations

a. Medical supplies, equipment, and repairparts are provided through medical logisticschannels. The HSMO manages Class VIII suppliesand equipment to include medical maintenance andrepair services for the division.

b. Two days of medical supplies are stockedby unit- and division-level medical treatmentelements. Five days of medical supplies aremaintained by the DMSO. During the initialdeployment phase, each FSMC will receive amedical resupply preconfigured PUSH packageevery 48 hours until elements of the corpsMEDSOM/MEDLOG battalion are established.

4-26

c. During deployment, lodgment, and earlybuildup phases, medical units will operate fromplanned prescribed loads and from existing pre-positioned war reserve stockpiles identified inLOGPLANS. Also, as defined in LOGPLANS,initial resupply efforts may consist of preconfiguredmedical supply packages tailored to meet specificmission requirements. Resupply by preconfiguredpackages will be direct to the division untilreplenishment line item requisitioning is establishedwith the supporting MEDSOM/MEDLOGbattalion. Resupply by preconfigured packages is

by operational needs. Planning must be coordinatedwith the supporting MEDSOM/MEDLOGbattalion.

d. Requests for medical materiel flow fromdivisional supported elements to the DMSO (Figure4-20). The DMSO issues from stock on hand orforwards the requisition to the corps MEDSOM/MEDLOG battalion, using the division TACCS asrequired. Shipment of medical material from theDSA to users in the forward area is by the backhaulmethod or coordinated with the movement control

intended to provide support during the initial phase; office (MCO).continuation on an exception basis may be dictated

4-45. Battalion Maintenance Section A management element.

a. The battalion maintenance section A motor vehicle repair shop.(Figure 4-21) is under the staff supervision of thebattalion S4. It is organized into three functional A power generator repair shop.work areas:

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FM 8-10-4

b. This section establishes the battalionmotor pool and provides unit-level (organizational)maintenance and repair services for all the medicalcompanies of the battalion. For unit maintenanceoperations, see FM 43-5.

c. The battalion motor officer plans, directs,and supervises activities of the battalionmaintenance section (less medical maintenance). Healso—

Keeps the battalion commander andstaff informed of the maintenance situation and theoperational status of equipment.

Analyzes the maintenance situation.

Plans and evaluates maintenanceprograms.

Coordinates maintenance operationswith direct support units and other units asrequired.

Monitors calibration requirementsand arranges for calibration support.

Keeps the battalion materielreadiness officer informed of the operationalreadiness status of vehicles and power generationequipment.

Monitors PLL operations and theArmy Oil Analysis Program.

Supervises the use of maintenanceservices and the training and licensing of vehicledrivers and equipment operators.

Directs and coordinates organiza-tional maintenance throughout the battalion.

In coordination with the Bn S3:

Implements training and safetyprograms for operators and supervisors of battalionvehicles and power generating equipment.

Inspects battalion units to ensureequipment maintenance standards; and to ensuremaximum use of equipment and vehicle assets.

Trains subordinates.

4-46. Division Preventive Medicine Section

a. Responsibilities. The PVNTMED sectionis responsible for supervising the commandPVNTMED program (see AR 40-5), This sectionassists in training unit field sanitation teams. ThePVNTMED section is staffed as shown in Figure4-22. Its specific functions include, but are notlimited to—

Assisting the surgeon in preparingthe staff estimate by identifying the medical threat.

Assisting the Bn S2/S3 in deter-mining requirements for medical intelligencecollection, particularly disease prevalence.

Conducting surveillance ofdivisional units to—

Ensure use of PVNTMEDmeasures at all levels.

Identify health threats andrecommend corrective action as required.

Assisting divisional units intraining PVNTMED measures against heat andcold injury, and food-, water-, and arthropod-bornediseases.

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Monitoring the immunizationprogram.

Monitoring the health aspects ofwater production, distribution and consumption.

Monitoring disease and injuryincidence to optimize early recognition of diseasetrends and recommending preemptive diseasesuppression measures.

Conducting epidemiologicalinvestigations of disease outbreaks andrecommending PVNTMED measures to minimizeeffect.

Monitoring division level resupplyof disease preventive supplies and equipment,including water disinfectants, pest repellents andpesticides.

Conducting limited entomologicalinvestigations and control measures.

Monitoring environmental/meteoro-logical conditions; assessing their health relatedimpact on division operations; and recommendingPVNTMED measures to minimize their effects.

Deploying PVNTMED teams insupport of specific units/operations as required.

Assisting in identification/evaluation of NBC contamination in water supplies.

b. Division Preventive Medicine Officer.The division PVNTMED officer is responsible forthe division’s PVNTMED program. Based on

command guidance and division requirements, heplans, directs and prioritizes the PVNTMEDsection’s activities; serves as the principal advisoron medical threats that will be encountered bydivisional units; and recommends PVNTMEDmeasures to minimize these threats.

c. Environmental Science Officer. Theenvironmental science officer assists the divisionPVNTMED officer in developing, implementing,and supervising the division PVNTMED program.He assesses potential health threats andrecommends PVNTMED measures. This officerprovides consultation to commanders concerningenvironmental sanitation advises on public healthpolicy affecting the health of the command; andadvises on public health matters during civil affairsoperations, when required. He also supervisesPVNTMED specialists monitoring the division’sPVNTMED program to identify potential or actualhealth hazards.

4-47. Concept for Preventive Medicine Support

a. Basis for Preventive Medicine Support.History teaches that in past conflicts more soldiershave been noneffective due to DNBI than to battleinjuries. Often the victor in battle has been the forcewith the healthiest troops. Consequently,PVNTMED operations are based on preemptiveaction; increased soldier and commanderinvolvement; and priority to combat units. Toaccomplish this the PVNTMED section is deployedas teams to support, specific units/operations (forexample, deployed in direct support of a brigade orbattalion task force) as required. The teams will beorganized based on the medical threat.

b. Predeployment Action. Before deploy-ment much can be done to minimize DNBI. Actionsinclude ensuring command awareness of potentialmedical threats and implementing PVNTMEDmeasures; monitoring immunization status ofpersonnel; and monitoring individual and unit’sawareness of heat or cold injury, and food-, water-,and arthropod-borne diseases. Immediateeffectiveness of PVNTMED measures will dependon the early arrival of PVNTMED personnel.During the initial deployment phase, PVNTMEDpersonnel are inserted to preemptively reduce themedical threat to deploying forces; they assess itseffect on follow-on forces. It is anticipated—

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FM 8-10-4

That sanitation breakdowns willoccur while troops are in debarkation assemblyareas.

That disease vectoring will begin assoon as forces enter the area of operations.

NOTE

To avoid health andenvironmental problemshistorically encounteredby deploying troops, it isimperative that divisionalpreventive medicineassets be deployed inadvance of the mainbody/forces.

c. Preemptive Action. Preventive medicineoperations are characterized by preemptive action.Preventive medicine cannot wait until troops areincapacitated to take action. They must initiateaction on presumptive information to reduce themedical threat. For example, mosquito populationsnear troop assembly areas must be suppressedwithout waiting for confirmation that they carrydiseases; sandflies in towns along routes of marchmust be suppressed without waiting for theincubation of sandfly fever; and inadequatesanitation practices must be brought to theattention of responsible commanders before the firstcase of dysentery appears. Lack of, or delay inpreemptive actions can significantly impact on thedeploying force’s ability to accomplish its assignedmission.

4-48. Division Optometry Section

a. Functions. The division optometrysection (Figure 4-23) provides limited optomertyservices, including routine eye examination andrefraction; spectacle assembly using presurfacedsingle-vision lenses; and spectacle repair services forunits organic or attached to the division.

b. Division Optometry Officer. The divisionoptometrist performs eye examinations and treatsvision disorders within his capabilities. He referspathological vision deficiency cases to Echelon III

4-30

physicians as required; he plans and directs theactivities of the optometry section; and providesclinical statistical input to the division surgeon.

4-49. Division Mental Health Section

a. The division mental health section(DMHS) is responsible for assisting the command incontrolling combat stress through preventionprograms; maximizing the RTD rate with farforward care of battle fatigue casualties; andproviding division-wide mental health services. TheDMHS is collocated with the DCS in the DSA.When the division is garrison-based, it also assistsin coordinating social support services for divisionpersonnel and their families. Functions of theDMHS include—

(1) Providing education programs andindividual case consultation to unit leaders andmedical personnel on. prevention, early recognitionand intervention for battle fatigue (also stressfatigue in noncombat situations), substance abuse,suicidal risk, and neuropsychiatric and personalitydisorders.

(2) Providing technical supervision—

For unit preventive psychiatry(combat mental witness) plans and SOPs.

For restoration to effectivenessof moderate battle fatigue casualties.

For the treatment and RTD ofsevere battle fatigue casualties.

(3) Providing direct clinical services(specialized differential diagnosis, evaluation,limited treatment and referral/disposition) tosoldiers with neuropsychiatric disorders and toproblematic battle fatigue cases.

FM 8-10-4

(4) Maintaining contact with supportedunits; provides staff planning to predict battlefatigue casualties; coordinates corps mental healthassets placed in direct support to treat battle-tiredcasualties; and assist in the rest and recuperation ofbattle fatigued units.

(5) Planning for and coordinating acorps-level Mental Health Program for providing upto 2 weeks observation and reconditioning therapy.This program is established in the corps supportarea to hold battle fatigue/neuropsychiatric patientsfor 14-days with the potential of returning them tothe division. Patients entering this program are notcounted as hospital admissions (not affected by thetheater evacuation policy) until after the 14-dayholding period.

(6) When the division is garrison-based,coordinating with unit commanders; supportingmedical department activity (MEDDAC) socialsupport services; and other social support servicesto assist soldiers in minimizing home-front stresses.

(7) Developing and conducting a com-prehensive combat mental fitness program which—

Monitors division units for lowmorale, AWOL, disciplinary problems, and otherunhealthy factors.

Uses intervention techniquesthat involve unit commanders, staff chaplains, andothers in correcting unit-centered problems.

Assists commanders toimprove organizational climate and effectivenessduring changes of command; unit rest andrecuperation; personnel deployment/rotationbetween CONUS/OCONUS; and other high stresssituations.

b. The division mental health section isstaffed as shown in Figure 4-24. The consolidationof assigned mental health officers in the DCSemphasizes the division-wide preventive, educationand treatment responsibilities of the section.

c. The division psychiatrist directs thedivision’s mental health program. This officer is aworking physician. His specific functions include—

Establishing and operating theDMHS.

Consulting on matters havingpsychiatric components. These include nuclearsurety, security clearances, child and spouse abuseprograms, and alcohol and drug abuse programs.

Diagnosing, treating, rehabilitating,and disposition of neuropsychiatric and battlefatigue patients.

Participating in the diagnosis andtreatment of the wounded, ill and injured, especiallythose who can RTD.

NOTE

General medical duties(treatment of wounded, ill andinjured) must not distract thepsychiatrist from his primaryneuropsychiatric duties.

Training and consultation for unitleaders and medical personnel on identification andmanagement of neuropsychiatric disorders.

Providing therapy or referral forsoldiers with psychiatric problems.

Supervising and training assignedand attached mental health personnel.

d. The psychologist assists in the division’smental health program, especially applying theknowledge and principles of psychology to—

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FM 8-10-4

Evaluating and assuring the RTD ofbattle fatigued soldiers.

Conducting surveys and evaluatingdata to assess unit cohesion and other factors onpredicting and preventing battle fatigue casualties.

Performing neuropsychologicaltesting to evaluate psychological problems,psychiatric and neurological disorders, and toscreen unsuitable soldiers.

Apprising unit leaders, primary carephysicians, and other clinical personnel on theassessment of individual and unit mental fitness.

Providing consultation for unitcommanders and combat stress controlcoordinators (mental health NCOs working atbrigade level) on problem cases.

Counseling and providing therapyor referring soldiers with psychological problems.

e. The social work officer assists in thedivision’s mental health program, especiallyapplying the knowledge and principles of socialwork to—

Evaluating battle fatigued soldiers.

Coordinating and assuring thereturn of battle fatigued soldiers to duty.

Identifying and resolving organiza-tional and social environmental factors whichinterfere with combat readiness.

Assuring support for divisionsoldiers and their families from Army and civiliancommunity support agencies.

Apprising unit leaders, primary carephysicians, and other clinical personnel of availablesocial service resources.

Providing consultation to unitcommanders and to DMHS combat stress controlcoordinators on problem cases.

Counseling and providing therapyor referring soldiers with psychological problems,including spouse and child abuse.

4-50. Overview of Mental Health Support

The overall effectiveness of the combat mentalfitness program depends on the assignment anddistribution of mental health personnel. It isessential that the medical commander promotetraining, including field experience and cross-training of critical clinical skills. To fill their roles,mental health personnel must be familiar with theunits they support; and be known by unit leadersand organic medical personnel. This can only beachieved by intensive involvement in garrison andfield training. The primary preventive role of theDMHS involves a continuum of services along thespectrum of conflict, from peacetime through lowintensity to high intensity conflicts. This entirecontinuum must therefore be included in theDMHS’s focus, training, and method of operation.

a. When the division is in garrison, theDMHS operates a Mental Health Clinic. Thedivision psychiatrist, assisted by the psychologist,social work officer, and behavioral sciencespecialists staff the division’s mental health clinic.

b. During tactical operations, DMHSofficers assure a 24-hour diagnostic and evaluationcapability at the DCS located in the DSA. Allpatients who are evacuated because of behavioral(functional) or mental symptoms are routed to thenearest DCS.

c. For detailed information on combatstress control, battle fatigue/neuropsychiatriccases, and combat stress control organizations andfunctions, see FM 8-51.

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Section V. SUPPORT COMPANY ELEMENT

4-51. Organization and Functions

a. The support company and battalion head-quarters elements are organized under the medicalbattalion HSC. The HSC is dependent upon—

(1) Elements of the division forreligious, legal, personnel and administrativeservices; clothing exchange and bath services;graves registration; support for securing andhandling enemy prisoner of war (EPW) patients;security during tactical moves; and area damagecontrol support.

(2) Elements of corps for finance,laundry, personnel and administrative support.

(3) Corps assets for air and groundevacuation of patients to corps level treatmentfacilities.

(4) The DISCOM headquarters andHeadquarters Company for food service support.

b. The support company is similar in designto the three forward support medical companies. Itsmajor functional components (Figure 4-14) include acompany headquarters, a treatment platoon, and anambulance platoon. The company provides unit- anddivision-level HSS in the DSA. It has capabilitiesto—

Perform triage, initial resuscitation,stabilization, and preparation of sick, wounded, orinjured patients for evacuation.

Provide outpatient consultationservices for patients referred from unit-level medicaltreatment facilities.

Perform emergency dental care andlimited preventive dentistry.

Provide basic diagnostic laboratoryand radiology services and patient holding.

Provide backup support for theforward support medical companies.

Provide ground ambulance evacua-tion (for patients selected to be held in the DSA andreturned to duty within 72 hours) from medicalcompanies operating in the BSAs. The companyalso provides ground evacuation from unit-levelmedical treatment facilities and nonmedical unitsoperating in the DSA.

Provide limited emergency medicalresupply to divisional unit-level medical elementsoperating in the DSA.

4-52. Company Headquarters

The company headquarters provides C2, billetingdiscipline, security, training, and administration forassigned personnel. The headquarters element ofthe support company must collocate with thebattalion headquarters; therefore, it is austerelystaffed. Technical NBC assistance and organiza-tional maintenance support for the company’svehicles, CE and power generation equipment isprovided by elements of the battalion headquarters.The company headquarters is staffed as shown inFigure 4-25. For communications, the companyheadquarters employs an FM tactical radio and isdeployed in the battalion command/operations net(Figure 4-9). The support company’s wire and radiocommunications nets are shown in Figure 4-13 andFigure 4-14 respectively. This element also—

Plans, directs, and supervises unittraining and security for its platoons.

Provides general supply support andcompany level administration for all elements of theHSC.

Plans and supervises rear area operationsas directed by the battalion commander.

a. Company Commander. The companycommander plans, directs, and supervises theoperations and employment of the company. He isresponsible for training, discipline, billeting,security, welfare, and tactical employment of theheadquarters and support company. Thecommander is also a working physician in the DCS.

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b. Field Medical Assistant. The fieldmedical assistant serves as the company XO. He isthe principal assistant to the commander in allmatters pertaining to the tactical employment ofthe company. This officer supervises andcoordinates the security, plans, tactical operations,communications, OPSEC, logistics, and trainingfunctions of the company.

c. First Sergeant. The first sergeant is theprincipal enlisted assistant to the commander. Thissenior NCO manages the administrative activitiesof the command post; supervises the activities ofthe supply sergeant and unit clerk maintains liaisonbetween the commander and assigned NCOs; andprovides guidance to enlisted members of thecompany, and represents them to the commander.

4-53. Treatment Platoon

The treatment platoon operates the DCS. Itreceives, triages, treats, and dispositions patientsbased upon their medical condition. This platoonalso provides professional services in the areas ofminor surgery, internal medicine, general medicine,and general dentistry. In addition, it provides basicdiagnostic laboratory and radiology services andpatient holding. The treatment platoon (Figure 4-26)is composed of a platoon headquarters, an areasupport section, and a treatment section. Theplatoon is normally collocated with the divisionoptometry and mental health sections. Forcommunications, the platoon employs six tacticalradios; operates the company’s net control station;and is deployed in the HSC wire communicationsnet.

4-54. Treatment Platoon Headquarters

This office is the C2 element for the platoon. Itdetermines and directs the disposition of patientsreceived from the FSMCs and other supportedunits; it coordinates their evacuation. Forcommunication this element employs an FMtactical radio mounted in its assigned vehicle.

a. Platoon Leader. The platoon leaderdirects, coordinates, and supervises platoonoperations and assumes command of the companywhen the commander is absent. This officer is alsothe physician on the area support treatment team;he directs the activities of the DCS.

b. Field Medical Assistant. The fieldmedical assistant is the platoon operations officer.He is the primary assistant to the platoon leader forthe platoon operations; OPSEC; communications;administration; organizational training supply;transportation and patient regulating/evacuation.

4-55. Area Support Section

The area support section forms the DCS. It iscomposed of an area support treatment team, anarea support squad, and a patient holding squad.These elements operate as a single treatment unit;they provide both unit- and division-level medicalsupport for units operating in the DSA and serve asthe primary MTF for patients that overflow BSAclearing stations. Elements of this section are notused to reinforce or reconstitute forward supportingmedical units. Normally, they are not used on areadamage control teams.

4-56. Area Support Treatment Team

a. The area support treatment team is thebase medical treatment element of the DCS. Itprovides troop clinic type services and ATM. Thisteam, in coordination with the DMSO, may alsoprovide limited emergency medical resupply ofsupported medical units operating in the DSA. Forcommunications, the team employs an FM tacticalradio, operates the company/treatment platoon netcontrol station, and monitors the battalioncommand net. The personnel staffing of this team isshown in Figure 4-26.

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b. The primary care physician is also the element provides emergency dental care to includetreatment platoon leader. He examines, diagnoses, treatment of minor maxillofacial injuries; limitedtreats, and prescribes courses of treatment for preventive dentistry; and dental consultationpatients. He also directs the activities of the DCS. services. The diagnostic element provides basic

diagnostic laboratory and radiology services.Medical laboratory specialists in both the HSC and

4-57. Area Support Squad FSMC perform laboratory tests in direct support ofATM activities. To augment area medical support

a. This squad comprises the- dental and efforts within the division these specialists have thediagnostic support elements of the DCS. The dental capability to collect diagnostic specimens and ship

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Paragraph 4-61 implements STANAG 2061.

them to higher echelon medical laboratories foraualyses. Test results may be transmitted torequesting MTFs via available computer systems[TACCS and others].

b. The dental officer (the division dentalsurgeon) examines, diagnoses, treats, and prescribestreatment for diseases, abnormalities, end defects ofteeth and their supporting structure. As the divi-sion dental surgeon, he serves as a special staffofficer to the division surgeon, he advises/overseesall dental matters, to include monitoring the state oforal health fitness within the division. He exercisestechnical control of division dental assets withrespect to—

Quality assurance.

Divisional Oral HealthProgram.

The dental provisions600-8-101 (Personnel Processing).

Treatment prioritiesaugmentation or reconstitution of division dentalassets is required.

He coordinates support from corps area supportdental units through the DMOC or the S2/S3 sectionof the medical battalion headquarters. This officeralso performs ATM procedures and supervises theactivities of the area support squad.

4-58. Patient Holding Squad

The patient holding squad operates the patientholding facility of the DCS. The primary function ofthis 20-patient capacity activity is to providenursing care for those patients admitted for minorinjuries or illnesses (to include battle fatigue andneuropsychiatric patients) that are expected to bereturned to duty within 72 hours. This facility isunder the direct supervision of the DCS physician.Patients are admitted to the patient holding facilityon an outpatient basis and are not counted ashospital admissions.

4-59. Treatment Section

a. The treatment section (refer to Figure4-26) is composed of two treatment squads,

4-36

designated “first” and “second” squad. Thesesquads perform routine medical care, triage, andATM. They are expansion elements of the DCS. TheHSC treatment squads are identical to those of theFSMC and the combat battalion’s (squadron’s)medical platoon. These squads may be employed toreinforce or reconstitute other divisional medicalelements. They may also he employed in directsupport of rear area task force operations, includingarea damage control and mass casualty operations.Each squad has the capability to operate as twotreatment teams (ALFA and BRAVO teams) for alimited period of time. Staffing for the treatmentteams is shown in Figure 4-26.

b. The primary care physician plans andsupervises the activities of the treatment squadexamines, treats, and prescribes courses oftreatment in the routine care of patients; providesATM care for seriously injured/wounded and servesas the task force surgeon when required.

4-60. Treatment Squad Operation andEmployment

Each treatment squad employs two HMMWVtreatment vehicles with four medical equipmentsets (MES); two trauma sets and two generalsick call sets (one of each type per treatment team).The squads normally locate with the DCS andoperate in tandem with the area support section.When the DCS displaces, one squad serves as thejump element and moves forward (or rearward) toestablish the DCS at the new location. In support ofrear operations or other special operations, onesquad may be employed as a direct support element,These squads may also operate as two treatmentteams and may be used to reinforce forward supportmedical companies. For communications, eachtreatment teem employs one FM tactical radiomounted in its assigned vehicle.

4-61. Division Clearing Station

Division clearing station is the generic term used indesignating the division level MTF in both the BSAand DSA (STANAG 2061). This medical treatmentfacility is operated by the medical company’streatment platoon. In the DSA it is collocated withthe division mental health and optometry sections.

FM 8-10-4

The DCS provides both unit- and division-level S2/S3 to regulate patients directly from BASs tomedical support to all divisional and nondivisional this MTF. Since the DSA clearing station is lessunits operating in the division support area. The likely to displace as frequently as a DCS in theDSA clearing station also serves as the backup for BSAs, it is ideally suited to be augmented with athe BSA DCS. While the DSA clearing station surgical capability. A suggested layout of a DCSnormally receives patients from units located in the with surgical squad capability is shown in FigureDSA, it may become necessary for the Med Bn 4-27.

4-62. Ambulance Platoon

a. The ambulance platoon (Figure 4-28)performs ground evacuation and en route patientcare for supported units in the DSA. It alsoevacuates patients from the BSA DCSs to the DSADCS. This platoon may also reinforce ambulanceplatoons of FSMCs. The HSC ambulance platoon isidentical to the FSMC ambulance platoon in TOE.

It is staffed with a platoon leader, a platoonsergeant, two aid/evacuation sergeants, sixaid/evacuation specialists, and eight medicalspecialists/ambulance drivers. The ambulanceplatoon comprises a platoon headquarters, fourambulance squads (or eight ambulance teams), oneHMMWV control vehicle, and eight HMMWVambulances.

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b. The platoon leader leads and plans for the route reconnaissances, develops and issues stripemployment of the platoon. He establishes and maps; and establishes AXPs for both ground and airmaintains contact with supported FSMCs; makes ambulances as required.

4-63. Ambulance Platoon Operations and Em-ployment

The ambulance platoon headquarters normallycollocates with the treatment platoon headquartersto maximize evacuation support coordination. Allambulance platoon assets may be deployed at onetime. The platoon normally places one ambulanceteam in direct support of each FSMC and places twoteams in support of units in the DSA. The

remaining three teams are used for task forceoperations, backup support, or ambulance shuttle.Each ambulance carries an MES configured for enroute patient care. For communications, theambulance platoon employs nine vehicular mountedFM tactical radios and deploys in the HSC wirecommunications net. The platoon operates its ownnet control station and monitors the supportcompany’s operations nets. The HSC ambulanceplatoon’s area of operations is shown in Figure 4-29.

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Section VI. FORWARD SUPPORT MEDICAL COMPANY

4-84. Organization and Functions BSA; also unit-level HSS to units without organicHSS. It is organized into a company headquarters, a

a. The FSMC has the overall mission to treatment platoon, and an ambulance platoonprovide division-level HSS to all units operating in a (Figure 4-30).

b. The FSMC provides—

Treatment for patients with minordiseases, triage, initial resuscitation/stabilization,ATM, and preparation for RTD or furtherevacuation.

Ground evacuation for patientsfrom BASS.

Emergency dental care.

Emergency medical resupply tounits operating in the BSA.

Medical laboratory and radiologyservices commensurate with division leveltreatment.

Outpatient consultation services forpatients referred from unit-level MTFs.

Patient holding for up to 20 patientsexpected to RTD within 72 hours.

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FM 8-10-4

4-65. Operations and Employment

a. The FSMC is organic to the medicalbattalion and is a DISCOM asset. It is dependentupon the supported brigade for local security andtactical movement. The company is also dependentupon the DISCOM supply and transportation (S&T)battalion for food service support. The FSMCusually deploys with its DCS in the BSA; however,the organic treatment squads have the capability ofoperating independently of the medical company fora limited period of time.

b. Medical support requests includingaeromedical evacuation, ground ambulance,emergency medical resupply, and reinforcementsupport are normally transmitted through thebrigade to the supporting FSMC; however, suchrequests may be transmitted directly to the FSMC.Ambulances from the ambulance platoon evacuatepatients from BASS and transport them to theFSMC clearing station. More seriously injuredpatients are evacuated by supporting corps airambulances. Patients treated by the FSMC mayeither be RTD, held for 72 hours, or evacuated to acorps hospital. The FSMC has a holding capabilityof 20 patients. Minimally ill or injured patients thatoverflow (exceed the capacity of the holding facility)the BSA clearing station may be evacuated to theDSA clearing station by HSC ambulances. Patientevacuation from the BSA clearing station to combatzone hospitals is performed by corps ground and airambulances.

c. Request for patient evacuation from theFSMC to corps MTFs are transmitted directly tothe supporting corps air or ground evacuation unit.These requests are monitored by the medicalbattalion S2/S3 staff; they may intervene whennecessary or upon request.

d. Two days of Class VIII supplies arestocked by all FSMC treatment elements. Duringthe initial deployment phase the FSMC will receivea medical supply PUSH package every 48 hours.Once the corps MEDSOM/MEDLOG battalion isestablished, Class VIII supplies will be requestedand filled by standard line item requisition.

e. Medical maintenance support is providedby the supply element of the FSMC headquarters.

Backup support is provided by the medicalbattalion DMSO.

f. The FSMC provides a liaison repre-sentative (normally a field medical assistant) to themaneuver brigade’s S2/S3 office to coordinate HSSrequirements for the brigade and to stay abreast ofthe combat situation.

NOTE

Division and corps medicalsupport elements (except airand ground ambulance ele-ments) placed in direct supportof a ground maneuver brigadeare OPCON to the FSMCcommander (brigade surgeon).

4-66. Company Headquarters

The company headquarters (Figure 4-31) isorganized into a command element, supply element,and an operations and communications element.The company headquarters provides C 2 for thecompany and attached medical units. It alsoprovides general and medical supply, unit-levelmedical maintenance, NBC operations, and CEsupport to organic and attached units. Forcommunications, the company headquartersemploys 3 tactical radios and a manual switchboard.See Figures 4-12 and 4-13 for FSMC radio and wirenets.

a. Command Element. The commandelement provides C², feeding, billeting, security,training, administration, and discipline of assignedpersonnel. This element is staffed with a companycommander, a field medical assistant/executiveofficer, a first sergeant, and a unit clerk.

(1) Company commander. The com-pany commander plans, directs, and supervises theoperations and employment of the company. Thecommander is also responsible for training,discipline, billeting, and security of the company.This officer, a physician at the DCS, also serves asthe brigade surgeon.

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(2) Field medical assistant. The fieldmedical assistant serves as the company XO. He isthe principal assistant to the commander in theemployment of company assets. The field medicalassistant assures liaison with the S3 of thesupported brigade and supervises the activities ofthe supply and operations/communicationselements of the company headquarters. He alsosupervises and coordinates the security, planning,tactical operations, communications, OPSEC,logistics, and training functions of the company.

b. Supply Element. The supply elementprovides general supply and armorer support for thecompany. It provides emergency medical supplyand routine medical equipment maintenancesupport for the company, and for supported medicalelements in the BSA. This element is staffed with aunit supply sergeant, a medical equipment repairer,a medical supply specialist, and an armorer.

c. Operations Element. This element plans,coordinates and trains NBC defense functions. Itoperates the company’s wire communications net(Figure 4-14); serves as NCS for the company’soperation nets (AM and FM voice—Figures 4-11 and4-12); and performs unit-level maintenance on allFSMC CE equipment. The operations element isstaffed with an NBC operations NCO, a senior radiooperator, a single channel radio operator, and atactical communications systems operator/mechanic.

4-67. Treatment Platoon

The treatment platoon operates the DCS. Itreceives, triages, treats, and dispositions patientsbased upon their medical condition. This platoonprovides for minor surgery, internal medicine,general medicine, and general dentistry. It providesbasic diagnostic laboratory, radiological, andpatient holding services. The treatment platoon iscomposed of a platoon headquarters, an areasupport section, and a treatment section (Figure4-26). For communications, the platoon employsseven tactical radios and operates its own NCS(Figure 4-13). It is deployed in the FSMC’s wirecommunications net (Figure 4-14).

4-68. Treatment Platoon Headquarters

This is the C2 element for the platoon. It directs thedisposition of patients and coordinates theirevacuation. For communication this element usesthe FSMC wire communications net and employs anFM tactical radio mounted in its assigned vehicle.

4-69. Area Support Section

The area support section forms the DCS. It iscomposed of an area support treatment team, anarea support squad, and a patient holding squad.These three elements operate as a single treatmentunit and provide unit- and division-level medicalsupport for units operating in the brigade areas.Elements of this section are not used to reinforce orreconstitute Echelon I units. Normally, they are notused on area damage control teams.

4-70. Treatment Section

a. The treatment section (Figure 4-26) iscomposed of two treatment squads (’‘first” and“second” squad). These squads perform routinemedical care and ATM. Each FSMC treatmentsquad is identical to the treatment squad of theinfantry battalion medical platoon and is orientedtoward reinforcing BSA medical assets. Each squadhas the capability to operate as separate treatmentteams (teams A and B) for a limited period of time.These squads provide troop clinic type services,ATM, and tailgate medicine. The operationalmedicine officer plans and supervises the activities

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of the treatment squad. He examines, treats, andprescribes courses of treatment in the care ofpatients; provides ATM care for the seriouslyinjured and wounded; and supervises the care andtreatment provided patients by other members ofhis squad.

b. Each squad employs two trauma and twosick call medical equipment sets (one of each typeper treatment team), two HMMWV treatmentvehicles, and two tactical radios (FM voice).Initially, these squads are located with the areasupport section to provide an expanded capabilityfor the DCS. But they are primarily oriented towardaugmenting or reinforcing combat battalion medicalplatoons.

4-71. Operations and Employment of the DivisionClearing Station

a. The DCS is operated by the FSMCtreatment platoon. Its neuropsychiatric andPVNTMED capability is enhanced by theattachment of CSC elements from the divisionmental health section and a PVNTMED team fromthe division PVNTMED section. The FSMC may beaugmented with a surgical detachment, giving itsDCS a surgical capability.

b. The DCS is normally deployed in thevicinity of the brigade trains. It should not belocated near targets of opportunity such asammunition or POL distribution points or othersuch targets subject to enemy assault. A suggestedlayout of a DCS is shown in Figure 4-27.Considerations for selecting the location of thisfacility include—

(1) Centrally located to provide equalsupport to the three maneuvering battalions.

(2) Near accessible evacuation routes.

(3) Avoidance of likely enemy targetareas.

(4) Near an open area suitable forlanding air ambulances.

c. Seriously ill or wounded patients arrivingat this facility are given necessary medicaltreatment and stabilized for movement. Patients

reporting with minor injuries and illnesses aretreated within the capability of attending medicaland dental officers. Patients are either held forcontinued treatment and observation for up to 72hours; evacuated to the MSMC DCS or corpshospital for further treatment, evaluation anddisposition; or treated and immediately RTD. Otherfunctions of this facility include—

Providing consultation and limitedclinical laboratory/radiology services.

Recording all patients seen ortreated at the MTF; notifying the brigade S1 andunits of all patients from their organization thatwere processed through the facility.

Verifying the information containedon the FMC of all patients.

Monitoring patients when neces-sary, for NBC contamination prior to medicaltreatment (refer to FM 8-9, FM 8-285, and TM8-215).

Assuring the decontamination andtreatment of NBC patients (refer to Appendix E).

NOTE

Patient decon isperformed by a pretraineddecon team. The team iscomposed of eightnonmedical personnelfrom supported units.Patient decon teamsperform best whentrained and exercisedwith the supportingmedical company.

d. Evacuation from the DCS is performedby ground and air ambulances from the supportingmedical brigade/group and ground ambulances fromthe medical battalion support company.

e. Ammunition and individual weapons(including hand grenades) belonging to patients to

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be evacuated out of the division will be collected bythe DCS and given to the BDE S4, CS/CSS unit’sdesignated representative, or disposed of asestablished by command SOP. Patients admitted tothe holding facility who are expected to RTD within72 hours may retain their weapons; such equipmentmay be given to FSMC armorer for safekeepingpending the patients final disposition. Patientstraveling to the division rear for routine medicalconsultation will retain their individual weaponsand equipment.

NOTE

No weapons/ammunitionor other equipment suchas night vision devices,CE equipment, maps, orclassified material will beevacuated out of thedivision. Patientsentering the treatmentchain will always retaintheir protective mask.

4-72. FSMC Ambulance Platoon

a. The FSMC ambulance platoon (Figure4-28) performs ground evacuation from BASS in theforward areas to the DCS located in the BSA. TheFSMC ambulance platoon is staffed with a platoonleader, a platoon sergeant, two aid/evacuationsergeants, six aid/evacuation specialists, and eightmedical specialists/ambulance drivers. Theambulance platoon comprises a platoon

headquarters, four ambulance squads (or eightambulance teams), one HMMWV control vehicle,and eight HMMWV ambulances.

b. The platoon leader leads the platoon andplans for its employment. He establishes andmaintains contact with medical platoons ofsupported maneuver battalions; makes routereconnaissances, develops and issues strip maps;and establishes AXPs for both ground and airambulances as required.

4-73. Employment of the FSMC AmbulancePlatoon

The FSMC ambulance platoon locates with thetreatment platoon for mutual support. This platoonis mobile in its operations; all ambulances may bedispatched at any given time. Each of its ambulanceteams carries a medical equipment set designed foren route patient care. For communications, theplatoon employs nine tactical radios (FM voice),operates its own NCS, and is deployed in the FSMCwire communications net. Prior to start of tacticaloperations, the platoon establishes contact withsupported medical platoons and places one or twoambulances on location with those units. Duringstatic situations, however, ambulance teams areretained at their base site to facilitate maximumcoverage for all supported units. In addition toproviding direct support for maneuver battalions,the ambulance platoon provides area support(routine sick call runs and emergency standby) on anon-call basis for CS units (for example, CAB,DIVARTY, and engineer units) operating within theBSA. The platoon’s area of operation is shown inFigure 4-32. The procedures for medical evacuationare discussed in paragraph 4-19c.

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4 - 4 4

FM 8-10-4

CHAPTER 5

UNIT-LEVEL HEALTH SERVICE SUPPORT

Section I. TYPE UNITS SUPPORTED

5-1. Mission and Functions

a. The mission and functions of unit-level(Echelon I) HSS elements are—

Prevention of disease and illnessthrough applied PVNTMED programs.

Acquisition and immediate treat-ment of the sick, injured, and wounded.

Clinical stabilization of the criticallyinjured or wounded.

Provision for routine medical care(sick call) and the immediate RTD of soldiers "fit tofight.‘‘

b. Echelon I HSS is reinforced by EchelonII and III HSS; each providing increased support tothe patient. During lulls in operations, unit-levelmedical personnel conduct tactical and technicalproficiency training. When required, they provideinstructions to nonmedical personnel in self-aid/buddy aid (first aid), CLS procedures, patientevacuation, field sanitation, and personal hygiene.

c. Unit level HSS within the division isprovided by organic medical elements assigned tocombat battalions, selected CS battalions, divisionheadquarters, CAB headquarters, and theDIVARTY headquarters. Their purpose is toprovide direct HSS to subordinate elements of theorganization. This support is provided by medicalplatoons or sections in the followingorganizations/units:

Armored Battalion—MedicalPlatoon, HHC.

Mechanized Infantry Bat-talion—Medical Platoon, HHC.

Infantry Battalion—MedicalPlatoon, HHC.

Division Artillery-Medical Section,Headquarters and Headquarters Battery (HHB).

Combat Aviation Brigade (CAB)–Medical Section, HHC.

Field Artillery Battalion (DirectSupport), DIVARTY–Medical Section,Headquarters and Headquarters and ServiceBattery (HHS).

Attack Helicopter Battalion, CAB–Medical Section, Headquarters and ServiceCompany.

Reconnaissance Squadron (RECONSQDN), CAB–Medical Section, Headquarters andHeadquarters Troop.

Infantry Division (Light)–MedicalSection, HHC.

d. The organic medical platoons andsections above are modular in design, and operatefrom mobile treatment shelters. They have organicvehicles which provide maximum deployability andmission responsiveness.

5-2. Area Support

Unit level HSS is provided on an area support basisto all organizations and units of the division withoutorganic HSS by medical companies of the FSB,MSB, or DISCOM medical battalion. Thesecompanies are located in the BSA and DSA.

