FM 8-55

CHAPTER 2

HEALTH SERVICE SUPPORT ESTIMATES, PLANS, AND ORDERS

Section I. PRINCIPLES OF PLANNING

2-1. Health Service Support Planning

a. Current HSS planning addresses themanagement of normal day-to-day operations,while short- and long-range planning coverprojected operations of successively longer periods.Planning is a continuous process. The plannermust remain sensitive to the demands for HSSbased upon constantly changing situational andoperational requirements. During currentoperations, staffs at all levels (especially highercommand levels) must continuously plan forsubsequent operations. Regardless of the type ofmilitary operation being supported or the level ofcommand providing the support, HSS plans mustbe made. These plans maybe either formal writtenplans or informal thought processes. Either planmust be well-communicated to be effective. Theplanner must proceed in an orderly, progressivemanner to ensure maximum effort and com-pleteness. The specific time required to planvaries with the type, size, and level of the commandconcerned. The amount of detail required to planwill also vary with the—

• Type of command.

• Experience of all personnel inthe command.

• Complexity of the operation.

• Factors of combined, joint ser-vices, or interagency participation.

• Time available.

b. Planners must develop well-thought-out plans and validate the plans through fieldtraining exercises and command and staff sim-ulations. The process of thinking through a plan

and conducting "What if?’’ drills by changing criticalvariables is especially useful. This process allowsthe HSS planner to envision potential results andto anticipate problems. Consequently, the plannercan become proactive instead of being reactive.The proactive planner can eliminate potentialproblems before they cause adverse consequences.He has more time to accomplish the requiredsynchronization to adjust operations when adverseconsequences arise because he has anticipatedproblems and has already considered potentialsolutions, The proactive planner has more time toaddress unanticipated problems and more time toplan HSS for future operations.

c. Effective and timely planning is es-sential to operate successfully on the battlefield.Failure in the planning process will result incommanders, their staffs, and subordinate unitsfinding themselves unprepared to function inmilitary operations. The modern, mobile battlefieldis the wrong place to be operating precariously.That approach will cost soldiers’ lives. Plannersmust have the initiative to ask questions that mayaffect the performance of their units, and theymust know their units well enough to answerquestions when asked.

2-2. Planning Sequence

The planning sequence is a series of steps repre-senting a logical progression of command and staffactions required to develop plans. The planningsequence attempts to prepare for all developmentsthat can reasonably be anticipated. Althoughsome actions ordinarily occur sequentially, otherstake place concurrently. Field Manual 101-5provides an in-depth discussion of the planningprocess.

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2-3. Current Plan

A plan developed in the planning sequence de-scribed in FM 101-5 is not necessarily implementedon completion. As new information becomesavailable or as events occur, the plan is reviewedand updated accordingly. This action continuesuntil the plan is implemented or until no re-quirement exists for the plan.

2-4. Coordination of the Plan

a. Coordination is one of the mostessential elements in successful planning. Fromthe beginning, the planner must continuouslycoordinate the various types of operations with thecommander and his assistants. With a knowledgeof the mission, the current situation, and theobjectives, the planner can better plan for thesupport that will be required. This method enableshim to begin the planning for support early andallows him time for more thorough planning. Hemust ask questions such as, What resources will Ineed to do the job? Where will Z obtain them?

b. The planner must also coordinatewith those staff representatives at the variousheadquarters who can furnish him neededinformation and who must coordinate their planswith his. He must begin early coordination inthose areas requiring close HSS interface withinthe CSS community.

c. Building the HSS interface as part ofthe CSS community is critical. Health servicesupport depends on the CSS system for a multitudeof support services such as—

(1) Class I (Subsistence, includingmedical B rations and gratuitous health and welfareitems).

equipment,

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(2) Class II (Clothing, individualtentage, tool sets and tool kits, hand

tools, and administrative and housekeepingsupplies and equipment). This class includes itemsof equipment (other than principal items)prescribed in authorization/allowance tables, anditems of supply (not including repair parts).

( 3 ) Class III (Petroleum, oils, andlubricants [POL]: Petroleum fuels; lubricants,hydraulic and insulating oils, preservatives, liquidand compressed gases, chemical products, coolants,deicing and antifreeze compounds, together withcomponents and additives of such products, andcoal).

(4) Class IV (Construction: Con-struction materials including installed equipmentand all fortification/barrier materials).

(5) Class V (Ammunition: indi-vidual small arms ammunition, and pyrotechnicsfor defense of self and patients).

(6) Class VI (Personal demanditems).

(7) Class VII (Major end items suchas vehicles and aircraft which are ready for theirintended use).

(8) Class IX (Maintenance repairparts for associated support items of equipment[ASIOE]).

(9) Class X (Material to supportnonmilitary programs).

(10)

tion.

Other support services such as—

(a) Nonmedical transporta-

(b) Potable water resupply.

(c) Liquid waste disposal.

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(d) Direct support(DS)/generalsupport (GS) maintenance backup.

units.

(e)

(f)semination.

(g)

(h)

(i)

(j)

(k)

(l)plies.

(m)medical units.

(n)

Trash/solid waste disposal.

Medical intelligence dis-

Rear operations.

Mortuary affairs.

Site support by engineer

Movement control.

Reconstitution.

Delivery of Class VIII sup-

Assistance in movement of

Nonmedical augmentation,such as personnel and air and g-round transportationfrom nonmedical units, to medical evacuation assetsin mass casualty situations.

d. Commanders and staff (planners)within units must know how, when, and withwhom to coordinate (synchronize) both internallyand externally. Proficient synchronizers tend tothink about what is happening and what will behappening two levels down, two levels up, and oneach side.

e. Just as HSS commanders must bemultifunctional to recognize CSS requirements, sotoo must future multifunctional CSS commandersrecognize medical requirements to integrate CSSeffectively across the spectrum of militaryoperations. They will have to understand what theHSS system is all about as they will have an

inherent responsibility for ensuring that HSS isplanned and provided in a timely, responsive, andeffective manner.

2-5. Characteristics of the Plan

A good HSS plan—

• Provides for accomplishing the mis-sion.

• Is based on facts and valid assump-tions. All pertinent data have been considered fortheir accuracy, and assumption shave been reducedto a minimum.

• Provides for the use of existing re-sources. These include resources organic to theorganization and those available from higherheadquarters.

• Provides for the necessary organi-zation. It clearly establishes relationships andfixes responsibilities.

• Provides for personnel, materiel, andother arrangements for the full period of thecontemplated operation.

• Provides for decentralized executionof the plan. It delegates authority to the maximumextent consistent with the necessary control.

• Provides for direct coordinationduring execution between all levels.

• Is simple. It reduces all essentialelements to their simplest form and eliminatesthose elements not essential to successful action.

• Is flexible. It leaves room foradjustments because of operating conditions and,where necessary, stipulates alternate courses ofaction (COA).

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• Provides for control. Adequate meansexist, or have been provided, to carry out the planaccording to the commander’s intent.

• Is coordinated. All elements fittogether, control measures are complete andunderstandable, and mutual support requirementsare identified and provided for.

2-6. Planning Guidance

The commander provides planning guidance tothe staff as required. The frequency, amount, andcontent of planning guidance will vary with themission, time available, situation, informationavailable, and experience of the commander andstaff. The commander may choose to issue initialplanning guidance to the staff when the mission tobe supported is announced; however, he must takecare not to unduly bias staff estimates. Thisguidance is used to direct or guide the attention ofthe staff in the preparation or revision of staffestimates and serves to expedite the decision-making process. Planning guidance should includeall elements of the commander’s intent.

2-7. Basic Planning Considerations

The commander’s intent and the mission assignedto the combat forces must be the basic considerationof all components in their planning for HSS.

a. Health service support preparationsand planning must be initiated early and designedspecifically to support the operation.

b. Certain basic factors and premisesmust be used for sound HSS planning, Among themost important are—

(1) Preparing a HSS estimate and aconcept of the HSS operation.

(2) Coordinating the efforts of thehealth services of the component forces to makemaximum use of available resources.

(3) Planning to assure flexibility forunforeseen contingencies such as nuclear,biological, and chemical (NBC) and directed-energy(DE) warfare.

Section Il. THE HEALTH SERVICE SUPPORT ESTIMATE

2-8. Surgeon’s Responsibility

a. After the commander providesplanning guidance, the surgeon should prepareestimates of requirements and descriptions ofprojects to be undertaken for establishing adequateHSS systems to support the mission. He preparesthis in his role as a special staff officer. Thesurgeon makes a health service estimate that maystand alone, or that may be incorporated into thepersonnel estimate. This estimate forms the basis

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for the subsequent HSS plan. All HSS possibilitiesthat could affect the successful support of anoperation must be considered. (See FM 8-42 foradditional discussion.)

b. The surgeon must determine whatbasic load modifications are required, whatadditional people skills are required, and anymission unique training that must be conducted.The surgeon must know his intelligence element,how medical information requirements are made

FM 8-55

known to the appropriate intelligence element,what medical intelligence is available, how medicalintelligence is disseminated, and how to integrateintelligence in general and medical intelligence inparticular into HSS operation plans (OPLANs)/operation orders (OPORDs). (See Appendix F andFM 8-10-8.)

c. The commander uses the HSSestimate, along with estimates of other individualstaff members, in the preparation of his ownestimate. He uses the information in the HSSestimate to select the best COA for the command,and for inclusion in the operational and logisticssupport plans.

d. After considering all the staffestimates, the commander completes his ownestimate and makes his decision. In the case of amedical command (MEDCOM) or medical brigadeheadquarters, the estimate is made by thecommander, assisted by his staff, and normallyresults in the publication of the HSS plan for thecommand. At lower echelons, the estimate is acontinuous mental process integrated in theplanning process.

2-9. Format for the Estimate

The process followed in preparing a HSS estimateof the situation is the same as that followed inpreparing an operational estimate.

a. Staff estimates may be presentedorally, or in writing. Often, only the staff officer’sconclusions or recommendations are presented tothe commander.

b. An example for a health serviceestimate is found in Appendix B. This format isapplicable to any echelon of command and can beused under any operational condition. It is lengthyand includes many more details than may beneeded in some situations. Each HSS planner

must vary it according to his needs. There is nobeginning or end to the estimate. It must becontinuously and constantly revised as cir-cumstances change, so that planned support canbe provided to the command from the time it ismobilized until it is inactivated.

c. The estimate is intended to be atimesaving and integral part of providing adequatesupport for all types of operations. If the estimateis prepared by the command surgeon (corpssurgeon/corps support command [COSCOM]surgeon), it must support the tactical commander’sintent. If prepared by a command such as aMEDCOM, medical brigade, or medical group, itbecomes the estimate of the medical commanderassisted by his staff. Normally, estimates at thedivision surgeon’s level are not formal writtendocuments; however, health service considerationsmay appear in a written personnel estimateprepared by the G1/S1 (Personnel/Adjutant,respectively). The commander or the staff officershould use the format as a guide and checklist.

2-10. Mission

a. The senior medical commander/command surgeon is responsible—

(1) For analyzing the mission of thecommand from the HSS perspective.

(2) For outlining the concept of HSSoperations, assigning taskings, and providingguidance for a casualty care system in support ofthe commander’s intent and concept of operations.

(3) For coordinating HSS with civilaffairs, other Services, and/or alliance and coalitionpartners, and other government agencies.

(4) For coordinating HSS with hostnations by providing medical liaison teams tocountries with which the US has HSS agreements

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or with relief agencies participating in the operationin concert with civil affairs.

(5) For anticipating the lack of HSSinfrastructure in a host nation and determiningthe impact upon refugee management.

b. The HSS mission is the basis for theestimate and is stated clearly in paragraph 1 of theestimate. It always conforms to the operations inwhich the supported personnel are engaged. Forexample, the mission might be to provide HSS tothe 52d Mechanized Division in a deceptionoperation on 10 and 11 June 92. The divisionattacks on 110310 June to secure high ground onHills 123, 456, and 789. 3d Brigade makes themain attack on the west. In another example, themission may be to save lives by providing basicmedical care, medical evacuation, and preventivemedicine (PVNTMED) sanitation enforcement andeducation.

2-11. Situation and Considerations

The health service situation will consist of HSSfacts, assumptions, and deductions that can affectthe operation. In this logical and orderlyexamination of all the HSS factors affecting theaccomplishment of the mission, the HSS plannermust be familiar with the commander’s intent.The information required includes medicalintelligence which is obtained through supportingintelligence channels. (See FM 8-10-8 for adiscussion on information requirements andpriority intelligence requirements.) The plannermust conduct a thorough evaluation of the enemysituation and the area of operations (AO) from thestandpoint of their effects on the health of thecommand and HSS operations. These areenumerated as follows in paragraph 2 of theestimate:

a. Enemy Situation. From hisspecialized point of view, the surgeon must consider

the enemy’s ability to adversely affect the HSSoperations of the command.

(1) The enemy’s attitude toward theGeneva Conventions could alter HSS if he is likelyto attack the friendly HSS system, or if he is knownto have attacked it. It could also determine thetype of medical care friendly prisoners of war canexpect.

(2) The enemy’s strength, disposi-tion, probable movements, logistic situation, andcombat efficiency must be considered to estimatethe number of patients requiring hospitalizationand evacuation.

(3) The enemy’s ability to inflictconventional and unconventional (NBC and DEwarfare) casualties is a concern. The type ofenemy weapons employed will influence thenumber and type of combat casualties. Heavyartillery bombardment, air attack, surpriseweapons and tactics, and continuous operationsincrease battle fatigue casualties, while guerrillaor terrorist attacks cause other combat stressreactions. Supplementary hospitalization andevacuation resources may be required.

(4) The enemy’s medical capabilities,sanitation discipline, and the health of potentialenemy prisoners of war (EPW) can be expected toinfluence the command’s medical work load as wellas the EPW patient work load.

b. Friendly Situation. A preliminaryestimate of medical work loads can be made whenthe friendly forces’ strength, combat efficiency,position, weapons, and plan of action are comparedwith those of the enemy.

(1) This comparison considers thetactical plan of the commander to determine thelocation of areas of casualty densities and the bestplacement of HSS units.

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(2) He must consider the enemy’sability to disrupt the rear operations of thecommand. Medical units in the rear must beincorporated into base clusters. Units must bepositioned logically to ensure maximum security.These facilities are so numerous that in manycases the ideal type of security may not be available.The threat to these units must not be aggravatedby positioning them near areas of high attackprobability such as ammunition or nuclear storagefacilities. To successfully defeat enemy deepoperations, clear-cut lines of authority for securitymust be established. These lines of authority mustbe clearly identified at all echelons before anyplans or operations are initiated. (See FM 100-15or FM 71-100 for detailed discussions.) FieldManual 8-10 addresses Article 24 of the “GenevaConvention for the Amelioration of the Conditionof the Wounded and Sick in Armed Forces in theField (GWS)." It also discusses US Army policy onthe use of Article 24 personnel in perimeter defense.

(a) Article 24 of the GWSprovides special protection for “Medical personnelexclusively engaged in the search for, or thecollection, transport, or treatment of the woundedor sick, or in the prevention of disease [and] staffexclusively engaged in the administration of medicalunits and establishments. . . . [Emphasis added.]”

(b) The GWS does not itselfprohibit the use of Article 24 personnel in perimeterdefense of nonmedical units such as unit trainslogistics areas or base clusters under overallsecurity defense plans, but the policy of the USArmy is that Article 24 personnel will not be usedfor this purpose. Adherence to this policy shouldavoid any issues regarding their status under theGWS due to a temporary change in their roles fromnoncombatant to combatant. Medical personnelmay guard their own unit without any concurrentloss of their protected status.

c. Characteristics of the Area of Op-erations. The HSS planner should obtain medical

intelligence regarding the AO from the supportingintelligence element (FM 8-10-8). This informa-tion must be considered in the planning process.The characteristics of the AO influence the numberof patients, as well as their collection and evac-uation.

(1) Terrain.

(a) Topography has the samebearing on HSS planning as it does on tacticalplanning. Using terrain to one’s advantage mayreduce combat casualties therefore decreasing theanticipated patient work load.

(b) Natural conditions mayfavor large populations of arthropods (insects,arachnids, and crustaceans) which commonly arevectors of many diseases and therefore coulddirectly increase the incidence of disease.

(c) Mountains, forests, andswamps can be expected to hamper HSS. Altitudeexposure at high terrestrial elevations frequentlyresults in reduced military performance and canresult in acute mountain sickness. Transfer ofpatients from shore to ship is particularly dependentupon coastline and harbor conditions. Availabilityof roads, landing strips, and railroads will beimportant in developing evacuation alternatives.Terrain factors such as protection, shelter, andwater supply are considered in consonance withevacuation alternatives and with the selection ofmedical treatment facility locations. Evacuationresources must be augmented when using difficultterrain.

(d) An increase in the hospitalbed allocation should be considered if the terrainanalysis suggests a significant increase in battleinjury (BI), wounded in action (WIA), diseaseadmissions, or difficulty in evacuating patients.Preventive medicine detachments should be taskedto reinforce forward deployed units if diseasepotential warrants.

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(e) The duration of hazardsfrom chemical-biological warfare agents mayincrease in the forest where the air is still and thefoliage is thick.

(2) Weather and climate.

(a) Climate influences the in-cidence of frostbite, hypothermia, snow blindness,immersion injuries, sunburn, heat exhaustion,heatstroke, combat stress, and other medicalmanifestations that detract from combat uniteffectiveness.

(b) Tropical, desert, and tun-dra conditions strongly favor the growth ofarthropod populations that highly increase theincidence of disease casualties. Preventivemedicine units become increasingly importantunder such adverse conditions.

(c) Humidity may affect stor-age life of medical supplies and equipment.

(d) Precipitation affects avail-able water supply, may impact on hospital siteselection, and may damage unprotected supplies.Rain and snow will have dramatic effects on roads,changing evacuation routes and increasingturnaround times.

(e) Temperature variationsmay require special protection of medical suppliesand may increase patient load because of heat andcold injuries. Weather also impacts on the level ofdegradation incurred while in mission-orientedprotective posture (MOPP) and thus has a directimpact on heat casualty volume. Additionally,requirements for medical facilities, supplies, andevacuation resources can be expected to increase.Because the rate of deterioration of health servicelogistics is influenced by both climate and weather,storage facilities must be estimated accordingly.Evacuation alternatives, particularly by air, will

be highly influenced by weather conditions. (SeeFM 1-230.)

(3) Dislocated civilian populationand enemy prisoners of war.

(a) Wartime stress and phys-ical damage can lead to rapid deterioration ofurban and rural utilities such as electricity, water,and sewage services. Consequent increases incommunicable disease could present a threat towhich friendly forces are vulnerable. Enemyprisoners of war and refugee populations also tendto be sources of communicable disease. Becausecities and towns tend to be located along axes ofpeacetime economic activity, they invariablyconfront CSS units moving on main supply routes(MSRs) and at crossroads of principal highways.Even if a disease outbreak is suspected, bypass ofsuch areas is generally impractical. Refugeepopulations, if not properly managed by localauthorities or military police, also tend toconcentrate on major transportation routes.

(b) Civil Affairs (CA) andmilitary police have the responsibility of workingwith the local authorities to manage the flow ofrefugees.

(c) Preventive medicine teamscould be tasked to assist local authorities toreactivate essential civilian sanitary services, or toestablish hygienic refugee assistance facilities.