Section II. MEDICAL PLATOON5-3. Assignment headquarters section, a treatment squad (two

treatment teams), an ambulance section, and aA medical platoon is organic to each combat combat medic section. The medical platoon isbattalion HHC. The platoon is organized with a organized as shown in Figures 5-1 and 5-2.

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FM 8-10-4

5 - 2

FM 8-10-4

5-3

FM 8-10-4

5-4. Battalion Surgeon

The battalion surgeon/medical platoon leader is themedical advisor to the battalion commander and hisstaff. He is the supervising physician (operationalmedicine officer) of the medical platoon treatmentsquad. This officer is responsible for all medicaltreatment provided by the platoon. His responsi-bilities include—

Planning and directing unit-level HSS forthe battalion.

Advising the battalion commander andhis staff on the status of the health of the command.

Supervising the administration, disci-pline, maintenance of equipment, supply functions,organizational training, and employment ofassigned or attached personnel.

Examining, diagnosing, treating, andprescribing courses of treatment for patients toinclude ATM.

Coordinating the establishment andtraining of patient decontamination teams.

Training CLS.

Supervising the battalion preventivepsychiatry program to include training troopleaders in the preventive aspects of stress onsoldiers.

Planning and conducting medical civicaction programs (MEDCAP), when directed.

5-5. Platoon Headquarters

a. The headquarters section, under thedirection of the battalion surgeon, provides for thecommand, control, communications, and logisticsfor the platoon. The platoon headquarters is mannedby the field medical assistant and the platoonsergeant. It is normally collocated with thetreatment squad to form the BAS. The commandpost includes the plans and operations functionsperformed by the field medical assistant. Theplatoon has access to the battalion wirecommunication network for communications withall major elements of the battalion and with

5-4

supporting units. Wireless communications for thissection consists of a tactical FM radio mounted inthe platoon headquarters vehicle. The medicalplatoon employs an FM radio network for HSSoperations (Figure 5-3). The headquarters sectionserves as the net control station for the platoon.

b. The field medical assistant, an MSCofficer, is the operations/readiness officer for theplatoon. He is the principal assistant to thebattalion surgeon for operations, administration,and logistics. The field medical assistantcoordinates HSS operations with the battalion S3and S4, and coordinates patient evacuation with thesupporting medical company. This officer serves asthe medical platoon leader in the absence of anassigned physician.

c. The platoon sergeant assists insupervising the operations of the platoon. He alsoserves as the ambulance section sergeant. This NCOprepares reports; requests general supplies as wellas medical supplies; advises on supply economyprocedures; and maintains authorized stockagelevels of expendable supplies. He supervises theactivities and functions of the ambulance section toinclude operator maintenance of ambulances andequipment; operations security (OPSEC); and EMT.

d. The PA is a warrant officer. He performsgeneral technical health care and administrativeduties. The PA is ATM qualified and works underthe clinical supervision of the medical officer. Heperforms the following duties:

FM 8-10-4

Establishes and operates a BAS orBAS minus (1 treatment team).

Treats, within his ability, sick orinjured patients. He refers those patients requiringtreatment beyond his capability to the supervisingphysician.

Provides initial resuscitation towounded personnel.

Conducts training for battalionpersonnel in first aid procedures (self-aid/buddy aid),CLS, field sanitation, evacuation of the sick andwounded, and the medical aspects of injuryprevention.

Assists in the conduct of thebattalion preventive psychiatry program, to includetraining troop leaders in the preventive aspects ofstress on soldiers.

Trains medical personnel in emer-gency medical procedures. See Appendix A for atraining procedures guide.

5-6. Treatment Squad

The treatment squad is the basic medical treatmentelement of the BAS. It provides routine medicalcare, triage, ATM, and tailgate medicine. Thissquad is staffed with an operational medicine officer(primary care physician/battalion surgeon), a PA,two EMT NCOs, and four medical specialists (referto Figure 5-1). The squad’s physician, PA, and EMTsergeants are all trained in ATM procedures,commensurate with their occupational positions/specialties.

5-7. Battalion Aid Station/Treatment SquadOperation

Battalion aid station is the generic term used indesignating the unit-level medical treatmentfacility.

a. The treatment squad can split into twotreatment teams and operate as two separate aidstations (BAS minus), normally not to exceed 24hours. In continuous operations, when operating for

longer periods, personnel efficiency and unitcapability will tend to deteriorate. Each teamemploys treatment vehicle(s) with two medicalequipment sets (MES); one trauma set and onegeneral sick call set. See Appendix D for an exampleof the treatment squad in the split team mode.

b. For communications, each treatmentteam uses a FM tactical radio and is deployed in themedical platoon’s operations net. However, undercertain tactical conditions the battalion S4 mayrequire BAS elements to use the S4 net.

c. The BAS is under the tactical control ofthe battalion S4 and is normally deployed in thevicinity of combat trains (see Figures 5-4 and 5-5 forsuggested layout of a BAS). To reduce ambulanceturnaround time in providing ATM to patientswithin 30 minutes of wounding, the BAS may splitand place its treatment teams as close to maneu-vering companies as tactically feasible. Thebattalion S4 closely coordinates locations forforward positioning CSS elements (includingmedical treatment elements) with the battalion S3.This is to ensure that the location of these elementsis known by commanders of maneuvering and CSforces. Coordination ensures that CSS elements arenot placed in the way of friendly maneuveringforces; in line of direct (incoming) fires or supportingfires (outgoing); or in areas subject to be overrun byrapidly advancing enemy forces. Treatment teamssituated close to (within 1000 meters of)maneuvering companies in contact must beprepared to withdraw to preplanned, alternatepositions on short notice.

d. When maneuvering companies anticipatelarge numbers of casualties, augmentation of themedical platoon with one or more treatment teamsfrom the FSMC should be made. Augmenting treat-ment teams are under the tactical control of thebattalion S4; but are under the operational controlof the battalion surgeon. A suggested scheme ofemployment is to place a team in close support ofeach maneuvering company while locating onetreatment team in the combat trains. Medicaltreatment facilities should not be placed neartargets of opportunity such as ammunition, POLdistribution points, or other targets that may beconsidered lucrative by the opposing force.Considerations for the location of the BAS shouldinclude—

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FM 8-10-4

plan.

density.

Tactical situation/commander’s Accessible evacuation routes.

Avoidance of likely target areasExpected areas of high casualty such as bridges, fording locations, road junctions,

and firing positions.

Security. Good hardstand drainage.

Protection afforded by defilade. Near an open area suitable for

Convergence of lines of drift.helicopter landing.

Available communication means.Evacuation time and distance.

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FM 8-10-4

e. At the BAS, patients requiring furtherevacuation to the rear are stabilized for movement.Constant efforts are made to prevent unnecessaryevacuation; patients with minor wounds or illnessesare treated and RTD as soon as possible. Otherfunctions of the BAS include—

Receiving and recording patients.

Notifying the S1 of all patientsprocessed through the BAS, giving identificationand disposition of patients.

Preparing field medical cards(FMCs) as required.

Verifying information contained onFMC of all patients evacuated to the BAS.

Requesting and monitoring medicalevacuation of patients.

Monitoring personnel, whennecessary, for NBC contamination prior to medicaltreatment.

Decontaminating and treating NBCpatients (refer to TC 8-12, FM 8-9, FM 8-285, TM8-215, and Chapter 6 of this manual).

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FM 8-10-4

NOTE

Patient decontamination(decon) is performed by apretrained decon team. Thisteam is composed of eightnonmedical personnel fromsupported units. Patient deconteams perform best when theytrain and exercise their skillswith the supporting BAS (seeAppendix E).

f. Evacuation from the BAS is performedby the FSMC’s ambulance platoon and by corps airambulance teams.

g. Patient holding and food service is notavailable at the BAS. Therefore, only proceduresnecessary to preserve life or limb, or enable a patientto be moved safely, are performed at the BAS.

h. Ammunition and individual weaponsbelonging to patients evacuated from the BAS aredisposed of as directed by command SOP/policy. Allexcess equipment collected at the BAS is disposedof by the battalion S4 or as directed by commandSOP.

NOTE

Patients will alwaysretain their protectivemask.

i. Patients requiring dental treatment areevacuated to the supporting medical companywhere emergency dental care is provided.

j. Patients requiring optometric servicesinitially report to the BAS. For those patientsrequiring only routine replacement of spectacles,necessary information is obtained from the indi-vidual and forwarded to the division optometrysection. The required spectacles are fabricated andforwarded to the BAS for issue to the patient. Foroptometry services other than routine repair orreplacement of spectacles, patients are transportedto the optometry section, located in the DCS.

5-8. Combat Medic Section

To foster good interpersonal relations and morale ofcombat troops, combat medics are attached tomaneuver companies on a continuing basis.However, during lulls in combat operations, theyshould return to the medical platoon forconsultation and proficiency training. Functions ofcombat medics are as follows:

Performs triage and EMT for the sick andwounded.

Arranges medical evacuation for litterpatients and directs ambulatory patients to patientcollecting points or to the BAS.

Initiates the FMC for the sick andwounded and, as time permits, prepares an FMC ondeceased personnel.

Screens, evaluates, and treats, within hiscapabilities, those patients suffering minor illnessesand injuries. He RTD those patients requiring nofurther attention.

Keeps the company commander and thebattalion surgeon (or the PA in the absence of thesurgeon) informed on matters pertaining to thehealth and welfare of the troops.

Maintains sufficient quantities of medicalsupplies to support the tactical situation.

Serves as a member of the unit fieldsanitation team. In this capacity, he advises thecommander and supervises unit personnel onmatters of personal hygiene and field sanitation(FM 21-10-1).

5-9. Ambulance Section

a. Medical platoon ambulances provideevacuation within the battalion. Ambulance teamsprovide medical evacuation and en route care fromthe soldier’s point of injury to the BAS. In masscasualty situations, nonmedical vehicles may beused to assist in casualty evacuation as directed bythe commander. Plans for the use of nonmedicalvehicles to perform medical evacuation should beincluded in the battalion’s tactical SOP.

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FM 8-10-4

NOTE Director guide ambulatory patientsto the BAS.

Performing operatorsmaintenance on ambu-lances is an importantpart of each ambulanceteam’s duties.

b. Under the modular medical system, theambulance squad consists of two ambulance teams.

(1) The aid/evacuation NCO performs—

Triage and advanced EMTprocedures in the care and management of traumapatients.

Assists in the care andmanagement of battle fatigue patients.

Prepares patient for move-ment.

Provides patient care en route.

Maintains contact withsupported units.

Collects casualties.

Performs NBC detectionprocedures.

(2) The medical specialist/ambulancedriver is trained in EMT procedures. He operatesand maintains the ambulance and all on-boardequipment. He assists the aid/evacuation NCO inthe care and handling of patients.

c. Specific duties of the ambulance team areto—

Maintain contact with supportedelements.

Find and collect the wounded.

Administer EMT as required.

Initiate or complete the FMC.

Evacuate litter patients to the BAS.

Perform triage when necessary.

Provide Class VIII resupply tocombat medics.

Serve as messengers within medicalchannels.

d. The number of ambulance squads in asection varies and is based on the type of parentorganization. The infantry, airborne, and air assaultmaneuver battalions ambulance sections have twoambulance squads; each is equipped with highmobility multipurpose wheeled vehicle (HMMWV)ambulances. The heavy combat maneuverbattalions ambulance sections have eightambulance squads equipped with M-113 trackedambulances.

5-10. Employment and Functions of theAmbulance Team

a. The ambulance team is a mobile combatmedic team. Its function is to collect, treat, andevacuate the sick and wounded to the nearesttreatment station or AXP. For communications, theambulance team employs an FM tactical radiomounted on its assigned ambulance. The team isdeployed in the medical platoon’s operations net;however, in certain circumstances it may operate inthe S4 net or as established by the battalion SOI.

b. The ambulance teams routinely deploywith the maneuver company trains; however, itoperates as far forward as the tactical situationpermits, and frequently finds and treats patientswho have not been seen by the company medic. Thisteam, when operating in a company’s AO, is nor-mally under the tactical control of the company XOor first sergeant, but remains under the technicaland operational control of the medical platoon. Anambulance team is normally designated to support aspecific company. To become familiar with thespecific terrain and battlefield situation, the teammaintains contact with the company during mostcombat operations.

c. During static situations where thecompany is not in enemy contact or is in reserve, the

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FM 8-10-4

team returns to the BAS to serve as back-upsupport for other elements in contact. However,during movement to contact, the ambulance teamimmediately deploys to its regularly supportedcompany. During combat operations, the team maydismount (leaving the ambulance in the trains area),find, treat, and move patients to safety, and laterevacuate them to the BAS. When moving patientsto the ambulance location, patient collecting point,or company aid post, the team is normally assistedby nonmedical personnel.

5-11. Medical Evacuation

a. Optimum patient care and treatment isdependent upon an evacuation system that provides

a continuous movement of patients. Medical evac-uation is the process of moving patients from thepoint of injury or illness to an MTF or betweenMTFs. Each stop in the process is to providemedical treatment to enhance the patient’s earlyRTD or to stabilize him for further evacuation. Theresponsibility for patient evacuation rests with thelevel of HSS to which the patient is to be evacuated(see Patient Evacuation Flow, Figure 5-6). Ambu-lances go forward, pickup patients, and move themto the supporting MTFs.

(1) Ambulance teams of the medicalplatoon evacuate patients from the company aidpost or patient collecting points to the BAS.

(2) Ambulance squads of the FSMCevacuate patients from the BAS to the DCS.

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FM 8-10-4

b. An ambulance shuttle system maybe set enabling a continuous rearward evacuation flow,up between the FSMC DCS and the BAS. An AXP while decreasing ambulance turnaround time.is established (Figure 5-7) so that ambulances are Patients are evacuated no further to the rear thanmoving forward as others move rearward; thus their conditions require.

c. Aeromedical evacuation in the CZ shouldbe used to the maximum extent possible for criti-cally ill or wounded patients. Refer to Appendix Ffor medical evacuation request procedures. Nor-mally, ground ambulances are used to evacuate theminimally ill or wounded and for those patients whocannot be evacuated by air. The specific mode ofevacuation is determined by the patient’s condition,aircraft/vehicle availability, the tactical situation,and weather conditions (METT-T factors). Whenboth air and ground ambulances are used, specificfactors are considered in determining whichpatients are to be evacuated by air and which are tobe evacuated by ground ambulances (see FM 8-10-6).Normally, the physician or PA treating the patient(or the senior medic in their absence) makes this

determination; it is based on the medical conditionof the patient. However, the goal is to get thetrauma patient to the initial treatment/ATMelement within 30 minutes of wounding.

5-12. Medical Supply

a. The medical platoon maintains a 2-day(48-hour) stockage of medical supplies. Normalmedical resupply of the platoon is performed by theDMSO through backhaul or in coordination with themovement control office (MCO). Medical resupplymay also be by preconfigured Class VIII packages(PUSH packages) throughput from the forwardMEDSOM/MEDLOG battalion located in the corpssupport area (Figure 5-8).

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FM 8-10-4

b. In a tactical environment, the emergencymedical resupply (ambulance backhaul) system isused. In this environment, medical supplies areobtained informally and as rapidly as possible,using any available medical transportation assets.The medical platoon submits supply requests to thesupporting FSMC, who in turn fills requests andships supplies forward. Request for items notavailable at the FSMC are forwarded to the DMSO;the request is filled from division stocks andshipped to the requestor by the most expedientmeans available. Air ambulances from corps andground ambulances from the DISCOM transportmedical supplies directly to BASs. Class VIIIresupply of combat medics is performed by ambu-lances of the medical platoon.

5-13. Property Exchange

Whenever a patient is evacuated from one treat-ment facility to another or is transferred from oneambulance to another, medical items such ascasualty evacuation bags (cold weather type bags),blankets, litters, and splints remain with thepatient. To prevent rapid and unnecessary depletionof supplies and equipment, the receiving agencyexchanges like property with the transferringagency. Medical property accompanying patients ofallied nations will be disposed of in accordance withcommand SOP and STANAG 2128, if applicable.

Section III. MEDICAL SECTIONS AND SPECIAL PURPOSE MEDICAL PLATOONS

5-14. Combat Support Unit and Division combat engineer battalion, a medical section in theHeadquarters Medical Section light division normally consists of one treatment

module. These treatment modules are designed toMedical sections are organic to CS units and the provide unit-level HSS for personnel of supporteddivision headquarters. With the exception of the units. A medical section is relatively small in

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FM 8-10-4

comparison to a medical platoon; therefore, it will organized as shown in Figure 5-9. Personnel staffingrequire augmentation from a supporting medical of this section includes a DIVARTY surgeon/company in mass casualty situations. operational medicine officer, a section sergeant/

EMT NCO, and two medical specialists.

5-15. Medical Section, HHB Division Artillery

a. Organizations and Functions. TheDIVARTY medical section/treatment team is

(1) DIVARTY Surgeon. leaders in the three FA battalions. Certainofficer is the medical advisor to the DIVARTY situations may require that the clinical supervisioncommander and his staff. He is the primary care of PAs in FA units be passed to the physician inphysician of the DIVARTY and is also the charge of the nearest supporting MTF. Suchsupervising physician for PA/medical section requirements, however, are coordinated through the

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FM 8-10-4

division surgeon. The DIVARTY surgeon isresponsible for medical treatment provided byDIVARTY medical personnel (inclusive of medicalpersonnel assigned to FA battalions). His dutiesinclude—

Operating the DIVARTY aidstation.

Planning and directing unit-level HSS for members of the DIVARTYheadquarters and FA battalions.

Arranging for division-levelHSS.

Arranging for patient evac-uation to the DCS.

Supervising the administrationand maintenance of equipment, the supply function,technical training, and the employment of medicalpersonnel.

Examining, diagnosing,treating, and prescribing courses of treatment forpatients to include ATM for the trauma patient.

Coordinating patient evac-uation.

(2) Section Sergeant. The sectionsergeant, who is also an EMT NCO, assists themedical officer in accomplishing his duties andsupervises the medical specialists. He preparesreports, requests general and medical supplies,maintains supply economy procedures, andmaintains authorized stockage level of expendablesupplies. This NCO also performs triage and ATMprocedures in the care of trauma and NBC-insultedpatients, and care and management of battle fatiguepatients. He also performs routine patient care andNBC detection procedures. His duties furtherinclude—

Establishing and operating theDIVARTY aid station.

Maintaining the patientaccountability/casualty reporting system.

Maintaining medical equip-ment sets.

5-14

Conducting tactical andtechnical proficiency training for subordinatemembers of the section.

Conducting sanitation inspec-tions of troop living areas, food service areas, wastedisposal areas, and potable water distributionpoints and equipment.

(3) Medical Specialists. Thesespecialists assist the section sergeant inaccomplishing his duties. They perform triage andEMT. Their specific duties include—

Erecting and breaking downfield medical shelter systems, to includechemical/biological

(FMC).

disposition log.

assigned vehicle,

protective shelters.

Performing patient care.

Initiating patient records

Maintaining the patient daily

Operating and maintainingtactical radio, and power

generation equipment. (Also may serve as a memberon the battery field sanitation team.)

b. Employment. The medical sectionestablishes a BAS near the DIVARTYheadquarters and provides unit-level medicalservice for members of the DIVARTY headquartersand headquarters battery.

(1) The section employs a HMMWVtreatment vehicle, a cargo trailer, and two medicalequipment sets: one trauma treatment set and onegeneral sick call set.

(2) For communications, the sectionemploys a telephone set (TA 312/PT) and isdeployed in the HHB wire net. It employs an FMtactical radio and is deployed as designated by theDIVARTY SOI. This section also has access to thesupporting medical company’s tactical operationsnet to request division-level HSS.

c. Operations. Paragraph 5-7 describesBAS operations; these are equally applicable to the

FM 8-10-4

DIVARTY BAS. Figures 5-4 and 5-5 showsuggested layouts of a BAS.

d. Medical Evacuation. The DIVARTYHHB medical section has no medical evacuationassets. Evacuation of patients to and from theDIVARTY BAS is provided by the supportingmedical company in the DSA.

e. Medical Supply. The medical sectionmaintains a 2-day (48-hour) stockage level ofmedical supplies for the HHB. Routine requests formedical supplies are submitted through commandchannels to the DMSO. Supplies may be picked upby the requesting unit or forwarded to theDIVARTY BAS during routine ambulance runs.For emergency resupply procedures, see paragraph5-12 b.

5-16.

This

f. Property Exchange. See paragraph 5-13.

Medical Section, Headquarters andHeadquarters Support Company, DirectSupport Field Artillery Battalion

section is organic to the Headquarters andHeadquarters Support Company (HHS) of thedirect support (DS) FA battalions; it is organized asshown in Figure 5-10. Personnel staffing for thismedical section includes a section leader/PA, asection sergeant/EMT NCO, two medicalspecialists, and three combat medics (batteryaidmen).

a. Section Leader/Physicians’ Assistant.The PA is an advisor to the battalion commanderand his staff. He is the primary medical careprovider for the battalion and supervises allactivities of the medical section. The PA is trainedin ATM procedures and works under the clinicalsupervision of a medical officer. He is responsible tothe supervising physician for all treatment providedby medical personnel of theduties include—

EstablishingBAS.

section. His specific

and operating the

Planning and supervising unit-levelHSS and coordinating division-level HSS for thebattalion.

Treating, within his ability, patientsreporting to him.

Referring patients who requiretreatment beyond his capability to the supervisingphysician.

(ATM) for theProviding initial resuscitation

wounded.

Training medical personnel and CLSin emergency medical procedures.

b. Section Sergeant. This NCO assists thePA in accomplishing his duties. The specific dutiesof this NCO are the same as those described for themedical section sergeant in the DIVARTY HHB(refer to paragraph 5-15 a (2).

c. Medical Specialists. The duties andfunctions of these specialists are the same as thosediscussed in paragraph 5-15 a (3).

d. Combat Medics. Combat medics areallocated to a DS FA battalion on the basis of one toeach firing battery. The duties and functions ofcombat medics are described in paragraph 5-8.

e. Employment. The medical sectionestablishes a BAS near the DIVARTYheadquarters and provides unit-level HSS.

(1) The section employs a HMMWVtreatment vehicle, a cargo trailer, and two medicalequipment sets: one trauma treatment set and onegeneral sick call set.

(2) For communications, the sectionemploys a telephone set (TA 312/PT) and isdeployed in the HHS wire communications net. Italso employs an FM tactical radio and is deployed inthe net designated by the DIVARTY SOI. Thissection also has access to the supporting medicalcompany’s tactical operationsdivision-level HSS.

f. Operations. ParagraphBAS operation; these are equallyFA BAS. Figures 5-4 and 5-5layouts of a BAS.

net to request

5-7 describes aapplicable to theshow suggested

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FM 8-10-4

g. Medical Evacuation. The FA battalion’s is provided by the supporting medical company inHHS medical section has no medical evacuation the BSA.assets. Evacuation of patients to and from the BAS

h. Property Exchange. See paragraph 5-13. (1) The flight surgeon (brigade surgeon)

5-17. Medical Section, Headquarters and Head-quarters Company Combat Aviation Brigade/Combat Aviation Squadron

a. Organization and Functions. The CABmedical section is organized as shown in Figure5-11. Personnel staffing this section include a flightsurgeon, an assistant flight surgeon, a sectionsergeant/EMT NCO, and two medical specialists.

5-16

is the medical advisor to the CAB commander andhis staff. He is the primary care physician of thebrigade. The flight surgeon is responsible formedical treatment provided by the medical section(brigade aid station). His duties include—

Operatingstation.

Examiningthe medical qualification for

the brigade aid

and determiningflying status of

FM 8-10-4

aviators within the brigade headquarters; or Examining, diagnosing, treat-aviators referred to him by units without a flight ing, and prescribing courses of treatment forsurgeon. patients to include ATM for trauma patients.

Planning and directing unit-level HSS for members of the brigade headquarters.

Arranging for evacuation ofpatients to the DCS.

Arranging division-level HSS.

Supervising the administrationand maintenance of equipment, the supply function,technical training, and the employment of medicalpersonnel.

(2) The assistant flight surgeon assiststhe flight surgeon in performance of his duties. Heserves as the aviation brigade flight surgeon in theabsence of the flight surgeon. His duties include—

Examining and determiningthe medical qualification for flying status ofaviators within the brigade headquarters; oraviators referred to his treatment section by unitswithout a flight surgeon.

Examining, diagnosing, treat-ing, and prescribing courses of treatment forpatients to include ATM for trauma patients.

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FM 8-10-4

b. Employment. See paragraph 5-15 b foremployment considerations.

c. Operations. Paragraph 5-7 describes aidstation operations; these are equally applicable tothe DIVARTY BAS. Figures 5-4 and 5-5 showsuggested layouts of a BAS.

d. Medical Evacuation. The brigade HHCmedical section has no medical evacuation assets.Evacuation of patients is provided by thesupporting medical company.

e. Medical Supply. See paragraph 5-12.

f. Property Exchange. See paragraph 5-13.

5-18. Medical Section, HHC Attack HelicopterBattalion, CAB.

a. Organization and Functions. The attackhelicopter battalion medical section is organized asshown in Figure 5-12. Personnel staffing this sectioninclude a section sergeant/EMT NCO, and twomedical specialists. For further explanation, seeparagraph 5-15 a.

b. Property Exchange. See paragraph 5-13.

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FM 8-10-4

5-19. Medical Platoon, HHT Reconnaissance specialists, six combat medics, four aid evacuationSquadron, CAB. NCOs, and two aid evacuation specialists.

(1) For flight surgeon responsibilities,a. Organization and Functions. The HHT see paragraph 5-17.

reconnaissance squadron CAB medical platoon isorganized as shown in Figure 5-13. Personnel (2) The PA performsstaffing this platoon include a flight surgeon, a PA, health care and administrativea section sergeant/EMT NCO, two medical paragraph 5-5).

general technicalduties (refer to

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FM 8-10-4

b. Section Sergeant. This NCO assists thePA in accomplishing his duties. The specific dutiesof this NCO are the same as those described for themedical section sergeant in the DIVARTY HHB(refer to paragraph 5-15 a (2).

c. Medical Specialists. The duties andfunctions of these specialists are the same as thosediscussed in paragraph 5-15 a (3).

d. Combat Medics. These aidmen areallocated to a squadron on the basis of one to eachfiring troop. The duties and functions of combatmedics are described in paragraph 5-8.

e. Ambulance Squad. Paragraph 5-10describes duties of ambulance squad members.

f. Employment. The medical sectionestablishes a BAS near the squadron headquartersand provides unit-level medical service for membersof the squadron.

(1) The section employs a HMMWVtreatment vehicle, a cargo trailer, and two medicalequipment sets: one trauma treatment set and onegeneral sick call set.

(2) For communications, the sectionemploys a telephone set (TA 312/PT) and isdeployed in the HHS wire communications net. Italso employs an FM tactical radio and is deployed inthe net designated by the squadron SOI. Thissection also has access to the supporting medicalcompany’s tactical operations net for requestingdivision-level HSS.

g. Operations. Paragraph 5-7 describes anBAS operation; these are equally applicable to thesquadron BAS. Figures 5-4 and 5-5 show suggestedlayouts of a BAS.

h. Medical Evacuation. Evacuation ofpatients from the BAS is provided by thesupporting medical company.

i. Medical Supply. The medical sectionmaintains a 2-day (48-hour) stockage level ofmedical supplies for the squadron. Routine requestsfor medical supplies are submitted through com-mand channels to the DMSO. Supplies may bepicked up by the requesting unit or forwarded to the

BAS during routine ambulance runs. For emergencyresupply procedures, see paragraph 5-12.

j. Property Exchange. See paragraph 5-13.

5-20. Medical Section, HHC DivisionHeadquarters

a. Organizations and Functions. The HHCdivision headquarters medical section is organizedas shown in Figure 5-14. Personnel staffing of thissection includes an operational medicine officer, asection sergeant/EMT NCO, two medicalspecialists, and two aid evacuation specialists.

(1) Operational medical officer. Theoperational medical officer is responsible for medicaltreatment provided by HHC medical personnel. Thespecific duties of this medical officer are the same asthose described in the DIVARTY HHB (refer toparagraph 5-15 a (l)).

(2) Section sergeant. Refer toparagraph 5-15 a (2).

(3) Medical specialists. Refer toparagraph 5-15 a (3).

(4) Aid evacuation team. Paragraph5-10 describes employment of ambulance teams.

b. Employment. The medical sectionestablishes a BAS near the division headquartersand provides unit-level HSS for members of thedivision headquarters and headquarters company.

(1) The section employs a HMMWVtreatment vehicle, a cargo trailer, and two medicalequipment sets: one trauma treatment set and onegeneral sick call set.

(2) For communications, the sectionemploys a telephone set (TA 312/PT) and isdeployed in the HHB wire communications net. Italso employs a FM tactical radio and is deployed inthe net designated by the division SOI. This sectionalso has access to the supporting medicalcompany’s tactical operations net to requestdivision-level HSS.

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FM 8-10-4

5-21. Medical Platoon, HHC Combat EngineerBattalion

a. Organization and Functions. The combatengineer battalion medical platoon is organized asshown in Figure 5-15. Personnel staffing this sectioninclude an operational medical officer, a sectionsergeant/EMT NCO, a emergency medical NCO,two medical specialists, six combat medics, and twoaid evacuation specialists. The operational medicalofficer (battalion surgeon) is the medical advisor tothe combat engineer battalion commander and hisstaff. He is the primary care physician of thebattalion. He is responsible for medical treatmentprovided by the medical platoon. The specific dutiesof this medical officer are the same as thosedescribed in the DIVARTY HHB (refer toparagraph 5-15 a (l).

b. Section Sergeant. Refer to paragraph5-15 a (2).

c. Medical Specialists. Refer to paragraph5-15 a (3).

d. Combat Medics. The duties and functionsof combat medics are described in paragraph 5-8.

e. Aid Evacuation Specialist. The duties ofthe aid evacuation specialist are described inparagraph 5-10.

f. Employment. The medical sectionestablishes a BAS near the engineer battalion andprovides unit-level HSS.

(1) The section employs a HMMWVtreatment vehicle, a cargo trailer, and two medicalequipment sets: one trauma treatment set and onegeneral sick call set.

(2) For communications, the sectionemploys a telephone set (TA 312/PT) and is

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FM 8-10-4

deployed in the HHB wire communications net. It also has access to the supporting medicalalso employs an FM tactical radio and is deployed in company’s tactical operations net to requestthe net designated by the engineer SOI. This section division-level HSS.

Section IV. OPERATING THE MEDICAL PLATOON

5-22. Introduction

a. Responsibilities. The medical platoonleader is responsible for providing quality HSS tothe battalion. A medical operations officer, aplatoon sergeant, a PA, and combat medics areassigned to help accomplish this mission.

b. Organization and Functions. An effectiveplatoon leader must first understand theorganization and functions of the platoon. The

officers basic course and Sections I, II, and III ofthis chapter explained how it is supposed to work.Now find out how the platoon really works: How isit unique? What are its strengths and weaknesses?It will take time to assess this, but the platoon leadershould begin immediately by being observant andasking questions.

c. Structure. Look at the physical plant.How is the garrison BAS laid out? Who has officesand desks? Why? Is there awaiting area for sick call

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FM 8-10-4

patients? Is it adequate? Where are patientsscreened? Where does the PA see patients? Arethere exam tables? Does the layout make the bestuse of the available space? Is the lighting adequate?Where are medical records maintained and are theysecure? Where are the sets, kits, and outfits (SKOs)kept? Where are the medical supplies kept? Is theaid station clean? Does it need to be painted?

d. Getting to Know the Platoon.

How do assigned soldiers interact?Are they cohesive? Who are the informal leaders?Ask the S3 how the platoon performed on the lastArmy Training Evaluation Plan (ARTEP); how itdid at Combat Training Center (CTC); how itperformed on other major field training exercises.What does the HHC commander think of theplatoon? What does the HHC first sergeant think ofit? Are the line company commanders satisfied withthe HSS they are receiving? What does thebrigade’s medical company commander think of theunit? What are the division surgeon’s/DMOC’sevaluations? Is the battalion commander satisfiedwith the HSS he is receiving?

These are just some of the manyquestions a platoon leader should begin to answer.As he becomes familiar with the platoon, he will findother areas which need attention. The key is toLEARN!

Mistakes are part of the learningprocess. A platoon leader should not be afraid tomake mistakes; however, the key is to learn frommistakes and not make the same one twice.

e. Personnel. A platoon leader must get toknow his platoon members.

(1) Medical operations officer. What isthe medical operations officer’s background? Whatwere his previous assignments? Has he participatedin operational planning for employment of medicalunits? Does he understand tactical operationalprocedures and maneuvers? Can he organize unitloading plans for best support operations? Does heunderstand the Army Equipment MaintenanceProgram? Does he have a working knowledge ofgeneral and medical supply operations? How doeshe get along with other members of the platoon?Does he train personnel in administrative,

maintenance, and logistical procedures? Does heprovide tactical training for platoon personnel?

(2) Platoon sergeant. What is theplatoon sergeant’s background? What were hisprevious assignments? How long has he been in theunit? What is his education level? Is he EMTcertified? Does he have the EFMB? What did hescore on his last SQT? Is he physically fit? Does hepossess a good military appearance? What is hismanagement style? How do the soldiers react tohim? How does he see his role? What does he thinkof his own previous performance? What does hethink of the platoon? What does he expect of theplatoon leader? How does he see the leader’s role?The platoon sergeant-platoon leader relationship isvital, especially knowing, understanding, andtrusting one another. If the platoon sergeant isgood, learn from him. If he is mediocre, push him. Ifhe is bad, counsel him (document the counseling andcoordinate further actions with the HHCcommander).

(3) Physicians’ assistant. Many of thesame questions asked of the platoon sergeantshould be asked of the PA. Many of the sameobservations should be made. Additionally, anattempt should be made to evaluate the PA’stechnical expertise. Does he train the medics? Doeshe “teach” the medics? How does he handle himselfwith patients? The brigade surgeon should be askedfor his evaluation of the assigned PA; the platoonleader should keep the brigade surgeon informed ofhis impressions of the PA, positive or negative.

(4) Combat medics. Why are theymedics? Why are they in the Army? What do theythink of the platoon? Do they have EMT/EFMBcertifications? Can they read a map? Can they use aradio properly? How did they score on their lastSQT? How did they score on their last ArmyPhysical Readiness Test (APRT)? Married?Children? Previous assignments? Age? How is theirhaircut, uniform, weight? Do they want to stay inthe Army? What is their job (in their own words)?How do they like their jobs? Are they satisfied withtheir own performance? What are their goals?

f. Transportation. Getting to know thevehicles.

(1) Status. Does the platoon have all thevehicles it is authorized? If not, why? Do the

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vehicles have communications (commo)? Does itwork? What is the maintenance status of thevehicles? Are they generally well maintained? (Askthe XO or motor sergeant.) Are the vehicles paintedwith the appropriate color scheme? Do they havethe Geneva emblem?

(2) Preventive maintenance checks andservices. Have the platoon sergeant teachpreventive maintenance checks and services(PMCS) for each of the assigned vehicles using the-10 technical manual standards. Spend a Saturdaymorning doing this if necessary. Get with the motorsergeant or XO and become familiar withmaintenance procedures. Spend time in the motorpool every day. Learn to operate all of the vehicles.The more knowledge the platoon leader has aboutmaintenance in general and the status of each of theassigned vehicles, the better off the platoon will be.

g. Learn Standard Procedures. A platoonleader must familiarize himself with the unit’sSOPs; the tactical SOP, administrative-logisticsSOP, and maintenance SOP. What additional SOPsdoes the platoon use; sick call, deployment,maintenance, training, and Medical ProficiencyTraining Program (MPTP)? Are the SOPs adequate.Are they simple and understandable?

operations, visit other aid stations to see how theyconduct sick call. A sequence in which sick call maybe conducted is—

Patient reports to the aid stationwith a sick slip (DA Form 689) signed by hiscompany commander/representative.

The patient is met at reception desk;a medic takes the sick slip, and directs the patient toa seat in the waiting area.

Receptionist “logs patient in” usingsome type of aid station log book.

Receptionist pulls patient’s healthrecord (HREC) from the file and annotates the dateand patient’s unit of assignment on a SF 600(Health Record-Chronological Record of MedicalCare).

Receptionist places a sign-out card(OF 23) in place of the HREC in the file drawer.

Receptionist places patient’s sickslip in HREC folder and gives HREC to medicdesignated to take vital signs.

Prior to taking vital signs, medicensures that the SF 600 is filled out correctly.

5-23. Garrison OperationsMedic calls for patient by name.

a. Routine Activities. The primary job forsoldiers is to be prepared for war. They prepare forwar by training, which means frequent fieldexercises. Field exercises are vitally important;however, the majority of most soldiers’ time is spentin garrison. The manner in which routine garrisonactivities are conducted is indicative of the waysoldiers will perform during training exercises andin combat. Run a tight ship in garrison; it will paybig dividends in combat.

b. Battalion Aid Station Administration.Sick call is a daily activity which usually takes placefirst thing in the morning. It is normally scheduledfor 1 hour, starting between 0530 and 0730. There isno standard method of conducting sick call. An aidstation should have a sick call SOP which explainsthe unit’s sick call procedures. Review the SOP withthe PA and other members of the unit to ensuretheir satisfaction with it. To improve your

Medic checks vital signs and recordsthem on the SF 600.

Medic obtains patient history,performs evaluation, and records the information onSF 600. Medic must sign the entry.

Physician/PA reviews the record,discusses the case with the medic, and either treatsthe patient or directs the medic as to propertreatment. Physician/PA makes notes asappropriate and countersigns the SF 600.

Patient is treated/medicationsdispensed.

Patient is returned to duty (RTD),put on quarters, or sent to troop medical clinic(TMC).

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Receptionist “signs patient out” inlog book.

NOTE

When physician/PA is notpresent, medics may useDA Form 5181-R (Screen-ing Notes of AcuteMedical Care [ LRA ] ) inaccordance with instruc-tions to evaluate patientand countersign notes.

c. Medical Records Administration.

(1) Purpose.

The HREC is a permanent andcontinuous file which is begun when a soldier entersthe service. The records kept in it are prepared asthe member receives medical and dental care ortakes part in research.

The primary purpose of theHREC is to ensure that AMEDD personnel have aconcise but complete medical history of everyone onactive duty or in a Reserve Component.

(2) Terminal digit filing system.

(a) Medical record folders (DAForm 3444-series) are 10 differently colored folders.The color of the folder represents the last two digits(the primary group) of the patient’s social securitynumber (examples: orange folder—00-09; lightgreen—10-19). Using the terminal digit filingsystem (TDFS), HRECs are filed with those of likecolor.

(b) Under the TDFS, the sponsor’s(soldier’s) SSN is divided into three groups. Recordsare filed using the last two groups; these are the lastfour digits of the social security number. The lasttwo digits are known as the primary group; thenext-to-last two digits are the secondary group.Records are arranged first by their primary groupnumbers, resulting in folders of like colors beingfiled together. Within each primary group, therecords are arranged in order of their secondarygroup numbers. Within the secondary group,

records are filed numerically by the first five digitsof the SSN.

(3) Policies and procedures. ArmyRegulation 40-66 sets policies and procedures forpreparing and using Army medical records. Theseregulations should be read and kept handy. Theyprovide the "what" and "how to" of medical recordsadministration.

(4) Inventories and records review.HRECs should be inventoried monthly foraccountability and quarterly for compliance withAR 40-66. When conducting the quarterly review ofHRECs, medics should ensure the following criteriaare met:

Medical records jacket is filledout correctly (AR 40-66).

All forms in the medical recordare in correct order as shown in AR 40-66.

The privacy act statement (DDForm 2005) which is printed on the inside (back) ofthe DA Form 3444-series jacket is signed and datedas required by AR 40-2.

A completed SF 88 and SF 93(as required) are in the medical record and have aphysician’s signature (AR 40-501).

Medical records for personnelwith allergies are identified with DA Label 162 anda DD Form 3365 present (AR 40-15).

Ensure that DA Form3444-series record jackets are being used for activeduty personnel. This includes all temporary/newmedical records.

Immunizations are recorded inthe medical record and in the PHS-731 as prescribedin AR 40-66.

Ensure that immunizations aregiven to all personnel in accordance with AR 40-562and as directed by the surgeon.

Ensure that TB Tine testshave been administered with every periodic physical(AR 40-26).

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Ensure that at least one set offitted earplugs is in the soldiers’ possession uponarrival.

Ensure that service member’sblood type is entered on front of medical recordjacket (AR 40-66).

Determine if personnel whowear glasses need CB mask inserts ordered, or needa new prescription if the last one is over 2 years old?

Ensure laboratory reports andx-ray report forms are mounted on their respectivedisplay sheets.

Ensure that the medical recordjacket has the correct tape coding (AR 40-66).

Ensure medical records re-moved from the files are accounted for by use of asigned card (OF 23).

Records for personnel who PCS(Permanent Change of Station) or ETS (ExpirationTerm of Service) are logged in the PCS/ETS book.

Medical record files arescreened at least quarterly (AR 40-66).

5-24. Medical Assemblage and Equipment SetsManagement

a. Assemblage. Medical assemblagemanagement is not a difficult task. Yet, this is onearea in which medical platoon leaders frequently runinto trouble. Failure to account for materiel isinexcusable. The best way to prevent accountabilityproblems is to become thoroughly familiar with theproperty management system and then use it. Themedical platoon leader is accountable for thesupplies and equipment issued to the platoon. Themedical platoon leader has supervisoryresponsibility for all property; he may be held liablefor damage or loss even if he has not signed for anyproperty.

b. Equipment Sets. The medical equipmentset (ME S), frequently referred to as sets, kits, andoutfits (SKO), provides the capability for the

medical platoon to perform its mission. The MEScontains the medical supplies and equipment used inproviding HSS to the battalion. It is contained inmetal chests which are stored in the BAS.

(1) Types of sets. There are two types ofmedical equipment sets: service-unique MES andmulti service MES. The set issued to the battalionmedical platoon is a service-unique MES. It ismanaged by the Army Medical Department andconsists of medical and nonmedical items under asingle stock number. Service-unique MES areidentified in Volume I of the Department of Defense(DOD) medical catalog. Revisions to components ofthe MES are published annually in the supplybulletin (SB) 8-75 series. The supply bulletinrevisions constitute authority for updatingassemblages.

(2) Component accountability. Themedical platoon MES (National Stock Number6545-00-457-6858) consists of expendable, durable,and nonexpendable items. It is important tomaintain control of all types of supplies; however,property accounting records of nonexpendableitems must be kept. DA Pamphlet 710-2-1 explainsprocedures to use in maintaining these records.

(3) Inventory. Components of the MESare inventoried at least every six months and aftereach FTX. This is done to maintain accountability yand assure readiness. During the inventory, aserviceability inspection is also conducted. Replaceobsolete, deteriorated, and outdated items; repair orreplace unserviceable items. Ensure that the MESstorage area provides adequate security and protec-tion from extreme temperatures.

(4) Control of medications.

(a) A DD Form 4998-RControl and Surveillance Records for TOEAssemblages) is prepared for each dated

(QualityMedicalitem of

medical supply. Inventory these medicationsregularly to ensure 100 percent accountability.Check with the DMSO and ask for the local proce-dures for drug rotation. The DMSO should allowrotation of medications which are nearing theirexpiration date (example: 90 days from expiration).Effective drug rotation requires management ofquality control cards and coordination with the

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DMSO. It increases the efficiency of the medicalsupply system and saves battalion budget dollars.

(b) Controlled medical items(scheduled drugs) may not be stored at the BASduring peacetime. However, a prepared DA Form2765-1 (Request for Issue or Turn-in), less documentnumber, with an 06/05 priority designator forrequired medications (code R&Q items) ismaintained. The DMSO will fill these requests uponnotification of the unit’s deployment.

(c) Expired stocks of medicalsupplies and items determined to be unsafe orunsuitable for use will be destroyed in accordancewith AR 40-61. Destruction is normally accom-plished at the DMSO, not the BAS; usually on amonthly basis and requires a DA Form 3161(Request for Issue or Turn-in) from the supportedunit.

5-25. The Division Medical Supply System

a. Health Services Materiel Officer. TheHSMO is a special staff officer who providesmedical logistical support to the division. Thissupport is in the form of both medical supply andmaintenance of medical equipment. The HSMO alsoprovides advice and assistance on matterspertaining to medical materiel. The HSMO is amember of the division medical supply section of theMSMC.

b. Mission. In peacetime, the DMSOresupplies the DISCOM medical companies and thedivision medical platoons using supply pointdistribution. (This means supported units pick upsupplies from the supply point.) The Class VIIIsupply point (DMSO warehouse) is normally locatedin the MSMC’s AO. Each supported unit has asupply account with the DMSO. Routine supplyrequests come from the supported unit directly tothe DMSO. However, requests for nonexpendableitems must go through the requestor’s unit propertybook officer (PBO). Refer to the battalion SOP forspecific procedures.

c. Receipt for Supplies. To establish a ClassVIII supply account, the supported unit mustprovide the DMSO a DA Form 1687 (Notice ofDelegation of Authority-Receipt for Supplies). TheDA Form 1687 is prepared in accordance with AR

710-2 and AR 40-61. A new DA Form 1687 must besubmitted upon change of approving authority;upon the addition or deletion of a designatedindividual; or at a minimum, every 12 months. Onlythose individuals designated on the DA Form 1687are authorized to receipt for medical supplies.

d. Request Document. The DA Form 2765-1is used to request medical supplies. Informationneeded to complete this form can be found in theArmy Master Data File (AMDF). The originalcompleted DA Form 2765-1 should be given to thePBO/DMSO. The BAS should retain the third copy(flimsy) of the DA Form 2765-1 in a due-in statusfile.

e. Durable Items. Request for durable itemsof medical supply are handled in much the sameway. Some additional documentation, such as amemorandum explaining why the item is needed, isnormally required for durable items. Request fordurable medical items are sent from the unit supplyroom to the DMMC. Upon receipt of the item, theDMMC notifies the unit supply room and adesignated individual from the unit receipts for theitem. The item is then placed on the unit’s propertybook (hand receipt) and issued to the medicalplatoon.

f. Document Register. The BAS mustmaintain a DA Form 2064 (Document Register)which lists all medical supply transactions. Thedocument register should be kept in accordancewith DA Pam 710-2-1 and should be reconciledmonthly. The DMSO can provide assistance inestablishing or reconciling the document register.

g. Priority Designator System. In medicalsupply, a priority designator system is used toestablish priority for requested supplies. Thepriority designators authorized for use are the sameas used in requesting other classes of supplies.Priority designators and their uses are—

13 (12 in USAREUR and someCONUS units) —this number is used for all normalsupply transactions.

06 (05 in USAREUR and someCONUS units) —this number is used for itemswhich, by their absence, cause a unit’s mission to be

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impaired. The DMSO will attempt to immediatelyfill an 06/05 request. The company commander ofthe requesting unit must sign the back of the DAForm 2765-1 for 06/05 requests.

03 (02 in USAREUR and someCONUS units) —this is the highest priority availablefor medical supplies and denotes a life or limbemergency. Supply requests with an 03/02 prioritymust be signed by a physician and authenticated bythe battalion commander of the requesting unit. TheDMSO will immediately fill an 03/02 request. If theitem is not available, the DMSO stops all otheractivity and uses every available means to securethe needed item. Thousands of dollars may beexpended to get the high priority item to thelocation in which it is needed by the most rapidmeans; therefore, ensure that the correct prioritydesignator is used on a supply request.

h. Excess Materiel. It is important thatunits not maintain more medical supplies than theyare authorized. However, situations arise where aunit acquires excess supplies. Turn in these suppliesto the DMSO using a DA Form 2765-1. Check withthe DMSO for local policies governing the turn-in ofexcess medical materiel.

5-26. Immunizations

a. Responsibility. Commanders areresponsible for assuring that all unit personnelreceive required immunizations and that records ofsuch immunizations are maintained.

b. Immunization Records. Soldiers areissued PHS Form 731 (International Certification ofVaccination, II Personal Health History) when theyreceive initial immunizations upon entering themilitary service. At the same time, a SF 601(Immunization Record) is initiated and placed in thesoldier’s health record. These forms are comparedfor accuracy when the soldier in processes to a newunit. If the soldier requires immunizations, referhim to the supporting TMC or hospital.

c. Administering Immunizations. Onoccasion, immunizations may be given at the BAS,such as flu shots. When this is done, a “member ofthe medical department/service trained andqualified in emergency resuscitative techniques”(this normally means a physician or PA) must be

present. An emergency tray (shock tray) must alsobe on hand for immediate treatment of seriousreactions. Personnel administering immunizationsmust be trained in immunization procedures. A listof personnel authorized to administer immuni-zations should be maintained at the BAS. Whenplanning to give immunizations at the BAS,coordinate with the supporting TMC andbrigade/division surgeon.

d. Status of Personnel. The BAS maintainsan immunization status composite record of allpersonnel in the unit. AR 40-66 and DA Pam 600-8require that this record be inspected by the unitcommander at specific intervals.

5-27. Maintenance

a. Maintenance Program. An effectivemaintenance program is essential to ensure a unit’sability to perform its mission. The most importantelement in a unit maintenance program is theequipment operator. He must be familiar with hisequipment and able to maintain it. Leaders ensurethat operators are trained in equipment mainte-nance procedures.

b. Procedures. This section represents abasic overview of maintenance procedures. Use it asa starting point from which to learn maintenanceand maintenance management procedures. To learnwhat you need to know requires that you “learn bydoing.”

c. Levels of Maintenance. Maintenanceoperations are divided into three levels (unit,intermediate, and depot) to efficiently coordinatethem with other military operations.

Unit maintenance. Unit mainte-nance is similar to the maintenance applied toprivately - owned vehicles. It focuses primarily onminor repairs, adjustments, and replacing minorcomponents, such as starters, generators, brakes,and spark plugs. The equipment operator/crew withthe aid of unit mechanics perform unit maintenance.This is the level of maintenance with which aplatoon leader is primarily involved.

intermediateIntermediate maintenance. Thelevel of maintenance has two

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orientations, direct support (DS) and generalsupport (GS).

Direct support maintenanceunits perform repair and return to the userfunctions. They are organic to the division and focuson far forward support. Direct support maintenanceunits perform repair work beyond the capability ofunit maintenance.

General support maintenanceunits perform major repairs and overhauls. Itemsrepaired at the GS level are returned to the supplysystem. General support maintenance does notperform a repair and return to the user function.

Depot maintenance. Depot mainte-nance is performed at fixed facilities in CONUS andmajor overseas areas. Depot maintenance ischaracterized by overhaul and rebuild functions.

d. Maintenance Terms and Functions. Tounderstand maintenance, a platoon leader must firstbecome familiar with terms used to describe variousmaintenance functions.

Prescribed load list. A prescribedload list (PLL) is the unit’s repair parts stockage. Itis composed of an authorized stockage list (ASL)which is a list of parts prescribed for a unit; alsodemand supported and command supported items.Demand supported items are parts for whichsufficient need has been historically established tojustify their stockage. Command supported itemsare parts which the unit commander has directed bestocked.

Preventive maintenance checks andservices. Preventive maintenance checks andservices (PMCS) consist of periodic checks (before,during, and after operations; daily, weekly,monthly) and scheduled services (Q-services). Theoperator’s technical manual (-10) for each item ofequipment lists the PMCS to be conducted and theirfrequency.

Cannibalization. Authorizedremoval of serviceable parts from unrepairableequipment by maintenance units.

Controlled exchange. Removal ofserviceable parts from unserviceable but repairable

equipment to bring a like piece of equipment tooperational status. This requires commandauthorization.

Technical manuals. Technicalmanuals (TMs) provide technical information(operator instructions, repair procedures, and repairparts) about specific pieces of equipment. Technicalmanuals are referred to as -10s (operator’s manual),-20s (unit and DS maintenance manuals), -30 (DS/GS manuals), -40 (GS and depot manuals), and -14(applies to all levels).

e. Battle Damage Assessment and Repair.Battle damage assessment and repair (BDAR)techniques expedite return of a damaged piece ofequipment to the current battle.

Battle damage assessment is usedto determine the extent of damage to equipment.Equipment is classified according to the type ofrepair needed; plans are made for repair of eachitem. Priorities for repair of battle damaged itemsare usually—

Most essential to the imme-diate mission.

Repairable in the least time.

Repairable but not in time forthe immediate mission.

Battle damage repair involves use ofemergency repair techniques to return a system to amission capability. Normally BDAR is only used incombat at the direction of the commander. Itincludes—

Shortcuts in parts removal orinstallation.

Modifying components fromother items.

Using parts from a noncriticalfunction elsewhere on an item to restore a criticalfunction.

Bypassing noncriticalcomponents to restore basic function capability.

Cannibalization.

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Making parts from kits oravailable material.

Using substitute fuels, fluids,or lubricants.

The BDAR program is not to beused in the repair of medical equipment. Onlymedical equipment repair personnel are adequatelytrained to effect the type of temporary fixesassociated with this concept. Due to the delicate,technological complex nature of most medical equip-ment, temporary fixes even by a medical equipmentrepairer is discouraged.

5-28. Maintenance Forms and Records

Numerous forms and records are used to documentmaintenance activities. These records are main-tained for historical purposes, to ensure necessaryservices are performed, and to establish require-ments for repair parts stockage.

a. Dispatch. DD Form 1970 (MotorEquipment Utilization Record) is commonlyreferred to as a "dispatch." It is issued to thevehicle operator by the unit maintenance clerkbefore the vehicle is used.

b. Inspection and Maintenance Worksheet.DA Form 2404 (Equipment Inspection andMaintenance Worksheet) is the “bread and butter”form of unit level maintenance (see TM 38-750). Theoperator uses this form to record faults that hecannot correct. Unit maintenance personnel refer tothe form to identify necessary repairs and annotatecorrective actions. It is used when conductingscheduled service and during other technicalinspections. The DA Form 2404 is quite versatileand is the most frequently used form in the motorpool.

c. Maintenance Request. DA Form 2407(Maintenance Request) is used by unit maintenancepersonnel as a request to support units (DS) forrepair work.

d. Lubrication Order. Lubrication order(LO) is more like a technical manual than amaintenance form. It details how to lubricate thevehicle, the types of lubricants to use, intervals to

be observed, and special precautions. An LO shouldbe kept on each vehicle with the appropriate TM.

5-29. Unit Maintenance Organization

a Battalion Maintenance Assets. Thebattalion’s maintenance assets (unit - levelmaintenance) are organized somewhat similar to itsmedical assets. All maintenance assets are organicto the battalion maintenance platoon. They areapportioned out to support the various companies.

b. Company Maintenance Section. Withinthe company maintenance section, the key playersare the battalion motor sergeant, normally an E-8,and the motor officer, usually the company XO. Themotor sergeant allocates jobs to his mechanics andsupervises their activities. He also runs the motorpool shop office. The motor officer is responsible tothe company commander for the unit’s maintenancestatus.

c. Battalion Maintenance Platoon. Thebattalion maintenance platoon is run by thebattalion motor officer (BMO). The battalion motorsergeant, an E-8, and the battalion maintenancetechnician, a warrant officer, assist the BMO. Thebattalion maintenance technician is the technicalexpert in the field of maintenance. He frequentlyinterfaces with DS maintenance and maintenancesupport teams.

5-30. Training

a. Importance. "The more you sweat intraining, the less you bleed in war." This ancientChinese proverb expresses the importance oftraining very simply and accurately. Much more hasbeen said and written about training, the bottomline of which is that to be prepared for war, we musttrain. Leaders have an obligation to ensure thateffective training takes place in the unit. Fortraining procedures, see Appendix A.

b. How to Train. Army trainingmanagement can be a difficult task, particularly fora new platoon leader. Do not expect to become animmediate expert. Study the system read Armytraining literature (AR 350-1, 25-series fieldmanuals, 8-series field manuals, local policies,

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regulations, and SOPs); talk with supervisors; andlearn from NCOs.

c. Get Involved in Training. The importanceof a leader’s involvement in training cannot beoveremphasized. Officers and NCOs do not onlyplan and present training, they also participate.Leader participation motivates soldiers; itemphasizes the importance of the training event. Asa participant, the leader can evaluate the quality ofthe training being presented. Participating intraining allows officers and NCOs to brush-up ontheir skills and, in many cases, to develop new skills.

d. Training Responsibilities. Unit trainingconsists of individual and collective training.Individual training is conducted for tasks which thesoldier must be able to complete unassisted, such asapplying a pressure dressing. Individual trainingdevelops the technical proficiency of the soldier.Collective training builds on individual skills andprovides the basis for unit proficiency in executingits missions, such as establishing an aid station andproviding HSS in a mass casualty situation.Generally, officers are responsible for collectivetraining and NCOs are responsible for individualtraining.

e. Battle Focus. The unit’s wartimemissions are the source from which all trainingactivities are derived. This is known as battle focus.A successful training program is achievable bynarrowing the focus to vital tasks that are missionessential. This is accomplished through thedevelopment of a mission essential task list(METL).

f . Mission Essential Task ListDevelopment.

The commander of each unit in theArmy from corps to company level must develop aMETL. The medical platoon, being a uniqueorganization in a combat arms battalion, should alsodevelop a METL. This is done by first consideringthe battalion’s mission and reviewing the battalionMETL. The medical platoon METL must supportthe battalion METL. The next step is to get a copyof the FSMC’s METL and discuss it with the FSMCcommander. The medical platoon METL must becoordinated with the FSMC METL. Other sourcesto consider are SOPs; emergency deployment

readiness exercise (EDRE) plans; and divisionsurgeon and DMOC plans and policies. The finalstep is to present the medical platoon METL (whichshould consist of roughly a half-dozen tasks) to thebattalion commander. Once the battalioncommander approves the METL, it becomes thesource document for developing the medical platoontraining plans. It should be changed only when theunit’s mission changes.

Involve the PA, medical operationsofficer, platoon sergeant, and other platoonmembers in the METL development process. Thiscreates a common understanding of the unit’scritical wartime requirements; it is essential indeveloping the platoon training plans.

A condition statement andstandards list for each mission essential task isdeveloped. The resulting training objective providesa clear list of expected training performance. Theplatoon sergeant will take the METL and develop asupporting individual task list for each missionessential task. Some documents which will assist indeveloping these collective and individual tasksare—

Mission training plans.

Soldiers training publications.

Deployment or mobilizationplans.

General defense plan.

Army, MACOM, and localregulations.

Local SOPs.

g. Planning.

(1) Needs assessment. The first step inplanning for training is the assessment. Assesscurrent training proficiency by reviewing trainingevaluations, such as CTC take-home packages, FTXafter-action reports, and inspection results. Alsoconsider recent or projected personnel turnover ornew equipment fielding. Finally, ask subordinatesfor their opinions and consider your ownobservations and impressions. Rate each task “T”

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(trained), “P” (needs practice), “U” (untrained), or“?” (unknown). The training requirements aresimply the training necessary to achieve and sustainthe desired levels of proficiency for each missionessential task.

(2) Training strategy. With theassistance of platoon members, develop a strategyto accomplish each training requirement. Thisshould include plans to improve proficiency in sometasks and sustain proficiency in others. The trainingstrategy establishes priorities by indicating thefrequency each mission essential task will beperformed during the training period. The strategyincludes guidance that links METL with trainingevents (coordinate training with the HHB/HHC/HHT/HHS commanders, S3 and, if necessary,battalion commander).

h. Planning Calendars.

(1) Battalion training schedules. Thebattalion produces long-range, short-range, andnear-term training schedules covering 1 year, 3months, and 1 week respectively. The weeklytraining schedules are normally provided for eachcompany. The medical platoon should get a copy ofthese schedules.

(2) Medical platoon input. The medicalplatoon should hold regular training meetings of keyleaders within the platoon to develop medicalplatoon input to the battalion’s training schedules.Before the long-range training schedule is prepared,the medical platoon leader should tell the HHCcommander, in general terms, what training themedical platoon needs during the upcoming year.Upon receipt of the long-range training calendar, themedical platoon should meet and refine plans fortraining in the first quarter. The medical platoonleader then provides specific information to theHHC commander for inclusion in the battalionquarterly training schedule. The medical platoonthen holds weekly training meetings to—

Review training conductedduring the previous week.

Discuss training plannedthe current week.

Make firm coordinationtraining scheduled for the upcoming week.

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Provide final details of medical platoon trainingplans for the upcoming week for inclusion in theweekly HHC training schedule.

(3) Coordinating medical platoontraining. Remember, all medical platoon trainingmust be conducted within the parametersestablished by the battalion/company trainingschedule. For example, the battalion trainingschedule calls for a FTX with a company force-on-force exercise; perhaps the medical platoon canconduct an evacuation exercise concurrently. Thisrequires coordination with the S3, companycommander, and possibly the FSMC commanderand others. Most of all, conforming medical platoontraining plans and activities to the parent unitactivities require creativity, flexibility, andinitiative on the part of the medical platoon leader.Training must be conducted without detractingfrom the HSS being provided the companiesundergoing training.

i. Expert Field Medical Badge.

(1) The program. The Expert FieldMedical Badge (EFMB) program has received highlevel attention in recent years. In many units, themedical platoon leader’s evaluation is directly tiedto the percentage of his platoon which passed theEFMB test. In some divisions, awards are given tothe battalion with the highest EFMB pass rate.Aside from these facts, the EFMB is an excellentprogram and is a good measure of training successand unit motivation. If planned and administeredcorrectly, EFMB training can tie directly into yourplatoons METL-based training program.

(2) Training and test management.EFMB training is managed differently at variousposts around the Army. Some provide centralizedEFMB training, while others leave it to the unit. Inmost divisions, EFMB training is conducted in theunit with some type of centralized training for alldivision EFMB candidates. EFMB testing isstandardized; however, the frequency of testingmay vary. For additional information on EFMBtraining and testing, see TC 8-100.

(3) Command. The medical platoonleader should find out how much emphasis thebattalion commander places on the EFMB and plantraining accordingly. Call the division surgeon or

FM 8-10-4

DMOC to get details of local EFMB training andtesting procedures.

j. Army Medical Department SystematicModular Approach to Realistic Training. The ArmyMedical Department Systematic Modular Approachto Realistic Training (ASMART) was created toprovide hospital-based clinical skills training anddevelopment to medical personnel. The programallows an established number of medics from eachunit to rotate through the hospital at set intervals.

Normally, medics will be enrolled in ASMART for aperiod of 90-180 days. The ASMART offers anexcellent opportunity for medical personnel tosharpen their clinical skills through work in theemergency room or in a hospital ward or clinic.However, the program must be closely monitored toensure that the participants are receiving goodtraining. If, as medical platoon leader, you are notsatisfied with the training being provided throughthe ASMART, discuss your concerns with thedivision surgeon and/or hospital commander.

Section V. EMPLOYMENT OF THE MEDICAL PLATOON

5-31. Planning and the Health Service SupportPlan

a. Planning. To ensure that HSS isresponsive to the battalion (squadron), the medicalplatoon leader or the medical operations officermust attend all operational briefings and planningsessions. They are responsible for providing theHSS portion of battalion SOPs, OPLANs, andoperation orders (OPORDs). The HSS planned fortactical operations is addressed in theadministrative and logistics annex of the battalionOPORD. It should include—

Location of forward treatment sites.

Ground and air medical evacuationroutes, ambulance exchange points, and far forwardpatient collecting points.

Location of the supporting DCS(medical company).

NOTE

The battalion surgeonand the medicaloperations officer mustkeep the medical platoonpersonnel informed of thetactical situation.

b. Health Service Support Plan. The healthservice support plan (HSSPLAN) must beresponsive and support the maneuver commander’sintent. The HSSPLAN is best disseminatedthrough the use of an overlay showing preplannedtreatment team/BAS locations and ambulanceexchange points. The HSSPLAN is keyed to themaneuver battalion’s OPORD. Once approved, theoverlay is distributed to maneuver companycommanders, elements of the medical platoon, thetactical operations center, and the ambulanceplatoon leader of the supporting FSMC. A sampleoverlay (HSSPLAN) depicting preplanned positionsfor ALFA and BRAVO treatment teams of a BASand AXPs of a FSMC ambulance platoon is shownin Figure 5-16. To effectively execute theHSSPLAN, the medical operations officer monitorsthe tactical situation. He maneuvers the treatmentteams and coordinates changes for AXP locationsbased on the progress of the battle. This allows theHSS system to rapidly clear the battlefield ofcasualties; to treat patients early; and to returnminimally injured soldiers to the fight.

5-32. Combat Medic

a. Allocation. As was mentioned previously,combat medics are allocated to mechanized infantryon the basis of one medic per platoon and a seniormedic for each company. In armor units, the alloca-tion is one medic per company. Normally, oneambulance team is positioned in the company area.

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b. Platoon Medic Location. The platooncombat medic normally locates with, or near, theelement leader. When the platoon is moving on footin the platoon column formation, he positionshimself near the element leader trailing the basesquad forward of the second team (Figure 5-17). Thisformation is the platoon’s primary movementformation. When the platoon is mounted, thecombat medic will normally ride in the same vehicleas the platoon sergeant (Figure 5-18). The combatmedic will provide care to the occupants of hisvehicle. He will not be able to treat occupantsother vehicles while the platoon is movingengaged.

ofor

c. Company Medic. The company combatmedic normally collocates with the first sergeant.When the company is engaged, the combat medicwill remain with the first sergeant and providemedical advice as necessary. As the tacticalsituation allows, he will provide medical treatmentand prepare patients for evacuation. The combatmedics assigned to the company’s evacuationvehicle work with the company medic in acoordinated effort. When a casualty occurs in a tankor an armed fighting vehicle, the aid/evacuationteam will move as close to the armored vehicle aspossible, making full use of cover, concealment, anddefilade. Assisted, if possible, by the vehicle’s crew,

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they will extract the casualty from the vehicle and evacuation. The company medic normally remainsadminister emergency medical treatment. The aid/ with the company command post, but may be usedevacuation team moves the patient to the treatment anywhere in the company, assisting the aid/squad/BAS or to a collecting point to await further evacuation teams in some situations.

5-33. Combat Lifesavers receives his medicalunit supply section.

supplies (resupply) through hisFor CLS training material and

Combat lifesavers are nonmedical unit members equipment, see Appendix B.who have received additional training to increasetheir skills beyond basic first aid procedures. Theprimarv duty of the CLS does not change. He is a 5-34. Preparation for Tactical Operationsfiighter first and medic second. The CLS medicalduties are performed when the situation permits.The CLS carries a CLS’s medical equipment set and

a. Planning. The lack of adequate planningon the part of medical platoon leaders and FSMC

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commanders has been repeatedly noted at theNational Training Center.

b. Tailoring Medical Platoon Organizationto Mission. The platoon organization best suited forspecific combat operations are discussed in SectionsII and III of this chapter. However, it is importantto realize that although the medical platoon isauthorized a certain number of personnel andamount of equipment with which to accomplish itsmission, on-hand figures seldom match thoseauthorized. The ability to accomplish the missionwith less personnel and equipment than authorizedis one of the greatest challenges which leaders faceArmywide.

c. Reconnaissance. All key personnel withinthe medical platoon, especially evacuation NCOs,conduct personnel through reconnaissance beforeand between phases of an operation. If an on-sitereconnaissance is not possible, a map recon isconducted. During the map recon, primary andsecondary evacuation routes through eachcompany’s sector are designated. Prepare anoverlay displaying evacuation routes, BASlocations at various points in the operation, and ifpossible, the FSMC location. In developing the HSSoverlay, use phase lines designated for themaneuver elements. Key BAS relocation uponmaneuver units crossing certain phase lines. Referto FM 101-5-1, Operational Terms and Symbols, forcorrect overlay symbols and techniques. Distributea completed overlay to each company commander,the S3, the FSMC commander, and ensure thatsenior company medics and evacuation NCOs havecopies.

d. Medical Platoon Operations Order. ASthe map recon is conducted, also develop themedical platoon OPORD. The medical platoonOPORD must be tied to the parent battalionOPORD and should be coordinated with the FSMC.It may be written or oral, but must use the fiveparagraph OPORD format. Prior to the operation,issue this order to members of the medical platoonand attached/supporting medical personnel.

5-35. Deployment

a. Complexity of Deployment. Fieldoperations begin with a deployment. This may be assimple as loading vehicles and convoying to a

training area on-post, or as complicated as loadingthe entire unit for an overseas deployment.

b. Movement Plans. The key to a successfuldeployment is accurate movement plans. Eachcompany should have a movement officer respon-sible for maintaining a unit movement file. This filecontains detailed information on the unit’scapability to deploy. It specifies transportationrequirements necessary to support the unit’smovement by various modes of travel, such as air,rail, or convoy. Among the most basic and mostimportant information assembled by the unitmovement officer is a list of prime movers (trucksdesignated to move trailers) and their designatedtrailers, and load plans for each vehicle.

c. Medical Platoon Loading Plans. Themedical platoon must be able to move all of itspersonnel (less company and platoon medics) andequipment to the field with its organic vehicles. Theplatoon’s load plans prescribe the method by whichthis is done. The load plan specifies exactly whatsupplies and equipment will be carried on whichvehicle. It specifies a prime mover for each trailer.The MES, BAS is divided between the platoon’s aidstation vehicles to give each treatment team equalcapability. The load plan allows for personalbaggage, tentage, camouflage nets and poles,heaters/stoves, tools, and any other miscellaneoussupplies and equipment. See Appendix D for anexample.

d. Evaluate Load Plan. The platoon loadplan must be accurate and workable. The only wayto be sure load plans are valid is to test them.Periodically, the medical platoon should load-out allof its supplies and equipment in accordance with theplatoon load plan (FTX deployments are goodopportunities to do this). This will reveal anyshortcomings in the load plans and will result inmore workable loading arrangements. Any changesmade during these practice load-outs should bereported to the company movement officer. Once anefficient load plan is developed for each vehicle, it ispublished so that the crew becomes familiar withthe configuration. Before deployment, inspect eachvehicle to ensure its configuration matches the loadplan.

e. Convoy. The final step in the deploymentprocess is normally a convoy to the maneuver area.

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The convoy will most likely be conducted as atactical road march consisting of several marchunits dispersed over various routes. The battaliontactical SOP prescribes convoy procedures; itincludes intervals between vehicles, speed, rest haltintervals, safety briefings, and night and blackoutdrive procedures. Convoys are relatively simpleoperations but require much coordination, closecontrol, and active attentive participation bydrivers.

5-36. Establishing the Battalion AidStation/Company Aid Post

a. Site Selection. Prior to deployment, aninitial site for the BAS is designated as well asfuture sites to be used as the operation progresses.This is done during the map recon, is coordinatedwith other staff members, and is published in thebattalion’s OPORD and the HSS overlay. Anexample of a BAS arrangement is depicted inFigures 5-4 and 5-5. Some factors to consider whenselecting a site for the BAS include—

Cover and concealment. The areaselected should provide maximum cover andconcealment without hampering mission orcommunications. Overhead cover is desirable forprotection from biological/chemical contamination,if attacked.

Accessibility. The site shouldprovide adequate access to all approach andevacuation routes.

Space. The site should haveadequate space for the unit’s operation andexpeditious loading and unloading patients,supplies, and equipment.

Drainage. The site should providegood drainage during inclement weather.

Decontamination area. The areashould be large enough to provide an area forpatient decontamination, if required.

Landing site. Provide an area for ahelicopter landing site.

Security. The site should providesecurity and be defendable.

Communications. When consideringall factors of site selection, remember that terraincan impede FM communication systems.

NOTE

If the BAS is collocatedwith the combat trains orif another staff memberselects the BAS site, themedical platoon leadermust ensure the abovefactors are considered.

b. Establish Battalion Aid Station. Whenthe BAS elements arrive at the operational site, thefollowing actions are taken:

An advance party is on location andhas the area secured.

Move BAS vehicles(covered and concealed, if possible).

Establish perimeternecessary.

into position

security, if

Configure supplies and equipmentinto tailgate medicine operational posture.

Establish helicopter landing siteand equipment to support patient care.

Report to the main CP, combattrains CP, and FSMC that the BAS is operational.

Make radio check with eachcompany senior medic.

Erect extension/tentage. Anexample of a M577 extension configured as a BAS(treatment station) is depicted in Figure 5-19.

Erect camouflage nets.

Operators perform after operationcheck of vehicles.

Complete final preparation toreceive patients, incorporate sleep/work schedule toensure radios are continuously monitored.

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c. Establish Company Aid Post. Whenestablishing a company aid post, take the followingactions:

Company medic remains with ornear first sergeant; this is his transportation.

If possible, collocate aid post withmedical evacuation vehicle (company medic mustnot depend upon this vehicle for his transportation).The company medic must remain with the company.

Prepare area to receive patients.

Make radio check with platoonmedics, if possible.

Camouflage as necessary.

5-37. Treat and Evacuate Patients

a. Combat Medic Care. When casualtiesoccur, first aid will usually be rendered by buddy aidor perhaps CLS care. The platoon medic/companymedic will then go to the casualty’s location or thecasualty will be brought to the medic. The combatmedic makes his assessment; administers initialmedical care; initiates a DD Form 1380 (FieldMedical Card); then requests evacuation or returnsthe individual to duty. A vehicle from theevacuation section (usually pre-positioned forward)picks-up the patient and transports him to the BAS.

b. Battalion Aid Station Care. When thepatient arrives at the BAS, initially he is taken to atriage point. When the treatment teams arecollocated, the PA usually performs triage (if thetreatment teams are separated or a mass casualtysituation exists, an EMT NCO performs triage). Thepatient is categorized as immediate, delayed,minimal, or expectant. Depending upon his triagecategory and the patient load, the patient is thentaken to either the patient holding area or thetreatment area. Ultimately, medical treatment isadministered and the patient is either evacuated tothe DCS or returned to duty.

c. Mass Casualty Situation. Keep in mindthat the type of operation being supported will to agreat extent determine the rate of casualtiesgenerated. In a high-intensity conflict, mass

casualty situations will develop. Medical treatmentand evacuation capabilities may be temporarilyoverwhelmed. Self/buddy aid and CLS care will becritical. Nonmedical vehicles may be required toevacuate casualties (FM 8-10-6). It is possible that adecision will have to be made to abandon patients;however, if patients have to be abandoned, a medicwith medical supplies must remain with them. Inany scenario, the guiding principle is to provide thegreatest good for the greatest number of patients.

5-38. Disestablish a Field Medical TreatmentFacility

When a unit receives orders to relocate, loadvehicles according to loading plans in order toprovide HSS while en route or at the relocation site.All potential sources of intelligence which could beused by enemy forces are removed before leavingthe area. All wires that were used for communica-tions are recovered and serviced. Prior to departing,all personnel are briefed on the move and issuedstrip maps. Patients awaiting evacuation are movedwith the BAS, if possible. The BAS must maintaincommunications and continue to monitor the battle.

5-39. Field Sanitation

a. Medical Threat. Poor field hygiene andsanitary practices pose a very real threat to unitsboth in training and combat. In fact, throughoutrecorded history, DNBI have accounted for a higherpercentage of casualties than have battle injuries.(In US history, this ratio is three to one.) Eventoday, outbreaks of diarrheal disease, foodpoisonings, arthropod bites, and environmentalinjuries (heat and cold) account for significanttraining time loss. Although the medical threatconsists of hundreds of casualty-producing injuriesand illnesses, the causes can be, reduced to sixprimary categories.

Heatcombinations of heatconsumption.

injuries causedstress and insufficient

Cold injuries caused bycombinations of inadequate clothing, low

bywater

temperatures, wind, and wetness.

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Diseases caused by bitingarthropods.

Diarrheal diseases caused bydrinking impure water, eating contaminated foods,or not practicing good individual and unitPVNTMED measures.

Diseases, trauma, or injuries causedby physical or mental unfitness.

Environmental or occupationalinjuries caused by carbon monoxide, noise, blastoverpressure, and solvents.

b. Preventive Medicine Measures. Themedical platoon leader is responsible for monitoringthe health of the soldiers in his battalion. He can beproactive in this regard by ensuring the provision ofthe following PVNTMED measures.

Large amounts of water to combatthe threat of heat injury. Joint planning factorsindicate that as much as 20 gallons per person perday will be required during operations in hotweather environments.