(d) Veterinary units may beused to assist in the control of animal diseases thatpresent a risk to the human population or to theagricultural economy. Veterinary units will alsoinspect subsistence fed to dislocated civilians andEPW to prevent foodborne diseases, as required.This will limit the impact these populations haveon Army Medical Department (AMEDD) resources.

(e) If resources permit, MTFor medical treatment/holding cot allocations could

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be increased to accommodate known or suspectedoutbreaks of disease.

(f) Class VIII and Class X mat-eriel (materiel to support nonmilitary programs)could similarly be accumulated in anticipation of alarger demand.

(g) Increased evacuation andhospitalization requirements for dislocated civilianpopulations will be supported by local resources,nongovernmental organizations, and relief agen-cies, whenever possible. Coordination with theselocal medical agencies should be proactive andaccomplished in concert with CA units. Thisshould minimize the strain on military medicalresources.

(4) Flora and fauna. Certain kindsof arthropods, animal diseases, and toxic plantsencountered in the area may also contribute to thenoneffective rate of the command. Orientation ofpersonnel and safeguards against arthropods,animals, and vegetation may be necessary.Preventive medicine units can develop desiredinformation. Veterinary units can evaluate thelocal crops and animals for availability andsuitability as fresh food sources. As a TO expandsand matures, more fresh food will be needed tosupport US Forces.

(5) Disease. The effects of majordiseases are delayed because of incubation periods.Knowledge of potential losses to malaria, dengue,sandfly fever, typhus, and other endemic disease isinvaluable in determining appropriate preventiveand control measures. These measures includerequirements for basic personal protectivemeasures, immunizations, chemoprophylaxes,immunoprophylaxes, pest management, or otherappropriate measures. Should time not allow forpreventive measures, disease information will beessential in estimating disease rates and forprojecting strength changes in maneuver units.

(6) Local resources. The HSSplanner requires information concerning theavailability from local sources of such items asfood, ice water, pharmaceuticals, and medical gases(oxygen and anesthetics).

(a) Although other units ofthe command are responsible for procuring foodand water, appropriate veterinary services orPVNTMED detachments are responsible for foodwholesomeness, hygiene, safety, and qualityassurance and for water treatment and storage.

(b) Availability of pharma-ceuticals or medical gases in the area affects supplystockage levels and transportation required forthe operation.

(c) The use of local facilitiessuch as hospitals, medical clinics, dental andveterinary schools, and their associated staffsshould be considered.

(d) The civil-military oper-ations (CMO) staff can provide liaison withindigenous health professionals and organizations.

(7) Nuclear, biological, and chem-ical and directed-energy weapons. The numbersand types of NBC/DE casualties depends on thescenario. However, these weapons produce masscasualties (MASCAL) whenever they are used.(See FM 8-10-7.) The uncertainty concerning thenumbers, types, and extent of injuries from NBCor DE weapons is made even more complex sinceinjuries from more than one type of these weaponscan affect the methods of patient treatment andprognosis. Another example is that acute ionizingradiation exposure increases the morbidity andmortality of virtually all patient types. Suchinsidious weapons and devices also produce a largenumber of patients with stress-related injurieswhose symptoms may be difficult to distinguishfrom true signs of injury. Nuclear, biological, andchemical weapons may produce large numbers of

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patients during a single attack so that medicalunits will have to face large peak patient loads.Directed energy weapons may also be used by thethreat force. The effects could be severe on HSSoperations.

(a) The CMO staff can identifynonmilitary organizations to support HSSoperations under these conditions.

(b) The NBC and DE threatmust be evaluated and included in the overallplanning concept to determine how to counter it.All medical units must be prepared to executecoordinated MASCAL plans.

(c) Health service supportunits will not generally establish themselves in acontaminated environment. However, all units inthe theater are at risk of attack. Furthermore,remaining or entering a contaminated area mayberequired to provide HSS. Commanders must ensurethat units and personnel are prepared to survive,defend, and continue operations in or near acontaminated area by instituting MASCALstandards for medical treatment. Presence ofcritical facilities such as nuclear power plants orchemical plants could impact on medical operations.The Bhopal and Chernobyl incidents are excellentexamples of how these type facilities could affectmedical operations.

(d) Veterinary service per-sonnel will advise all DOD theater logistics unitsand user units on storing subsistence to pre-vent NBC contamination, on monitoring anddetecting NBC contamination of rations and, whennecessary, on decontaminating rations to ensurefood safety.

(e) Preventive medicine unitsand all HSS personnel will be alert for abnormaldisease patterns in order to detect NBC effects.The sick soldier or local population is likely to bethe first indication of biological warfare use; rapid

identification may be critical to the survival oftheater forces.

(f) The Area Medical Lab-oratory (AML) has special capabilities to supportHSS units in NBC environments. The AML isdescribed in Chapter 7.

d. Strengths to be Supported. Thestrengths to be supported are usually shown in atable in which the personnel strength is brokendown into categories indicating the types andamounts of support to be required. These categoriesmay include Army, Navy, Air Force, Marines,allies, EPW, indigenous civilians, detained persons,and civilian internees. Various experience ratesare applied against these strengths to estimate theexpected patient load. The detail in which thetabulation is prepared varies with the scope andtype of the operation.

e. Health of the Command.

(1) An important consideration inmaking the estimate is the health of the command.The following factors affect casualty estimates andindicate command and medical measures thatshould be taken prior to each operation beingplanned:

•

•

•and drug prophylaxis.

•

•equipment.

•

Acclimation of troops.

Presence of disease.

Status of immunizations

Status of nutrition.

Adequacy of clothing and

State of fatigue, morale,unit cohesion, and training.

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• Physical conditioning.

• Oral health fitness level.

(2) The planner is concerned withproviding HSS regardless of patient origin. He isinterested in all causes for patient admission,requirements for beds, geographic dispersion ofpatients, and the accumulation in medical workload. Combat commanders are pnmarily interestedin assessing combat power from which they candevelop alternatives for subsequent operations.The surgeon is best served by data expressed as"rates/l000/period," which simplifies planning forHSS. The commander can better evaluatealternative operational concepts if projected lossesare expressed as “percentage reduction” in combatstrength of combat units. Recognizing that majordisease impacts are delayed because of incubationperiods, knowledge of potential losses to malaria,dengue, sandfly fever, typhus and similar diseasesis invaluable for—

• Phasing the proposed tac-tical operations.

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• Managing individual re-placements.

• Task organizing maneuverunits for the next operation.

(3) Therefore, if disease is expectedto exert a significant impact on the force, con-sideration should be given to projecting changesin the strength of subordinate components notonly for disease and combat losses expected duringthe operation of concern but also for disease lossesthat will exert their operational impact duringfollowing periods. The return to duty (RTD) rateof WIA and disease and nonbattle injury (DNBI)cases is also of primary interest to the commanderand staff.

f . Assumptions. An assumption is asupposition on the current or future course ofevents, assumed to be true in the absence ofpositive proof. Assumptions are sometimesnecessary to enable the planner to complete theestimate of the situation and to decide on a COA tosupport the operation. In addition to a statementof facts, logical assumptions are included in thisparagraph as a basis for development of theestimate. Subsequently, these assumptions maybe deleted or modified as new information becomesavailable. Assumptions are usually restricted tohigher levels of planning and normally apply onlyto factors beyond the control of friendly forces suchas enemy capabilities and weather.

g. Special Factors. Factors that are notlisted elsewhere or items of such importance to theparticular operation that they merit specialconsideration are mentioned. For example, howpatients suffering from combat stress may affectthe operation is a consideration.

Health Service Support Analysis

The analysis in paragraph 3 of the estimate is alogical comparison of the estimated requirementsof the command and the support means availablefor the operation.

a. Patient Estimates. Estimates ofpatients can be prepared from data compiled inparagraph 2 of the estimate. Patients are estimatedas to number, distribution in time and space, areasof patient density, possible MASCAL, and lines ofpatient drift and evacuation. The surgeon canconsult experience tables to assist him indetermining requirements for the operation. Fromthis data, hospital bed estimates can also be made.(See Chapter 5.)

b. Support Requirements. Require-ments are calculated from the estimate of patientsand the data contained in paragraph 2 of the

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estimate. The planner should consider separatelythe requirements for the following:

(1) Patient evacuation, medicalregulating, and patient reporting and account-ability (Chapter 4).

(2) Hospitalization (Chapter 5).

(3) Health service logistics, to in-clude blood management (Chapters 6 and 8,respectively).

(4)(Chapter 7).

(5)

(6)

(7)(Chapter 11).

(8)

Medical laboratory services

Dental services (Chapter 9).

Veterinary services (chapter 10).

Preventive medicine services

Combat stress control (CSC)services (Chapter 12).

(9)13).

(10)tions, computers,

(11)(Chapters 2,6,8,

(12)

Area medical support (Chapter

Command, control, communica-and intelligence (Chapter 14).

Support to other Servicesand 10).

Others, as appropriate.

Neither the resources available nor the allotmentof specified units should be considered at this stagein the analysis. Only the HSS resourcesREQUIRED to support the commander’s operationplan are determined.

c. Resources Available. Having de-termined the HSS requirements, the surgeon then

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considers the resources on hand or readily avail-able to meet the requirements. See paragraph 3of the estimate, Example B-1, Appendix B. Max-imum use of available personnel and suppliespromotes the overall effectiveness of the HSS ofthe command. To ensure all aspects of HSS areconsidered, review the following supportingcategories:

(1) Organic HSS units and per-sonnel. Medical units that are organic componentsof the command are listed and under each is astatement describing its location, strength, andreadiness for action. Professional and specialtypersonnel capabilities must also be considered.

(2) Attached medical units andpersonnel. Medical units already attached andthose that may be readily available, their locations,strengths, readiness, and professional and specialtypersonnel capabilities are considered.