Adequate changes of socks andclothing to prevent cold injuries caused by wetclothing.

Arthropod repellents, aerosolinsecticide, bed nets, and louse powder for theindividual; pesticides and associated equipment forfield sanitation teams; and PVNTMED unitssupport to prevent arthropod-borne disease.

Iodine tablets and calciumhypochlorite to maintain water potability.

Adequate fresh air ventilation inconfined vehicles and in maintenance and sleepingareas. Proper ventilation prevents carbon monoxidepoisoning.

Adequate hearing protection.

Adequate vision protection toprevent traumatic eye injury from laser devices,sighting devices, and secondary projectiles.

(1) Individual protective measures.The mobility and dispersion of modern fightingforces require that individual soldiers take actionsto protect themselves against the medical threat.These simple individual actions are calledPVNTMED measures. Applying these measurescan significantly reduce the time loss due to DNBI.The soldier should—

Protect himself against heatby–

Drinking plenty of water.

Using the correctwork/rest cycle as directed by his leader.

Eating all meals toreplace salt.

Recognizing the riskassociated with wearing mission-oriented protectionposture (MOPP) clothing, body armor, or wheninside armored vehicles.

Modifying his uniform asdirected/authorized by his leader.

Protect himself against thecold by—

Drinking plenty of waterto replace loss of fluids during periods of strenuousexercise.

Wearing his uniformproperly in loose layers to hold maximum body heat.

Washing his feet dailyand keeping them dry by changing socks severaltimes a day.

Keeping his body warmby exercising his trunk and limbs wheneverpossible. Exercising his feet, hands, and face toincrease circulation.

Protect himself against bitingarthropods by—

Using his uniform as abarrier.

Using arthropod/insectrepellent.

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Takingor tablets as prescribed.

Usingaerosol insecticide at night.

antimalarial pills

a bed net and

Keeping himself and hisuniform clean.

Protect himself againstdiarrhea by—

Only consuming food,drink, or ice approved by medical authorities.

Using treated water whenavailable. When not available, treating water byusing iodine tablets or chlorine ampules, or boilingit.

Washing his hands.

Washing his mess kit.

Burying his waste.

Maintain physicalfitness by—

Exercising.

Preventinginfections.

Preventingdisease.

and mental

skin

dental

Preventing genital andurinary tract infections (drinking plenty of water).

Bathing when possible.

Minimizing sleep loss.

Improving resistance tostress.

Ensuring adequateventilation while in closed spaces such as whenfiring weapons from inside an armored vehicle.

Wearing hearingprotection while associated with source of noise(that is, aircraft, tactical vehicles, and all calibers ofweapons).

Wearing eye protectionwhen exposed to sources of traumatic injury such aslasers.

(2) The field sanitation team. Thecompany field sanitation team consists of organicmedical personnel; or at least two soldiers, one ofwhom is an NCO, when organic medical personnelare not available. The team is specially trained inwater supply, food service sanitation, wastedisposal, pest management, environmental injuries,and non-NBC chemical hazards (see FM 21-10-1).The field sanitation team serves as an aid to the unitcommander in protecting the health of his company.Through regular inspections, the field sanitationteam ensures sanitary standards are maintainedand PVNTMED measures are practiced. Table 5-1 ishelpful in identifying activities which are ofPVNTMED significance.

5-40. Medical Training in the Field

a. Importance. Conducting medical trainingduring a battalion FTX can be a challenge. Whenproperly conducted, however, medical play can lendsignificant realism to training exercises. Thisbenefits both the medical platoon and the battalionas a whole. The medical platoon learns to performmedical treatment and evacuation operations undersimulated combat conditions. The battalion learnsto complete its mission under situations in which itis suffering casualties. For information on planningfor deployment to CTC, see Appendix G.

b. Lessons Learned. Previously, the keychallenge in incorporating medical play intotraining exercises was sometimes convincing thebattalion commander to do it. Fortunately, CombatTraining Center experience has shown the need forrealistic training to include medical play. Now, thechallenge is in operating and reacting to realisticcasualty scenarios. Again, this tests the initiative,creativity, and flexibility of medical platoon leaders.Observations and lessons learned at CTC arepresented in Appendix G.

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NOTEThe key to mission success isdetailed preplanning. AHSSPLAN must be preparedfor each support mission.Ensure that the HSSPLAN isin concert with the tacticalplan. Use the plan as a startingpoint and improve on it whileproviding HSS.

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CHAPTER 6HEALTH SERVICE SUPPORT IN TACTICAL OPERATIONS

Section I. SUPPORT OF OFFENSIVE OPERATIONS

6-1. Offensive Operations

The offensive is the decisive form of war. It is themethod by which wars are won. In combat, USforces will conduct offensive operations, wheneverand wherever the opportunity presents. Thebattalion or battalion TF conducts offensiveoperations to achieve one or more of the following:

Defeat enemy forces.

Secure key or decisive terrain.

Deprive the enemy of resources.

Gain information.

Deceive and divert the enemy.

Hold the enemy in position.

Disrupt an enemy attack.

6-2. Types of Offensive Operations

a. Major Types. There are five major typesof offensive operations in which the battalion TFparticipates:

Movement to contact.

Hasty attack.

Deliberate attack.

Exploitation.

Pursuit.

b. Task Force Participation. The TFnormally participates in these operations as part ofa larger force. Commanders at each level—

Find or create a weak point.

Suppress enemy fires.

Isolate the enemy and maneuveragainst weak points.

Exploit success.

6-3. Sequence of an Attack

Generally, the following sequence is followed inbattalion TF attacks:

a. Reconnaissance. Reconnaissance beginsas soon as possible after the TF receives its mission.Information on the avenues of approach, obstacles,and the enemy positions is critical to planning theattack. Reconnaissance continues throughout theattack.

b. Movement to a Line of Departure. Whenattacking from positions not in contact, units oftenstage in rear assembly areas. They road march toattack positions behind friendly units in contactwith the enemy; conduct a passage of lines, thenbegin the attack.

c. Maneuver. The TF maneuvers to aposition of advantage.

d. Deployment. The TF deploys to assaultor to fix the enemy if bypassing.

e. Attack. The enemy position is engagedwith fire; assaulted; or bypassed.

f. Consolidation and Reorganization orContinuation. The TF eliminates resistance andprepares for or conducts further operations.

6-4. Forms of Maneuver

a. Types of Attack. Attacks are of two basictypes: hasty and deliberate. The two are distin-guished primarily by the time available for planningand the extent of preparation. The basic forms ofmaneuver used in the attack are envelopment,penetration, frontal attack, and infiltration.

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Frequently, attacks will use more than one form ofmaneuver; for example, a penetration that leads toan envelopment.

b. Envelopment. An envelopment is thepreferred form of maneuver. In an envelopment, theattacker strikes the enemy’s flank or rear. Theenvelopment causes the enemy to fight in adirection from which he is less prepared.Envelopment requires a weak flank, found primarilyby aggressive reconnaissance.

c. Penetration. In the penetration, thebattalion concentrates its force to rupture thedefense on a narrow front, normally a platoon. Thegap created is then widened to pass forces throughto defeat the enemy and to seize objectives. Asuccessful penetration depends on surprise and theattacker’s ability to suppress enemy weapons; toconcentrate forces at the point of attack; and toquickly pass sufficient forces through the gap todestroy the enemy’s defense. A penetration isnormally attempted when enemy flanks are strong,or when the enemy has a weak or unguarded gap inhis defense. To penetrate a well-organized positionrequires a quick rupture and rapid destruction of thedefense’s continuity to deny him reaction time.Without rapid penetration, the enemy canreposition forces to block or counter the maneuver.

d. Frontal Attack. The frontal attack is theleast preferred form of maneuver. In the frontalattack, the TF uses the most direct routes to strikethe enemy. This attack is normally employed whenthe mission is to fix the enemy in position or deceivehim. Although the frontal attack strikes theenemy’s front, it does not require that the attackerdo soon line or that all subordinate unit attacks befrontal. Frontal attacks, unless in overwhelmingstrength, are seldom decisive.

e. Infiltration. Infiltration is a form ofmaneuver where combat elements move by stealthto objectives to the rear of the enemy’s positionwithout fighting through prepared defenses. All orpart of the TF may move by infiltration.Infiltrations are slow and are often conductedduring reduced visibility. Success requires effectivereconnaissance to discover and secure undefendedroutes. Such routes are normally found in roughterrain or in areas difficult to cover with observationand fire. The infiltrating elements avoid detection;

however, if detected they avoid decisiveengagement.

6-5. Main and Supporting Attacks

In offensive operations, the commander designatesmain and supporting attacks.

a. Main Attack. The units conducting themain attack are assigned a mission which, whenachieved, successfully accomplishes the TF’smission. The main attack secures a key terrainobjective (position) or destroys an enemy force.Traditionally, terrain objectives have been assignedto the elements making the main attack; but attacksby fire to destroy an enemy force may also be themain attacker’s mission.

b. Supporting Attack. The supportingattack allows the main attack to be successful. Thesupporting attack contributes to the success of themain attack by accomplishing one or more of thefollowing:

Occupying terrain to support-by-firethe maneuver of the main attack.

Fixing the enemy in position.

Deceiving the enemy as to thelocation of the main attack.

Isolating the objective.

6-6. Synchronization of Offensive Operations

The commander and staff synchronize and integrateall combat, CS, and CSS assets that are available.The primary offensive employment of maneuverelements include—

a. Tanks. With their combination ofmobility, firepower, and armor protection, tanks arethe primary mounted assault element of the TF.Tanks are used to weight the main attack. Tanksmay be assigned support-by-fire missions whentheir direct fires are needed to support assaults; or ifobstacles initially prevent them from assaulting theenemy. Normally, tanks are employed in at leastplatoon strength. When a reserve is formed, tanksare normally allocated to it.

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b. Infantry. Mounted infantry is used in themain attack when enemy antiarmor fires are weak orhave been suppressed. Because of vulnerability toantiarmor fires, Bradley fighting vehicles (BFVs)are used to over-watch tanks or dismountedinfantry when facing more than light antiarmorresistance. Dismounted infantry may lead byinfiltration to clear obstacles or key enemy positionsand disrupt the enemy’s defense. Dismountedinfantry can maneuver on untrafficable terrain toattack from an unexpected direction, permitting theresumption of mounted combat. Dismountedinfantry may assault along with tanks againststrong enemy resistance to protect the tanks fromclose-range antiarmor weapons. Infantry can also beused extensively in reconnaissance and counter-reconnaissance roles.

c. Antiarmor Company. In the offense, theantiarmor company maneuvers to provide over-watch and support-by-fire. Security and economy offorce missions are also appropriate.

d. Scouts. During the offense, the scoutplatoon is employed in a security or reconnaissancerole for the moving force. The primary mission forthe scout platoon in the offense is reconnaissance.

e. Attack Helicopters. Attack helicoptersmay be employed by brigade to provide over-watch;to cover areas ground units cannot cover; or torapidly mass to provide increased antiarmorcapability. When this occurs, coordination isrequired to ensure synchronized application ofcombat power.

6-7. Health Service Support of OffensiveOperations

a. General. The offensive operations ofarmored and mechanized forces are characterized byspeed, heavy direct and indirect fires, andaudacious, independent actions by subordinateelements. The potential for high casualty rates isgreater for offensive operations than for any othertype of operation. It follows that HSS for offensiveoperations will be a challenging endeavor. Throughdetailed planning and realistic training inpeacetime, creative methods of supporting offensiveoperations may be developed. Some facts toconsider in planning include—

The Ml13A3, although an improve-ment over the A2, cannot match the top speeds ofthe Ml and the M2/3.

The need for mobility may precludethe use of company aid posts and will limit BAScapabilities.

Evacuation lines will lengthen.

Combat medics may not be able toreach individual casualties in armored vehicles.

Casualties will be incurred in unevennumbers among the attacking companies/companyteams.

b. Health Service Support Guidelines.General guidelines for supporting offensiveoperations include—

Pre-position medical evacuationvehicles as far forward as possible prior to theattack.

Provide additional ambulance teamsto main attack companies/teams.

Request additional ambulancesfrom the FSMC.

Use patient collecting points.

Use AXPs.

Depend on combat lifesavers.

Operate the BAS as treatmentteams, leap frogging them forward as the attackprogresses.

Practice tailgate medicine.

Concentrate on stabilization careand rapid evacuation.

6-8. Conduct of Offensive Operations

a. General. The remainder of this sectiondiscusses the conduct of specific offensive opera-tions. It will provide a brief discussion of HSS

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considerations for each operation. As the medicalplatoon leader, you must be familiar with theseoperations in order to plan HSS. In a broader sense,however, you should study military tactics in orderto be a competent officer and leader.

b. Movement to Contact.

(1) Battalion task force. The battalionTF conducts a movement to contact to make orregain contact with the enemy and to develop thesituation. Task forces conduct movement to contactindependently or as part of a larger force. Normally,the battalion TF is given a movement to contactmission as the lead element of a brigade attack; or asa counterattack element of a brigade or division.Movement to contact terminates with the occupa-tion of an assigned objective or when enemyresistance requires the battalion to deploy andconduct an attack to continue forward movement.

(2) Organization of battalion task force.During a movement to contact, the battalion TF isorganized with a security force, advance guard,main body, and flank and rear guards. The securityforce, consisting primarily of the scout platoon,performs a screening and reconnaissance missionacross the entire TF frontage. It operates 2 to 6kilometers ahead of the advance guard. The advanceguard usually consists of a company team thecomposition of which is dependent upon METT-T.It is the initial main effort and operates 1 to 2kilometers ahead of the main body. The main bodycontains the bulk of the combat elements and isarmed to achieve all-around security. The tacticalCP follows the advance guard; the main CP movesbehind the lead element of the main body. Flank andrear guards usually are platoon-sized elementsunder company control.

(3) Characteristics of movement. Themovement to contact is characterized by a lack ofinformation concerning the enemy’s location and/orstrength. Units conducting movement to contactare prepared for meeting engagements followedusually by a hasty or deliberate attack.

(4) Health service support. TO supportthe movement to contact, medical personnel andevacuation vehicles are positioned within thebattalion. One arrangement is to place one combatmedic with the scouts; the company and platoon

medics with the other elements; two ambulanceteams with the advance guard, one with each of theother companies, and the remainder with the treat-ment teams; split BAS elements into treatmentteams with one following the tactical CP behind theadvance guard and the other following the main CPin the main body. FSMC ambulances move with themain body. The uncertain y inherent in the move-ment to contact means the medical platoon must beprepared for any situation. Evacuation routes areplanned throughout the axis of advance. Ambulanceteams must know the location of the treatmentteams at all times. The treatment teams mustexpect to perform tailgate medicine and facilitaterapid evacuation. The medical platoon must beprepared for a meeting engagement and whateverfoIlows.

c. Hasty Attack.

(1) The hasty attack is conducted eitheras a result of a meeting engagement or when bypasshas not been authorized and the enemy force is in avulnerable (unprepared or unaware) position. Hastyattacks are initiated and controlled withfragmentation orders (FRAGOs).

(2) There are two categories of hastyattack.

Attack against a moving force.When two opposing forces converge, the side thatwins is normally the one that acts fastest andmaneuvers to advantage positions on theopponent’s flank. Task force contingency planningand quick reactions on contact facilitate theexecution of a hasty attack. The advance guardattacks or defends, depending on the size anddisposition of the enemy force. The TF commandermaneuvers trailing or adjacent teams against theenemy’s flank or rear, while attacking by fire andstopping enemy units attempting to do the same.

Attack against a stationaryforce. A hasty attack against a stationary force(composed mainly of individual fighting positionsand hasty protective obstacles) is begun after scoutsor lead company teams reconnoiter the enemy’spositions to find flanks or gaps that can beexploited. This must be done quickly to gain theinitiative. The TF coordinates maneuver elementsand supporting fires to avoid a piecemeal

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commitment of combat power. Dismounted infantryassaults supported by direct and indirect fires maybe necessary to defeat the enemy.

(3) Support for the hasty attackincorporates basic principles of HSS to offensiveoperations. In the hasty attack, little time will beavailable for planning and preparation. The tacticalSOP is the primary guide to HSS operations in thiscase. Key considerations in support of hasty attacksare—

Ensure rapid patient evacua-tion. (Preplan and use your evacuation SOP.)

Maintain mobility bypracticing tailgate medicine.

Locate BAS/treatment teamsnear MSRs.

d. Deliberate Attack.

(1) Characteristics. Task forcedeliberate attacks differ from hasty attacks; theyare characterized by precise planning based ondetailed information, thorough preparation, andrehearsals. Deliberate attacks normally includelarge volumes of supporting fires, main andsupporting attacks, and deceptive measures. Thetank or mechanized infantry battalion will normallyconduct a deliberate attack as the main orsupporting effort of a brigade attack, or as thebrigade reserve.

(2) Health service support. The delib-erate attack is supported through a detailed,coordinated HSSPLAN. Task organize medicalassets in support of elements in which high casualtyrates are expected. Prepare a detailed overlayindicating current and future treatment teamlocations, AXPs, and primary and alternateevacuation routes. Inform the FSMC of thesituation; request additional assets if necessary; andissue an OPORD to the medical platoon.

e. Exploitation.

(1) Purpose. The exploitation isconducted to take advantage of success in battle.Exploitation prevents the enemy from reconsti-tuting an organized defense or conducting an

orderly withdrawal. It may follow any successfulattack. The TF normally participates in theexploitation as part of a larger force. The keys tosuccessful exploitation are speed in executing andmaintaining direct pressure on the enemy.

(2) Objective. The TF conducting anexploitation moves rapidly to the enemy’s rear areaby using movement to contact techniques; theyavoid or bypass enemy combat units, then destroylightly defended and undefended enemy installa-tions and activities. The TF is usually assigned anobjective deep in the enemy rear based on the highercommander’s intent. This objective may be one thatwill contribute significantly to the destruction oforganized resistance or one for orientation andcontrol.

(3) Health service support. In exploi-tation operations, speed becomes even moreimportant. Medical elements must maintain theirmobility; rapid treatment and evacuation areessential. Because an exploitation followsimmediately upon a successful attack, medicalsupplies may become a problem. Ensure thatnecessary supplies are brought forward in FSMCambulances. Use FSMC drivers to communicateurgent medical supply needs to the FSMC.

f. Pursuit.

(1) Purpose. The pursuit normallyfollows a successful exploitation. It differs from anexploitation in that a pursuit is oriented primarilyon the enemy force rather than on terrain objectives.While a terrain objective may be designated, theenemy force is the primary objective. The purpose ofthe pursuit is to run the enemy down and destroyhim.

(2) Conduct. The TF participates in thepursuit as part of a larger force. The pursuit isconducted using a direct-pressure force, anencircling force, and a follow-and-support force. TheTF may comprise or be part of any of these forces.

The direct-pressure forcedenies the enemy the opportunity to rest, regroup,or resupply by repeated hasty attacks; it forcesthem to defend without support or to stay on themove. The direct-pressure force envelops, cuts off,destroys, and harasses enemy elements.

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The encircling force moves direct-pressure force elements; secure lines ofwith all possible speed to get in the enemy’s rear, communication; secure key terrain, or guardblock his escape, and with the direct-pressure force, prisoners or key installations.destroy him. The enveloping force advances alongroutes parallel to the enemy’s line of retreat to (3) Health service support. In pursuitestablish positions ahead of the him. operations, support is the same as for exploitation

operations.The follow-and-support force is

organized to destroy bypassed enemy units; relieve

Section II. SUPPORT OF DEFENSIVE OPERATIONS

6-9. Defensive Operations

The purpose of defense is to defeat the enemy’sattack and gain the initiative for offensiveoperations. Defensive operations achieve one ormore of the following:

Destroy the enemy.

Weaken enemy forces as a prelude to theoffense.

Cause an enemy attack to fail.

Gain time.

Concentrate forces elsewhere.

Control key or decisive terrain.

Retain terrain.

6-10. Characteristics of Defensive Operations

a. Preparation.

The defender has significantadvantages over the attacker. In most cases, he notonly knows the ground better, but, having occupiedit first, he has strengthened his positions. He isstationary and under cover in carefully selectedpositions, with prepared fires and obstacles.

An enemy attack is preceded andaccompanied by massed supporting fires. Tosurvive, units must use defilade, reverse slope, andhide positions; use supporting and suppressive fires:

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and avoid easily targeted locations. The defendermust use all available time to prepare fightingpositions and obstacles; to rehearse counterattacks;and to plan supporting fires and CSS in detail.

b. Disruption. An attacker’s strength comesfrom momentum, mass, and mutual support ofmaneuver and CS elements. The defender must slowor fix the attack; disrupt the attacker’s mass, thenbreak up the mutual support between the attacker’scombat and support elements. This results in apiecemeal attack that can be defeated in detail. Ageneral aim is to force the attacker to fight anonlinear battle; to make the attacker fight in morethan one direction. This makes it more difficult forhim to coordinate and concentrate forces and fires;and to isolate and overwhelm the defender. It alsomakes securing his flanks, CS, CSS, and C2

elements more difficult.

c. Concentration. To gain local superiorityin one area, the defender is often forced to economizeand accept risks elsewhere. Reconnaissance andsecurity forces enable him to "see" the battlefield,and thereby reduce risk. The defender should be ableto rapidly concentrate forces; mass combat power todefeat an attacking force, then disperse and prepareto concentrate again. The main effort is assigned toone subordinate unit. All other elements and assetssupport and sustain this effort. The commandermay shift his focus by assigning a new unit as themain force, if other units encounter unexpecteddifficulties.

d. Flexibility. The commander designatesreserves; deploys forces with logistic resources indepth to ensure continuous operations; and provides

FM 8-10-4

options to the defender if forward positions arepenetrated.

6-11. Framework of the Defense

The TF normally defends as part of a larger force.The defensive framework within which corps anddivisions organize and fight consist of five elements.

Deep operations forward of the forwardline of own troops.

Security force operations forward of andto the flanks of the defending force.

Main battle area operations.

Reserve operations in support of the maindefensive effort.

Rear operations to retain freedom ofaction in the rear area.

a. Deep Operations.

Deep operations are actions againstthose enemy forces not yet in direct contact with theFLOT. Deep operations create opportunities foroffensive action by reducing the enemy’s closurerates; separating attacking echelons; disrupting hisC,2 CS, and CSS; and slowing the arrival times ofsucceeding echelons. Deep operations are conductedusing indirect fires, EW, USAF and Army aviation,deception, and maneuver forces.

Task forces have no deep operationscapabilities, although they may be part of a deepmaneuver operation.

b. Close Operations.

The forward security force normallyestablished by corps is called a covering force. Itbegins the fight against the attacker’s leadingechelons in the covering force area (CFA). Coveringforce actions weaken the enemy; permit the corpscommander to reposition forces; and deceive theenemy as to the size, location, and strength of thedefense.

A battalion TF may fight as a partof a covering force operation. When it disengages

from the enemy, it becomes part of the MBA forcesor reserve. Main battle area units assume control ofthe CFA at the battle handover line; they assistcovering force units to break contact and withdrawthrough the MBA.

c. Main Battle Area Operations.

Based on their estimate of thesituation and intent, brigade commanders assignsectors or battle positions (BPs) to TFs. Normally,assigned sectors coincide with a major avenue ofapproach, while BPs and attack helicopter firingpositions are on the flanks of main approaches. Thebrigade commander designates and sustains themain effort by giving priority of CS assets to theforce responsible for the most dangerous avenue ofapproach into the MBA. The commander canstrengthen the effort on the most dangerous avenueby narrowing the sector of the unit astride it.

Task force commanders structuretheir defenses by deploying units in depth withinthe MBA. A mounted reserve of up to one-half of theTF strength provides additional depth and gives thecommander a maneuver capability against theenemy. A commander can create a reserve by takingrisk on less likely enemy avenues of approach in theMBA.

Penetration by enemy forces mustbe anticipated and provided for in the OPLAN.Separation of adjacent units is likely, especially ifthe enemy is conducting nuclear, biological, andchemical (NBC) operations. Main battle area forcescontinue to strike at the enemy’s flank, andcounterattack across penetrations.

d. Reserve Operations.

The commitment of reserve forces atthe decisive point and time is key to the success of adefense. The TF has been designated as a reserveforce; it can expect to receive one or more of thefollowing missions: counterattack; spoiling attack;block, fix, or contain; reinforce; or rear operations.

When the TF designates a reserve,its most common use is in the counterattack role.The composition, location, and mission of a reserveis based on the TF commander’s estimate of thesituation and intent.

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e. Rear Operations. The battalion TF doesnot have a rear operations fight within its assignedsector. However, a maneuver battalion assigned arear mission by a higher headquarters may conductoffensive operations against enemy conventional orunconventional forces in the rear area.

6-12. Sequence of the Defense

A defense will often be conducted in the followingsequence:

a. Occupation. During this phase, the scoutsare usually the first to clear the proposed defensiveposition. They check for enemy OPs and NBCcontamination. Leaders then reconnoiter andprepare their assigned areas. Security is establishedforward of the defense area to allow occupation ofpositions and preparation of obstacles withoutcompromise. During occupation, movement isminimized to avoid enemy observation.

b. Passage of the Covering Force. The TFestablishes contact with, and assists thedisengagement and passage of the covering force orother security elements.

c.tration,securityfortified

Defeat of Enemy Reconnaissance, Infil-and Preparatory Fires. Consistent withrequirements, TF elements remain inpositions to avoid casualties and shock

associated with indirect fires. The enemy willattempt to discover the defensive scheme byreconnaissance and probing attacks of the advanceguard. The enemy may also attempt to infiltrateinfantry to disrupt the defense or to breachobstacles. Task force security forces must defeatthese efforts using maneuver and fires.

d. Approach of the Enemy Main Attack.Task force security elements observe and reportenemy approach movement. The TF commanderrepositions or reorients his forces to mass againstthe enemy’s main effort. Enemy formations areengaged at maximum range by supporting fires andclose air support to cause casualties; to slow anddisorganize him; to cause him to button up; and toimpair his communications. Obstacles are closed.Direct fire weapons are repositioned as required, ormaneuvered to attack the enemy from the flank. The

TF commander may initially withhold fires to allowthe enemy to close into an engagement area. Then atthe decisive time, concentrate fires on the enemy.

e. Enemy Assault. As the enemy deploys,he becomes increasingly vulnerable to obstacles.The TF uses a combination of obstacles, blockingpositions, and fires to break up the assaultingformation. Continued maneuver to enemy flank andrear is used to destroy him and to increase thenumber of directions to which he must react. Somesecurity elements may stay in forward positions tomonitor enemy second-echelon movement; and todirect supporting fires on these forces as well as onhis artillery, AD, supply, and C2 elements.

f. Counterattack. As the enemy assault isslowed or stopped, the TF commander will launchhis counterattack (by fire or by maneuver) tocomplete the destruction of the enemy forces.

g. Reorganization and Consolidation. TheTF must quickly reorganize to continue the defense.Attacks are made to destroy enemy remnants,casualties are evacuated, and units are shifted andreorganized to respond to losses. Ammunition andother critical items are cross-leveled and resupplied.Security and obstacles are reestablished and reportsare submitted.

6-13. Types of Defense

The battalion TF will normally use three basic typesof defense; defend a sector, defend a BP, and defenda strongpoint. Figure 6-1 summarizes the factors acommander considers in selecting a BP versus asector.

a. Defense of a Sector.

A defensive sector is an areadesignated by boundaries; it defines where a unitoperates and the terrain for which it is responsible.Defense in sector is the most common defensemission for the TF.

Defend in sector is the leastrestrictive mission. It allows the TF commander toplan and execute his defense using the best

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technique to accomplish the mission. He may usesectors, BPs, strongpoints, or a combination ofmeasures to accomplish his mission.

To control his forces, the TFcommander establishes coordinating points; phaselines; on-order BPs; and contact points.

commander maneuvers his forces outside the BP, henotifies the next higher commander and coordinateswith adjacent units. Task force security, CS, andCSS assets are frequently positioned outside the BPwith approval from the headquarters assigning theBP.

c. Defense of a Strongpoint.b. Defense of a Battle Position.

A BP is a general location andorientation of forces on the ground, from whichunits defend. The BP can be for units from battalionTF to platoon size. A unit assigned a BP is withinthe general area of the position. Security forces mayoperate well forward and to the flanks of BPs forearly detection of the enemy and for all-aroundsecurity. Units can maneuver in and outside of theBP as necessary to adjust fires or to seizeopportunities for offensive action in compliancewith the commander’s intent.

The commander may maneuver his

The mission to create and defend astrongpoint implies retention of terrain with thepurpose of stopping or redirecting enemy forma-tions. Battalion strongpoints can be established inisolation when tied to restrictive terrain on theirflanks. A bypassed strongpoint exposes the enemy’sflanks to attacks from friendly forces.

The TF pays a high cost in man-power, equipment, material, and time for theconstruction of a strongpoint. It takes several daysof dedicated work to construct one. Strongpointsalso sacrifice the inherent mobility advantage ofheavy forces. Strongpoints mav be on the FEBA. or

elements freely within the assigned- BP. When the in depth in the brigade MBA.

6-14. Health Service Support in Battalion defensive, and retrograde actions within an overallDefensive Operations mobile defense framework. This combination results

in a nonlinear front which creates confusion amonga. Flexibility in Support. To support a attacking forces and complicates HSS operations.

battalion defending in sector requires flexibility in The nonlinear front means that planned evacuationadapting medical assets to the changing tactical routes, usable in some sectors, may be blocked bysituation. A sector defense combines offensive, enemy penetration in others. Some defending

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elements may become temporarily encircled orbypassed by enemy forces. Rapidly moving enemyunits may threaten or over-run the BAS.

b. General.

(1) Difficulties encountered. Healthservice support in the defense is more difficult thanin the offense. Casualty rates may be lower, but dueto the defensive rearward maneuver, patientcollection and evacuation will be more complicated.Combat medics and ambulance teams will beexposed to more direct enemy fires. They will haveless time to locate, treat, and evacuate the wounded.Defensive operations will generally produce highercasualty rates among medical personnel, therebyreducing treatment and evacuation capabilities.

(2) Health service support plan. Themedical platoon should use the defensivepreparation time to resupply combat medics and toreplace battle losses. The platoon leader and medicaloperations officer should develop a detailedHSSPLAN. They should contact the FSMC andthoroughly coordinate the HSS relationship. Eitherthe medical platoon leader or the medical operationsofficer must participate in the TF’s battle planning.When planning and coordinating HSS for defensiveoperations, consider the following actions:

Select covered and concealedBAS and company aid post sites.

Ensure adequate medicalsupplies are available. If necessary, requestadditional supplies.

Plan for evacuation within thedefensive area.

Plan and coordinate in detailevacuation by the FSMC from BAS to the DCS.

Plan to continue HSS shouldthe unit become encircled.

Consider the potential ofhaving to hold patients for an indefinite period oftime, without adequate resources.

Discuss with the FSMCcommander the possibility of positioning a FSMCtreatment team within the BP/strongpoint.

(3) Patient load. The heaviest patientload can be expected during the initial phase of theenemy attack. Many casualties will be evacuatedusing nonmedical vehicles during this phase (FM8-10-6). The BAS, operating as a whole or asseparate treatment teams, should be establishedfurther rearward than in offensive operations.Evacuation lines will shorten as the forwardcompanies maneuver rearward. Communicationdifficulties may arise due to enemy jamming.Enemy use of NBC weapons is possible.

(4) Increased risk. Health servicesupport to a battalion defending from a BP or astrongpoint is considerably different from that for asector defense. Battle positions and strongpointsare restrictive measures which limit maneuver.Reduced dispersion will create shorter intervalevacuation lines and a more centralized, controlledmedical operation. The reduced dispersion alsocreates increased risk of high casualty rates.Evacuation out of a BP or strongpoint may bedifficult or temporarily impossible.

c. Covering Force Support.

(1) Problem encountered. Support to acovering force can be extremely complicated. Thecovering force will most likely face a much largerenemy force. It is expected to trade minimumgeographic space for maximum time. To beeffective, the covering force must remain highlymobile and avoid decisive engagement. The medicalplatoon of a covering force unit faces all of thedifficulties inherent in defensive operations. Itsmission is further complicated by the rapidmovement and overpowering number of attackingunits.

(2) Employment. The medical platoonof a covering force unit will most likely choose tooperate its BAS in the split team configuration. Itshould concentrate on providing expeditiousstabilizing care and rapidly evacuating patients.Combat medics and evacuation sections should beemployed as for any other defensive operation.When participating in a covering force operation,mobility of the medical platoon is critical.

(3) Preparation. Some preparation timemay be available prior to enemy contact. Duringthis time, the medical platoon leader meets with the

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supporting FSMC commander rider or covering forcemedical staff officer. A detailed HSSPLAN isprepared. The medical platoon leader must knowwho is providing evacuation support (a coveringforce medical company or one from the MBA).Priorities for use of nonmedical vehicles areestablished with the commander and S3. Themedical platoon leader must clearly establish withhis unit commander situations under which patientsmay be abandoned. This information is dissem-inated so that medical elements can continue tooperate without communications and while takingcasualties among themselves.

d. Battle Handover.

(1) Transition. As the covering forcemoves to the rear, the TF commander prepares forthe battle handover. The handover is the transitionfrom the CFA battle to the MBA battle in which theMBA forces begin to engage the enemy.

(2) Coordination requirements. Thebattle handover can be a hazardous operation andrequires extensive coordination. Covering force areaforces will have conducted an intense fight and maybe considerably attrited. They may requireassistance in reaching and passing through MBAforces. In the worst case, handover presents thepotential for confusion, disorganization, and

resultant high casualty rates within both CFA andMBA elements. The medical platoon must beprepared for this.

(3) Health service support coordination.The medical operations officer should contact theCFA battalion/TF medical operations officer tocoordinate HSS responsibilities for the battlehandover and rearward passage, if possible. If theCFA element has suffered heavy casualties, theymay require augmentation of personnel/equipment;if casualties have been light, they may be able toprovide the MBA medical platoon with Class VIIIsupplies or evacuation assistance, as necessary. Themedical operations officer should then contact theFSMC and pass on information concerning enemyforces; casualty experience; evacuation routes;requisite site selection; and possibly logisticalassistance.

(4) Operation. The medical operationsofficer must stay on top of the tactical situation inorder to maneuver treatment teams and evacuationassets. Patient collecting points and AXPs willcontribute to HSS efforts. Treatment by CLS andcombat medics will be essential. Company medicsand evacuation NCOs must be capable of per-forming independently; this will ensure continuityof HSS under disrupted communications or loss ofkey medical leaders.

Section III. SUPPORT OF RESERVE OPERATIONS

6-15. Reserve Operations

When designated as a reserve for a higherheadquarters, the battalion TF may be assigned oneor more of the following missions:

Counterattack.

Spoiling attack.

Block, fix, or contain enemyforce.

Reinforce.

Rear operations.

Given more than one mission, the TF commanderdevelops, plans, coordinates, and prepares forexecution of his contingencies based on establishedpriorities.

6-16. Counterattack

a. Attack Assignment. Counterattackplanning and execution is assigned by brigade tocommitted and reserve TFs. Normally, more thanone counterattack option is planned for andrehearsed. Counterattacks may be conducted toblock an impending penetration of the FEBA; tostop a force that has penetrated; to attack throughforward defenses to seize terrain; or to attack enemyforces from the flank and rear.

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b. Timing the Attack. A counterattack, atany level, is usually the decisive point in anengagement. The commander’s timing in commit-ting his reserve to the counterattack is critical. Toensure success, the counterattack must be wellplanned and precisely executed. The battalionmedical operations officer must be in touch with thetactical scenario and prepared to execute theHSSPLAN.

c. Health Service Support. In preparing andexecuting the HSSPLAN, consider the following

Forward movement may be veryswift. Medical assets must keep up.

Ambulance teams should move withsupported companies.

If attack covers a broad frontage,consider splitting BAS into two treatment teams.

6-17. Spoiling Attack

This is a preemptive, limited objective attack aimedat preventing disrupting or delaying the enemy’sability to launch an attack. The objective of thespoiling attack is the enemy force, not terrain. Thereserve is often used to conduct spoiling attacks sothat forward units can concentrate on defensivepreparations within the MBA. Spoiling attacks arenormally directed against an enemy force that ispreparing to conduct an attack; that hastemporarily halted to rearm and refuel; or is makingthe transition from mounted to dismountedoperations. Enemy artillery is also a prime target.

NOTE

Health service supportconsiderations for offensiveoperations apply.

The initial engagement will beviolent and decisive.

6-18. Block, Fix, or ContainThe commander may be forced to

continue the mission under high casualty rates.

A successful counterattack willlikely result in the capture of EPWs; some EPWswill be in need of medical treatment.

Consideration for support ofoffensive operations apply.

NOTE

The Geneva Conventionrequires that wounded enemyprisoners receive medical careequal to that given to friendlycasualties. We will, of course,meet this requirement.However, it is important toremember to search theprisoner and forward anydocuments found to the S2. Foradditional information onEPW care, see Appendix H.

The reserve may be ordered to establish a hasty BPto block, fix, or contain enemy forces within aportion of the battlefield. This action may benecessary to blunt a penetration while other forcesmaneuver against the flanks or rear of the enemyforce. An enemy force may be held in one area of thebattlefield while he is defeated in another.

NOTE

Health service supportconsiderations for offensiveoperations apply.

6-19. Reinforce

Reserve forces may be committed to reinforce unitsthat have sustained heavy losses; also to build upstronger defenses in critical areas of the battlefield.Considerations must be given to how they will beintegrated into the defensive scheme, C2

arrangements, and where they will be positioned.The techniques used to reinforce are similar to thoseused during a relief in place.

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6-20. Rear Operations defensive sketches, OPs, patrols, obstacles, ADweapons sites, and reaction forces.

a. Execution. The reserve battalion mayoperate as a division combined arms tactical combatforce with a rear operations mission. The TF mustnot allow itself to become so dispersed that it cannotmass for other reserve missions. Nevertheless, theTF normally uses dispersed company positions; thisreduces the TF signature on the battlefield andhelps spread its companies to accomplish rearoperations. The TF completes intelligence prepara-tion of the rear area for probable enemy avenues ofapproach and for likely enemy landing zones (LZs)and drop zones (DZs). It positions forces at thelocations to interdict the rear area threat. Based onthe IPB, location of CS and CSS elements within thebrigade rear area, and their own dispositions, the TFassigns areas of responsibility to its companies orteams. Task forces are responsible for their ownsecurity within assigned areas. The TF alsocoordinates with CS and CSS base clusters for theirdefense, to include–

Critical CS and CSS assets to beprotected.