(3) Supporting medical units. Con-sideration is given here to the evacuation andother support furnished by higher echelons as wellas from the Air Force and the Navy.

(4) Civil public health capabilitiesand resources. Host-nation medical personnel andsupplies reported by CA as available from civilpublic health must also be listed. Civilian medicalfacilities and personnel may be used in some casesto augment military facilities; in other cases, thesurgeon may be requested to give them support.He should be acquainted with their potential.Cultural differences and medical care philosophiescan impact on health care provided. Civil Affairspersonnel assist in planning for the maximum ofhost-nation support. They also assist in carryingout host-nation agreements.

personnel.indigenous

(5) Indigenous or retained medicalConsideration is given to the use ofand retained personnel and their

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supplies in providing medical care for theirrespective categories of personnel.

(6) Health service logistics. Thesurgeon must consider supplies and equipment onhand, immediate resupply availability, thecondition of this materiel, and the organization’scapability to maintain it.

(7) Medical troop ceiling. Themedical troop ceiling should be reviewed by thecommand surgeon to determine the possibility ofsecuring additional medical support units. Thisaction should be effected as early as possible toensure the timely receipt of the required units. SeeChapter 14 for a discussion of the medical troopceiling.

d. Courses of Action. By taking intoconsideration all support requirements andresources available, the planner can then determinemajor problem areas and difficulties. Based onthis determination, several possible COA can bedeveloped and listed which will provide thenecessary HSS. In this subparagraph, the plannerlists these COA and considers policies, standingoperating procedures (SOPS), and procedures thatwill accomplish the support mission. He limitshimself to such considerations as—

2-14.

• Centralization versus decen-tralization of HSS. (Will authority be delegated tothe maximum extent consistent with the neces-sary control?)

• Dependence on evacuation byother Service components.

• Extent to which civilian andEPW labor will be used.

• Evacuation policies.

2-13. Evaluation and Comparison ofCourses of Action

In paragraph 4 of the estimate, the plannerevaluates and compares the various COA developedin paragraph 3. He does this by comparing theCOA to determine which one CAN best BESUPPORTED FROM THE HSS PERSPECTIVE.He lists those difficulties which will have differenteffects on each possible COA. This then enableshim to evaluate these COA in terms of their inherentstrengths and weaknesses. By next comparing thepossible COA in the light of these strengths andweaknesses, he is able to identify further the basicadvantages and disadvantages of each. He doesnot draw conclusions at this time, but defers thisaction until the comparison of all possible COA iscompleted.

Conclusions

a. Paragraph 5 of the estimate repre-sents the end of the thought process of the estimateand is the basis for the development of the HSSplan. The statements represent the commandsurgeon’s or medical commander’s “decision” andserve as a guide to other staff members and/orsubordinates in their planning.

b. The planner—

(1) Indicates whether the HSS mis-sion for the operation can/cannot be accomplished,

(2) Indicates which COA can bestbe supported from the HSS perspective.

(3) Lists factors which may ad-versely affect the health of the command.

(4) Lists the limitations and de-ficiencies in the preferred COA that must be broughtto the commander’s attention.

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(5) Includes a COA which is lessthan desirable, but which best supports thecommander’s operational mission with the mosteconomical use of available HSS resources.

(6) Provides a general statement ifthe HSS mission cannot be accomplished.

c. Further details regarding generalestimates of the situation are contained in FM101-5.

2-16. Mission, Enemy. Terrain and Weather.Troops, and Time Available

The acronym METT-T (mission, enemy, terrainand weather, troops, and time available) is a usefultool to remember and organize planning con-siderations, particularly when the plan is not a

formal written plan, or when the planner does nothave quick access to planning references.

a. Mission refers to the same respon-sibilities and considerations as discussed inparagraph 2-10.

b. Enemy refers to considerations dis-cussed in paragraph 2-11a, enemy situation.

c. Terrain and weather refers to theconsiderations discussed as “characteristics of theAO" in paragraph 2-11c.

d. Troops refers to the friendly situation,paragraph 2-11b, and to the resources available,paragraph 2-12c.

e. Time refers to the amount of timeavailable to formulate and execute the plan.

Section Ill. THE BASE DEVELOPMENT PLAN

2-16. A Base

a. A base is a locality from which anoperation or activity is projected, or is to beprojected. It varies in size and type and may rangefrom a radar station to a base with complete shiprepair facilities and cantonment facilities for thetraining and staging of several divisions of troops.The most complex type of base is one where theArmy, Air Force, and Navy share a locality—

• That was recently the scene ofintensive combined amphibious operations, or

• Where facilities are rapidlydeveloped for support of continued tacticaloperations while still being subject to enemy attack.

b. Bythe acquisition,

2-14

definition, base development isdevelopment, improvement, and

expansion (or rehabilitation)resources of an area or location

of facilities andfor the support of

forces. This area may develop into an establishedcommunications zone (COMMZ).

c. Base development includes theprovision of personnel and facilities required forconstruction, port operations, transportation,hospitalization, maintenance, communications,and all other activities involved in base operations.The theater OPLAN includes a logistics annex.This annex contains information and instructionsconcerning what is to be done in support of combatoperations, but does not include detailed in-formation as to the means for accomplishing theseends. This type of detailed information is containedin the base development plan (BDP). It ensuresthe timely availability of personnel, materials, andfacilities required to support contingency plans orcontinued operations.

FM 8-55

2-17. Planning Sequence

a. A planning sequence usually beginswith the publication of a joint strategic capabilitiesplan by the Joint Chiefs of Staff (JCS) to thetheater commander. The theater commander thenissues a base development planning directive tohis Service component commanders. This directiveis based on the operational concept and the forcestructure. The directive includes selected basesites, assigned support missions, operational targetdates, preliminary estimates, and instructionsrequired for specific planning. When more thanone Service component or when an allied serviceoccupies or has a requirement for the same type offacilities on a base or geographical area, a jointBDP is required. This plan ensures interservicecoordination and avoids duplication of effort.

b. A planning directive is provided tothe appropriate Service component commandersearly in the preparation of BDPs. This directivehas no specific format, but may—

• Allocate responsibilities to theService component commanders for projects andfunctions.

• Specify priorities and comple-tion dates for projects.

• Specify construction standards.

• Allocate facilities and real estateto subordinate commands.

• Indicate the command structureand designate the commander or commanderscharged with base development.

• Indicate the scope and mag-nitude of the logistic support capabilities of thebase.

govern

2-18.

• Specify SOPs and directives toimplementation of the plan.

The Plan

a. The BDP is the product of concurrentplanning by the theater commander, the com-manders of the component Services, and the the-ater Army (TA) commander. It is accomplishedaccording to the planning directive. It is thegoverning instrument for planning and es-tablishing a base. The plan is a compilation of allthe information necessary for the theatercommander and his staff to coordinate the effortsof subordinate commands in base development. Itprovides specific direction and includes all phasesof concurrent planning undertaken by thesubordinate commands concerned. The BDP setsforth the base facilities to be provided and the CSSfunction to be performed. It covers such mattersas categories of construction, priorities, andrestrictions on use of critical materials. Within aTO, the BDP is published in a standard format, asoutlined in Joint Publication 4-01. It is issued asan appendix to the logistics annex of the OPLAN.The BDP serves as the mechanism by whichrequirements, identified in the logistic annex tothe OPLAN, are converted into facilities, in-stallations, and other construction requirements.As a starting point, the base developer must haveinformation as to those requirements such as tonsof dry cargo to be stored, gallons or barrels ofpetroleum to be moved, troops to be housed, andexpected hospital patient load to include types ofpatients expected.

b. Using standard planning factorstempered by experience, these requirementsbecome warehouses to be built, pipelines to beinstalled, troop camps to be established, and MTFsto be constructed. (See paragraph 2-21b.) Estimatesof requirements are made in each of the functionalareas of CSS, and the validity of the BDP willdepend largely on the accuracy of these estimates.

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If more precise information is available, planningfactors in FMs 101-10-1/1 and 101-10-1/2 shouldnot be used. In addition to determining constructionrequirements, the BDP provides the rationale forestimating construction cost, real estate acquisitionrequirements, and the size of the constructionforce. The BDP becomes the theater commander’sconstruction directive when implemented.Normally, no major construction will be undertakenunless it is contained within the approved plan.The BDP may not be completely responsive to thesituation as it actually develops. During the firstfew months of an operation, urgently neededconstruction should be accomplished without delay,but a comprehensive review of the plan will berequired to evaluate how well the planner visualizedthe events that are actually taking place.

2-19. Theater Base Development PlanningStaff

a . The TA commander forms a basedevelopment planning staff that is responsible fordeveloping the BDP (or the Army’s portion of ajoint BDP) and for staff supervision in the executionof the plan on implementation. The planning staffwill be provided representatives from—

• Service component commands(to include the TA MEDCOM).

• Theater Army general andspecial staff sections.

• Theater Army subordinatecommands and agencies involved in basedevelopment planning and execution.

b. The mission of the base developmentplanning staff is to develop the theater BDP forsubmission to and approval by the TA commander.This planning staff also provides advice andrecommendations to the TA commander in all

matters pertaining to base development planning,programming, and execution.