Intelligence preparation of thebattlefield, to include local enemy approaches andpossible LZs/DZs.

Review of base and base clusterdefensive preparations to include perimeter

Coordination of fire support.

Coordination for aviation operationsincluding reconnaissance, fire support, andtransport.

Coordination with MP and othercombat-capable units and base cluster reactionforces.

Events or contingencies that willtrigger commitment of the TF to destroy a rear areathreat.

b. Health Service Support. The dispersioncommon to a battalion performing a rear operationsmission complicates the HSS situation. Evacuationlines are lengthy. Use AXPs and FSMC or MSMCambulances, if practical. Company aid posts arevital and must operate somewhat autonomously—company medics must know their business. Due tothe dispersion, the BAS may choose to operate asseparate treatment teams. Level II support maycome from the MSMC in the DSA—if this is a newsupport relationship it should be well coordinated.

Section IV.

6-21. Retrograde Operations

SUPPORT OF RETROGRADE OPERATIONS

Avoid combat under unfavorableconditions.

Retrograde operations are organized movementsaway from the enemy. A retrograde may be forced Gain time.by enemy action or executed voluntarily. Theunderlying reason for conducting a retrograde Reposition or preserve forces.operation is to improve a tactical situation orprevent a worse one from occurring. A retrogradeoperation may be used to economize forces, Use a force elsewhere.maintain freedom of maneuver, or avoid decisivecombat. A battalion TF conducts a retrograde as Harass, exhaust, resist, and delay thepart of a larger force to– enemy.

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Draw the enemy into an unfavorableposition.

Shorten lines of communication andsupply.

Clear zones for friendly use of chemical ornuclear weapons.

Conform to the movement of otherfriendly forces.

6-22. Types

There are three types of retrograde operations:delay, withdrawal, and retirement. They can becharacterized as follows:

Delay—trade space for time and avoiddecisive engagement to preserve the force.

Withdrawal-break contact. (Free a unitfor a new mission.)

Retirement-move a force not in contactto the rear.

6-23. Planning Considerations

All retrogrades are difficult and inherently risky. Tosucceed, they must be well organized and wellexecuted. A retrograde operation requires thefollowing elements:

a. Leadership and Morale. Maintenance ofthe offensive spirit is essential among subordinateleaders and troops in a retrograde operation.Movement to the rear may be seen as a defeat or athreat of isolation; therefore, soldiers must haveconfidence in their leaders and know the purpose ofthe operation and their role in it.

b. Reconnaissance, Surveillance, andSecurity. Timely and accurate intelligence isespecially vital during retrograde operations.Reconnaissance and surveillance must locate theenemy; then security elements must deny himinformation and counter his efforts to pursue;outflank; isolate; or bypass all or a portion of theTF. The commander must establish a security forcethat is strong enough to—

Secure enemy avenues of approach.

Deceive the enemy and defeat hisintelligence efforts.

Overwatch retrograding units.

Provide rear guard, flank security,and choke point security.

c. Mobility. To conduct a successful retro-grade, the TF seeks to increase its mobility andsignificantly slow or halt the enemy.

The TF improves its mobility by–

Reconnoitering routes andBPs.

Positioning AD and securityforces at critical points.

Improving roads, controllingtraffic flow, and restricting refugee movement toroutes not used by the TF.

Rehearsing movements.

Evacuating casualties, recover-able supplies, and excess materiel before theoperation.

Displacing nonessential CSSactivities early in the operation.

Covering movements by fire.

The TF degrades the mobility of theenemy by—

Occupying and controllingchoke points and terrain that dominate high speedavenues of approach.

Destroying roads, bridges, andrafting on the avenues not required for friendlyforces.

Improving existing obstaclesand covering them with fire.

Employing indirect fire andsmoke to degrade the enemy’s vision and to slow his

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rate of advance. To ensure continuous coverage, TFmortars normally move in split sections.

Conducting spoiling attacks tokeep the enemy off balance and force hisdeployment.

d. Deception. The objective of deception isto hide the fact that a retrograde is taking place;this is essential for success. Deception is achievedby maintaining normal patterns of activity in radiotraffic; artillery fires; patrolling and vehiclemovement. Additional considerations include usingdummy minefield or decoy positions, and con-ducting feints and demonstrations under limitedvisibility conditions. Retrograde plans are neverdiscussed on unsecure radio nets.

e. Conservation of Combat Power. Thecommander must conserve his combat power by—

Covertly disengaging and with-drawing less mobile units and nonessential elementsbefore withdrawing the main body.

Using mobile forces to cover thewithdrawal of less mobile forces.

Using minimum essential forces toprovide security for withdrawal of the main body.

6-24. Delay

a. Purpose. A delay is an operation in whicha force trades space for time while avoiding decisiveengagement. The delay incorporates all of thedynamics of defense, but emphasizes preservationof the force and maintenance of a mobilityadvantage. The TF may attack, defend, or conductother actions (such as ambushes and raids) duringthe delay to destroy the enemy or to slow the enemy.The battalion TF may be given a delay mission aspart of the covering force; as an economy-of-forceoperation to allow offensive operations in anothersector; or to control a penetration to set up acounterattack by another force.

b. Control of Actions. A delay may beconducted from successive positions or fromalternate positions. Successive positions are usedwhen the delay is conducted over a wide front;alternate positions are preferred for a narrow sector.

The delay is normally well planned and uses graphiccontrol measures to display the commander’sintent. Incorporate these control measures in theHSS overlay.

c. Health Service Support. Detailed HSSplanning is essential to the medical platoon’s abilityto support a delay operation. The nature of a delay,with its inherent mix of operations (offensive,defensive, and retrograde), creates a complicatedbattlefield situation. Combat medics, evacuationNCOs, and other key medical personnel must have agood understanding of the commander’s intent andthe HSSPLAN. This will occur if planning iseffective and includes the following considerationsimplicit in delay operations:

Expect evacuation difficulty.Patient evacuation in delay operations iscomplicated due to the changing forward andrearward movement; to possible communicationdisruptions; and to congested evacuation routes.

Ambulance crews may be atincreased hazard due to the rearward movement ofthe force.

Locate BAS further toward the rear.

Consider operating separate treat-ment teams to support the successive or alternatepositions.

Plan for possible necessity toabandon patients.

Plan for frequent BAS relocations.

Plan for future operations; whathappens when the retrograde ends?

6-25. Withdrawal

A withdrawal is an operation in which all or part ofthe battalion frees itself for a new mission. Awithdrawal is conducted to break contact with theenemy when the TF commander finds it necessaryto reposition all or part of his force; or when requiredto attain separation for employment of specialpurpose weapons. It may be executed at any time,during any type of operation. There are two types of

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withdrawals—withdrawal not under enemy pressureand withdrawal under enemy pressure. Both typesbegin while the battalion is under the threat ofenemy interference. Preferably, withdrawal is madewhile the battalion is not under enemy pressure.Withdrawals are either assisted or unassisted. Anassisted withdrawal uses a security force providedby the next higher headquarters in breaking contactwith the enemy and to provide overmatching fires.In an unassisted withdrawal, the TF provides itsown security force.

6-26. Retirement

a. Purpose. A retirement is a retrogradeoperation in which a force that is not in contact withthe enemy moves to the rear in an organized

manner. A retirement is usually made at night. Ifenemy contact is possible, on-order missions aregiven to the march units.

b. Leadership Responsibilities. A retire-ment may have an adverse impact on the morale offriendly troops. Leadership must be positive; theymust keep troops informed of the retirementpurpose and future intentions of the command.

c. Health Service Support. Support of awithdrawal or retirement should be conducted muchas for a movement to contact. However, in awithdrawal or retirement, most of the medicalvehicles are in the rear of the main body. Since theseoperations are normally conducted as part of alarger force, necessary coordination with the FSMCshould be relatively easy.

Section V. SUPPORT OF OTHER TACTICAL OPERATIONS

6-27. Passage of Lines

a. Purpose. A passage of lines is an opera-tion in which one unit is passed through thepositions of another. When a unit moves toward theenemy through a stationary unit, it is a forwardpassage. Rearward passages are movements awayfrom the enemy through friendly units. Thecovering force withdrawing through the MBA, or anexploiting force moving through the initialattacking force, are examples.

b. Conduct. A passage of lines is necessarywhen one unit cannot bypass another. A passage oflines may be conducted to–

Continue an attack or counter-attack.

Envelop an enemy force.

Pursue a fleeing enemy.

Withdraw covering forces or mainbattle forces.

c. Vulnerability of Units. The TF isvulnerable during a passage of lines. As units are

6-16

concentrated, the fires of the stationary unit may bemasked and the TF is not dispersed to react toenemy action. Detailed reconnaissance and coor-dination are key to ensure a quick and smoothpassage.

d. Health Service Support. The passage oflines may offer the medical platoon leader theopportunity to interface with his counterpart in theunit being passed. This is an excellent opportunist yto share information concerning enemy forces;casualty experience; evacuation routes; requisitesite selections; and possibly logistical assistance.The passage of lines can be a hazardous operation,particularly when conducted while in contact withthe enemy. Health service support must be plannedand coordinated between participating units.

6-28. Relief Operations

a. Responsibilities. A relief is an operationin which a unit is replaced in combat by anotherunit. Responsibilities for the mission and assignedsector or zone of action are assumed by the incomingunit. Reliefs may be conducted during offensive ordefensive operations and during any weather orlight conditions. They are normally executed during

FM 8-10-4

limited visibility to reduce the possibility ofdetection.

b. Purpose. The purpose for relief is tomaintain the combat effectiveness of committedelements. A relief may be conducted to—

Reconstitute a unit that hassustained heavy losses.

Introduce a new unit into combat.

Rest units that have conductedprolonged operations.

Decontaminate or provide medicaltreatment to a unit.

Conform to a larger tactical plan ormake mission changes.

6-29. Breakout from Encirclement

a. Encircled Force. A breakout is anoffensive operation conducted by an encircled force.A force is considered encircled when all groundroutes of evacuation and reinforcement are cut offby the enemy.

b. Conduct. A breakout is conducted toallow the encircled force to regain freedom ofmovement; or to regain contact with friendly units.Encirclement does not imply that the battalion TFis surrounded by enemy forces in strength. Threatdoctrine stresses momentum and bypassing offorces that cannot be quickly reduced. An enemyforce may be able to influence the TF’s subsequentoperations while occupying only scattered positions;it may not be aware of the TF location, strength, orcomposition. The TF can take advantage of this byattacking to break out before the enemy is able totake advantage of the situation.

c. Health Service Support. During thebreakout, patients will most likely have to betransported by combat units using nonmedicalorganic assets. Health service support (treatment)will have to be delayed until the breakout iscompleted.

6-30. Linkup

a. Purpose. A linkup is the meeting of two ormore friendly ground forces that have beenseparated by the enemy. The battalion TF mayparticipate as part of a larger force, or it mayconduct a linkup with its own resources. Linkup isconducted to relieve or join a friendly force, or toencircle an enemy force.

b. Coordination of Maneuver Schemes. Allelements in a linkup carefully coordinate theiroperations to minimize the risk of fratricide. Thiscoordination is continuous and increases as theunits approach the linkup points. Control measuresused are as follows:

Zones of attack or axes of advance.If one or more of the forces are moving, theirdirection and objective are controlled by the higherheadquarters.

Phase lines. Movement is controlledby a higher headquarters through the use of phaselines.

Restrictive fire lines. Restrictive firelines (RFLs) are used to prevent friendly forces fromengaging one another with indirect fires. Onetechnique is to make the phase lines on-order RFLs.As the unit crosses a phase line, the next phase linebecomes the RFL.

Checkpoints. Checkpoints are usedto control movement and designate overwatchpositions.

Linkup and alternate linkup points.The linkup point is a designated location where twoforces meet and coordinate operations. The pointmust be easily identifiable on the ground, andrecognition signals must be planned. Alternatelinkup points are established in the event thatenemy action precludes linkup at the primary point.

c. Health Service Support Implications.Tailgate medicine will be employed during linkupmovement. Upon linkup, all medical assets will beconsolidated into a medical platoon operation.

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6-31. Guard Operations

a. Mission. A guard operation is a securityoperation in which a unit protects a larger unit by—

Maintaining surveillance.

Providing early warning.

Destroying enemy reconnaissanceelements.

Preventing enemy ground observa-tion of main body.

Preventing enemy use of direct fireagainst the main body.

b. Functions. The guard force provides thelarger force warning, reaction time, and maneuver

6-32. General

space. The guard force delays, destroys, or stops theenemy within its capability. The commander con-ducting the guard operation must know the intent ofthe higher force commander and the degree ofsecurity required.

c. Performance. Guard operations can be tothe front, rear, or flanks of the main body. BattalionTFs have the mobility, organization, and equipmentto perform a guard operation as a part of a brigadeor division offensive operation. They may beassisted by air cavalry or attack helicopter unitsunder their OPCON.

d. Health Service Support. Health servicesupport for offensive operations (paragraph 6-7)equally apply to guard operations.

Section VI. SPECIAL OPERATIONS

Health service support is limited to the same degreeas combat effectiveness when operating in areas ofextreme weather and/or terrain hazards. Medicalunits require special purpose equipment (primarilyshelter and transportation) in quantities commen-surate with their support mission to overcome theserestrictions. Operations in freezing or extremely hottemperatures require continuing protection of medi-cal items that deteriorate rapidly. Environmentalrestrictions may reduce the capability of thedivision’s evacuation assets; therefore, litter bearersand ground/air ambulance elements must be rein-forced with other medical and/or nonmedicalresources. Medical treatment elements requirespecial shelter protection which neutralizesextremes in weather adapts easily to difficultterrain; and can be erected and dismantled quickly.Unusual types and larger numbers of patients oftenresult from prolonged exposure to extreme naturalhazards; therefore, prevention is the most effectivemethod in dealing with extreme conditions.Abnormally high numbers of patients requireaugmentation of division treatment and/orevacuation resources.

6-33. Mountain Operations

a. The tactical problems of the divisionmedical companies in mountain operations aresimilar to those encountered in other terrain. Lackof good road networks will add to the difficulties.One DCS should be established in support of eachcommitted brigade. These should be as close aspossible to the BAS supported, yet must be situatedso as to permit easy evacuation by the units insupport. Use of ambulances forward of the DCSmay be impossible. Personnel normally employed inthis link of evacuation may be used as litter bearers;or they may supervise litter bearers furnished fromother sources. Problems will arise, but by maximumuse of personnel and equipment, the divisionmedical company can give support within its area ofresponsibility.

b. Troops operating in mountainous terrainare subject to unusual illnesses; these includemountain sickness, high altitude pulmonary edema,and cerebral edema. All three are caused by rapidascent to altitudes of 2,400 meters (about 7,875 feet)and above. They can be prevented in most soldiers

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by acclimation, progressive ascent, and slowassumption of physical activities. For more detailedinformation on mountain operations see FM 90-6.

c. Mountain operations require medicalpersonnel to carry additional equipment. Items suchas ropes, pitons, piton hammers, and snap links areall necessary for the evacuation of patients andestablishment of a BAS. Unnecessary items ofequipment including those for which substitutes orimprovisations can be made are left behind. Heavytentage, bulky chests, extra splint sets, excesslitters, and non-essential medical supplies should bestored. If stored, these supplies should be readilyavailable for airdrop or other means of transport.Medical items that are subject to freezing must notbe exposed to the low temperature experienced inmountainous areas.

d. For forward medical elements to maintaina satisfactory level of medical supplies, allpersonnel, vehicles, and aircraft going forwardshould carry small amounts of medical supplies andequipment; examples are blood substitutes,dressings, and blankets. Smaller supplies andequipment may be rolled in blankets and lashed tobackboards or carried in partially folded litters.

e. Since the transportation of heavy tentagemay be impracticable, shelter for patients must beimprovised to prevent undue environmentalexposure. In the summer or in warm climates,improvision may not be necessary, but there is aclose relationship between extreme cold and shock;thus medical personnel should always consider theneed to provide shelter for patients. Shelter may befound in caves, under overhanging cliffs, behindclumps of thick bushes, and in ruins. They may bebuilt using a few saplings, evergreen boughs, shelterhalves, or similar items. The time a patient is to beheld will influence the type of shelter used. Whenpatients are to be kept overnight, a betterweatherproofed shelter must be constructed.

f. The evacuation of patients in mountainwarfare presents varied problems. In addition to thetask of carrying a patient to the nearest medicalelement, there is the difficulty of moving over roughterrain.

(1) The proportion of litter cases toambulatory cases is increased in mountainous

terrain; even a slightly wounded individual may findit extremely difficult to move across the terrain.Because of the added exertion and increased pain, itmay be necessary to transport a patient by litterwho would normally return to the BAS by himself.

(2) In cold weather and in high moun-tains, speed of evacuation is vital; there is a markedincrease in the possibility of shock among patientsin extreme cold.

(3) Special consideration must be givento the conservation of manpower. Litter hauls mustbe kept as short as the tactical situation will permit.A litter team is not capable of carrying a patient forthe same distance over mountainous terrain as overflat territory. To decrease the distance of litterhauls, medical elements should locate as close aspossible to the troops supported.

(4) It is important to be able to predictthe number of patients that can be evacuated withavailable personnel. It has been demonstrated thatwhen the average terrain grade exceeds 20° to 25°the four-man litter team is no longer efficient; itshould be replaced by a six-man team. The averagemountain litter team should be capable of climbing120 to 150 vertical meters of average mountainterrain and return with a patient in approximatelyone hour.

(5) Another problem is evacuation atnight. The wounded should be located andevacuated during the day. Many casualties wouldnot survive the rigors of the night on a mountain incold weather. Night evacuation over rough terrain isimpractical and results are rarely equal to the effort.When possible the night evacuation route should bemarked with tracing tape and rope handlines; theyare installed during daytime. However, if routes areexposed to enemy observation and fire by day,patients must be removed from the area by night;but only as far as necessary. At the first pointaffording shelter from enemy observation and fire, aholding station should be established; shelter,warmth, food, and supportive care should beprovided. Patients should be brought from forwardareas to this point; they are held until daylight, thenevacuated to the rear.

(6) Before initiating evacuation, con-duct a reconnaissance of the terrain and the road

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network in the area. To this, add information onclimatic conditions, facilities and personnelavailable, and the tactical mission. Only after all ofthese factors are assembled and evaluated can asound medical evacuation plan be formulated. Thefollowing factors peculiar to mountain operationsshould be considered before making the finalselection of evacuation routes:

Snow and ice are firmestduring the early morning hours.

GIacial or snow fed streams areshallowest during the early morning.

Mountain streams afford poorroutes of evacuation because of rough, slipperyrocks and the force of moving water.

Talus slopes (those slopes withan accumulation of rock debris strewn around)should be avoided; they are difficult to traverse.Loose and slippery rocks on such slopes will oftencause litter bearers to fall or drop the patient;compounding his existing injury and possiblycausing injury to members of the litter bearer team.

Choose routes that are justbelow the crest of a ridge. These trails are usuallyeasiest to follow and the ground affords the bestfooting.

(7) The difficulties of medicalevacuation encountered in mountain operationsemphasize the advantages of air evacuation. Thetime between injury and treatment is a determiningfactor in the patient’s recovery. Evacuation by air,which is the most rapid, most comfortable, and thesafest means is the optimum method. However,total reliance on air ambulances is inadvisable;rapidly changing weather conditions in moun-tainous areas adversely affect aeromedicalevacuation. All available means of collection andevacuation should be used.

g. When operating in mountainous terrain,the maneuver battalion is often decentralized to anextent that a centrally located BAS is not practical.In these circumstances, it may be necessary to splitthe medical platoon into two small sections capableof minimal HSS. Close-terrain conditions severelylimit the platoon’s capabilities; personnel andequipment augmentation may be required.

h. In mountainous terrain, there is usuallyadequate concealment and defilade to allow themedical platoon to establish the BAS close to theFLOT. If one station is operated, it should belocated as close as possible to the fighting troops,generally in the center of the battalion’s area ofoperations. If the platoon is required to operatemore than one treatment site, each treatment teamis given a specified area of responsibility; it islocated centrally as far forward as possible insupport of the troops for which the station isresponsible. The term centrally located does notnecessarily mean the geographical center of an area.Many factors must be considered in determining acentral location for a given area. These includeexpected patient loads; lines of drift; roads or pathsfor evacuation to and from the station; and terrainfeatures having a direct influence on litter carry.The following advantages are obtained whenconsideration is given to the location of BAS:

Relatively short or easy litter hauls.

Medical facilities closer to the unitsthey support.

Closer contact with company com-manders affords greater ease in following changes inthe tactical plan.

Adequate shelter.

Patients are sorted, given necessary emergencymedical care, RTD, or provided shelter and warmthuntil transportation becomes available.

i. When the BAS is in a split mode, it isdesirable that the medical platoon headquarterssection be augmented with additional six-man litterteams. The augmentation litter teams may berecruited from all available sources (including theuse of indigenous personnel); they must be familiarwith military mountaineering techniques. Theaugmentation should be completed before the actualneed.

j . As in normal situations, combat medicswill be furnished to the rifle companies by themedical platoon. Insofar as possible, combat medicsare always allocated to the same company (andplatoon); this encourages close relationship betweenthem and the men of the company. Emphasis should

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be placed on training the combat medics in hazardsof cold and wind; relationship of these factors to theproblem of shock; conservation of body heat andimprovised methods of providing warmth (toinclude the construction of small windbreaks andshelters); and techniques of military mountaineeringand mountain evacuation procedures.

k. Supported companies should establishpatient collecting points.

(1) In mountainous terrain, it will oftenbe necessary to consider the establishment ofpatient collecting points. These patient collectingpoints operated by combat medics are designatedintermediate points along the route of evacuationwhere patients may be gathered. Whenever patientsare to be transferred from one type of transporta-tion to another, a patient collecting point/AXP isneeded.

(2) Defilade positions are abundant inmountainous areas. Patient collecting points shouldbe established as far forward as possible. An AXPmay be established behind each of the BASS, or acentrally located point may be operated; whicheverwill ensure the most efficient HSS and provide thegreatest relief to litter bearer personnel.

(3) Patient collecting points aremovable and should be placed, whenever possible,away from difficult terrain. Patient collecting pointsalong routes of march should not be establishedroutinely, unless—

It is certain that these pointswill be in territory under secure control of friendlyforces.

The number or severity ofwounded justifies such a point.

l. Litter relay points may also have to beestablished during mountain operations.

(1) If sufficient litter bearers areavailable, a chain of litter relay points, from theBAS to a point where evacuation can be taken overby ambulances, should be established.

(2) Each relay point should have oneNCO and four litter bearers. However, when short of

personnel, one NCO could be used to supervise morethan one relay point. Each point is responsible forthe evacuation of all patients received. Whenreturning to their relay point, litter bearers bringempty litters and other medical supplies which arerequired by forward medical personnel. This willpermit maximum use of available litter bearers;litter bearers operating in a chain of relay points canevacuate far more wounded than teams attemptingto evacuate the wounded from the frontline to theBASS; or from the BASS to the ambulance pickuppoint. Personnel can rest on the return to their post;they also become familiar with the short section ofmountain trail over which they travel. This makes itpossible for them to operate over the trail at night;also gives the wounded a much smoother ride.

6-34. Jungle Operations

a. Difficult terrain, wide dispersion ofcombat units, inadequate roads, and insecure linesof communication all have a direct influence on HSSin jungle operations. The manner in which medicalunits support tactical organizations depends on howthey are employed. Wide variations may beexpected, but the general principles of HSS willapply.

b. The evacuation of wounded in junglewarfare presents difficult problems. Ambulancesmay not be practical on trails, unimproved muddyroads, and in swamps. There is a higher proportionof litter cases; even a slightly wounded individualmay find it impossible to walk through denseundergrowth. As a result, the patient normallyclassified as ambulatory may become a litter case.Evacuation is usually along supply routes which areadequately protected against enemy action.

c. The organization of the medical companyis such that it will support divisional elements on anarea basis. Ambulances may be replaced by othermore maneuverable vehicles. Air evacuation may beused to relieve surface transportation. Waterwaysmay afford a good route of evacuation. Army airambulances equipped with rescue hoists are a fastand efficient means of evacuation in the jungle.

d. There are other problems encountered injungle operations; personal hygiene and sanitationis a serious and continuous one. as is the incidence of

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diseases peculiar to jungle areas. The incidence offungus diseases of the skin is especially serious. Inaddition to maintaining high standards of personalhygiene and sanitation, strict preventive medicinemeasures must be observed and enforced at alltimes (refer to paragraph 4-19b(4)). For moredetailed information on jungle operations see FM90-5. For management of skin disease, see FM 8-40.

6-35. Cold Weather Operations

a. The environment in cold weatheroperations is a primary factor. Individuals mustunderstand the effects of the cold environment; theymust have the training, stamina, and willpower totake protective actions. In this climate, the humanelement is all-important; The effectiveness ofequipment is greatly reduced; therefore, specializedtraining and experience are essential. The climatedoes not allow a margin of error for the individual orthe organization. The mobility of units is restricted;their movement must be carefully planned andexecuted; a movement can be as difficult toovercome as the enemy. Momentum is difficult toachieve and can be quickly lost.

b. With modifications, current Armydivisions are suited for operations in cold weather(see FM 31-71). Changes in personnel and equipmentauthorizations are the result of emphasis onmobility; maintenance; communications; and CSS.Equipment is eliminated or added based on itssuitability to the terrain and environment.

c. The conduct of military operations islimited by considerations that are foreign to moretemperate regions:

Long hours of daylight and dust ofsummer.

Long nights with bitter cold andstorms of winter.

Mud and morass of the transitionperiods of spring and autumn.

Disrupting effects of naturalphenomena.

Scarcity of roads and railroads.

Vast distances and isolation.

The lack of maps can adverselyaffect mobility, firepower, and communications.

In spite of these conditions, operations areaccomplished; they require employment ofaggressive leadership; a high state of training andfull logistical support.

d. Because of the hostility of cold weather,units operating in northern latitudes shouldestablish a relatively short patient holding period.Adverse environmental conditions make it difficultfor medical units to provide definitive care over anextended period. The evacuation policy is changedas the tactical situation dictates. The general natureof the terrain makes surface evacuation of patientsdifficult in winter and virtually impossible insummer. The lack of good evacuation routes and theneed to move supplies over the same route greatlyrestrict patient evacuation. The most practicalmeans of patient evacuation is air evacuation.Aircraft resupplying the area can be used to carrypatients on the return trip. Total reliance on airevacuation must be avoided; aircraft operations willbe restricted by cold weather conditions.

e. To enhance HSS in extremely coldweather, the following operational principles apply:

(1) Prompt acquisition and evacuationof patients to heated treatment stations.

(2) Augmentation of unit collectingelements by division level medical elements.

(3) Use of enclosed and heated vehiclesfor medical evacuation.

(4) Provision of heated shelters atfrequent intervals along the evacuation route.

(5) Readily available air transportationfor patient evacuation.

(6) Special vehicles for surfaceevacuation of patients.

(7) Heated storage for medical supplies.

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f. In the deep snows, storms, and bitter coldof winter, prompt evacuation and treatment ofpatients is even more essential. It is extremelydifficult to find and evacuate patients; early medicalcare can be rendered only if medical personnel areimmediately available. Procedures should beestablished for medical care on patrols, at strong-points, and in heated aid stations near front lines. Ifmedical personnel are not readily available, otherpersonnel must promptly evacuate patients.Medical treatment elements must be well forward inthe combat area to prevent unnecessary losses dueto evacuation delays.

6-36. Desert Operations

a. Planning for HSS is especially importantin the desert; the greater distances used inmaneuver and deployment complicate medicaltreatment, evacuation, and supply procedures.Roads and trails are scarce and usually connectvillages and oases. Wheeled vehicles can travel inany direction over much of the desert; they need notbe confined to roads and trails because much of thedesert area is flat and hard surfaced. Limited watersupplies, coupled with the increased demandscreated by very high temperatures, low humidity,and dust, cause additional concerns for HSSplanners. Use FM 90-3 when preparing HSS plans fordesert operations.

b. The greater distances between unitslimit the availability of combat medics. Medicalunits should be augmented when possible; alsotroops should be given additional first aid trainingbefore desert operations.

c. The large area over which a battle isfought presents special problems in the timelyacquisition, treatment, and evacuation ofpatients. Any number of patients in a fighting unitmay restrict the maneuverability of that unit andjeopardize its mission. Medical units are furnished agreater number of evacuation vehicles for operatingin deserts. Medical treatment elements are locatedfarther to the rear in desert operations. Medicalevacuation by fixed-wing aircraft and helicopters isvaluable because of their speed and the reducedturnaround time.

d. Many diseases of military significancemay be found in the desert. The diseases are foundin its human inhabitants, animals, arthropods, andlocal water and food supplies. The cold of the desertnight, even in summer, may require warm clothing.Cold weather injuries may occur during the desertwinter. It is the desert sunshine, wind, and heat,however, that have the greatest effect upon militaryoperations. The dryness of the desert heatdistinguishes it from the heat of the tropics; thisadds to the problem of coping with it. Medicalelements must be provided additional watersupplies to treat heat injuries (heat cramps, heatexhaustion, and heat stroke). All water, except fromquartersmaster water points, is consideredcontaminated and unfit for drinking it may also beunfit for bathing or for washing clothing.

e. Intestinal diseases tend to increaseamong personnel living in the desert. This may beprevented by good food service sanitation, includingsupervision of cleaning eating and cooking utensils;supervision of food handlers; disposal of garbageand human wastes; and protection of food andutensils. Solid wastes should be burned when thesituation permits. Soakage pits are used to disposeof liquid wastes; they are filled with soil whenleaving an area. Deep pit latrines should be used ifthe soil is suitable. Arthropods and rodents must becontrolled to prevent the diseases they carry.Preventive medicine measures include protectiveclothing; clothing impregnants; arthropodrepellents; residual and space sprays;immunizations; and suppressive drugs. Incidenceof disease will be reduced by individuals applyingpreventive medicine measures; practicing good fieldsanitation and personal hygiene avoiding food andwater from native villages; and constant command/medical supervision.

6-37. River Crossing Operations

a. The river barrier itself exerts decisiveinfluence on the use of HSS units. Attack across ariver line creates a medical problem comparable tothat of the amphibious assault. Medical elementscross as soon as combat operations permit. Earlycrossing of treatment elements reduces turnaroundtime for all crossing equipage which must loadpatients on the far shore. Maximum use is made ofair evacuation assets to prevent excessive patient

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buildup in far shore treatment facilities. Near shoretreatment facilities are placed as far forward asassault operations and protective considerationspermit; this reduces evacuation distances from off-loading points. For more detailed information onriver operations, see FM 90-13.

b. In defensive operations, HSS resourcesdeployed on the far shore are restricted to theminimum needed to provide support. Evacuationfrom far shore treatment facilities is accomplishedusing both surface and air evacuation; this reducesthe accumulation of patients forward of the riverbarrier. Near shore treatment facilities are locatedfarther to the rear to preclude their having todisplace in a cross-river withdrawal. Defiladelocations are avoided for medical elements becausethey are prime target areas for enemy artillery andair attack.

c. Health service support in the attack ofriver lines, while conforming in general to the HSSdoctrine of offensive operations, present specialproblems during ferrying and bridging operations.Health service support must concern itself with thesupport of the combat troops during the advance tothe river line (preliminary phase); during the rivercrossing and capture of the initial objective (phaseI); during operations to seize the intermediateobjective (phase II); and during the attack to gainthe bridgehead (phase III).

(1) Health service support preliminaryphase. There are relatively few patients resultingfrom this phase when secrecy in movement to theriver is maintained. Patient collecting points mayormay not be established along the main approachesto the crossing sites.

(2) Health service support, phase I. Atthe end of the preliminary phase, BAS and DCSs areestablished to provide normal support in the area ofeach crossing. Litter bearers may be employed neareach crossing site. Ambulances are moved as near tothe river as possible. Medical platoons furnish closeHSS; combat medics accompany their companies inthe crossing. Ambulance squads organic to themedical platoons cross in succeeding waves; and thetreatment squad establishes the BAS on the farbank as soon as the situation permits. Patients areplaced on returning craft for evacuation to the nearbank. When helicopters are employed as a means of

air landing assault troops, the returning aircraftmay be used to evacuate patients to medicaltreatment elements on the near bank. Airambulance elements provide air evacuation ofpatients from the far bank during phase I if thetactical situation allows air assault operations.

(3) Health service support, phase II.During this phase, the FSMC provides evacuationon both banks of the river until a DCS has beenestablished on the far bank. When phase II isnearing completion, the DCS is moved forward to aposition close to the near bank or across to the farbank as conditions dictate. A relatively highpriority is granted to division HSS elements formovement across any established bridges. In theabsence of bridges, movement of HSS elements isaccomplished by surface craft or air.

(4) Health service support, phase III.During this final phase, HSS units are moved acrossthe river as rapidly as possible; they resume normaloperations on the far bank. Division clearingstations may be called upon to care for a largernumber of patients, pending the establishment ofbridges and the resumption of normal evacuation byhigher command.

6-38. Rear Operations and Area Damage Control

a. Rear operations consist of those actions,including area damage control, taken by all units(combat, CS, CSS, and host nation) singly or incombination to secure the force; to neutralize ordefeat enemy operations in the rear area; and toensure freedom of action in deep and close-inoperations. It is a system designed to ensurecontinuous support.

b. Area damage control operations are thosemeasures taken before, during, or after a hostileaction or a natural or man - made disaster tominimize its effects.

c. Health service support is provided bydivision medical companies, medical platoons, andmedical sections. These units establish and operatea BAS/DCS on or near the edge of the damage area.

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d. See FM 90-14 and FM 3-100 foradditional information on area damage controloperations.

6-39. Military Operations on Urbanized Terrain

a. General. Throughout history, battleshave been fought on urbanized terrain. Some recentexamples are the battles for Manila, Stalingrad,Hue, Beirut, and Panama City. Military operationson urbanized terrain (MOUT) are planned andconducted on a terrain where man-made structuresimpact on the tactical options available to thecommander. This terrain is characterized by a three-dimensional battlefield, having considerable rubble;ready-made fortified fighting positions; and anisolating effect on all combat, CS, and CSS units. Inthis environment, the requirement for a detailedHSSPLAN cannot be overstated. Medical andtactical planners must plan, train, prepare, andequip for patient evacuation from under, at, andabove ground level. An additional concern inurbanized terrain is the increased potential fordisease transmission due to disruption of utilities(water, sewage, waste disposal), the large numbersof refugees and displaced persons, and breakdownsin sanitation and personal hygiene.

b. Equipment Requirements. Materielrequirements for HSS of MOUT includes uniqueequipment, especially for the extraction and theevacuation of patients.

Axes, crowbars, and other toolsused to break through barriers.

Special harnesses, portable blockand tackle equipment, grappling hooks, collapsiblestretchers and SKED stretchers, lightweightcollapsible ladders, heavy gloves, and blankets withshielding for use in lowering patients from buildingsor moving them from one building to another atsome distance above the ground using ropes andpulleys.

Equipment for the extraction ofpatients from tracked vehicles, safe and quickretrieval from craters, basements, sewers, andsubways. Patients may have to be extracted frombeneath rubble and debris.

The anticipated increase in woundsand injuries requires increased supplies ofintravenous (IV) resuscitation fluids. Individualsoldiers may carry these fluids to hasten theiravailability y and shorten the time between woundingand initiation of vascular volume replacement.

Air ambulances equipped with arescue hoist may be able to evacuate patients fromthe roofs of buildings or may be able to insertneeded medical personnel and supplies. The use ofSKED stretchers expedites patient hoisting.

Effective communications facemany obstacles during MOUT. Line of sight radiosare not effective. Individual soldiers will not haveaccess to radio equipment. Alternate forms ofcommunications, such as markers, panels, or fieldexpedients (fatigue jacket or T-shirt), which can bedisplayed by wounded or injured soldiers indicatingwhere they are, may be employed.

c. Nonmaterial Requirements.

(1) Patient collecting points should beestablished at relatively secure areas accessible toboth ground and air ambulances. Life- or limb-threatening injured or wounded soldiers should beevacuated by air ambulance, when available.Patient collecting points should be designated inadvance of the operation and should—

Offer cover from enemy fires.

Be located as far forward as thetactical situation permits.

Be identified by an unmis-takable feature (natural or man-made).

Allow rapid turnaround ofambulances.

(2) Route markings to the MTF anddisplay of the Geneva Red Cross at the facility mustbe approved by the tactical commander. Camou-flaging the Red Cross can forfeit the protections, forboth medical personnel and their patients, affordedunder the Geneva Convention. Refer to Appendix Hfor additional information. The site selected must beaccessible, but separated from lucrative enemytargets, as well as civilian hazards such as gasstations or chemical factories.

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(3) Medical evacuation in the MOUTenvironment is a labor-intensive effort. Much of theevacuation effort must be accomplished by litterteams; this is due to rubble, debris, barricades, anddestroyed roadways. When this occurs, anambulance shuttle system or litter shuttle should beestablished. Medical personnel must be able to useand teach manual carries, as well as improvise as thesituation dictates. In moving patients, you should—

Use covered evacuation routessuch as storm water sewers and subways. Sanitarysewers should not be used; there is a danger ofmethane gas buildup in these systems.

Use easily identifiable pointsfor navigation and patient collecting points.

Rest frequently by using alitter shuttle system.

(4) Self-aid, buddy aid, and the CLSskills are essential in this environment. Due to thenature of MOUT, injured and wounded soldiers maynot be reached by the combat medic for extensiveperiods of time. The longer the period betweeninjury or wounding and medical treatment, thepoorer the prognosis. Therefore, units operating inthis environment must ensure that all soldiers areproficient in self-aid and buddy aid, and that CLSare trained. In paragraph b above, it isrecommended that each soldier carry IVresuscitation fluids with him so that the CLS caninitiate replacement fluid therapy before the combatmedic reaches the casualty. The soldier’s chance forsurvival increases when he begins receiving IVresuscitation fluids early.

d. Ground Evacuation. When using groundevacuation in support of MOUT, the HSS plannermust remember that built-up areas have manyobstructions to vehicular movement. Factorsrequiring consideration include—

Vehicular operations within theurban terrain are complicated and canalized byrubble and other battle damage.