2-20. Health Service Support Consider-ations

In planning the HSS portion of base development,the TA surgeon and his staff must consider thefollowing basic factors:

a. Mission. The mission assigned to anadvanced base serves as the basis for establishingthe extent of development and the schedule ofreadiness for the medical facilities that are includedin such development. Only those medical facilitiesthat are essential for fulfillment of the HSS missionshould be authorized.

b. Degree of Permanence. Plans providefor only the minimum medical facilities necessaryconsistent with the safety, health, morale, andprotection of using forces. In a highly mobilesituation, or for an operation of expected shortduration, the requirement for new bases would betransitory in nature. Planning for such situationsmust consider, as a probability, the abandonmentor the roll up of any facilities provided. Maximumeffort, therefore, must be exerted to use all possibleexisting facilities to satisfy US forces’ requirements,New facilities should consist of little beyond thosewhich can be established by using units employinglocally available materials. If ultimate peacetimeuse of the base is anticipated, initial developmentis planned for later incorporation into permanentbase development.

c. Limitations on Manpower, Supplies,or Equipment. The theater commander usuallyhas at his disposal only limited resources inmanpower, supplies, and equipment. Becauseunloading capacities in objective areas are limited,strict control of shipping is established. All basedevelopment planning, including HSS, should

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conform to those limitations established by overalltactical and logistical considerations.

d. Estimated Phased Population. Toprepare the BDP, it is necessary to make estimatesof the troop population at successive stages in thedevelopment of the base. These estimates must listthe major units and headquarters, as well asaccompanying units, including combat, combatsupport (CS), and CSS troops of all Servicesconcerned. Initial estimates are revised to conformto troop lists as they become known. The re-capitulation of troops is stated in the final plan.

e. Natural and Local Resources. Everyeffort is made to develop natural and local resourcesof an area to provide maximum effective support ofmilitary operations. Any exploitation of theseresources which conserves medical personnel,supplies, equipment, or time must be given dueconsideration by the surgeon. All estimates should,as far as possible, be based on fact. Use of localcivilian and EPW labor is included in thisconsideration. Planning for the use of localresources should be based on reliable information,preferably supported by on-site reconnaissance.

f . Areas Available for Development.

(1) Areas suitable for medicalfacilities in the objective area are usually restrictedin size and number. This is particularly true in theimmediate landing area and in the vicinity of portsand beaches. If base development involves morethan one Service, consideration must be given tothe allocation of areas or space/facilities requiredby each Service component for support. The jointBDP will include the assets and requirements ofall Services involved. To the maximum degreepossible, the facilities planned to meet the needs ofone Service will be designed to accommodate similaror related requirements of the other Servicesoperating in the same area. If the requirements ofthe Services are in conflict, the theater commander

reevaluates the requirements of each Service andallocates areas so as to ensure the most effectiveoverall development of the base area.

(2) When information of theobjective area is incomplete and the location ofcertain high priority installations such as airfieldscannot be indicated definitely, the BDP shouldprovide that all suitable sites found be reserved forthe use of the Service concerned until they arereleased for other use. As a corollary, each Servicemakes early reconnaissance and releases allunsuitable sites at the earliest possible date.

(3) The possibility of the need forfuture expansion should be considered by thesurgeon in studying available areas and in selectingand recommending facility sites.

g. Priority of Development.

(1) Determining priorities to de-velop bases is an intricate task. It involvescompromise and reconciliation between operationaland logistical considerations. After dates ofoperational readiness have been established, thebase development planners ensure that requiredconstruction forces and supplies are provided inthe objective area. Partial use of incomplete basefacilities is usually necessary even though con-struction efficiency is consequently lowered andthere is delay in final completion. Priority fordevelopment is established by balancing op-erational requirements against the constructionprogram. While flexibility should be provided forcontingencies, a decision on major changes shouldbe reserved at the appropriate command level.This procedure will prevent hasty changes basedon limited knowledge and/or consideration of thefactors involved. The senior commander ashoremust have authority to make necessary changes inthe BDP in conformity with the tactical situationand physical conditions present in the objectivearea.

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(2) Factors that may governdevelopment priorities include—

• The urgency of meetingspecial operational requirements.

• The ease or difficulty ofcompleting construction tasks for reasons otherthan enemy opposition.

• The anticipated interfer-ence by enemy operations with certain constructionefforts.

h. Unloading Health Service Personnel,Supplies, and Equipment. Estimates of terminalcapacity available for unloading health servicepersonnel, supplies, and equipment in the basearea are essential in determining the extent of thedevelopment possible during any given period oftime. The surgeon must give further considerationto the availability of facilities to accommodate allhealth service resources.

i. Selection of Treatment Facility Sites.(See the hospitalization section in FM 8-10 andTraining Circular [TC] 8-13.) •

j. Deployment of Automatic Data Pro-cessing (ADP) Resources. (See Technical Bulletins(TBs) 18-13 and 18-106.)

•

2-21. Construction Requirements •

a. Analysis of Construction Task. Afterthe major elements of the BDP are reasonablyfirm, the planners can analyze the constructiontask. Although construction is a function of theengineers, using Services are responsible formaking known their general construction require-ments for facilities and installations and forassisting with construction plans. For example,the surgeon coordinates with the engineer in theconstruction of all MTFs. Much of the difficulty

encountered by construction forces is often due toa lack of complete planning or understanding ofrequirements. As changes in the situation develop,revisions in plans must be made so that actualneeds are met, rather than those outlined in anoutdated plan. Flexibility in such matters isimportant.

b. Medical Treatment Facility Con-struction.

(1) The nature of the supportoperation will dictate the standard or type ofconstruction. Operations of short duration willrequire an austere type of construction. Support oflong-duration operations will require the highestconstruction standards possible. Combat zone(CZ) MTFs must maintain the flexibility inherentin mobile and semimobile units. With the fieldingof Deployable Medical Systems (DEPMEDS)equipment in both the CZ and the COMMZhospitals, construction requirements are greatlyreduced. However, the requirements for sitepreparations such as those listed below remain thesame:

Site preparation.

Trash and garbage pits.

• Soakage pits or liquid dis-posal system.

Incinerators.

• Protective trenches.

Facilities such as showers,latrines, wash, and dining.

• Motor parking.

• Landing zone.

• Perimeter security.

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• Fuel storage.

• Power generationment placement.

equip-

(2) The MTF planner must providethe engineer command with detailed and specificrequirements for contaminated waste storage anddisposal. Host nation or TO requirements maydemand higher standards of construction incontaminated waste storage and disposal sitesthan are otherwise needed for the MTF itself.These specific needs must be provided to theengineer command early since they may require“design from scratch” facilities.

(3) In the absence of DEPMEDS-equipped hospitals, consideration should be givento the use of existing facilities in the areas whichwere originally designed as MTFs, or which arereadily adaptable to use as a MTF. Attention totypes of buildings, their potential patient capacity,

and their effective use prior to the conduct of anoperation may result in the selection/use of facilitiesthat will save precious time and resources.

c. Standards of Construction for Con-tingency Operations. Joint Publication 4-01establishes the system for identifying constructionstandards. Construction standards are basedprimarily on the length of the contingency operationand are set by the theater commander. Thefollowing construction standards conform to JCSrequirements and are included in the facility/installation descriptions printed in TechnicalManual (TM) 5-301 and in the Theater ConstructionManagement System (TCMS):

• Initial—less than 6 months.

• Temporary--6 to 24 months.

The two standards of construction are shown inTable 2-1.

Table 2-1. Construction Standards

INITIAL TEMPORARY

APPLICABILITY.

SPECIALIZEDCONSTRUCTION SUPPORT.

EXPECTED DURATION

LESS THAN 6 MONTHS

ALL FORCES DURING INITIAL DEPLOYMENTTO A THEATER OF OPERATIONS OR ONRELOCATION TO A NEW LOCALE WITHIN THETHEATER WHEN EXISTING FACILITIES ARENOT AVAILABLE AT THE NEW SITE.

CANTONMENT CLEARING AND GRADINGFOR DRAINAGE AND FACILITY SITE.GRADING AND MINIMUM STABILIZATION OFROADS. INSTALLATION OF TACTICALBRIDGING AND RELOCATABLE PORTFACILITIES. CONSTRUCTION OF TACTICALAIRFIELDS AND OTHER OPERATIONALFACILITIES. CONSTRUCTION OF PROTECTIVEBARRICADES FOR POL; AMMUNITIONSTORAGE; AIRCRAFT PARKING; ANDCOMMAND AND CONTROL FACILITIES.

6 TO 24 MONTHS

FORCES WHOSE MISSION ORIENTATION ISFIXED. FORCES SUBJECT TO RELOCATIONPROVIDED CONTINUOUS USE OF THEFACILITIES WILL BE OBTAINED THROUGHUNIT ROTATION OR OTHER MEANS.

ENGINEERED SITE PREPARATION,INCLUDING BUILDING FOUNDATIONS ORCONCRETE SLAB FLOORS;PREFABRICATION OF BUILDINGCOMPONENTS; SUPERVISION OFBUILDING ERECTION; CONSTRUCTION OFALL-WEATHER ROADS, FIXED BRIDGING,AND FIXED PORT FACILITIES; AND PAVINGOF AIRFIELDS. INSTALLATION OF STEELSTORAGE TANKS AND PIPED SYSTEMSFOR POL AND WATER SUPPLY.

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Table 2-1. Construction Standards (Continued)

INITIAL TEMPORARY

SHELTERS SUCH AS TROOPHOUSING, DININGFACILITIES, AND ADMIN-ISTRATIVE BUILDINGS.

COLD STORAGE.

ELECTRICITY.

WATER.

SEWAGE.

SOLID WASTE (GARBAGEAND TRASH).

ROADS AND HARDSTANDS.

BRIDGES.

AIRFIELD PAVEMENTS.

LIQUID FUEL STORAGE ANDDISPENSING.

1. TERMINAL.

EXPECTED DURATION

LESS THAN 6 MONTHS

ORGANIC EQUIPMENT THAT CAN BE ERECTEDBY USING ACTIVITIES.

PORTABLE UNITS.

ORGANIC

ORGANIC EQUIPMENT.

PIT OR BURNOUT LATRINES. (IF LOCALSEWAGE SYSTEMS ARE AVAILABLE ANDSUITABLE [CAPACITY AND DRAINAGE],THEY MAY BE SUBSTITUTED OR USED TOSUPPLEMENT ORGANIC SOURCES.)

PIT OR TRENCH.

STABILIZED WITH LOCAL MATERIALS.