Bypassed pockets of resistance andambushes pose a constant threat along evacuationroutes.

Land navigation using tactical mapsproves to be difficult. Commercial city maps can aidin establishing evacuation routes, when available.

Ambulance teams must dismount,search for, and rescue casualties.

Movement of patients becomes apersonnel intensive effort. There are insufficientmedical personnel to search for, collect, and treatthe wounded. Litter bearers and search teams willbe required from supported units, as the tacticalsituation permits.

Refugees may hamper movementinto and around urban areas.

Civilian personnel, detainees, andenemy prisoners of war are provided medicaltreatment in accordance with the command policyand the Geneva Convention.

e. Aeromedical Evacuation. When usingaeromedical evacuation assets in support of MOUT,the medical planner must consider enemy ADcapabilities and terrain features (both natural andman-made) within and adjacent to the built-upareas.

(1) Factors which may affect the use ofair ambulances are—

Movement is highly restrictedand is canalized over secured areas, down wideroads, and open areas.

Telephone and electrical wireand communications antennas hinder aircraftmovement.

Secure landing zones must beavailable.

Landing zones may includebuildings with helipads on their roofs or sturdybuildings, such as parking garages.

Snipers with AD capabilitiesmay occupy upper stories of taller buildings.

(2) Helicopters remain the preferredmethod of evacuation.

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f. Training. In addition to the self-aid,buddy aid, and CLS training, HSS personnel mustbe familiar with the tactics, techniques, andprocedures used by the combat soldier in MOUT.

(1) For HSS personnel to survive andserve in this environment, they must know how to—

Cross open areas safely.

Avoid barricades and mines.

Enter and depart buildingssafely.

Recognize situations wherebooby traps or ambushes are likely and areadvantageous to the enemy.

(2) Many of the techniques used in amountainous terrain for the extraction and

evacuation of patients can be applied to medicalevacuation in a MOUT. By using the SKEDstretcher, the patient can be secured inside the litterfor ease in vertical extractions and evacuations.

(3) Health service support personnelmust practice and become proficient in using agrappling hook, scaling walls, and rappelling.Rappelling techniques can be used to gain entry intoupper levels of buildings as well as accompanyingthe patient during vertical extraction andevacuation.

(4) Detailed information on the conductof combat operations in the urban environment iscontained in FM 90-10-1. Additional information onHSS to MOUT is contained in FMs 8-42 and 8-10-6.Health service support planners and providers mustbe proficient in the skills required for thisenvironment.

Section VII. HEALTH SERVICE SUPPORT IN A NUCLEAR,BIOLOGICAL, CHEMICAL, OR DIRECTED ENERGY ENVIRONMENT

6-40. General

a. On future battlefields, the enemy mayemploy NBC weapons and directed energy (DE)devices. Chemical, biological, and DE protectivemeasures and procedures to mitigate the effects ofnuclear weapons must be included in the medicalplatoon training programs and daily operations.This section provides guidance for HSS duringnuclear warfare, enemy biological or chemicalattack, and enemy employment of DE devices. Thematerial presented in this section emphasizescontingency planning for immediate problemsconfronting HSS units following enemy actions. Thelarge numbers of patients, the loss of MTFs andpersonnel from NBC attacks, and DE deviceemployment will reduce our capability to provideHSS.

b. Nuclear, biological, chemical, and DEactions create high casualty rates, materiel losses,obstacles to maneuver, and contamination. Mission-oriented protection posture Level 3 and 4 results inbody heat buildup, reduces mobility, and degrades

visual, touch, and hearing senses. Laser protectiveeyewear may degrade vision, especially at night.Individual, and ultimately, unit operationaleffectiveness and productivity are degraded.

c. Contamination is a major problem inproviding HSS in an NBC environment. To increasesurvivability as well as supportability, the medicalplatoon must take necessary action to avoid NBCcontamination. Maximum use must be made of—

Alarm and detection equipment.

Unit dispersion.

Overhead cover, shielding materiels,and collective protective shelters.

Chemical agent resistant coatings.

Generally, a biological aerosol attack will notsignificantly impact materiel, terrain, or personnelin the short term. Detailed information oncharacteristics and soldier dimensions of the nuclear

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battlefield; NBC operations; extended operations incontaminated areas: NBC decontamination; NBCcontamination avoidance; and NBC protection arecontained in Field Manuals 8-285, 8-250, 8-50, 3-100,3-5, 3-4, and 3-3.

d. On the integrated battlefield HSS isfocused on keeping the soldier in the battle.Effective and efficient triage and emergencytreatment in the operational area saves lives,assures judicious evacuation, and maximizes thereturn to duty rate.

6-41. Medical Planning Factors

a. To provide HSS, definitive planning andcoordination is required at all levels of command.

This includes provisions for treatment, evacuation,and hospitalization. Field Manuals 8-285,8-55, 8-9,and TM 8-215 contain additional information inplanning for HSS operations. Higher headquartersmust distribute timely plans and directives tosubordinate units. Provisions for emergencymedical care of civilians, consistent with themilitary situation, must be included.

b. The medical platoon leader should make aquick appraisal to determine the expected patientload. Consider the use of triage and EMT decisionmatrices for managing patients in a contaminatedenvironment. A sample decision matrix is shown inFigure 6-2. Training medical personnel in the use ofthese matrices should enhance their effectiveness inproviding HSS.

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6-42. Logistical Considerations

a. The medical platoon is organized andequipped to provide support in a conventionalenvironment. However, it must be trained andprepared to operate in all battlefield situations.Employment in an NBC environment willnecessitate the issue of chemical patient treatmentsets, and chemical patient decontamination sets.

b. The DMSO maintains a 48-hourcontingency stock level of Class VIII supplies.These medical supplies and equipment must beprotected from contamination by chemical agent.Class VIII stocks are dispersed to prevent or reducedamage or contamination caused by NBC weapons.Health service support plans include the protection(NBC hardening) of contingency stocks and therapid resupply of affected units. Contaminateditems are decontaminated prior to issue to usingunits.

c. The division PVNTMED section isresponsible for testing the quality of water for thedivision. Water from local sources (lakes, ponds, orpublic water systems) is subject to beingcontaminated; therefore, it is essential to test thelocal source for contaminants before use. Frequentretesting by water production personnel isrecommended. Once a water source is contaminated,it is marked with appropriate NBC contaminationmarkers. The water is not used until a determinationis made that it is safe for use, or water treatmentequipment capable of removing the contaminants isemployed. When water becomes contaminated, it isdisposed of in a manner that prevents secondarycontamination; the area is marked. All waterdispensing equipment is monitored frequently forpossible contamination. Water supply on the NBCbattlefield is provided on an area basis by elementsof the supply and transportation battalion. Watersupply is normally provided to maneuver elementsthrough unit distribution.

6-43. Personnel Considerations

During NBC actions, HSS requirements willincrease and medical reinforcement may benecessary. Following an enemy NBC attack, oremployment of DE devices, medical personnel willbe fully active in providing emergency medical care;

they will provide more definitive treatment as timeand resources permit. Nonmedical personnel shouldprovide search and rescue of the injured or wounded;provide immediate first aid; and performdecontamination procedures. Nonmedical personnelwill be needed to man the patient decontaminationstation at the BAS (FM 8-285 and TC 8-12). Therequirement for nonmedical personnel should beincluded in the battalion tactical SOP.

6-44. Disposition of Treatment Elements

Site selection factors dictate that the BAS not belocated at or near likely target areas. Selecting acovered and concealed site is extremely important ina potential NBC environment.

a. A minimum of eight medical personnelare required to operate a collective protectiveshelter (CPS) system and provide medical care. OneEMT NCO performs triage and EMT on patientsbefore decontamination. One aidman monitors thepatient during decontamination procedures. Twoaidmen monitor and provide care to patients whenthey leave the decontamination site. Theseindividuals care for patients awaiting admission tothe CPS; they also provide care for RTD or otherpatients requiring evacuation without receivingtreatment in the CPS. One medic operates from theCPS airlock. He removes patient’s protective maskand monitors patient’s prior to their entering theinterior of the CPS. He also assists with treatmentin the CPS. The physician and PA operate inside theCPS with the assistance of the airlock aidman andone additional aidman.

b. Operation of CPS systems at the BAS ina chemical environment requires more than fourmedical personnel. This is why the squad does notsplit into teams. A viable method of obtainingadditional HSS in the area of operations would be torequest additional medical teams from the FSMC.

c. The BAS is equipped with two medicalequipment sets for chemical agent patienttreatment and one medical equipment set forchemical agent patient decontamination. Each sethas enough consumable supplies for thedecontamination and treatment of sixty chemicalagent patients. These sets are also used at clearingstations, corps and COMMZ hospitals, anddispensaries to decontaminate and treat chemical

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agent patients. The number of sets vary, dependingon the treatment site.

6-45. Civilian Casualties

Civilian casualties may become a problem inpopulated or built-up areas; the BAS may berequired to provide assistance when civilian medicalresources cannot handle the workload. Aid tocivilians, however, will not be undertaken at theexpense of health services for US personnel.

6-46. Nuclear Environment

a. The medical platoon must be capable ofsupporting the maneuver unit’s operations in anuclear environment. The three damaging effects ofa nuclear weapon are blast, thermal radiation (heatand light), and nuclear radiation (principally gammarays and neutron particles). Well - constructedfoxholes with overhead cover and expedient shelters(for example, reinforced concrete structures,basements, railroad tunnels, or trenches) providegood protection from nuclear attacks. Armoredvehicles also provide protection against both theblast and radiation effects of nuclear weapons.Casualties generated in a nuclear attack will likelysuffer concurrent injuries (for example, acombination of blast, heat, and radiation injuries)which will complicate HSS. Nuclear radiationcasualties fall into three categories:

Irradiated casualty. The irradiatedcasualty is one who has been exposed to ionizingradiation, but is not contaminated. They are notradioactive, and pose no radiation threat to medicalcare providers. Casualties who have sufferedexposure to initial nuclear radiation will fit into thiscategory.

Externally contaminated casualty.The externally contaminated casualty has radio-active dust and debris on his clothing, skin, or hair.He presents a “housekeeping” problem to the BAS,similar to the vermin-infested patient arriving at apeacetime MTF. The externally contaminatedcasualty should be decontaminated at the earliesttime consistent with required HSS. Lifesaving careis always rendered, when necessary, beforedecontamination is accomplished. Radioactive

contamination can be monitored with a radiationdetection instrument such as the AN/PDR-27 orAN/VDR-2. Removal of the outer clothing willresult in greater than ninety-percentdecontamination; soap and water can be used tofurther reduce the contamination levels. Acontaminated patient, or even several contaminatedpatients are unlikely to present a radiation hazardto attending medical personnel.

Internally contaminated casualty.The internally contaminated casualty is one thathas ingested or inhaled radioactive materials, or hashad radioactive material injected into the bodythrough an open wound. The radioactive materialcontinues to irradiate the casualty internally untilradioactive decay and biological eliminationremoves the radioactive isotope. Attending medicalpersonnel are shielded, to some degree, by thepatient’s body. Inhalation, ingestion, or injection ofquantities of radioactive material sufficient topresent a threat to medical care providers is highlyunlikely.

b. Medical units operating in a residualradiation environment will face three problems—

Immersion of the treatment facilityin fallout, necessitating decontamination efforts.

Casualty production due to gammaradiation.

Hindrances to evacuation caused bythe contaminated environment.

6-47. Medical Triage

Medical triage, as discussed in earlier sections, isthe classification of patients, according to the typeand seriousness of injury. This achieves the mostorderly, timely, and efficient use of medicalresources. However, the triage process for nuclearpatients is different than for conventional injuries.The four categories for triage of nuclear patientsare:

Immediate treatment group (Tl). Thoserequiring immediate lifesaving surgery. Proceduresshould not be time-consuming and concern only

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those with a high chance of survival, such asrespiratory obstruction and accessible hemorrhage.

Delayed treatment group (T2). Thoseneeding surgery but whose conditions permit delaywithout unduly endangering safety. Life -sustainingtreatment such as intravenous fluids, antibiotics,splinting, catherization, and relief of pain may berequired in this group. Examples are fracturedlimbs, spinal injuries, and uncomplicated burns.

Minimal treatment group (T3). Thosewith relatively minor injuries, such as minor frac-tures or lacerations, who can be helped by untrained

personnel or look after themselves. Buddy care isparticularly important in this situation.

Expectant treatment group (T4). Thosewith serious or multiple injuries requiring intensivetreatment, or with a poor chance of survival. Thesepatients receive appropriate supportive treatmentcompatible with resources, which will include largedoses of analgesics as applicable. Examples aresevere head and spinal injuries, widespread burns,or high doses of radiation; this is a temporarycategory.

The effect of radiation on the triage of patients isshown in Table 6-1.

6-48. Biological Environment

a. A biological attack (using bomblets,rockets, or spray/vapor dispersal, release ofarthropod vectors, and terrorist/insurgentcontamination of food and water, frequentlywithout immediate effects on exposed personnel)may be difficult to recognize. The medical platoonmust monitor biological warfare indicators such as:

Increases in disease incidence orfatality rates.

Sudden presentation of an exoticdisease.

Other sequential epidemiologicalevents.

b. Passive defense measures such asimmunizations, good personal hygiene, physicalconditioning, using arthropod repellents, wearingprotective mask, and good sanitation practices willmitigate the effects of most biological intrusion.

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NOTE

Normally, biological agentsdelivered as a vapor will benonpersistent.

c. Decontamination of most biologicallycontaminated patients can be accomplished bybathing with soap and water.

d. Treatment of biological agent patientswill require observation and evaluation of theindividual to determine necessary medications.

6-49. Chemical Environment

a. Handling chemically contaminatedpatients may provide the greatest challenge tomedical units on the integrated battlefield. Allcasualties generated in a liquid chemicalenvironment are presumed to be contaminated. Dueto the vapor hazard associated with contaminatedpatients, medical personnel operating BAS andDCS without a collective protective shelter (CPS)system may be required to remain at MOPP level 4for long periods of time. When CPS systems are not

available, clean areas must be located for treatingpatients.

b. A patient processing station forchemically contaminated patients must beestablished by the medical platoon to handle theinflux of patients (Figure 6-3). Generally, the stationis divided by a “hotline” into two major workingareas; a contaminated working area situateddownwind of a clean working area. Personnel onboth sides of the “hotline” assume a MOPP levelcommensurate with the threat agent employed(normally MOPP 4). The patient processing stationshould be established in a contamination-free area ofthe battlefield. When CPS systems are notavailable, the clean treatment area should be locatedupwind 30 to 50 meters of the contaminated workarea. When personnel in the clean working area areaway from the hotline, they may reduce their MOPPlevel, especially the physician and PA. Chemicalmonitoring equipment must be used on the cleanside of the hotline to detect vapor hazards due toslight shifts in wind currents; if vapors invade theclean work area, medical personnel may have toremask to prevent low level chemical agentexposure and minimize clinical effects (such asmiosis).

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c. Initial triage, emergency medicaltreatment, and decontamination are accomplishedon the “dirty” side of the hotline. Life-sustainingcare is rendered, as required, without regard tochemical contamination. Secondary triage, ATM,and patient disposition are accomplished on theclean side of the hotline. When treatment must beprovided in a contaminated environment, outside ofCPS, the level of care may be reduced to first aidprocedures because treaters are in MOPP 3 or 4.

d. Medical platoons will requireaugmentation with nonmedical personnel to meetpatient decontamination requirements created by achemical attack. This augmentation must comefrom the supported units. See Appendix E foroperating a patient decontamination station.

6-50. Directed Energy Environment

A new dimension on the battlefield of the future willbe the employment of directed energy devices.These may be laser, microwave, or radio frequencygenerated sources. Medical management ofcasualties from these sources will compound thealready overloaded medical treatment resources.Medical management of DE patients at the BASwill consist of evaluation, application of eyeointment, patching, and evacuation. Injuries frommicrowave and radio frequency sources will bediscussed in other publications as data becomesavailable. Refer to FM 8-50 for additionalinformation on prevention and medical managementof laser injuries.

6-51. Special Operations

Possible enemy employment of NBC weapons in theextremes of climate or terrain warrants additionalconsideration. Consideration must include thepeculiarities of urban terrain, mountain, snow andextreme cold, jungle, and desert operations in anNBC environment; also the NBC-related effectsupon medical treatment and evacuation. For a moredetailed discussion on NBC aspects of urbanterrain, mountain, snow and extreme cold, jungle,and desert operations see FM 90-10, FM 90-10-1,FM 90-6, FM 31-71, FM 90-5 and FM 90-3.

a. Mountain Operations. In mountainoperations, units may be widely dispersed. Close-terrain may limit concentrations of troops, fewer

targets may exist; therefore, a lower patient loadmay be anticipated. Logistical problems, includingmedical evacuation, will increase. Health servicesupport resources are spread over a wide area.Mountain passes and gorges may tend to canalizenuclear blast and clouds of chemical and biologicalagents. Ridges and steep slopes may offer someshielding from thermal radiation effects. Roads andrailways may be nonexistent or of limited use, thusrestricting movement and complicating patientevacuation. A greater reliance on air ambulancesupport can be expected.

b. Operations in Snow and Extreme Cold.The effects of extreme cold weather combined withNBC-produced injuries have not been extensivelystudied. However, with traumatic injuries, coldhastens the progress of shock, providing a lessfavorable prognosis. Reflection of thermal radiationfrom snow and ice-covered areas will tend toreinforce the thermal effect. Care must be exercisedwhen moving chemically-contaminated patientsinto a warm shelter. Chemical contamination on thepatient’s clothing may be inapparent. When theclothing begins to warm, the chemical agent maybegin to vaporize, thereby contaminating theshelter. This effect is known as “off-gassing.”

c. Jungle Operations. In rain forests andother jungle environments the overhead canopy willto some extent shield personnel from thermalradiation. It may ignite, however, creating thedanger of forest fires and resulting in burn injuries.By eliminating sunlight, the canopy may increasethe persistency effect of some chemical agents nearground level. The canopy will also provide afavorable environment for biological agents.

d. Desert Operations. In desert operations,troops may be widely dispersed, thus presentingless profitable targets. However, the lack of coverand concealment will mean that troops are moreexposed. Smooth sand is a good reflector of boththermal and blast effects; therefore, these effectswill generate an increase in injuries. High deserttemperatures will reinforce the discomfort anddebilitation of soldiers wearing MOPP.

6-52. Medical Evacuation in an NBCDEEnvironment

a. An NBCDE environment will force theunit commander to consider to what extent he will

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commit evacuation assets to the contaminated area.If the battalion or TF is operating in a contaminatedarea, most or all of the medical platoon evacuationassets will operate there also. Efforts should bemade to keep some ambulances free fromcontamination.

b. On the modern battlefield we have threebasic modes of evacuating casualties (personnel,ground vehicles, and aircraft). Using personnel tophysically carry the casualties involves a great dealof inherent stress. Cumbersome MOPP gear, addedto climate, increased workloads, and the fatigue ofbattle, will greatly reduce personnel effectiveness. Ifevacuation personnel are to be sent into aradiologically contaminated area, operationalexposure guidance must be established. Radiationexposure records must be maintained by thebattalion NBC NCO and made available to thecommander, staff, and medical platoon leader.Based on operational exposure guidance, thecommander or medical platoon leader will decidewhich evacuation elements to send into thecontaminated area. Again, every effort is made tolimit the number of evacuation assets which arecontaminated. Evacuation considerations shouldinclude the following:

(1) A number of ambulances willbecome contaminated in the course of battle.Optimize the use of resources, medical ornonmedical, which are already contaminated beforeemploying uncontaminated resources.

(2) Once a vehicle or aircraft hasentered a contaminated area, it is highly unlikelythat it can be spared long enough to undergo acomplete decontamination. This will depend uponthe contaminant, the tempo of the battle, and theresources available to the evacuation unit.Normally, contaminated vehicles (air and ground)will be confined to dirty environments.

(3) Use ground ambulances instead ofair ambulances in contaminated areas; they aremore plentiful, are easier to decontaminate, and canbe replaced more easily. However, this does notpreclude the use of aircraft.

(4) The relative positions of thecontaminated area, FLOT, and Threat air defensesystems will determine where helicopters may be

used in the evacuation process. One or morehelicopters may be restricted to contaminated areas;with ground vehicles being used to cross the lineseparating contaminated and clean areas. Theground ambulance proceeds to a decontaminationstation; the patient is decontaminated; then a cleanground or air ambulance is used, if furtherevacuation is required. The routes used by groundvehicles to cross between contaminated and cleanareas are considered dirty routes and should not becrossed by clean vehicles. The effects of wind andtime upon the contaminants must be considered.

(5) The rotorwash of the helicoptersmust always be kept in mind when evacuatingpatients, especially in a contaminated environment.The intense winds will disturb the contaminantsand further aggravate the condition. The aircraftmust be allowed to land and reduce to flat pitchbefore patients are brought near. This will reducethe effects of the rotorwash. Additionally, ahelicopter must not land too close to adecontamination station (especially upwind)because any trace of contaminants in the rotorwashwill compromise the decontamination procedure.

c. Hasty decontamination of aircraft andground vehicles is accomplished to minimize crewexposure. Units should include deliberatedecontamination procedures in their SOPS. Asample aircraft decontamination station that maybe tailored to a particular unit’s needs is provided inFM 1-102 and FM 3-5.

d. Evacuation of patients must continue,even in an NBC environment. The medical platoonleader must recognize the constraints NBCoperations place upon him; then plan and train toovercome these deficiencies.

NOTE

The key to mission success isdetailed preplanning. AHSSPLAN must be preparedfor each support mission.Ensure that the HSSPLAN isin concert with the tacticalplan. Use the plan as a startingpoint and improve on it whileproviding HSS.

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APPENDIX ATRAINING PROCEDURES GUIDE

The following guide is provided to help you design effective training using the Five-P Model (planning,preparing, presenting, practicing, and performing).

A-1. Planning

Review command guidance, unitmissions, and FM 25-100.

Review the training objective (task,conditions, and standards).

Determine the soldiers or units to betrained.

Determine the place and time oftraining.

Determine the resources andfacilities available.

Consult training references.

Review coordinating instructionsand special considerations.

Use backward planning.

Determine what, where, how, andwhen the training will take place.

List all necessary actions to preparefor training.

Estimate the time needed for eachaction.

Arrange the necessary actions inreverse order, beginning with the last action andworking back to the first.

Schedule the necessary actions.

Develop the training outline.

Write a training statement based onthe training objective.

Develop a caution statement(personnel or equipment hazards or securityclassification).

Select the presentation method(demonstration, demonstration with practice,conference, lecture, or combination of two or more).

Address pretest, if applicable.

A-2. Preparing

Prepare yourself.

Know how to perform the task beingtrained.

Know how to train others to performthe task.

Prepare the soldiers.

Identify the soldiers or units to betrained.

Motivate the soldiers.

Announce the training.

Train any prerequisite tasks first.

Prepare the equipment, facilities, andmaterials.

Reserve, request, and requisition.

Receive equipment and materialsbefore rehearsals.

Operate the equipment to becomefamiliar with it and to check it for completeness andspare parts.

Prepare the training support personnel.

Ensure they understand theirsupport roles.

Ensure they know their role asevaluators.

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Ensure they are equipped andprepared to perform.

A-3. Presenting

practice.Provide enough information to permit

Give information that motivates.

Present information that allows transferof training, if applicable.

Tell the soldiers exact task, conditions,and standard.

A-4. Practicing

Train the tasks step by step.

Give the soldiers a basic knowledgeof, and familiarity with, each task.

Build confidence.

Train the tasks to standard.

Improve soldier performance tomeet the training objective standards.

Use sustainment training.

Train the tasks in realistic settings.

Add realism to increase thechallenge.

Train to achieve time requirements.

Use sustainment training.

A-5. Performing

Evaluate performance with a post-training check, by sampling, by on-the-jobobservation, by test or evaluation by higherheadquarters, or by internal evaluation.

Record and report the results.

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APPENDIX BCOMBAT LIFESAVER

B-1. Introduction

This is an introduction to the combat lifesaver andthe combat lifesavers course. Direct any questionson enrollment to the Army Institute for Profes-sional Development, Newport News, VA. Direct anyquestions on the subject matter content to theCommandant, Academy of Health Sciences, USArmy, ATTN: HSHA-TII, Fort Sam Houston, TX78234-6100.

B-2. Role of the Combat Lifesaver

a The AirLand Battle doctrine wasdeveloped for a widely-dispersed, rapidly-movingbattlefield. Battlefield constraints will limit theability of medical personnel to provide immediate,far forward care. Therefore, a plan was developed toprovide the needed additional care to combatsoldiers. Part of this plan is the combat lifesaver.

b. The combat lifesaver is a bridge betweenthe self-aid/buddy aid training provided all soldiersand the medical training given to the combat medic.The combat lifesaver is given additional first-aidtraining and training in selected medical tasks (suchas initiate an intravenous infusion and provideinitial care to a soldier suffering from battle fatigue).

c. The combat lifesaver is a nonmedicalsoldier trained to provide emergency care as asecondary mission. He does not replace the combatmedic. The primary mission of the combat lifesaveris his combat mission. Normally, one member ofeach squad, team, or crew will be trained as acombat lifesaver. The combat lifesaver will providecare to members of his squad, team, or crew as themission permits. When he has no combat mission toperform, the combat lifesaver may provide limitedcare for casualties and assist the combat medic.

B-3. Training the Combat Lifesaver

A correspondence course has been developed fortraining both active duty and reserve componentpersonnel. The course is offered only in the groupstudy mode. Classroom instruction is provided byqualified instructors selected by the battalioncommander or battalion/squadron surgeon.Students who successfully complete the written and

performance tests will receive promotion points andbe certified as a combat lifesaver. The courseconsists of student subcourse texts, studentexamination, and an instructor’s manual.

B-4. Administering the Combat Lifesaver Course

a. Equipment and Supplies. Arrange forequipment and supplies as early as possible. Thepurchase of some items, such as intravenousinfusion trainers and rescue breathing manikins,may be required. The local Training andAudiovisual Support Center (TASC) may have theseitems available. Training items will not be providedby either the Institute for ProfessionalDevelopment (IPD) or the Academy of HealthSciences, US Army.

b. Enrollment. Request for enrollment mustbe made to IPD on DA Form 145. Separate DAForms 145 are used to enroll the students and theinstructors. A roster containing the names, rank,SSN, and component of the students must beattached to the DA Form 145. Enrollment requestshould be sent to IPD six weeks prior to beginningthe course. Information for enrollment is in DAPamphlet 351-20.

c. Facilities. Reserve facilities well inadvance. The facilities should allow clearobservation of demonstrations and provide room forstudent practice. Handwashing devices arerequired.

d. Course Material. All course material willbe sent from IPD. Check all material carefully. Theintroductory material will list the equipment neededand procedures for teaching, testing, retesting, anddropping students.

e. Preparation. Each student is issued thesubcourses two weeks before classes begin. Thisgives the student time to study the subcourses.Students should also be provided materials such asdressings to practice tasks during the preparationtime.

f. Conduct of the Course. The classroomportion of the CLS course is a 3-day program.Soldiers who successfully complete the course arecertified as combat lifesavers.

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g. Record of Certification. Certification ofthe combat lifesaver training completion isforwarded in accordance with DA PAM 351-20 forannotation on service members DA Form 2-1, items17 and 19. Certificates of training will be issued atunit level (IPD will not issue these certificates).

h. Recertification. Recertification of eachcombat lifesaver must occur annually at unit level.Course material provided by IPD for the initialcombat lifesaver course may be reproduced andused in recertification training/testing. It isrecommended that recertification consist of bothhands-on and written testing. Recertification doesnot require the 3-day course training. Servicemembers must ensure that their DA Form 2-1,items 17 and 19 are updated annually, or as therecertification occurs. It is the responsibility of theS1 to ensure that personnel matters concerning thecombat lifesaver program are resolved, NOT THEMEDICAL PLATOON LEADER.

i. Aidbags.

(1) Each certified combat lifesaver willbe issued a combat lifesaver aidbag. The aidbag willbe packed in accordance with the prescribed packinglist and will be secured as a sensitive item (forexample, weapon or night vision devices) at unit

level. The aidbags will be issued to the combatlifesaver only upon deployment (training or actual).

(2) It is the responsibility of eachcombat lifesaver to ensure that—

His aidbag is stocked inaccordance with prescribed packing list.

All stocked items areserviceable.

Items have not exceeded theirexpiration date.

(3) Stockage items for the combatlifesaver aidbag will be requested through unitsupply channels, NOT THE AID STATION.

(4) Aidbag control is the commander’sresponsibility. Medical platoon personnel do notshare this responsibility.

(5) If a combat lifesaver failsrecertification, he will not be issued an aidbag.

B-5. Medical Equipment Set

The combat lifesaver medical equipment set is aCTA 8-100 item and can be requested through theDMSO.

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APPENDIX CMEDICAL INTELLIGENCE

C-1. Modem Warfare and the Medical Threat

The characteristics of modern warfare that definethe medical threat include the following

a. Significant increases in woundedcasualties beyond the capability of the HSS systemto provide timely medical care.

b. Enemy combat operations in friendly rearareas interdicting lines of communication anddisrupting vital combat support and combat servicesupport activities. This will seriously impact on theability of HSS personnel to retrieve and evacuatewounded, sick, and injured soldiers and providethem timely medical care.

c. Prolonged periods of intense, continuousoperations under all types of conditions that taxsoldiers to the limits of their physiological andemotional endurance.

d. Premeditated attack upon medicalorganizations, personnel, or Class VIII, medicalmateriel; although this action is not currentlyanticipated, it may occur. Also, a steady erosion ofbattlefield medical resources will result from–

The level of combat intensity, heavyuse of supplies, and the ever-increasing range ofindirect fire weapons.

The enhanced lethality, woundingcapability, and destructive properties of munitions.

The collateral and residual effects ofconventional, nuclear, biological, and/or chemicalweapons.

The actions of terrorists (individualsor groups) directed against defenseless targets,especially to hospitals and medical facilities.

e. Infectious diseases that pose a majorthreat to combat forces. These may be in the form ofnaturally occurring endemic diseases or diseasesintroduced as a biological weapon.

f. Environmental factors such as extremesin temperature and altitude and the presence ofpoisonous animals, plants, and insects. These are

important considerations as causative agents ofdisease and injury casualties.

g. Application of advanced technologies toenhance existing weapons and munitions and thedevelopment of new weapon systems. These mayprovide the health service support system with newdiagnostic and treatment challenges. Excellentexamples of technology driven developments thatwe may confront include—

Engineered biochemical compoundsused as biological warfare agents.

Genetically engineered micro-organisms used as biological warfare agents.

Directed energy weapons consistingof high- and low-energy lasers and high-energymicrowave, radio frequency, and particle weapons.

Enhanced blast effect weapons usedagainst personnel.

New flame and incendiary com-pounds and munitions.

Enhanced nuclear weapons withincreased lethality from radiation.

Possible mind-altering agents.

C-2. Aspects of Medical Intelligence

Medical intelligence, which is a functional area oftechnical intelligence, is that category ofintelligence resulting from the collection,evaluation, analysis, and interpretation of foreignmedical, biotechnological, and environmentalinformation. See FM 8-10-8 for specific information.

C-3. The Significance of Medical Intelligence

Medical intelligence is critical to strategic andtactical planning and operations to conserve thefighting strength. It is a highly technical area whichmust be complete (collected, evaluated, analyzed,and interpreted) so that the end product istechnically accurate and contains all requiredinformation.

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a. At the strategic level, the objective ofmedical intelligence is to contribute to theformulation of national and international policypredicated in part on foreign military and civiliancapabilities of the medical or biological scientificcommunity.

b. At the tactical level, the objective ofmedical intelligence is to provide intelligenceevaluation and analyses of the following factors inthe theater:

employment tactics and chemical or biologicalagents used.

Antidotes to protect against thenuclear, biological, or chemical threat.

Weather and/or terrain implications.

Medical intelligence also assists in identifyingcaptured enemy materiel and equipment and how itcan be used in treating enemy prisoners of war(EPW).

Conditions concerning people oranimals.

C-4. Integrating Medical IntelligenceEpidemiological information (inci-

dence, distribution, and control of infectiousdiseases).

Plants.

Enemy’s field health servicesupport.

New weapons systems or employ-ment methods that could alter health servicesupport planning factors.

Medical implications of con-tamination from NBC weapons based on

If medical intelligence confirms or reveals a newthreat based on the types of wounds or the types ofdiseases being treated, the appropriate medical staffofficer advises the tactical commander. Tacticalplanners can use this information to counter thesethreats, and HSS planners can use the intelligenceto develop HSS responsive to the demands of thearea of operations. See FM 8-10-8 for a detaileddiscussion on how to obtain medical intelligence;how to determine medical intelligence requirements;how medical personnel report information gainedthrough casual observation of activities in plainview of the discharge of their duties; and on thehandling of captured medical materiel.

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APPENDIX DBATTALION AID STATION SPLIT TEAM OPERATIONS

AND LOADING PLANS

D-1. General

This section presents one deployment option for theBAS. The concept is configured based on the BASof an armor battalion. The deployment and config-uration of your BAS may differ based on themission, use this section only as a guideline. YourBAS should be configured to best support the unitoperation plan.

D-2. Objectives of the Split Team Operation

a. To provide the option of split teamorganizing the BAS.

b. To increase the operational capability ofthe BAS.

c. To provide a means of maintaining fulloperational status during movement ("leapfrogging" the BAS).

d. To provide the capability of maintaininga functional BAS in the event one team is destroyedor contaminated.

e. To provide a means of supporting twofronts of simultaneous enemy activity, whether inthe offense, defense, or during retrogradeoperations.

f. To provide the capability of moreeffectively dispersing the BAS at an operationalsite.

g. To provide a means of organizing chestscapable of supporting a push packet system ofresupply.

h. To provide a standardized systemcapable of reducing learning curves associated withreplacement of personnel.

D-3. Organization

The BAS is organized into an (A) element and a (B)element. Personnel, equipment, and vehicles areequally divided between the two elements inaccordance with the BAS SOP.

D-4. Sets, Kits, and Outfits (SKO)

a. Where applicable, and based on TOES,SKOs are broken down into identical (A) and (B)subsets.

b. The SKOs for evacuation teams areidentified by the attached unit designation (A), (B),(C), and (D).

c. SKOs are functionally subdivided intotwo groups.

(1) Subsets capable of supportingcasualties requiring ATM.

(2) Subsets capable of supportingpatients reporting for sick call complaint.

D-5. Sets, Kits, and Outfits Organization

a. ATLS subsets.

(1) ATLS subset (Al and B1).

(a) Organized as the primary chestfor evaluation and treatment of trauma - relatedcases.

(b) Used for tailgate medicalsupport and establishment of the BAS.

(c) Maintained on the Carrier,Command Post (M577A2).

(2) ATLS subset (A2 and B2).

(a) Organized as a resupply chestfor ATLS subset (A1 and B1).

(b) Maintained on the truck,cargo, 2 1/2 ton (M35A2).

(3) ATLS subset (A3 and B3).

(a) Organized as a resupply chestfor ATLS subset (A1 and B1).

(b) Maintained on the M35A2.

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FM 8-10-4

(4) ATLS subset (A4 and B4).

(a) Organized as a resupply chestfor ATLS subset (Al and B1).

(b) Maintained on the M35A2.

(5) ATLS subset (A5 and B5).

(a) Organized as a storage chestfor Dressing, First Aid, 4 x 7 inches.

(b) Maintained on the M35A2.

(6) ATLS subset (A6 and B6).

(a) Organized as a storage chestfor Bandage, Muslin, Camouflaged, 37 x 37 x 52inches.

(b) Maintained on the M35A2.

(7) Oxygen subset (A and B).

(a) Organized as treatment chestfor patients requiring oxygen therapy.

(b) Available for tailgate medicaIsupport and establishment of the BAS.

(c) Maintained on the M577A2.

(8) Intravenous (IV) subset (A1, A2,B1, and B2).

(a) Organized as treatment chestfor patients requiring IV therapy.

(b) Available for tailgate medicalsupport and establishment of the BAS.

(c) Maintained on the M577A2.

(9) Satchel (A and B).

(a) Organized for the treatment ofpatients requiring minor surgical procedures.Surgical instruments are further subdivided intotwo equal minor surgical packs.

(b) Available for tailgate medicalsupport and establishment of the BAS.

D-2

(c) Maintained on the M577A2.

(10) Trauma bag.

(a) Organized for speed andmobility in supporting trauma patients.

(b) Each vehicle maintains onetrauma bag.

(c) Each aidman maintains onetrauma bag.

b. Sick call subsets.

(1) Sick call subset (A1 and B1).

(a} Organized as primary chest forevaluation and treatment of sick call complaints.

(b) Used for tailgate medicalsupport and establishment of the BAS.

(c) Maintained on the M577A2.

(2) Sick call subset (A2 and B2).

(a) Organized as a supplementalchest for evaluation and treatment of sick callcomplaints.

(b) Available for tailgate medicalsupport and establishment of the BAS.

(c) Maintained on the M577A2.

(3) Sick call subset (A3 and B3).

(a) Organized as a medical re-supply chest for sick call subset (A1 and B1).

(b) Maintained on the M35A2.

c. Other SKO/subsets.

(1) Aidman subset (A, B, C, and D).

(a) Organized for the treatment ofsick call/trauma patients, by the combat medic, atthe front line of own troops (FLOT).

FM 8-10-4

(b) Maintained on the companycarrier, personnel, armored (M113A2) evacuationvehicle.

(2) Aidman medication subset (A, B, C,and D).

(a) Organized for storage of medi-cations used in the treatment of sick call patients.

(b) Maintained on the companyM113A2 evacuation vehicle.

(c) During winter months, whenthere is a high probability of freezing, the subset ismaintained in the garrison BAS facility until analert notification is issued.

(3) Homestation subset (A and B).

(a) Organized for the physicalsupport of the BAS operation.

(b) Available for tailgate medicalsupport and establishment of the BAS.