TACTICAL OR HASTY BRIDGING TECHNIQUES.

TACTICAL SURFACING MATERIALS.

RELOCATABLE, NONRIGID STORAGE ANDDISTRIBUTION.

6 TO 24 MONTHS

SIMPLE WOOD FRAME STRUCTURES (OFEQUAL USE) USING LOCAL MATERIALS,AUSTERE PREFABRICATED BUILDINGS,AND RELOCATABLE BUILDINGS.CONSTRUCTION MATERIALS, BUILDINGS,AND TECHNIQUES ARE BASED ON A LIFE-CYCLE COMPARISON.

PORTABLE UNITS WITH SHED.

ORGANIC AND/OR LOW VOLTAGE {440VOLTS) GENERATORS AND DISTRIBUTIONSYSTEMS, SOME CENTRAL POWERPLANTS; HIGH VOLTAGE DISTRIBUTION.

QUARTERMASTER DELIVERED WITHLIMITED PIPED DISTRIBUTION TO MTFs,DINING FACILITIES, BATHHOUSES, ANDHIGH-VOLUME USERS. SOME CENTRALTREATMENT PLANTS; PIPEDDISTRIBUTION.

PIT OR BURNOUT LATRINES;WATERBORNE TO PRIMARY TREATMENTFACILlTY FOR MTFs, DINING FACILITIES,BATHHOUSES, AND HIGH-VOLUME USERS.

PIT OR TRENCH; LOCAL CONTRACTORREMOVAL.

SOME PRIMARY ROADS PAVED; OTHERROADS AND HARDSTANDS ALL-WEATHERWITH SELECTED BASE COURSEMATERIALS.

FIXED.

PAVED OR TACTICAL SURFACINGMATERIALS.

RELOCATABLE, RIGID STORAGE ANDDISTRIBUTION.

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Table 2-1. Construction Standards (Continued)

INITIAL TEMPORARY

2. FORWARD.

3. PORT.

EXPECTED DURATION

LESS THAN 6 MONTHS 6 TO 24 MONTHS

RELOCATABLE, NONRIGID STORAGE AND RELOCATABLE, RIGID STORAGE ANDDISTRIBUTION. DISTRIBUTION.

RELOCATABLE. FIXED OR RELOCATABLE.

(1) Where specific types of construc-tion are listed under a standard, they are intendedto be illustrative of the quality of construction.Alternatives using native materials should beconsidered. Selection of materials and constructiontechniques should include consideration of thepriority of the requirements, cost, climatic condi-tions, availability of material locally, availabilityand capabilities of construction activities, andtransportation costs. The life-cycle cost of arelocatable facility should include the initialprocurement costs, erection costs, and disassemblycosts, as applicable (less the residual value of thecomponents of materials recovered for reuse). Anyequipment or quality of construction authorizedunder a lower standard may be used under ahigher standard.

(2) Standards of construction relateto quality of the installations provided. The lowerstandard, “Initial,” requires a minimum of engineerconstruction effort. “Temporary,” the higherstandard, may require buildings for some facilities,paved roads, and waterborne sewage. Within thestandards, certain other choices are available suchas whether to use wood or steel frame. Thestandard of construction will not be uniformthroughout the theater; however, the theatercommander may place a ceiling on construction ata specific level such as, No construction authorized

above temporary. Normally, each major projectwill have a standard allocated to it depending onthe factors discussed below. As a general guideline,the most austere standard that will meetoperational requirements and provide necessaryfacility life will be considered. Normally, noconstruction involving the expenditure of engineereffort will be authorized if the duration of theoperation is expected to be less than 180 days.Obviously, exceptions to this policy may be madewith regard to port facilities and lines of communi-cation if construction rehabilitation is operationallynecessary. It is entirely possible that agreementswith the host nation may require construction to ahigher standard than is justified by a strict analysisof the proposed operation. United States nationalpolicy may indicate that benefits will accrue throughthe construction of permanent facilities that willrevert to the host government after the terminationof hostilities.

(3) A lack of engineer troops andthe requirement to provide facilities quickly mayresult in construction to a lower standard thandesired. It is perfectly reasonable to construct to alow standard and then to upgrade the facilities astroops and time become available. Upgradingfacilities to a higher standard is more costly thanconstructing to the higher standard in the firstplace, and this option may be foreclosed because of

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fund constraints. Certain equipment such ascomputers, radars, and communication gear mayrequire environmentally controlled conditions toensure proper operation. Failure to construct thehigher standard could result in the failure of thisequipment to operate. Control of the constructioneffort is a matter for command emphasis. Thenatural desire of any commander assigned to a TOis to provide the best possible facilities for hispersonnel. Should all commanders be allowed tofollow this desire, there would soon be no construc-tion material available for operational projects. Asa matter of policy, the theater commander shouldstate that no construction will be authorized in thetheater unless—

• It is contained in the ap-proved BDP, or

• It is specifically approvedby the theater commander as having overridingimportance for mission accomplishment.

Upon initiation of the construction program, thebase development planning staff will be chargedwith staff supervision over execution of the plan.Part of its responsibility will be to assure thatconstruction assets are not channeled off intounauthorized projects. In line with this effort,tight controls will be placed on the issuance ofconstruction material (Class IV) and on the use ofengineer troops. Perhaps most important of all isthe factor of self-discipline at all levels.

2-22. Responsibilities of the Health ServiceSupport Planner

a. The fact that most construction is anengineer responsibility does not relieve the medicalunit commander and his staff from any furtheraction. The HSS planner must incorporate therequirement for MTF construction and/or site prep-aration into the BDP. There must be timely planningand coordination between the MTF, higher medical

headquarters, and the engineer units. The degreeof participation by the MTF will depend on the sizeof the project. If a new facility and/or a majormodification of an existing facility are needed,most of the planning and design will take place ata higher medical headquarters. However, theMTF commander and his staff, if in the TO, shouldbe consulted during the predesign phases.

b. The degree of the MTFs participa-tion during the construction phase greatly increaseswhen major modifications to existing facilities orconversion of nonmedical permanent structures tomedical facilities are programmed. Examples ofmajor modifications include installation of centralair conditioning, upgrading of water and sewagelines, addition of warehouses, modernization ofoperating rooms, or the conversion of existingbuildings to MTFs. Special and extraordinaryelectrical requirements for hospital-peculiarequipment must be identified and made known tothe engineer units during this phase of planning.These types of construction involve long-rangeplanning. The initiation of a project begins withthe submission of work requests by the MTFcommander. The flow of work requests throughcommand channels will vary in accordance withlocal procedures. Coordination is normally effectedwith the area coordinating committee. Constructionspecifications and rough drawings are prepared atthe senior medical headquarters level and reviewedwith the MTF commander and his staff prior tobeing forwarded through channels to the engineercommand. The input of the medical unit com-mander and his staff is critical to the provision ofadequate and appropriate health care facilities.

c. Final approval of the project is nor-mally made by the TA commander, subject to theavailability of funds, labor, and supplies. Finaldrawings and determination of whether to usecivilian or military construction personnel is aresponsibility of the engineer command. Finaldrawings are prepared in phases. Each phase isreturned to the senior medical headquarters for

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review. Each phase should also be reviewed withthe MTF commander and his staff. Onceconstruction starts, the project is under thesupervision of the engineer command. The MTFcommander, however, should forward progressreports and comments to his higher headquarters.Under no circumstances should the MTF com-mander try to make major job changes directlywith the project engineer. Final acceptance of theproject is normally a joint operation between theengineer command, the senior medical head-quarters, and the MTF commander.

d. Determination of what constitutesmajor and minor construction will vary with thelocal policy. Of primary interest to the MTFcommander is the fact that minor constructionprojects will involve a direct relationship betweenhim and the engineers. Examples of minor con-struction include enlargement of rooms throughthe removal of walls and construction of smallstorage sheds. The job request originates withthe MTF and is usually a responsibility of theServices section, Final approval rests with the

area commander and will depend upon theavailability of funds, labor, and supplies.

e. The success of any constructionproject, whether major or minor, is greatlyenhanced by the active interest and participationof the MTF commander and his staff in all phasesof construction. The MTF commander shouldmake every effort to be a member of the areacoordinating committee. The MTF health servicemateriel officer should establish close relationswith the officer in charge of engineer activitiesand/or the supporting engineer units.

f . To provide HSS, facilities of varioustypes are needed. Health service support plannersat senior medical headquarters are responsible forparticipating with the engineers and other Servicesin the construction of these facilities. Thisresponsibility includes coordination with thecommander, TA area command, transportationcommand, personnel command, and engineercommand, and with the TA headquarters regardingsuitable sites for medical facilities and installations.

Section IV. THE HEALTH SERVICE SUPPORT PLAN/ORDER

2-23. Preparation of the Plan assigned in the HSS plan. An exampleplan is at Appendix C.

Before the HSS estimate is completed, the com-mander or the surgeon has started his preparationof the HSS plan. As each problem is recognizedand solved, a part of the plan is automatically 2-24. Responsibilitydefined. These bits of fragmentary informationshould be disseminated to surgeons of subordinate a. Each medical unit and

of a HSS

medicaland higher commands as early as possible to assist headquarters involved in providing HSS mustthem in preparing their plans and estimates. Once prepare its own plan. This plan will be based onthe estimate is completed, it defines requirements, the commander’s intent and the OPLAN and/oridentifies resources, and determines policies and the administrative/logistics (ADMIN/LOG) plan ofprocedures. Now, specific responsibilities must be the next higher headquarters.

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(1) The OPLAN covers a singlemilitary operation or a series of connected militaryoperations to be carried out simultaneously orsuccessively. When the plan is put in effect, orexecuted, the plan becomes an OPORD.

(2) The ADMIN/LOG plan appliesto CSS operations. It is based on the command’soperations requirements. When put into effect, orexecuted, it is the ADMIN/LOG order. (See Figure2-1 for an example of paragraph 5 of the ADMIN/LOG order.)

(3) See FM 101-5 for a detailedexplanation of OPORDs, ADMIN/LOG orders,SOPS, fragmentary orders (FRAGOs), and warningorders. Field Manual 101-5 also provides a detaileddiscussion on annexes to orders.

b. The medical commander or surgeonmust continually know and be familiar with theplans and general policies of the tactical commanderto adapt HSS to changes. The medical commandermust ensure that adequate resources are availablefor the successful accomplishment of the HSSmission.

2-26.

2-25. Purpose and Scope

a. The HSS plan varies in its purposeand scope according to the size and complexity ofthe operation which it supports. The HSS plan ofa combat or CS battalion, for example, as a minimumincludes the location of the patient collecting pointsand the battalion aid station (BAS). On the otherhand, the HSS plan for a division considers morefunctions because of the greater extent of supportresponsibilities. Some examples of these respon-sibilities are the location of MTFs and thedistribution and assignment of evacuation assets.

b. The standard format of the plan isdetailed and all-inclusive to fit the most complex

situation. This format is a checklist and guide;only those portions that apply are to be used.Subparagraphs that do not apply or are addressedin the tactical standing operating procedures(TSOPs) maybe omitted entirely and subsequentsubparagraphs numbered accordingly. However,the planner must exercise caution in determiningwhich subparagraphs are inappropriate to avoidan incomplete plan.

c. The OPLAN is used to prepare—

• The medical unit OPLAN orOPORD. (See Appendix C for an example.)

• The HSS annex to an OPLAN ororder. (See Appendix C for an example. )

• Paragraph 4b or paragraph 5 ofthe ADMIN/LOG plan or order. (See Figure 2-1 foran example of paragraph 5, ADMIN/LOG order.)

Format

The plan must be in consonance with the format ofthe OPLAN. (In addition to the following, seeAppendix C.)

a. Heading. The security classificationis designated by the command headquarters andwill be placed at the top and bottom of each page ofthe plan. Numbers and letters for identificationand filing purposes are designated by theresponsible headquarters. When reference is madeto locations by map coordinates, maps are listed,including the applicable sheets. If no maps arereferenced, this portion of the heading is omitted.The time zone applicable to the operation followsthe references used in preparing the plan. Timesin other zones are converted to the time zone of thecurrent operation by using Figures 2-2 and 2-3.The phrase local should never be used.

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5. Health Service Support

This paragraph contains information and instructionsfor supported units that prescribe the plan for evacuationand hospitalization of sick, wounded, or injured militarypersonnel.

(This paragraph should be supported by an overlay.)

a. Medical Evacuation. This subparagraph shouldstate routes, means, and schedules (if any) of evacuationand responsibilities. Evacuation and en route treatmentpolicies should be included, when applicable. Specificpolicy for evacuation by air or ground methods andevacuation of NBC-contaminated patients is included.Information concerning medical evacuation requestprocedures and channels should be included ifapplicable and different from SOP. The evacuationpolicy may be included in this paragraph.

b. Medical Treatment Facilities. List of all appro-priate treatment facilities (for example, troop medicalclinics, aid stations, clearing stations, hospitals)belonging to or supporting organizations the order iswritten for, their locations, and times of opening orclosing, if appropriate. Definitive treatment policiesincluding treatment of contaminated casualties shouldbe included.

c. Other Services. Include pertinent information onany other health service matters (for example, dental,preventive medicine, health service logistics and bloodmanagement, combat stress control, veterinary, med-ical laboratory, and area medical support). Includeunit locations, support information, policies, and anyothers, as appropriate.

Figure 2-1. Example of paragraph 5, ADMIN/LOG order.

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Figure 2-2. Time zone chart.

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Figure 2-3. Time conversion table.

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b. Task Organization. The task orga-nization indicates how the command is organizedto accomplish the mission. The task organizationmay appear after the time zone or in Annex A. Ifthere are to be attachments for limited admin-istration or control, this fact should be indicated inparagraph 1.

c. Body.

(1) Paragraphs 1, 2, and 3 (sit-uation/mission/execution). The first threeparagraphs follow the format of the OPLAN. Theycontain guidance for logical planning, are ofassistance to subordinate HSS planners, and ensureconformity within the plan. (See Appendix C.)

(2) Paragraph 4 (service support).Paragraph 4 contains a statement of the CSSinstructions and arrangements supporting theoperation that are of primary interest to the unitsand formations being supported. (If lengthy, de-tails may be included in an annex and referencedhere.) Subparagraphs are titled “Supply,” “Trans-portation,” "Services," "Labor," and “Maintenance.”

• The supply subparagraphoutlines such matters as supply priorities formedical units and handling of hospital patientration supplements. It addresses health servicelogistics organizations and gives locations. Loc-ations may also be provided in a map overlay (asan annex to the plan). Information in thissubparagraph may be simplified by makingreference to SOPS that include required infor-mation.

• The transportation sub-paragraph considers the medical requirements forvarious means of supporting transportation andplanned movements.

• The services subparagraphpertains to medical units and facilities such asmortuary services, laundry, bath, construction,

real estate requirements, and support from areapersonnel replacement units (for RTD of personneldischarged from MTFs). It also outlines themaintenance of Class VIII equipment and otheritems of equipment. It may also address minimalreequipping of RTD soldiers released from MTFsat Echelons III and IV. Minimal reequipping ofRTD soldiers will consist of basic uniform items toprotect the soldiers during transit to replacementcompanies.

• The labor subparagraphincludes policies on the use of civilian or otherlabor personnel. Restrictions on the use of civilians,interns, and/or detainees will be in compliancewith existing agreements or arrangements.

• The maintenance sub-paragraph includes priority of maintenance,location of facilities, and collecting points.

(3) Paragraph 5 (patient evacu-ation, treatment and hospitalization, and otherhealth services).

• The evacuation subpara-graph outlines the evacuation plans for all friendlyforces to include Navy, Marine, Air Force, allies,and civilian personnel. Plans for medical evac-uation of EPW are also included. Medicalevacuation requirements and units available arelisted to include their locations, missions, andattachments. The location of patient collectingpoints and ambulance exchange points are placedon overlays.

• The treatment and hos-pitalization subparagraph outlines policies andfacilities/units, to include their locations, missions,and attachments. Locations may also be providedin a map overlay attached as an annex.

The other health servicessubparagraph includes the provision of theremaining HSS functions: medical laboratory

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services; health service logistics, to include blood;dental services; veterinary services; PVNTMEDservices; combat stress control services; areamedical support, and required command, control,communications, computers, and intelligence.

(4) Paragraph 6 (miscellaneous).This paragraph is used to discuss any areas ofsupport not previously addressed which may berequired or needed by subordinate elements in theexecution of their respective HSS missions.Examples of discussion points are command postlocations, signal operations instructions, claims,special reports that may be required, jointagreements, and international or host-nationsupport agreements affecting HSS.

d. Ending. The ending of the plancontains the commander’s or surgeon’s (or otherappropriate) signature, a list of annexes (if any),and the distribution. Annexes may include thetask organization (unless included in the plan),medical overlay, PVNTMED, or professional annex,or similar data.

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2-27. Modification

The commander or the staff surgeon at each levelmust modify his plans to fit each situation as itarises. He must remain constantly abreast of the

tactical situation. He must continue to plan for thenext operation while operating the HSS for thecurrent operation. Current tactical conceptsemphasize flexibility with diversification ofplanning and operations. Accordingly, all HSSplans which support tactical operations must beflexible. They must have alternatives which canbe used during the course of the operation in orderto meet rapidly changing situations. Alternativesthe commander is considering must also beconsidered by the surgeon. The surgeon must bein a position to receive information from medicalelements under his control, or technical supervisionso that he can direct changes and modifications inexisting plans according to the requirements of thesituation. In addition, the HSS planner must bealert to the magnitude of the problems whichmight confront him in NBC warfare. The uniqueconditions to be encountered in NBC warfarerequire a case-by-case analysis of each situation.

Execution of the Plan

Execution of the plan necessitates close, continuous,and effective interface between HSS and CSSsystem planners. The surgeon and all medicalcommanders must continuously monitor, direct,and control the HSS situation to ensure that therequired support is provided the tactical com-mander.

Section V. JOINT HEALTH SERVICE SUPPORT PLANNING

2-29. Joint Task Force Operations operation. Joint force commanders choose thecapabilities they need from the air, land, sea, space,

a. Joint Publication 1, Joint Warfare of and special operations forces at their disposal.the US Armed Forces, notes:

Generally, joint operations are directed by theThe nature of modern warfare demands Commanders in Chief (CINC) of the unified com-

that we fight as a team. This does not mean that mands and executed by their subunified commandsall forces will be equally represented in each and Service components.

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b. Some CINC, however, conduct op-erations within their area of responsibility (AOR)by activating joint task forces (JTFs). Joint taskforces are established to accomplish specific, limitedobjectives that require the significant and closelyintegrated efforts of forces from two or moreServices. The Commander, JTF (CJTF) is ap-pointed by the CINC and exercises operationalcontrol (OPCON) over assigned and attached forces.The CJTF may wear an additional hat as thecommander of a JTF Service component. JointPublication 5-00.2 provides detailed guidance andprocedures for forming, staffing deploying, em-ploying, and redeploying a JTF for short-noticecontingency operations.

c. A variety of scenarios exist that lendthemselves to designating an Army corps com-mander as a CJTF. When this occurs, the corpssurgeon becomes the surgeon and assumesresponsibility for planning, coordinating, andcontrolling joint HSS within the CJTF jointoperational area (JOA). Joint Publication 4-02provides operational and organizational guidelinesto meet the HSS requirements of combatantcommands, JTFs, and Service components.