(c) Maintained on the M577A2.

(4) Medical Equipment Set GroundAmbulance (6545-01-141-9476).

(a) Organized and packed as perstandard packing list.

(b) Maintained on each M577A2and M113A2.

(5) Medical Equipment Set, ChemicalAgent Patient Treatment (6545-01-141-9469).

(a) Organized and packed as perstandard packing list.

(b) Maintained on the M35A2,until required by the treatment squad.

(6) Medical Equipment Set, ChemicalAgent Patient Decontamination (6545-01-176-4612).

(a) Organized and packed as perstandard packing list.

(b) Maintained on the M35A2,until required by the treatment squad.

(7) Splint set (6545-00-952-6975).

(a) Organized and packed as perstandard packing list.

(b) Maintained on each M577A2and M113A2.

(8) Book set (7610-00-911-3827).

(a) Organized and packed inaccordance with SB 8-75-2.

(b) Maintained on the M577A2,either the (A) or (B) element based on METT-T.

d. Sample loading plans for medical platoonvehicles are shown in Figures D-1 through D-12.Specific loading plans for your organization must beprepared based on available vehicles.

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D-4

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D-5

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D-6

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D-7

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D-8

FM 8-10-4

D-9

FM 8-10-4

D-10

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D-11

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D-12

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D-13

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D-14

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APPENDIX E

PATlENT DECONTAMINATION PROCEDURES

E-1. Decontaminate a Chemical Agent Litter ination (decon) team. Figure E-1 presents onePatient concept for establishment of the chemical agent

patient decontamination station. The litter patientBefore most patients receive medical treatment, is decontaminated and undressed as follows:they are decontaminated by the patient decontam-

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FM 8-10-4

NOTES

1. Bandage scissors are used in thisprocedure. They are placed in acontainer of 5 percent chlorinesolution between each use.

2. A 5 percent chlorine solution isused to decontaminate thescissors and decontaminationteam member’s gloves and aprons(7 heaping MRE spoonsful of 70percent calcium hypochloritegranules in 1 gallon of water). A0.5 percent chlorine solution isused to decontaminate thepatient’s skin, bandages, wounds,mask, and splints (1 heapingMRE spoonful of 70 percentcalcium hypochlorite granules in1 gallon of water).

3. Use the ABC-M8VGH (M8)detector paper or the ChemicalAgent Monitor (CAM) to deter-mine the extent of contaminationon each patient before beginningdecontamination procedures.Some patients may have alreadybeen decontaminated.

4. For treatment procedures, referto FM 8-9, FM 8-285, and TM8-215.

a. Step 1: Decontaminate the patient’s maskand hood.

(1) Move the patient to the clothingremoval station. After the patient has been triagedand treated (if necessary) by the senior medic in thepatient decontamination area, he is moved to thelitter stands at the clothing removal station.

(2) Decontaminate the mask and hood.Use the M291 or M258A1 Skin DecontaminationKit; or sponge down the front, sides. and top of themask hood with a 5 percent chlorine solution, Keepthis solution off of patient’s skin.

(3) Remove the hood. Remove the hoodby cutting the M6A2 hood (see Figure E-2) or, byloosening the hood from the mask attachmentpoints for the Quick Doff Hood or other similarhoods. Before cutting the hood, dip the scissors in a5 percent chlorine solution. Then cut the neck cord,zipper cord, and the small string under the voice-mitter. Next, release or cut the hood shoulderstraps and unzip the hood zipper. Proceed bycutting the hood upward, close to the filter inletcover and eye lens outsert, upward to the top of theeye outsert, and across the forehead to the outeredge of the other eye lens outsert. Proceeddownward toward the patient’s shoulder stayingclose to the eye lens and filter inlet cover, thenacross the lower part of the voicemitter to thezipper. After dipping the scissors in the chlorinesolution, cut the hood from the center of theforehead over the top of the head and fold the leftand right sides of the hood to the side of thepatient’s head, laying the sides of the hood on thelitter.

(4) Decontaminate the protective maskand face. Using the pads from the M291 kit, thewipes from the M258A1 kit, or a 0.5 percent chlorinesolution, wipe the external parts of the mask. Coverboth mask air inlets with gauze or your hand to keepthe mask filters dry. Continue by wiping theexposed areas of the patients face, to include theneck, and behind the ears.

(5) Remove the Field Medical Card. Cutthe patient’s Field Medical Card (FMC) tie wire,allowing the FMC to fall into a plastic bag. Seal the

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FM 8-10-4

plastic bag and rinse the outside of the bag with a0.5 percent chlorine solution. Place the plastic bagwith the FMC under the back of the protective maskhead straps.

b. Step 2: Remove gross contamination.Remove all gross contamination from the patient’sovergarment by wiping all visible contaminationspots with a chlorine solution, M291 pads, or wipesfrom the M258A1 kit. Decontaminate the maskby–

Using the M291 pad on the exteriorand interior of the mask, OR

Using the M258A1 wipe 1, thenwipe 2 for the exterior of the mask; using wipe 2,then wipe 1 for the interior of the mask. - -

c . Step 3: Remove the patient’s protectiveovergarment and personal effects.

(1) Cut the patient’s overgarment. Theovergarment jacket and trousers are cutsimultaneously. Two persons will be cuttingclothing at the same time. Cut clothing aroundbandages, tourniquets, and splints.

CAUTION

Bandages may have beenapplied to control severebleeding, and are treated liketourniquets. Bandages,tourniquets, and splints areremoved only by medicalpersonnel.

(a) Remove overgarment jacket.Make two cuts, one up each sleeve from the wristarea of the sleeves, up to the armpits, and then tothe collar (Figure E-3). Do not allow the gloves totouch the patient along the cut line. Dip the scissorsin the 5 percent chlorine solution before makingeach cut to prevent contamination of the patient’suniform or underclothing. Keep the cuts close to theinside of the arms so that most of the sleevematerial can be folded outward. Unzip the jacket;roll the chest sections to the respective sides withthe inner surface outward. Continue by tucking theclothing between the arm and chest.

(b) Remove the overgarmenttrousers. Cut both trouser legs starting at theankle as shown in Figure E-4. Keep the cuts near theinseams to the crotch. With the left leg, continuecutting to the waist, avoiding the pockets. With theright leg, cut across at the crotch to and join the leftleg cut. Place the scissors in the 5 percent chlorinesolution. Fold the cut trouser halves away from thepatient and allow the halves to drop to the litterwith contaminated (green) side down. Roll the innerleg portion under and between the legs.

(2) Remove outer gloves. T h i sprocedure can be done with one person on each sideof the patient working simultaneously. If thepatient’s condition permits, lift his arms bygrasping his gloves (Figure E-5) and roll theovergarment sleeve material away from the patientas you lift. While holding the patient’s arms up,grasp the jacket material near the zipper and fold itaway from the patient. Grasp the fingers of theglove, roll the cuff over the fingers, turning theglove inside out. Do not remove the inner cottongloves at this time. Carefully lower his arms acrosshis chest after the gloves have been removed. Do notallow the patient’s arms to come into contact with

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FM 8-10-4

the exterior of his overgarment. Drop his gloves intothe contaminated waste bag. Dip your gloves in the5 percent chlorine solution.

(3) Remove the overboots. Cut theoverboot laces and fold the lacing eyelets flatoutwards. If the green overboot is worn, first try toremove the overboot without cutting, if necessary,cut the boot along the front. While standing at thefoot of the litter, hold the heel with one hand, pullthe overboot downwards, then pull towards you toremove the overboot over the combat boot heel. Ifthe two overboots are removed simultaneously, thiswill reduce the likelihood of contaminating one ofthe combat boots. While holding the heels off of thelitter, have a decon team member wipe the end of thelitter with the 5 percent chlorine solution toneutralize any liquid contamination that wastransferred to the litter from the overboots. Lowerthe patient’s heels onto the decontaminated litter.Place the overboots in the contaminated waste bag.

(4) Remove the patient’s personaleffects. Remove the patient’s personal effects fromhis protective overgarment and battledress uniformpockets. Place the articles in a plastic bag, label

with patient’s identification, and seal the bag. If thearticles are not contaminated, they are returned tothe patient. If the articles are contaminated, placethem in the contaminated holding area until theycan be decontaminated, then return them to thepatient.

d. Step 4: Remove the patient’s battledressuniform.

(1) Remove the combat boots. Cut theboot laces along the tongue. Remove the boots bypulling them towards you. Place the boots in thecontaminated waste bag. Do not touch the patient’sskin with contaminated gloves when removing hisboots.

(2) Remove inner clothing. Follow theprocedures for cutting away the protective over-garment and rolling it away from the patient. If thepatient is wearing a brassiere, it is cut between thecups; both shoulder straps are cut where they attachto the cups and are laid back off of the shoulders.Remove the socks and cotton gloves.

e. Step 5: Transfer the patient to adecontamination litter. After the patient’s clothinghas been cut away, he is transferred to a decontami-nation litter or a canvas litter with a plastic sheetingcover. Three decontamination team members decon-taminate their gloves and apron with the 5 percentchlorine solution. One member places his handsunder the small of the patient’s legs and thighs; asecond member places his arms under the patient’sback and buttocks; and the third member places hisarms under the patient’s shoulders and supports thehead and neck. They carefully lift the patient usingtheir knees, not their back to minimize back strain.While the patient is elevated another decon teammember removes the litter from the litter standsand another member replaces it with a decontami-nation (clean) litter. The patient is carefully loweredonto the clean litter. Two decon members carry thelitter to the skin decontamination station. Thecontaminated clothing and overgarments are placedin bags and moved to the decontaminated wastedump. The dirty litter is rinsed with the 5 percentdecontamination solution and placed in a litterstorage area. Decontaminated litters are returnedby ambulance to the maneuver units.

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FM 8-10-4

NOTEBefore obtaining anotherpatient, the decontaminationteam drinks approximately 1/2cup of water. The amountconsumed is increased ordecreased according to thework level and the temper-ature.

f. Step 6: Skin decontamination.

(1) Spot decontamination. With thepatient in a supine position, spot decontaminate theskin using the M291/M258A1 kit or a 0.5 percentchlorine solution. Decontaminate areas of potentialcontamination, particularly tears or holes in theprotective ensemble; other areas include the neck,wrists, and lower parts of the face.

(2) Aidman care. During clothingremoval, the clothing around bandages,tourniquets, and splints were cut and left in place.

(a) The aidman will replace the oldtourniquet by placing a new tourniquet 1/2 to 1 inchabove the old one. He will then remove the old oneand the skin is decontaminated using the M291pads, the M258A1 wipes, or the 0.5 percent chlorinesolution.

(b) Usually the aidman will gentlycut away bandages. The aidman decontaminates thearea around the wound with the 0.5 percent chlorinesolution. If bleeding begins the aidman replaces thebandage with a clean one. DO NOT use the M291pads or wipes from the M258A1 kit around thewounds.

(c) DO NOT remove splints.Splints are decontaminated by applying the 0.5percent chlorine solution to them to include thepadding and cravats. Splints are not removed untilthe patient has been evacuated to a corps hospital.The patient is checked for completeness ofdecontamination by use of M8 detection paper orthe CAM.

NOTE

Other monitoring devices maybe used when available.

(d) Dispose of contaminatedbandages and coverings by placing them in acontaminated waste bag. Seal the bag and place it inthe contaminated waste dump.

g. Step 7: Transfer the patient across theshuffle pit. The patient’s clothing has been cut awayand his skin, bandages, and splints have beendecontaminated. The litter is transferred to theshuffle pit and placed upon the litter stands. Theshuffle pit is sufficiently wide enough to preventmembers of the patient decon team to straddle itwhile carrying the litter. A third member of thedecon team assists with transferring the patient to aclean treatment litter in the shuffle pit (Figure E-1).

(1) Decontamination personnel rinse orwipe down their aprons and gloves with the 5percent chlorine solution.

(2) Three decon team members lift thepatient off of the decontamination litter. Onemember places his arms under the small of thepatient’s legs and thigh; the second member placeshis arms under the small of the patient’s back andbuttocks; and the third places his arms under thepatient’s shoulders and supports the head and neck.They carefully lift the patient with their knees, nottheir back to minimize back strain.

(3) While the patient is elevated,another decon team member removes the litter fromthe stands and returns it to the decontaminationarea. A medic from the clean side of the shuffle pitreplaces the litter with a clean one. The patient islowered onto the clean litter. Two medics from theclean side of the shuffle pit move the patient to theclean treatment area. The patient is treated in thisarea or awaits processing into the collectiveprotective shelter. The litter is wiped down with the5 percent chlorine solution in preparation for reuse.

NOTE

Before decontaminatinganother patient, each deconteam member drinks approx-imately 1/2 cup of water. Theexact amount of waterconsumed is increased ordecreased according to thework level and temperature(see Figure E-6).

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E-2. Decontaminate an Ambulatory ChemicalAgent Patient

All ambulatory patients will not be completelydecontaminated at the battalion aid station. Stablepatients not requiring treatment at the BAS, butrequiring evacuation to the division clearing stationor a corps hospital for treatment may be evacuatedin his protective overgarments and mask by anyavailable transportation; such as a patient with abroken arm. However, before evacuation, spotremoval of all thickened agents from his protectiveclothing will be accomplished. For ambulatorypatients requiring treatment at the BAS, completedecontamination will be accomplished. A member ofthe decontamination team or other ambulatorypatients will assist in the clothing removal and skindecontamination of these patients. Bandagescissors are used in this procedure; they arereturned to the container of 5 percent chlorinesolution when not in use.

E-6

1.

2.

NOTES

Most ambulatory patients will betreated in the contaminatedtreatment area and returned toduty.

Upon removal of an ambulatorypatient’s clothing, he becomes alitter patient. The BAS and DCSdo not have clothing to replacethose cut off during thedecontamination process. Thepatient must be placed in apatient protective wrap (PPW) forprotection during evacuation.

a. Step 1: Remove load bearing equipment.Remove the load bearing equipment (LBE) byunfastening/unbuttoning all connectors or tie

FM 8-10-4

straps; then place the LBE into a plastic bag. Placethe plastic bag in the designated storage area.

b. Step 2: Decontaminate the patient’s maskand hood.

(1) Send patient to clothing removalstation. After the patient has been triaged andtreated (if necessary) by the senior medic in thepatient decontamination station he walks to theclothing removal station.

(2) Decontaminate and remove maskhood.

(a) Sponge down the front, sides,and top of the hood with a 5 percent chlorinesolution. Keep this solution off of the patient’s skin.Remove the hood by cutting the M6A2 hood (FigureE-2) or where possible with the Quick Doff Hood orother hoods, by loosening the hood from the maskattachment points. Before cutting the hood, dip thescissors in the 5 percent chlorine solution. Begin bycutting the neck cord, zipper cord, and the smallstring under the voicemitter. Next, release or cutthe hood shoulder straps and unzip the hood zipper.Proceed by cutting the hood upward, close to thefilter inlet cover and eye outserts, to the top of theeye outsert, across the forehead to the outer edge ofthe next eye outsert. Proceed downward toward thepatient’s shoulder staying close to the eye lens andfilter inlet, then across the lower part of thevoicemitter to the zipper. After dipping the scissorsin the 5 percent chlorine solution again, cut the hoodfrom the center of the forehead over the top of thehead and fold the right and right sides of the hoodaway from the patient’s head, removing the hood.

(b) Decontaminate the protectivemask and patient’s face by using the pads from theM291 kit, the wipes from the M258A1 kit, or the 0.5percent chlorine solution. Wipe the external parts ofthe mask, cover both mask air inlets with gauze oryour hands to keep the mask filters dry. Continue bywiping the exposed areas of the patient’s face, toinclude the neck and behind the ears.

c. Step 3: Remove the Field Medical Card.Cut the FMC tie wire, allowing the FMC to fall intoa plastic bag. Seal the plastic bag and rinse it withthe 0.5 percent chlorine solution. Place the plasticbag under the back of the protective mask headstraps.

d. Step 4: Remove all gross contaminationfrom the patient’s overgarment. Remove all visiblecontamination spots by using the pads from theM291 kit, the wipes from the M258A1 kit, or asponge with the 5 percent chlorine solution.

e. Step 5: Remove overgarments.

(1) Remove overgarment jacket.

(a) Have the patient stand withhis feet spread apart at shoulder width. Unsnap thejacket front flap and unzip the jacket. If the patientcan extend his arms, have him clinch his fist andextend his arms backward at about a 30 degreeangle. Move behind the patient, grasping his jacketcollar at the sides of the neck, peel the jacket off theshoulders at a 30 degree angle down and away fromthe patient. Avoid any rapid or sharp jerks whichspread contamination; gently pull the inside sleevesover the patient’s wrists and hands.

(b) If the patient cannot extendhis arms, you must cut the jacket to aid in itsremoval. Dip the scissors in the 5 percent chlorinesolution between each cut. As with the litterpatient, cut both sleeves from the inside starting atthe wrist up to the armpit. Continue cutting acrossthe shoulder to the collar. Cut around bandages orsplints, leaving them in place. Next, peel the jacketback and downward to avoid spreading contami-nation. Ensure that the outside of the jacket doesnot touch the patient or his inner clothing.

(c) Remove the patient’s butylrubber gloves by grasping the heel of the glove, peelthe glove off with a smooth downward motion. Placethe contaminated gloves in a plastic bag with theovergarment jacket. Do not allow the patient totouch his trousers or other contaminated objectwith his exposed hands.

(2) Remove the patient’s overboots.Remove the patient’s overboots by cutting the laceswith scissors dipped in the 5 percent chlorinesolution; fold the lacing eyelets flat on the ground.Step on the toe and heel eyelets to hold the overbooton the ground and have the patient step out of it.Repeat this procedure for the other overboot. If theoverboots are in good condition, they can bedecontaminated and reissued.

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FM 8-10-4

(3) Remove overgarment trousers.

(a) Unfasten or cut all ties,buttons, or zippers before grasping the trousers atthe waist and peeling them down over the patient’scombat boots. Again, the trousers are cut to aid inremoval. If necessary, cut both trouser legsstarting at the ankle, keep the cuts near the inside ofthe legs, along the inseam, to the crotch. Cut aroundall bandages, tourniquets, or splints. continue to cutup both sides of the zipper to the waist and allow thenarrow strip with the zipper to drop between thelegs. Place the scissors in the decontaminationsolution. Peel or allow the trouser halves to drop tothe ground. Have the patient step out of the trouserlegs one at a time. Place the trousers in thecontaminated disposal bag.

(b) Have the patient remove hiscotton glove liners to reduce the possibility ofspreading contamination. Have the patient graspthe heel of one glove liner with the other glovedhand; peeling the glove off of his hand, Hold theremoved glove by the inside and grasp the heel ofthe other glove, peeling it off of his hand. Place bothgloves in the contaminated waste bag.

(c) Place the patient’s personaleffects in a clean bag and label with the patient’sidentification. If they are not contaminated, givethem to him. If his personal effects are contami-nated, place the bagged items in the contaminatedstorage area until they can be decontaminated, thenreturn them to the patient.

f. Step 6: Check patient for contamination.After the patient’s overgarments have beenremoved, check his battledress uniform by using M8detection paper or the CAM. Carefully survey allareas of the patient’s clothing, paying particularattention to discolored areas on the uniform, dampspots, tears, and areas around the neck, wrist, ears,and dressings, splints, or tourniquets. Removespots by using the 0.5 percent chlorine solution,using the pads from the M291 kit, or the wipes fromthe M258A1 kit or cutting away the contaminatedarea. Always dip the scissors in the 5 percentchlorine solution after each cut. Recheck the areawith the detection material.

g. Step 7: Decontaminate the patient’s skin.

(1) Use the pads from the M291 kit, thewipes from the M258A1 kit, or the 0.5 percentchlorine solution to spot decontaminate exposedneck and wrist areas, other areas where theprotective overgarment was damaged, dressings,bandages, or splints.

(2) Have the patient hold his breath andclose his eyes. Have him or assist him in lifting hismask at the chin. Wipe his face quickly from belowthe top of one ear being careful to wipe all folds ofthe skin, top of the upper lip, chin, dimples, earlobes, and nose, up the other side of the face to thetop of the other ear. Wipe the inside of the maskwhere it touches the face. Have the patient resealand check his mask.

CAUTION

Keep the decontaminationsolution out the patient’s eyesand mouth.

h. Step 8: Remove bandages and tourni-quets. During the clothing removal, the clothingaround bandages, tourniquets, and splints was cutand left in place.

(1) The aidman will replace the oldtourniquet by placing a new one 1/2 to 1 inch abovethe old tourniquet. When the old tourniquet isremoved, the skin is decontaminated with the M291pads, the M258A1 wipes, or the 0.5 percent chlorinesolution.

(2) Do not remove splints. Decontam-inate them by thoroughly rinsing the splint,padding, and cravats with the 0.5 percent chlorinesolution..

(3) The aidman gently cuts awaybandages. The area around the wound is rinsed withthe 0.5 percent chlorine solution, and the aidmanirrigates the wound with the 0.5 percent chlorinesolution. The aidman covers massive wounds withplastic secured with tape. Mark the wound ascontaminated. The aidman also replaces bandagesthat are needed to control massive bleeding.

(4) Dispose of contaminated bandagesand coverings by placing them in a plastic bag and

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sealing the bag with tape. Place the plastic bags inthe contaminated waste dump,

i. Step 9: Proceed through the shuffle pit tothe clean treatment area. Have the decontaminatedpatient proceed through the shuffle pit to the cleantreatment area. Make sure that the patient’s bootsare well decontaminated by stirring the contents ofthe shuffle pit as he crosses it.

E-3. Decontaminate Biological Agent-Contaminated Patients

The decontamination station as established forchemical agent patients can also be used forbiologically contaminated patients. The 8-manpatient decontamination team is required forbiologically contaminated patient decontaminationprocedures.

E-4. Decontaminate Biological Agent-Contaminated Litter Patient

a. Remove the FMC by cutting the tie wireand allowing the FMC to drop into a plastic bag.Keep the FMC with the patient.

b. Patient decontamination team membersfirst apply a liquid disinfectant, such as chlorinedioxide, to the patient’s clothing and the litter.

NOTE

Disinfectant solution for use inpatient decontamination proce-dures must be prepared inaccordance with the labelinstructions on the container.The strength of solution for useon the skin can also be used toirrigate the wound.

c. Patient decontamination team membersremove the patient’s clothing as in decontaminationof chemical agent patients. Bandages, tourniquets,and splints are not removed. Move patient to a cleanlitter as described for a chemical agent patient.Place patient’s personal effects in a clean plastic

bag label the bag. If uncontaminated, give topatient. If contaminated, place in contaminatedstorage, decontaminate when possible, then returnto patient. Place patient’s clothing in a plastic bagand dispose in a contaminated waste dump.

d. Bathe patient with soap and warm water,followed by reapplication of a liquid disinfectant.The medic places a new tourniquet 1/2 to 1 inchabove the old tourniquet, then he removes the oldone. The medic removes bandages and decontam-inates the skin and wound with the disinfectantsolution or the 0.5 percent chlorine solution; hereplaces the bandage if needed to control bleeding.Splints are disinfected by soaking the splint,cravats, and straps with the disinfectant solution.

NOTE

Use a 0.5 percent chlorinesolution to decontaminatepatients suspected of beingcontaminated with myco-toxins.

e. Two decontamination team membersmove patient to the hotline and transfer him to aclean litter as described for chemical agent patients.Place the patient’s FMC in the plastic bag on theclean litter with him. Two medics from the cleanside of the hotline move the patient from the hotlineto the clean treatment/holding area.

E-5. Decontaminate Biological Agent-Contaminated Ambulatory Patients

a. Remove the patient’s FMC by cutting thetie wire and allowing it to drop into a plastic bag.Keep the bagged FMC with the patient.

b. Apply a liquid disinfectant solution, suchas chlorine dioxide, over the patient’s clothing.

c. Remove the patient’s clothing asdescribed for a chemical agent patient. Do notremove bandages, tourniquets, or splints. Placepatient’s clothing in a plastic bag and move theplastic bag to the contaminated waste dump.

d. Have the patient bathe with soap andwarm water. If the patient is unable to bathe

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himself, a member of the decontamination teammust bathe him. Reapply the disinfectant solution.A medic places a new tourniquet 1/2 to 1 inch abovethe old one and removes the old one. A medicremoves bandages and decontaminates the woundand surrounding skin area with the disinfectantsolution or the 0.5 percent chlorine solution. Themedic replaces the bandage if required to controlbleeding. Splints are decontaminated in place byapplying the disinfectant solution or the 0.5 percentchlorine solution to the splint, cravats, and straps.

NOTE

Use a 0.5 percent chlorinesolution to decontaminateambulatory patients suspectedof being contaminated withmycotoxins.

e. Direct the patient to cross the hotline tothe clean treatment area. His boots must be decon-taminated at the hotline before he enters the cleantreatment area.

NOTE

This patient becomes a litterpatient. He must be placed in apatient protective wrap beforeevacuation.

E-6. Decontaminate Nuclear-ContaminatedPatients

The practical decontamination of nuclear contam-inated patients is easily accomplished withoutinterfering with the required medical care.

NOTE

Patients must be monitored byusing a RADIAC meter before,during, and after each step ofthe decontamination proce-dure.

E-7. Decontaminate a Nuclear-ContaminatedLitter Patient

a. Patient decontamination team membersremove the patient’s outer clothing as described forchemical agent patients. Do not remove bandages,tourniquets, or splints. Move the patient to a cleanlitter. Place the patient’s contaminated clothing in aplastic bag and move the bagged clothing to thecontaminated waste dump.

b. Wash exposed skin surfaces with soapand warm water. Wash the hair with soap and warmwater, or clip the hair and wash the scalp with soapand warm water.

c. Move the patient to the hotline. Twomedics from the clean side of the hotline move thepatient into the clean treatment area.

E-8. Decontaminate a Nuclear-ContaminatedAmbulatory Patient

a. Have the patient remove or a decontami-nation team member assists the patient in removinghis outer clothing. Place his contaminated clothingin a plastic bag and move the bagged clothing to thecontaminated waste dump.

b. Wash exposed skin surfaces with soapand warm water. Wash his hair with soap and water,or clip the hair and wash the scalp with soap andwater.

c. Direct the patient to move to the hotline.Decontaminate his boots before he crosses into theclean treatment area.

NOTE

This patient becomes a litterpatient. He must be protectedby using a blanket or otherprotective material duringevacuation.

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F-1. General

Procedures for requesting medical evacuationsupport must be institutionalized down to the unitlevel. Procedural guidance and standardization ofrequest procedures are provided in this appendixand FM 8-10-6.

F-2. Unit Evacuation Plan

APPENDIX FEVACUATION REQUEST PROCEDURES

Before initiating any operation, a unit must have anevacuation plan in effect. The plan may be astandard SOP or it may be designed for a particularoperation. It can be published in various waysdepending on the level of headquarters and theamount of detail required. For example, it maybe inthe form of verbal instructions at the squad orplatoon level, a comment in the SOI, or a paragraphin the unit operations order. The unit evacuationplan is essential to requesting and effectingevacuation because it identifies—

Primary and alternate channels to beused in submitting the MEDEVAC request (TableF-l).

Primary and alternate evacuation route(s)to be used.

Methods of evacuation to be used,

Location of the destination medicaltreatment facilities to be used, if predesignated.

F-3. Determination to Request Medical Evacua-tion and Assignment of Medical EvacuationProcedures

The determination to request MEDEVAC andassignment of MEDEVAC precedence is made bythe senior military person present, based on theadvice of the senior medical person at the scene.Assignment of MEDEVAC precedence is necessarybecause it provides the supporting medical unit andcontrolling headquarters with information that isused in determining priorities for committing theirevacuation assets. For this reason, correctassignment of precedence cannot be over-emphasized; overclassification remains a continuingproblem. Patients will be picked up as soon as

possible, consistent with available resources andpending missions. The following are categories ofprecedence and the criteria used in theirassignment:

Priority I—URGENT. This precedence isassigned to emergency cases that should be evac-uated as soon as possible and within a maximum of2 hours to save life, limb, and eyesight.

Priority IA—URGENT-SURG. Thisprecedence is assigned to patients who must havefar forward surgical intervention to save life andstabilize for further evacuation.

Priority II—PRIORITY. This precedenceis assigned to sick, injured, and wounded personnelrequiring prompt medical care, This precedence isused when the individual should be evacuatedwithin 4 hours or his medical condition willdeteriorate to such a degree that he becomes anURGENT precedence.

Priority III—ROUTINE. Thisprecedence is assigned to personnel requiringevacuation, but whose medical condition is notexpected to deteriorate significantly. The sick,injured, or wounded in this category should beevacuated within 24 hours.

Priority IV—CONVENIENCE. Thisprecedence is assigned to patients for whom airevacuation is a matter of medical convenience ratherthan necessity.

F-4. Unit Responsibilities in Evacuation

A decision to request MEDEVAC places certainresponsibilities on the requesting unit in the overallevacuation effort. To prepare for and assist duringevacuation, the unit must—

a. Ensure that the tactical situation permitssuccessful evacuation.

b. Ensure that a person familiar with theprinciples of helicopter operations is designated to–

Select and prepare the landing site.

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Brief his ground crew on safetymeasures.

Contact the pilot and providedirections to the landing site.

Direct the loading and unloading ofthe helicopter according to the pilot’s instructions.

Brief the pilot on the position ofenemy troops; direct him to other units in the area ifasked; and make every effort to speed the helicopteron its way.

Receive back-hauled medicalsupplies and report the type and quantity, wherethey are delivered, and provide informationconcerning patients evacuated.

c. Ensure that patients are ready for pickupwhen the request is submitted.

d. Move patients to the safest aircraftapproach and departure point.

e. Mark friendly positions when armedhelicopter escort is provided.

f. Have an English-speaking representativeat the pickup site when evacuation is requested fornon-US personnel.

g. Guide the helicopter during landing andtakeoff when the tactical situation permits.

F-5. Types of Medical Evacuation RequestFormats and Procedures

a. There are two established MEDEVACformats and procedures: one for wartime use andone used in peacetime. The wartime procedures arealso used during peacetime training situations torequest MEDEVAC for simulated and constructivepatients.

(1) Simulated patients are thoseindividuals who do not have a real wound, injury, orillness but must be physically moved or cared for tomeet training and evaluation requirements.

(2) Constructive patients are represent-ation of patients in reports, messages, or other

written and oral communications; they do notrequire physical movement or care.

b. Several differences exist betweenwartime and peacetime MEDEVAC requestformats and procedures. The wartime MEDEVACrequest format is shown at Table F-1. The peacetimerequest form differs in two line item areas:

(1) Line 6–changed to number andtype of wound, injury, or illness (two gunshotwounds and one compound fracture). If seriousbleeding is reported, it should be followed by thevictim’s blood type.

(2) Line 9–changed to description ofterrain (flat, open, sloping, wooded). If possible,include relationship of landing area to prominentterrain feature.

c. Security is another basic differencebetween wartime and peacetime requestingprocedures. Under all nonwar conditions, the safetyof US military and civilian personnel outweighs theneed for security and clear text transmissions ofMEDEVAC requests are authorized. During war-time, the rapid evacuation of patients must beweighed against the importance of unitsurvivability. Accordingly, wartime MEDEVACrequests are transmitted by secure means only.

F-6. Collection of Medical EvacuationInformation

The information collected for the wartimeMEDEVAC request, Line numbers 3 through 9, issubject to brevity codes. The information collectedis limited to the specific remarks provided in TableF-1. (Example: the information to be collected forLine 4 pertains to special equipment to be placed onboard the evacuation vehicle. The limiting remarksrestrict identification to: none required hoist;Stokes litter; and forest penetrator. No otherremarks are authorized for Line 4.)

F-7. Preparation of the Medical EvacuationRequest

Table F-1 provides the procedures for preparation ofthe MEDEVAC request, to include informationrequirements and sources:

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a. During wartime and training situations,brevity codes must be used in preparing allMEDEVAC requests. The authorized codes areprovided in Table F-1; they are also provided in thestandard SO I, I tern 104. Use of locally devisedbrevity codes is not authorized. If the unit preparingthe request does not have access to securecommunications, the MEDEVAC request must beprepared in encrypted form. Encrypting is requiredfor all information on the request with the exceptionof—

(1) The MEDEVAC line numberidentifier. This information is always transmitted inclear text.

(2) The call sign and suffix (Line 2)which can be transmitted in clear text.

b. During peacetime, two MEDEVAC linenumber items (Lines 6 and 9) will change. Details forthe collection of information and requestpreparation are shown in Table F-1. More detailedprocedures for use in the peacetime request formatmust be developed by each command to meetspecific requirements.

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F-8. Transmission of the Request

The MEDEVAC request should be made by themost direct communications means to the medicalunit that controls evacuation assets. Thecommunications means and channels used dependon the situation (organization, communicationmeans available, location on the battlefield, distancebetween units). The primary and alternate channelsto be used for requesting MEDEVAC are specifiedin the unit evacuation plan.

a. Secure Transmissions. Under all wartimeconditions and for constructive and simulatedpatients during training, MEDEVAC requests willbe transmitted by SECURE MEANS only.Therefore, the use of nonsecure communicationsdictates that the MEDEVAC request betransmitted in ENCRYPTED FORM. Regardless ofthe type (secure or nonsecure) communicationsequipment used in transmission, it is necessary to–

Make contact with the intendedreceiver.

Use the call sign and frequencyassignments from the SOL

Use the proper radio procedures.

Ensure that transmission time iskept to a minimum (20 to 25 seconds maximum).

Provide the opening statement: “IHAVE A MEDEVAC REQUEST.”

b. Receiver Acknowledgement. After theappropriate opening statement is made, thetransmitting operator breaks for acknowledgement.Authentication by the receiving or transmittingunit should be done in accordance with SOP.

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c. Clear Text and Encrypted Transmissions.If secure communications equipment is used intransmission, the MEDEVAC request will betransmitted in CLEAR TEXT. However, if thecommunications equipment used in transmission isnot secure, the MEDEVAC request must betransmitted in ENCRYPTED FORM with theexception of the following:

(1) The MEDEVAC line numberidentifier (Line 1, Line 2, Line 3, and so forth). Thisinformation is always transmitted in clear text.

(2) The call sign and suffix (Line 2)which can be transmitted in clear text.

NOTE

When using DRYAD NumeralCipher, the same “SET” line isused to encrypt the grid zoneletters and the coordinates(Line 1 of the MEDEVACrequest). To avoid mis-understanding, a statement ismade that the grid zone lettersare included in the message.This must be accomplishedunless the unit SOP specifiesthat the DRYAD NumeralCipher is to be used at alltimes.

d. Letter and Numeral Pronunciation. Theletters and numerals that make up the request willbe pronounced in accordance with radio procedures.In transmission of the request, the MEDEVAC linenumber identifier will be given followed by theevacuation information (example: Line One.TANGO PAPA FOUR SIX FIVE THREE SEVENNINER).

e. MEDEVAC Line Numbers 1 through 5.MEDEVAC Line numbers 1 through 5 of therequest must always be transmitted first. Theinformation enables the evacuation unit to begin themission and avoids unnecessary delay if theremaining information is not immediately available.The information for Lines 6 through 9 may betransmitted to the evacuation vehicle en route.

f. Monitoring Requirement. Aftertransmission and acknowledgement areaccomplished, the transmitting operator mustmonitor the frequency (Line 2 of the request) to waitfor additional instructions or contact from theevacuation vehicle.

F-9. Relaying Requests

If the unit receiving the request does not control theevacuation means, it must relay the request to theheadquarters or unit that has control or to anotherrelaying unit. When the relaying unit does not haveaccess to secure communications equipment, therequest must be transmitted in encrypted form. Themethod of transmission and specific units involveddepends on the situation. Regardless of the methodof transmission, the unit relaying the request mustensure that it relays the exact information originallyreceived and that it is transmitted by secure meansonly. The radio call sign and frequency relayed (Line2 of the request) should be that of the requestingunit and not that of the relaying unit. If possible,intermediate headquarters or units relayingrequests will monitor the frequency specified in Line2. This is necessary in the event contact is notestablished by the MEDEVAC unit or vehicle withthe requesting unit.

F-10. Helicopter Landing Sites

a. Responsibility. The unit requesting airambulance service is responsible for selecting andproperly marking the helicopter landing sites.

b. Criteria for Landing Sites.

(1) The helicopter landing site and itsapproach zones to the areas should be free ofobstructions. Sufficient space must be provided forthe hovering and maneuvering of the helicopterduring landing and takeoff. The approach zonesshould permit the helicopter to land and take offinto the prevailing wind whenever possible. It isdesirable that landing sites afford helicopter pilotsthe opportunity to make shallow approaches.

(2) Definite measurements for landingsites cannot be prescribed since they vary withtemperatures, altitude, terrain, loading conditions,

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and individual helicopter characteristics. Theminimum requirement for light helicopters is acleared area of 30 meters in diameter with anapproach and departure zone clear of obstructions.The CH-47 Chinook should not be brought into alanding site that is smaller than 40 meters indiameter.

C. Removing or Marking Obstructions. Anyobject likely to be blown about by the wind from therotor should be removed from the landing area.Obstacles, such as cables, wires, or antennas at ornear the landing sites, which cannot be removed andmay not be readily seen by a pilot, must be clearlymarked. Red lights are normally used at night tomark all obstacles that cannot be easily eliminatedwithin a landing site. In most combat situations, itis impractical for security reasons to mark the topsof obstacles at the approach and departure ends of alanding zone. In a training situation or at a rear arealanding site, red lights should be used wheneverpossible to mark obstructions. If obstacles or otherhazards cannot be marked, pilots should be advisedof existing conditions by radio.

d. Identifying the Landing Site (Figures F-1through F-4).

(1) When the tactical situation permits,a landing site should be marked with the letter” H,”“T,” or “Y,” using identification panels or otherappropriate marking material. Special care must betaken to secure panels to the ground to preventthem from being blown about by the rotor wash.Firmly driven stakes will secure the panels tautly;rocks piled on the corners are not adequate.

(2) If the tactical situation permits, thewind direction may be indicated by a small windsock or rag tied to the end of a stick in the vicinity ofthe landing site, by a man standing at the upwindedge of the site with his back to the wind and hisarms extended forward, or by smoke grenades whichemit colored smoke as soon as the helicopter issighted.