2-30. Joint Health Service Support Rela-tionships and Responsibilities

a. The JTF surgeon is the principaladvisor to the CJTF for all HSS matters. The JTFsurgeon’s office is normally built upon the Servicestaff of the JTF surgeon, augmented by HSSplanners and operations officers from otherServices. The JTF surgeon can expect to receivebroad guidance and a general concept of medicaloperations from the unified command surgeon.

b. The JTF surgeon’s office should bestaffed to effectively facilitate joint planning andcoordination of JOA HSS, standardization andinteroperability, and integration within the overalljoint operation.

c. Specifically, the JTF surgeon’s officemust be prepared to—

(1) Maintain liaison with compo-nent command surgeons and resolve HSS conflictssurfaced by JTF components.

(2) Provide detailed HSS guidance,assign HSS tasks, and develop the joint HSSconcept of operations. In the interest of maximizingthe use of potentially limited HSS resources, theJTF surgeon may direct joint use of HSS assets.For example, the JTF surgeon may direct the Navycomponent to provide all Echelon III hospitaliza-tion or the Army component to provide all rotary-wing aeromedical evacuation for the entire JTF.In these instances, joint staffing of units is normallynot considered a prerequisite for their joint use.

(3) Consolidate component patientestimates, assess the sufficiency of the evacuationpolicy within the area of operations, and recommendchanges if appropriate.

(4) Advise the CJTF on HSS aspectsof combat operations; rest, rotation, and recon-stitution policies; PVNTMED; and other HSSfactors that could affect joint operations.

(5) Monitor JTF medical readinessto include component status of patient beds, healthservice logistics (including blood products), andstaffing.

(6) Report JTF medical readinessstatus to the CINC in accordance with the unifiedcommander’s OPORD.

(7) Coordinate HSS provided to andreceived from allies or friendly nations.

(8) Coordinate medical intelligencesupport and identify medical essential elementsof information (EEI) and requests for informa-tion (RFI).

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(9) Prepare Annex Q for all JTFplans and orders. See Appendix C for an exampleformat. Also, see Appendix C for an examplechecklist.

(10) Advise the CJTF on HSS aspectsof the Geneva Conventions and the Law of LandWarfare.

(11) Supervise the activities of theArea Joint Medical Regulating Office (AJMRO)and Area Joint Blood Program Office (AJBPO).

d. The AJMRO functions as part of theJTF surgeon’s office and manages the movementof patients to and between medical facilities withinthe JOA. The Joint Medical Regulating Office(JMRO) coordinates the movement of patients toCONUS with the Armed Services MedicalRegulating Office (ASMRO). Specific functions ofthe JMRO/AJMRO are discussed in Chapter 4.

e. The AJBPO functions as part of theJTF surgeon’s office and manages the theaterblood program. Specific functions of the JBPO/AJBPO are discussed in Chapter 8.

2-31. Health Service Support Consider-ations in Joint Task Force Planning

a. The type of operations that mayrequire the activation of a JTF are normally crisisor emergency situations for which there may notbean existing OPLAN. Joint crisis action planning(CAP) progresses through a logical sequence fromproblem recognition to the execution of an OPORD.There are six phases in the process; however,time constraints may force these phases to becompressed. The six phases are situation dev-elopment, crisis assessment, COA development,COA selection, execution planning, and execution.The unified command will normally identify andactivate the JTF during the COA developmentphase.

b. Upon JTF activation, the JTF surgeonbegins operational planning. Specifically, the JTFsurgeon should—

(1) Review unified command SOPSand OPORDs.

(2) Update and standardize HSSplanning factors as required.

(3) Determine the extent of andinitiate planning to medically support non-combatant evacuation operations (NEO). Theseoperations may be conducted in the environmentsof conflict or war.

(4) Obtain and review medicalthreat and PVNTMED information pertinent tothe operation. Identify additionally requiredmedical EEI and RFI to the JTF intelligence section.

(5) Develop JTF medical policiesand procedures.

(6) Coordinate with JTF oper-ational planners during concept development andassess medical risks associated with alternate COA.

(7) Assess host-nation HSS avail-ability.

(8) Develop and coordinate the JTFHSS concept with component and unified commandsurgeons. Plan for joint use of assets to ensureminimum essential hospitalization and evacuationsupport.

(9) Evaluate projected forcedeployment flow and ensure that timely andresponsive HSS, including the theater aeromedicalevacuation (AE) system, is available throughoutthe operation.

(10) Activate the AJMRO andAJBPO and disseminate medical regulating andblood management procedures.

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c. During the operation, the JTF surgeon d. As the operation nears completion,may be directed to begin planning follow-on civil- the JTF surgeon should begin planning HSS formilitary, CA, or peacekeeping operations support. the redeployment of the JTF and/or transfer ofJoint HSS considerations for these operations will be HSS responsibilities to a follow-on subunifieddiscussed in other joint publications currently command.under development.

Section VI. JOINT TASK FORCE CRISIS ACTIONHEALTH SERVICE SUPPORT

PLANNING FOR

2-32. Crisis Action Planning Phase I, Sit-uation Development

Often, the JTF will not have been activated at thisstage in the CAP process. However, if it has, theJTF surgeon should consider the following:

a. What type of military forces might beused to resolve the crisis or conflict, and how mightthey be supported medically?

b. If combined action is possible, whattype of HSS could be required or provided by othernations?

c. What steps can be taken to collectadditional medical information about the threat,crisis, conflict, or region?

d. How are medical requirements enteredinto the consolidated intelligence collection plan?

(1) How many of the noncombatants

e. How will the communications systemsupport the passing of medical information, reports,and requests?

2-33. Crisis Action Planning Phase II, CrisisAssessment

a. If noncombatantquired, consider the following:

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evacuation is re-

are known to require medical care?

(2) Where are these noncombatantslocated? Is there a published plan addressing theircollection prior to evacuation?

(3) Is a permissive or nonpermissiveNEO anticipated? How best can it be medicallysupported?

(4) Are there any civilian casualtyprojections for NEO?

(5) What is the medical evacuationpolicy for NEO patients?

(6) Has direct liaison with embassyhealth officials been authorized and established?

(7) Has the Department of Stateauthorized pets to accompany NEO evacuees? Areany animals prohibited from US entry by the Foodand Drug Administration? What will be done withpets brought to evacuation control points?

b. If any humanitarian, civil, or securityassistance medical requests have been made byforeign governments, how can they be supported?

c. Are there any treaties, legal agree-ments, host-nation agreements, or status-of-forcesagreements between the US and foreign govern-ments that are medically significant? Stand-

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ardization agreements already in existence maybe used to form the basis for detailed coalitionagreements and procedures.

d. Are there any concept plans(CONPLANs) or OPLANs for the area or situation?

e . What type of foreign military or civ-ilian infrastructure is established within the JOA?What and where are its key elements?

2-34. Crisis Action Planning Phase III,Course of Action Development

a. What specific HSS factors affect theactions under consideration?

b. What HSS assets are provided in theOPLAN?

c. Is available HSS adequate to supportplanned operations? If not, what additional assetsare required? How will the JTF request them? Areall medical units, to include aeromedical evacuationliaison teams (AELTs) and aircrews, on the Time-Phased Force and Deployment List (TPFDL) andscheduled for timely arrival? See Appendix E fora discussion of the TPFDL.

d. If an intermediate staging base isrequired, what medical units should be positionedthere?

e. What airfields are available forintratheater and intertheater AE?

f . Have medical personnel augmen-tation requirements been identified and requested?

2-35. Crisis Action Planning Phase IV,Course of Action Selection

No medical actions are required.

2-36. Crisis Action Planning Phase V,Execution Planning

a. Is the selected COA medically sup-portable with available HSS assets?

b. If not, will required HSS assets beavailable before mission execution?

c. If not, is the CJTF aware of the risks?

d. What is the status of communications?Have any dedicated or medically-unique nets,procedures, or requirements been identified?

e. Has sufficient coordination with joint/combined forces and the host nation been con-ducted?

f . Have medical sustainability and re-supply requirements been established? Are ClassVIII channels established?

g. Is the HSS portion of the OPORDready to be published? Does it address assistanceto US nationals, civilian internees, detainedcivilians, displaced civilians, and EPW?

h. Is the JMRO/AJMRO fully func-tional?

i. Is the JBPO/AJBPO fully functional?

j. Is the AE system planning complete?

(1) Have primary and secondaryaeromedical airfields been identified?

(2) Are sufficient assets planned foror in place (aeromedical evacuation control center[AECC], aeromedical evacuation control element[AECE], AELT, mobile aeromedical staging facility

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[MASF], aeromedical staging facility [ASF], andAE crews)? See Chapter 4 for a discussion of theseassets.

(3) Are AELTs located at key lo-cations within each Service component’s HSSsystem?

(4) Do Service components under-stand they are required to move patients tosupporting MASFs? Will they be able to do so?

(5) Are sufficient items such aslitters, straps, and blankets available?

2-37. Crisis Action Planning Phase VI,Execution

Once the plan is executed, the JTF surgeon and theJTF Service component surgeons monitor, direct,coordinate, and control the HSS situation to ensurethat the required support is provided the CJTF.

SECTION VIl. MEDICAL INPUT FOR THE JOINT TASK FORCEOPERATION ORDER

2-38. Medical Annex 2-39. Guidance

Neither the unified command nor the JTF The JTF basic OPORD will provide general med-OPORD—developed in CAP—will be as compre- ical guidance and the theater evacuation policy. Ithensive or detailed as an OPLAN developed will note that detailed medical guidance will followby the deliberate planning process. However, in a separately published Annex Q. To ensurethe standard medical Annex Q provides an rapid dissemination of these documents, they willappropriate framework for the abbreviated JTF usually be published via a Worldwide Militarymedical annex. Command and Control System (WWMCCS) tele-

conference established for the operation.

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