(3) In night operations, the followingfactors should be considered:

(a) One of the many ways to marka landing site is to place a light at each of the fourcorners of the usable landing area. These lights

should be colored in order to distinguish them fromother lights which may appear in the vicinity. Aparticular color can also serve as one element inidentifying the site. Flare pots or other types ofopen lights should not be used because they usuallyare blown out by the rotor downwash and oftencreate a hazardous glare and/or reflection on aircraftwindshields. The site can be further identified anddistinguished from others operating in the generalvicinity by a coded signal flash to the pilot from aground operator using the directed beam of a signallamp, flashlight, vehicle lights, or other meanspreviously agreed upon. The coded signal iscontinuously flashed to the pilot until recognition isassured. After recognition, the signal operator, fromhis position on the upwind side of the landing sitedirects the beam of light downward along theground to bisect the landing area. The pilot makeshis approach for landing in line with the beam oflight and towards its source, landing at the center ofthe marked area. All lights are displayed for only aminimum time before arrival of the helicopter andare turned off immediately after the aircraft lands.

(b) When the use of standardlighting methods is not possible, pocket-sized redand/or white strobe lights or chemical light sticksare excellent means for aiding the pilot inidentifying the land zone. Open flames should beused only as a last resort. When using open flames,ground personnel should advise the pilot before helands. Burning material must be secured in such away that it will not blow over and start a fire in thelanding zone. Precautions should be taken to ensurethat open flames are not placed in a position wherethe pilot must hover over or be within three metersof them.

(c) During takeoff, only thoselights requested by the pilot are displayed; they areturned off immediately after the aircraft’sdeparture.

(4) When the helicopter approaches thelanding site, the ground contact team can ask thepilot to turn on his rotating beacon briefly in orderto identify the aircraft and confirm its position inrelation to the landing zone. The rotating beaconcan be turned off as soon as the ground contact teamhas located and identified the aircraft. The groundcontact team can help the pilot by informing him of

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his location in relation to the landing zone,observing the aircraft’s silhouette, and guiding theaircraft toward the landing zone. While the aircraftis maneuvering toward the landing zone, two-wayradio contact is maintained and the type of lightingor signal being displayed is described by the pilotand verified by the ground personnel via radio. Thesignal should be continued until the aircraft touchesdown in the landing zone.

(5) Proper use of FM homing proce-dures can prove to be a valuable asset. Through theuse of FM homing, the pilot can more accuratelylocate personnel on the ground. The success of ahoming operation depends upon the actions ofpersonnel on the ground. First, they must beoperating an FM radio which is capable oftransmitting within the frequency range of 30 to69.95 megahertz; then they must be able to gainmaximum performance from the radio throughproper tuning and operation as prescribed in” thetechnical manual for the set. The range of FM radiocommunications is limited to line of sight; therefore,personnel should remain as clear as possible ofobstructions and obstacles which could interferewith or totally block the radio signals. Groundpersonnel must have knowledge of the FM homingprocedures. When the pilot asks the radio operatorto “key the microphone,” he is simply asking thatthe transmit button be depressed for a period of 10

to 15 seconds. This gives the pilot an opportunity todetermine the direction to the person using theradio.

F-11. Loading Patients Aboard Rotary-WingAircraft.

a. Responsibility for Loading and Securing.The pilot of the evacuation aircraft is responsible forensuring that the litter squad follows the prescribedmethods of loading and securing litters and relatedequipment. The final decision regarding how manypatients may be safely loaded into the helicopterrests with the pilot.

b. Safety Measures. When loading andunloading a rotary-wing aircraft, certainprecautionary measures must be observed. Litterbearers must present as low a silhouette as possibleand must keep clear of the rotors at all times. Thehelicopter must not be approached until signaled todo so and then approached at a 45 degree angle fromthe front of the aircraft. If the helicopter is on aslope and conditions permit, loading personnelshould approach the aircraft from the downhill side.Directions given by the crew must be followed, andlitters must be carried parallel to the ground.Smoking is not permitted within 50 feet of theaircraft.

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APPENDIX G

COMBAT TRAINING CENTERS LESSONS LEARNED

G-1. Planning for Deployment to CombatTraining Centers

Planning for deployment to Combat TrainingCenters (CTCs) must begin months in advance of theactual departure date. Plans must include thefollowing at a minimum:

Arrange for PROFIS physician toaccompany medical platoon to CTC. Coordinatethrough division surgeon at least 120 days prior torotation.

Determine transportation requirements:such as how many and what type railcars will berequired for movement by rail (flat or box)? Todetermine the number of cars required, the weightand cube of all components (to include personalgear, CTA items, and leased items) must beestablished. Begin making transportationarrangements at least 6 months in advance ofdeparture date; also coordinated the arrangementswith your S4. The exclusion of any TOE items dueto transportation constraints must be carefullyevaluated for the impact on the mission.

Arrange for the lease of essentialequipment not provided for in the TOE.EXAMPLE: cardiac defibrilator/monitor, for use inreal world medical treatment of patients. Arrangefor the lease at least 6 months before the departuredate to ensure that the item is on hand.

Ensure that all medical equipment setsare complete. Request medical items (controlled/accountable drugs) at least 2 months beforerotation.

Ensure that all TOE equipment is onhand and in working order. Verify the status andavailability of all equipment at least 2 monthsbefore rotation. Have all equipment serviced/repaired as needed to be 100 percent operational.

Arrange for POL support.

Establish resupply support (includingClass VIII) for items needed during the trainingperiod. Prepare signature cards for request andreceipt of supplies. Arrange for support from HSSelements/hospital for patients requiring care beyondyour unit capabilities.

Prepare for prevention of heat injurycasualties. EXAMPLE: Ensure water consumptionpolicies are established and monitored. Personnelmust drink water frequently.

Establish food service support if notprovided for in deployment instruction.

Ensure sundry supplies are available forpersonnel.

Prepare overlays showing BAS, AXP,PCP, and split treatment team locations, if maps ofthe operational area are available.

Prepare OPORD, SOP, and HSSPLANfor medical platoon. Prepare input for inclusion inhigher command and support elements’ OPORD,SOP, and HSSPLAN.

Prepare unit for mission through unittraining at home station; begin training METLupon notification of rotation if not already in force.

G-2. Medical Lessons Learned

Lessons learned from medical units during CTCrotations are as follows:

Medical platoon leadership notpreparing/reviewing and forwarding feeder reportsin a timely manner.

Exclusion of physicians from CTCrotation is hindering the medical platoon inconducting realistic training.

The crew on the Ml13 is inadequate toprovide en route patient care. Two medicsauthorized (driver and treater); three required(driver, track commander, treater). Armor requires atrack commander.

Combat medic with radio required to manthe AXP.

Field artillery medical section does nothave radios.

BAS authorized systemic, pulmonary,and anaphylaxis resuscitative kit (SPARK), but nocardiac defibrilator/monitor.

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Work/rest not practiced by line units.Personnel working 30 plus hours without restperiods. Performance degraded after this length oftime.

Use of lensatic compass requiresdismounting tracked vehicles. For accuratereadings, the TC must be several meters from thevehicle.

Early request for nonmedical vehicleSupport in movement of mass casualties was notsupported on a timely basis.

Communications was hindered by radiosbeing borrowed from medical units and notavailable for the BAS to contact the medicalcompany.

BAS M577s being used as alternatecombat trains CPs. This violates the GenevaConventions, jeopardizing the patients and medicalunits protection.

BAS not employing the M51 sheltersystem during training. This prevented theirtraining in the employment of the system.

Resupply system for medical suppliesinadequately planned for and ineffective.

Cooled storage for IV solution notprovided at the BAS. These solutions requireprotection from excessive heat such as desert/hotclimate conditions (NTC environment).

Medical platoon deploying without nightvision devices although authorized by MTOE.

Mass casualty plans need to be welldeveloped, coordinated with supporting units/sections, documented in an SOP, and rehearsedduring training.

The medical platoon leader is a member ofthe staff and should be accepted as such. He shouldattend mission briefings and have the responsibilityfor medical planning and, in turn, brief the medicalsupport plan. When the medical platoon leader isnot included in the planning, this can result inmissed coordination when the taskings are finallypassed to the medical platoon.

During the planning phase, the battalionneeds to—

Develop a plan to access, handle,evacuate, and treat NBC casualties.

Look at methods for performingMEDEVAC missions.

Ensure the assets required formission accomplishment are included.

Provide a plan for including themedics on the mission.

The support for medical evacuationrequires an analysis by the medical support element.They must determine the best methods to supportthe tactical operations based on the platoon’s statusand capabilities.

Companies submitted an abbreviatedMEDEVAC request which severely degradedcasualty evacuation. Lines often omitted includedsite frequency, call sign, and security. This resultedin patients not being located and evacuationvehicles being destroyed. Units must becomefamiliar with the MEDEVAC request format. Itmust be used during all field training exercises.

An effective SOP for casualty evacuation;soldiers understanding of first aid procedures; andleaders awareness of the combat and field trainslocations are instrumental in preventing soldiersdying of wounds.

Coordination of medical evacuationoperations must be emphasized within thebattalion. The battalion needs to standardizeprocedures for designating patient collecting pointsand the hand over of patients to the medicalcompany.

Units need to triage/prioritize casualtiesfor treatment and evacuation. When this is notdone, soldiers with superficial wounds are treatedbefore those with life-threatening wounds. A unitSOP for casualty evacuation can consolidate orcoordinate the effort. The absence of sufficientmedics and trained combat lifesavers can intensifythe problem.

G-2

FM 8-10-4

When casualties were taken on thebattlefield, self-aid or buddy aid was rarelyadministered. When aid and litter teams wereidentified, soldiers were uncertain of theirduties/responsibilities as aid/litter team members.There was no plan or system in place to ensurecasualties were treated and evacuated to the patientcollecting points. Once at the patient collectingpoint, there was no triage during evacuation. If thecompany had two patient collecting points,casualties were evacuated to the other collectingpoint without regard to the type and extent ofinjury. On several occasions, the unit did not knowthat their casualties were never evacuated from thecompany patient collecting point. This resulted insoldiers dying of wounds.

The medics in the line companies did notestablish and maintain platoon and companypatient collecting points effectively. The medics didnot consistently organize collecting points tofacilitate rapid evacuation of patients. Sites forLZ/PZs for MEDEVAC operations were notselected consistently or effectively. The lack oftriage and treatment of patients resulted in severalpatients being designated as died of wounds.Though the technical proficiency was present, theability to apply those skills to a tacticalenvironment was not always evident.

The battalion S1 and the medical platoonleader must develop a medical evacuation planbased on METT-T. The medical platoon leadersupervises the execution of his portion of the plan inthe forward area.

The need to brief CSS personnel andrehearse their functions is just as critical as therehearsals conducted by maneuver units. Route andconvoy briefings, patient evacuation practice, andsecurity reaction plans must all be briefed andpracticed. Ensure rehearsals are conducted to thelowest possible level and for all probablecontingencies in preparation for all operations.

Classes (OPD/NCOPD) need to be caughtwhich explain in detail the HSS system of a lightinfantry division. The battalion PA or personnelfrom the medical battalion should be considered asinstructors. All FTXs need to incorporate HSS playin the scenarios, from squad through brigade level.

The medical platoon leader needs toreceive training from the medical battalion toinclude participation in their FTXs/CPXs. Thebattalion should give him time to learn his job andnot overwhelm him with additional duties.

The battalion medical platoon, inconjunction with the medical company, shouldwar-game medical evacuation procedures to clearlydefine responsibilities and refine supportrequirements. This war-gaming can be conductedusing the LOGMOD/ADMIN GTAs, variousterrain models, and various missions which thebattalion can receive.

Practice preparation of formalized staffestimates and the service support paragraph orannex of orders. The formats and procedures mustbe practiced to ensure complete written or verbalorders are prepared for actual field operations. Themost important requirement is to understand theformat; to prevent the omission of critical infor-mation when orders are prepared in the stressfulenvironment of a field operation.

Practice using air ambulances to includesupport planning, LZ site selection and preparation,defense, and communications.

War-game the coordination proceduresused by the regiment to execute the HSS missionsat all levels. These war games (executed using theMED SIM GTA and the LOGMOD GTA) are avail-able from all local TASCs. They will assist inrefining procedure and in structuring the HSSsystem at all levels.

There needs to be cross-training to coverthose MOSs that are one deep in the unit. Reassign-ments or injuries may keep these personnel fromdeploying. They may become incapacitated whilein the field. Their absence will cause a decline in thequality of care being provided.

Medical evacuation should have adedicated radio frequency; it should be monitoredby the medical company. If the SOI does not list afrequency, then employ a spare.

The battalion aid station must establishand maintain communication with the supportingmedical company at all times. When contact is

G-3

FM 8-10-4

broken, the platoon leader must hastily rectify the within each crew/team/section. With a minimalsituation. Presently, calls go through the field number of medical personnel assigned in the linetrains, brigade tactical operations center, and units, the combat lifesavers and their equipment,FASCO before being received by the supporting add the required dimension of care that can decreasemedical company. This caused a waste of time, the number of died of wounds. In the mass casualtydelay in response, and ties up communication nets. situations that occurred during this rotation, their

valued training was not present.Combat lifesavers are an integral facet of

the HSS doctrine. They place life-sustaining skills

G-4

FM 8-10-4

APPENDIX H

THE GENEVA CONVENTIONS

H-1. Effect of Geneva Conventions on HealthService Support

The conduct of armed hostilities on land is regulatedby both written and unwritten law. This land war-fare law is derived from two principal sources—custom and lawmaking treaties such as the Hagueand Geneva Conventions. The rights and duties setforth in these conventions are part of the supremelaw of the land; a violation of any one of them is aserious offense.

H-2. Geneva-Wounded and Sick (GWS)

a. Custodial and medical responsibilitiesmust be carried out for persons (military or civilian)who are wounded as a result of military operationsregardless of their nationality or legal status.

NOTE

Persons whose legal status isin doubt are accorded protec-tion and treatment as prisonersof war until their legal status isdetermined.

b. Collection and treatment of the sick andwounded are responsibilities of medical personnel.The custodial and accounting functions are respon-sibilities of military police.

H-3. Identification and Protection of MedicalPersonnel Under GWS

Medical personnel who become captured are notconsidered prisoners of war but retained personnel.

a. Protected personnel include–

(1) AMEDD personnel exclusivelyengaged in the—

Search for or collection, trans-port, or treatment of the wounded or sick.

Prevention of disease.

Administration of medicalunits and establishments (for example, this includes

personnel such as the office staff, ambulancedrivers, cooks, cleaners which form an integral partof the unit or establishment).

Veterinary staff functionsrelating to the administration of medical units andestablishments.

(2) Non-AMEDD personnel who havereceived special medical training, if carrying outtheir auxiliary medical duties when captured by theenemy. Once in enemy hands they become prisonersof war when not doing medical work.

(3) Chaplains.

b. Each protected individual must–

(1) Carry a special water-resistant,pocket-size identity card (DD Form 1934) which–

Bears the red cross on a whitebackground (the distinctive emblem of the GenevaConventions).

Is worded in the nationallanguage of the issuing force.

Contains the surname and firstname (at least), date of birth, rank, social securitynumber, protected capacity serving, photograph,signature, and/or fingerprints of carrier.

Is embossed with the stamp ofthe appropriate military authority (AR 640-3).

(2) Wear on the left arm a water-resistant armlet bearing the red cross emblem of theGeneva Convention (DA Pam 27-1 and FM 27-10).

H-4. Identification of Medical Units, Facilities,and Vehicles Under GWS

a. Identify–

(1) All medical units and facilitiesexcept veterinary units. Medical facilities alsoinclude the nonpatient care areas, such as those fordining, maintenance, and administration.

(2) Air and surface (ground and water)medical vehicles.

H-1

FM 8-10-4

Paragraph H-5 implements STANAG 2931.

NOTE H-6. Defense of Self and Patients Under Care

Under tactical conditions, theneed for concealment may out-weigh the needs for recognition(AR 750-1).

b. How:

(1) Display the distinctive flag of theGeneva Conventions (red cross on a whitebackground) over the unit/facility and in otherplaces on the unit/facility as necessary toadequately identify it. (The other emblemrecognized by terms of Geneva Convention is thered crescent. Emblems not recognized by theGeneva Convention but used by other countries,such as the red shield of David by Israel, should alsobe respected.)

(2) Mark with the distinctive Genevaemblem (red cross on a white background).

(3) The GWS protects from attack anymedical vehicle appropriately marked andexclusively employed for the evacuation of the sickand wounded or for the transport of medicalpersonnel and equipment. The GWS prohibits theuse of medical vehicles marked with the distinctiveemblems for transporting nonmedical troops andequipment.

H-5. Camouflage of the Geneva Emblem

NATO Standardization Agreement 2931 OPprovides for camouflage of the Geneva emblem onmedical facilities where the lack of camouflagemight compromise tactical operations. Medicalfacilities on land, supporting forces of other nations,will display or camouflage the Geneva emblem inaccordance with national regulations and proce-dures. When failure to camouflage would endangeror compromise tactical operations, the camouflageof medical facilities may be ordered by a NATOcommander of at least brigade level or equivalent.Such an order is to be temporary and local in natureand countermanded as soon as the circumstancespermit. It is not envisaged that fixed, large, medicalfacilities would be camouflaged. The Standardiza-tion Agreement defines“medical units, medicalaircraft on the ground.”

H-2

“medical facilities” asvehicles, and medical

a. Protected personnel are–

(1) Authorized to be armed with onlyindividual small arms. (AR 71-13 provides thedoctrine that governs the small arms medicalpersonnel are authorized [limited to pistols or rifles,or authorized substitutes].) These small arms mayonly be used for defensive purposes. The presence ofmachine guns, grenade launchers, booby traps, handgrenades, light antitank weapons, or mines in oraround a medical unit would seriously jeopardize itsentitlement to protected status under the GWS. Thedeliberate arming of a medical unit with such itemscould constitute an act harmful to the enemy andcause the medical unit to lose its protected statusunder the Convention. This conclusion is not alteredin the case of mines regardless of the method bywhich they are detonated nor is it altered by thelocation of the medical unit. If the local non-AMEDD commander situates a medical unit whereenemy attacks may imperial its safety, then thatcommander should provide adequate protection forthe medical unit and its personnel.

(2) Permitted to fire only when they ortheir patients are under direct attack in violation ofthe GWS. Use of arms by AMEDD personnel forother than protection of themselves or their patientsviolates the GWS provisions governing theprotected status of AMEDD personnel and resultsin the loss of protected status. AR 350-41 states theAMEDD personnel and non-AMEDD personnel inmedical units will not be required to train or qualifywith weapons other than individual or small armsweapons. However, AMEDD personnel attendingtraining at NCO education system courses willreceive weapons instruction that is part of thecurriculum. This will ensure that successfulcompletion of the course is not jeopardized byfailure to attend the weapons training portion of thecurriculum.

(3) Responsible for their own defensewhen operating at locations which preclude theirbeing incorporated within defensive perimeters ofnonmedical units. In addition to relying on theirspecial status, medical units can provide for theirdefense by employing passive defense measures.Passive measures are those taken to reduce the

FM 8-10-4

probability of and to minimize the effects of damagecaused by hostile action. Examples of thesemeasures are the preparation of individual fightingpositions within the immediate unit area; noise andlight discipline; posting perimeter sentries; andchanneling traffic in the unit area.

b. Protected personnel (under overallsecurity defense plans) will NOT be required—

To man or help man the perimeterdefense of nonmedical units such as unit trains,logistical areas, or base clusters.

To take offensive action againstenemy troops.

To require such actions will cause loss of protectedstatus and will result in inadequate care of our sickand wounded prisoners of war. The platoon leadermust clearly articulate this to all levels of command.The misuse of HSS vehicles/equipment will void allprotection granted under the Geneva Conventions.

H-7. Geneva-Prisoners of War

a. US Military Forces are responsible forEPWs from the moment of capture.

b. The echelon commander and medical unitcommanders jointly exercise responsibilities for thecustody and treatment of the sick, injured, orwounded enemy personnel and detained civilianpersonnel.

c. The sick, injured, or wounded prisonersare treated and evacuated through normal medicalchannels but are physically segregated from UnitedStates and allied patients. They are guarded bypersons other than medical personnel as provided by

the echelon commander. Evacuation of these EPWpatients from the combat zone is initiated as soon astheir medical conditions permit.

d. When intelligence indicates that largenumber of EPWs may result from an operation,medical units may require reinforcement to supportthe anticipated additional EPW patient work load.Procedures for estimating the medical work loadinvolved in the treatment and care of enemy EPWpatients are described in FM 8-55.

e. Enemy medical personnel are consideredretained personnel rather than prisoners of war.They are to be employed to the maximum extentpossible in such health service support duties ascaring for detained or EPW patients, preferablythose of their own armed forces. Captured medicalsupplies should be used in the care of these patients.

H-8. Geneva-Civilian Persons

a. When the United States is the occupyingpower, US Forces have the responsibility to ensurethat all civilian and refugee subsistence and healthservice needs are provided.

b. Sick or injured civilian persons resultingfrom military operations are provided initial medi-cal treatment, as required, in conformance withestablished theater policies; then, they are trans-ferred to appropriate civil control authorities assoon as possible. When such persons are evacuated,proper accommodations must be provided, includ-ing satisfactory conditions of hygiene, health,safety, and nutrition (Articles 49 and 55). Inconditions of armed conflict and to the extentpracticable, the Army must seek to fulfill the abovecommitments, as well as to protect and assistcivilians and refugees under its control.

H-3

FM 8-10-4

AD

AC

ACR

ADA

ADC

ADC-M

ADC-OT

ADC-S

admin

ADP

AFMIC

AG

AHSUSA

ALO

AM

amb

AMCO

AMDF

AMEDD

AO

APRT

AR

ARTEP

ASL

GLOSSARY

ABBREVIATIONS, ACRONYMS, AND DEFINITIONS

area code

armored cavalry regiment

air defense

air defense artillery

assistant division commander

assistant division commander—maneuver

assistant division commander—operations and training

assistant division commander—support

administration

automatic data processing

Armed Forces Medical IntelligenceCenter

Adjutant General

Academy of Health Sciences, USArmy

aviation liaison officer

amplitude modulation

ambulance

aircraft maintenance company

Army Master Data File

Army Medical Department

area of operations

Army Physical Readiness Test

Army Regulation

Army Training Evaluation Plan

authorized stockage list

ASMART

Asst

ATGM

ATLS

ATM

ATP

AVIM

AXP

BAS

BDAR

Bde

BF/NP

BFV

BICC

Biomed

BMO

Bn

BP

Br

BSA

C2

CAB

CAM

CAP

Army Medical DepartmentSystematic Modular Approach toRealistic Training

assistant

antitank guided missile

advanced trauma life support

advanced trauma management

ammunition transfer point

aviation intermediate maintenance

ambulance exchange point

battalion aid station

battle damage assessment andrepair

brigade

battle fatigue/neuropsychiatric

Bradley fighting vehicle

battlefield information controlcenter

biomedical

battalion maintenance officer

battalion

battle position

branch

brigade support area

command and control

combat aviation brigade

chemical agent monitor

company aid post

Glossary-1

FM 8-10-4

CAS

CBT

Cdr

CE

CESO

CFA

CFV

cGy

CLS

co

COMMO

COMMZ

COMSEC

CONUS

COSCOM

CP

CPS

CPX

CS

CSC

CSCC

CSM

CSS

CTA

CTC

CZ

close air support

combat

commander

communications-electronic

communications - electronics staffofficer

covering force area

cavalry fighting vehicle

centigray

combat lifesaver

commander/commanding officer

communications

communications zone

communications security

continental United States

corps support command

command post

collective protective shelter

command post exercise

combat support

combat stress control

combat stress control company

command sergeant major

combat service support

common table of allowances

Combat Training Center

combat zone

DA

DA Pam

DCS

DD

DE

decon

DIA

DISCOM

Div

DIVARTY

DMHS

DMMC

DMOC

DMSO

DNBI

DOD

DOW

Drv

DS

DSA

DZ

EAC

EDRE

EFMB

EMT

Department of the Army

Department of Army Pamphlet

division clearing station

Defense Department

directed energy

decontamination

Defense Intelligence Agency

division support command

division

division artillery

division mental health service

division materiel managementcenter

division medical operations center

division medical supply office

disease and nonbattle injuries

Department of Defense

died of wounds

driver

direct support

division support area

drop zone

echelons above corps

emergency deployment readinessexercise

Expert Field Medical Badge

emergency medical technician/emergency medical treatment

Glossary-2

FM 8-10-4

EPW

ETS

EVAC

Evac Bn

EW

FA

FARP

FARRP

FASCO

FAST

FEBA

Fld

FLOT

FM

FMC

FOUO/NOFORN

FRAGO

FSB

FSCOORD

FSE

FSMC

FSO

FTX

G1

G2

enemy prisoner of war

expiration term of service

evacuation

evacuation battalion

electronic warfare

field artillery

forward area refuel point

forward area rearm and refuel point

forward area support coordinationofficer

forward area support team

forward edge of the battle

field

forward line of own troops

frequency modulation/field manual

Field Medical Card

for official use only/not releasable toforeign nationals

fragmentation orders

forward support battalion

fire support coordinator

fire support element

forward support medical company

fire support officer

field training exercise

Assistant Chief of Staff, G1(Personnel)Assistant Chief of Staff, G2(Intelligence)

G3

G4

G5

GC

Gen

GP

GPW

GS

GTA

GWS

HATS

HHB

HHC

HHS

HHT

Hlth

HMMWV

HQ

HREC

HSC

HSMO

HSS

HSSPLAN

Assistant Chief of Staff, G3(Operations and Plans)

Assistant Chief of Staff, G4(Logistics)Assistant Chief of Staff, G5 (CivilAffairs)

Geneva-Civilian Persons

generator

group

Geneva-Prisoners of War

general support

graphic training aid

Geneva-Wound and Sick

health alert and threat summary

headquarters and headquartersbattery

headquarters and headquarterscompany

headquarters and headquarterssupport company

headquarters and headquarterstroop

health

high mobility multi-purpose wheeledvehicle

headquarters

health record

headquarters and support company

health service materiel officer

health service support

health service support plan

Glossary-3

FM 8-10-4

IAW

IDSM

IEW

IFV

IHFR

Intel

IPB

IPD

IPR

ITV

IV

LASER

LBE

Ldr

LIC

LO

LOG

LOGMOD

LOGPLAN

LRA

LRS

LtWVeh

LZ

MACOM

Glossary-4

in accordance with

intermediate direct supportmaintenance

intelligence and electronic warfare

infantry fighting vehicle

improved high-frequency radio

intelligence

intelligence preparation of thebattlefield

Institute for ProfessionalDevelopment

intelligence production requirement

improved tow vehicle

intravenous infusion

light amplification by stimulatedemission of radiation

load bearing equipment

leader

low intensity conflict

liaison officer/lubrication order

logistics

logistics module

logistics plan

local reproduction authorized

long-range surveillance

light wheeled vehicle

landing zone

major command

Maint

MBA

MCO

MCP

Mech

MED

Med Bde

MEDCAP

MEDCOM

MEDDAC

MEDEVAC

Med Gp

MEDLOG

MEDOPS

MEDSOM

MEDSTEP

MES

METL

METT-T

MI

MIP

MOC

MOD

MOPP

MOS

maintenance

main battle area

movement control officer

maintenance collection point

mechanized/mechanic

medical

medical brigade

medical civic action program

medical command

medical activity

medical evacuation

medical group

medical logistics

medical operations

medical supply, optical, and medicalmaintenance

medical standby equipmentprogram

medical equipment set

mission essential task list

mission, enemy, terrain, troops, andtime availablemilitary intelligence

mission oriented intelligenceproduction

medical operations center

module

mission-oriented protection posture

military occupation specialty

FM 8-10-4

MOUT

MP

MPTP

MRO

MS/MSC

MSB

MSE

MSMC

MSR

MTF

MTOE

Mtr

NATO

NBC

MBCDE

NCO

NCOIC

NCOPD

NCS

NP

NRTD

NTC

OACSI

OCONUS

military operations on urbanizedterrain

military police

Medical Proficiency TrainingProgram

medical regulating officer

Medical service Corps

main support battalion

mobile subscriber equipment

main support medical company

main supply route

medical treatment facility

modified table of organization andequipmentmotor

North Atlantic Treaty Organization

nuclear, biological, chemical

nuclear, biological, chemical, anddirected energy

noncommissioned officer

noncommissioned officer in charge

noncommissioned officer profes-sional development

net control station

neuropsychiatric

nonreturn to duty

National Training Center

Office for the Assistant Chief ofStaff for Intelligence

outside of continental United States

OEG

OF

Ofc

OIC

OP

OPCON

OPD

OPLAN

OPORD

Opr

OPSEC

OTSG

PA

PCP

PCs

PDR

PHS

PLL

Plt

PMCS

POL

POV

PROFIS

PSYOPS

PVNTMED

PZ

operational exposure guide

optional form

office/officer

officer in charge

observation post

operational control

officer professional devepolment

operations plan

operations order

operator

operations security

Office of The Surgeon General

physicians’ assistant

patient collecting point

permanent change of station

Physician’s Desk Reference

Public Health Service

prescribed load list

platoon

preventive maintenance checks andservices

petroleum, oils, and lubricants

privately owned vehicle

professional officer filler system

psychological operations

preventive medicine

pick-up zone

Glossary-5

FM 8-10-4

R&S

RACO

Recon

RFL

RMSS

RTD

RTO

S1S2

S3

S4

S&T

SAR

SB

SF

Sgt

Sim

SKO

SOI

SOP

SPARK

SPC

Spt

Sqd

Sqdn

Glossary-6

reconnaissance and surveillance

rear area combat operations

reconniassance

restrictive fire line

regional medical supply section

return to duty

radiotelephone operator

Adjutant (U.S. Army)Intelligence Officer (U.S. Army)

Operations and Training Officer(U.S. Army)

Supply Officer (U.S. Army)

supply and transportation

search and rescue

supply bulletin

standard form

sergeant

simulations

sets, kits, and outfits

security operations instructions

standing operating procedure

systemic, pulmonary, and anaphy-laxis resuscitative kit

specialist (E4)

support

squad

squadron

skill qualification test

SSN

STANAG

STI

STIR

Surg

Svc

SwBD

Tac

TAC CP

TACCS

TACP

Tailgatemedicine

TAMMS

TASC

TB

TB Tine

social security number

Standardization Agreement

statement of intelligence interest

scientific and technical intelligenceregister

surgeon

service

switchboard

tactical

tactical command post

Tactical Army Combat ServiceSupport (CSS) Computer System

tactical air control party

Procedure employed to retainmaximum mobility duringmovement halts or to avoid the timeand effort required to set up aformal, operational treatmentfacility (for example, during rapidadvance and retrograde operations).Tailgate medicine consists ofdispensing medications, bandagingand splinting, and performingsimple emergency life sustainingprocedures. It is performed at the“tailgate” of a vehicle using aneasily reached set of medicalsupplies and equipment. Mobility ofthe unit is not affected; only three tofive minutes are required to open orclose this service.

The Army Maintenance Manage-ment System

Training and Audiovisual SupportCenter

technical bulletin

tuberculosis testSQT

FM 8-10-4

TC

TDFS

TDY

TF

TIRS

TM

TMC

TO

TOC

TOE

Trk

TRMT

(U)

training circular/track commander

terminal digit filing system

temporary duty

task force

terrain index reference system

technical manual

troop medical clinic

theater of operations

tactical operations center

table of organization and equipment

truck

treatment

unclassified

UMCP

US

USAF

USAITAC

USAMMA

USAREUR

Veh

WHO

WO

WRAIR

XO

unit maintenance collection point

United States

United States Air Force

United States Army Intelligenceand Threat Analysis Center

United States Army MedicalMateriel Agency

United States Army, Europe

vehicle

World Health Organization

Warrant Officer

Walter Reed Army Institute ofResearch

executive officer

Glossary-7

FM 8-10-4

REFERENCES

REQUIRED PUBLICATIONS: Requiredpublications are sources that users must read inorder to understand or to comply with thispublication.

ARMY

40-2

40-5

40-15

40-26

40-61

40-66

40-501

40-562

71-13

350-1

350-41

640-3

710-2

750-1

REGULATIONS (AR)

Army Medical TreatmentFacilities: GeneralAdministration

Preventive Medicine

Medical Warning Tags andEmergency IdentificationSymbol

Tuberculosis Detection andControl Program

Medical Logistics Policies andProcedures

Medical Record and QualityAssurance Administration

Standards of Medical Fitness

Immunizations andChemoprophylaxis

The Department of the ArmyEquipment Authorization andUsage Program

Army Training

Army Forces Training

Identification Cards, Tags, andBadges

Supply Policy Below theWholesale Level

Army Materiel MaintenancePolicy and Retail MaintenanceOperations

DEPARTMENT(DA Pam)

27-1

27-10

351-20

600-8

710-2-1

OF THE ARMY PAMPHLET

Treaties Governing LandWarfare

Military Justice Handbook forthe Trial Counsel and theDefense Counsel

Army Correspondence CourseProgram Catalog

Management andAdministrative Procedures

Using Unit Supply System(Manual Procedures)

FIELD MANUAL (FM)

1-102 Army Aviation in an NBCEnvironment

3-3 Contamination Avoidance

3-4 NBC Protection

3-5 NBC Decontamination

3-100 NBC Operations

3-101 Chemical Staffs and Units

3-106 Field Behavior of BiologicalAgents

7-72 Light Infantry Battalion TaskForce

7-93 Long Range Surveillance UnitOperations

8-9 NATO Handbook on theMedical Aspects of NBCDefensive Operations (AMedP-6)

8-10 Health Service Support in aTheater of Operations

References-1

FM 8-10-4

8-10-8

8-15

Medical Intelligence in a Theaterof Operations

25-5 Training for Mobilization andWar

Medical Support in Divisions,separate Brigade, and ArmoredCavalry Regiment

Training the Force25-100

31-71

63-1

Northern Operations

8-20

8-21

Health Service Support in theCombat Zone

Combat Service SupportOperations–Separate Brigade

Health Service Support in theComummications Zone

Combat Service SupportOperations—Division

63-2

Combat Service SupportOperations: Armored,Mechanized and MotorizedDivisions

8-35 Evacuation of the Sick andWounded

63-2-2

Management of Skin Diseases inthe Tropics at Unit Level

8-40

Combat Service SupportOperations–Corps

63-3Prevention and MedicalManagement of Laser Injuries

8-5063-20

63-21

Forward Support Battalion

Planning for Health ServiceSupport

8-55 Main Support Battalion,Armored, Mechanized, andMotorized Divisions (SPJ Main)

8-230

8-250

8-285

Medical Specialist63-22 HHC and DMMC DISCOM,

Armored, Mechanized, andMotorized Divisions

Preventive Medicine

Treatment of Chemical AgentCasualties and ConventionalMilitary Chemical Injuries Tank and Mechanized Infantry

Battalion Task Force71-2

Guide for the Battalion S410-14-2

10-52

17-95

21-10

21-10-1

21-11

25-2

25-3

25-4

71-3 Armored and MechanizedInfantry BrigadeField Water Supply

Armored and MechanizedDivision Operations

Cavalry Operations 71-100

Field Hygiene and SanitationDesert Operations90-3

90-5

90-6

90-10

Unit Field Sanitation TeamJungle Operations

First Aid for SoldiersMountain Operations

Unit Training ManagementMilitary Operations onUrbanized Terrain (MOUT)Training in Units

An Infantryman’s Guide toUrban Combat (How to Fight)

How to Conduct TrainingExercises

90-10-1 (HTP)

References-2

FM 8-10-4

90-11 Extreme Cold Weather

90-13 River Crossing Operations

90-14 Rear Battle

100-5 Operations

100-10 Combat Service Support

100-15 Corps Operations

101-5 Staff Organizations andFunctions

101-5-1 Operational Terms and Graphics

TECHNICAL MANUAL (TM)

8-215 Nuclear Handbook for MedicalService Personnel

38-750 Army Equipment RecordProcedures

38-750-1 The Army MaintenanceManagement System (TAMMS)Field Command Procedures

TRAINING CIRCULAR (TC)

8-12 Use of the M51 Shelter Systemby Division Level Medical Units

8-100 Expert Field Medical BadgeTest

SUPPLY BULLETIN (SB)

8-75-series These supply bulletins providecurrent listings and information

on medical supplies andequipment. See DA Pam 25-30for complete list.

COMMON TABLE OF ALLOWANCES (CTA)

8-100 Army Medical DepartmentExpendable/Durable Items

PROJECTED REFERENCES: Projectedpublications are sources of additional informationthat are scheduled for printing but are not yetavailable. Upon print, they will be distributedautomatically via pinpoint distribution. They maynot be obtained from the USA AG PublicationsCenter until indexed in DA Pamphlet 25-30.

FIELD MANUALS (FM)

8-10 Health Service Support in aTheater of Operations

8-10-1 Health Service Support inDivision, Separate Brigade, andArmored Cavalry Regiments

8-10-3 Division Medical OperationsCenter–TTP

8-10-5 Brigade and Division Surgeons’Handbook–TTP

8-10-6 Medical Evacuation in a Theaterof Operations—TTP

8-10-7 Health Service Support in anNBC Environment–TTP

8-51 Combat Stress Control in aTheater of Operations

References-3

FM 8-10-4

Index-1

FM 8-10-4

Index-2

FM 8-10-4

Index-3

FM 8-10-4

Index-4

FM 8-10-4

Index-5

FM 8-10-4

Index-6

FM 8-10-416 November 1990

By Order of the Secretary of the Army:

CARL E. VUONOGeneral, United States Army

Chief of Staff

Official:

THOMAS F. SIKORABrigadier General, United States Army

The Adjutant General

DISTRIBUTION:

Active Army, USAR, and ARNG: To be distributed in accordance with DA Form 12-11-E, requirementsfor FM 8-10-4, Medical Platoon Leaders’ Handbook–Tactics, Techniques, and Procedures (Qty rqr blockno. 4897), FM 8-15, Medical Support in Divisions, Separate Brigades, and the Armored Cavalry Regiment(Qty rqr block no. 0816).

* U.S. GOVERNMENT PRINTING OFFICE : 1994 O - 300-421 ( 02263)