2-64. A basic characteristic of an organizing modern AHS is the distribution of medical resources and capabilities to facilities at various levels of location and capability, which are referred to as roles. As a general rule, no role will be bypassed except on grounds of efficiency or battlefield expediency. The rationale for this rule is to ensure the stabilization/survivability of the patient through ATM and far forward resuscitative surgery prior to movement between MTFs (Roles 1 through 3). (A discussion on the roles of care is contained in Appendix A.)
2-65. Role 1. The first medical care a Soldier receives is provided at Role 1 (also referred to as unit-level medical care). This role of care includes—
Immediate lifesaving measures.
Disease and nonbattle injury prevention.
Combat and operational stress preventive measures.
Patient location and acquisition (collection).
Medical evacuation from supported units (point of injury or wounding, company aid posts, or casualty collecting points [CCPs]) to supporting MTFs.
Treatment provided by designated combat medics or treatment squads. (Major emphasis is placed on those measures necessary for the patient to RTD or to stabilize him and allow for his evacuation to the next role of care. These measures include maintaining the airway, stopping bleeding, preventing shock, protecting wounds, immobilizing fractures, and other emergency measures, as indicated.)
2-66. Nonmedical personnel performing Role 1 first-aid procedures assist the combat medic in his duties.
First aid is administered by an individual (self-aid/buddy aid) and enhanced first aid by the combat lifesaver (CLS).
Self-aid and buddy aid. Each individual Soldier is trained to be proficient in a variety of specific first-aid procedures. These procedures include aid for chemical casualties with particular emphasis on lifesaving tasks. This training enables the Soldier or a buddy to apply first aid to alleviate a life-threatening situation.
Combat lifesaver. The CLS is a nonmedical Soldier selected by his unit commander for additional training beyond basic first-aid procedures. A minimum of one individual per squad, crew, team, or equivalent-sized unit should be trained. The primary duty of this individual does not change. The additional duty of the CLS is to provide enhanced first aid for injuries based on his training before the combat medic arrives. Combat lifesaver training is normally provided by medical personnel assigned, attached, or in sustainment units. The senior medical person designated by the commander manages the training program.
2-67. Role 1 medical treatment is provided by the combat medic or by the physician, the physician assistant (PA), or the health care specialist in the battalion aid station (BAS). In Army special operations forces (ARSOF), Role 1 treatment is provided by special operations combat medics (SOCMs), special forces medical sergeants (SFMSs), or physicians and PAs at forward operating bases, special forces (SF) operating bases (SFOBs), or in joint special operations task force (JSOTF) areas of responsibilities (AOR).
Emergency medical treatment (EMT) (immediate far forward care) consists of those lifesaving steps that do not require the knowledge and skills of a physician. The combat medic is the first individual in the medical chain who makes medically-substantiated decisions-based on medical military occupational specialty (MOS)-specific training.
At the BAS, the physician and the PA in a treatment squad are trained and equipped to provide ATM to the battlefield casualty. This element also conducts routine sick call when the tactical situation permits. Like elements provide this role of medical care to brigades, division, corps, and EAC units.
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2-68. Role 2.
z At this role, care is rendered at the Role 2 MTF which is operated by the treatment platoon of divisional and nondivisional medical companies/troops. Here the patient is examined and his wounds and general medical condition are evaluated to determine his treatment and evacuation precedence, as a single patient among other patients. Advanced trauma management and EMT including beginning resuscitation is continued, and, if necessary, additional emergency measures are instituted, but they do not go beyond the measures dictated by immediate necessities. The Role 2 MTF has the capability to provide packed red blood cells (RBCs) (liquid), limited x-ray, laboratory, and dental support.
z Role 2 AHS assets are located in the—
Brigade support medical company (BSMC), assigned modular brigades which include the heavy brigade combat team (HBCT), infantry brigade combat team (IBCT), the Stryker brigade combat team (SBCT), and the medical troop in armored cavalry regiments (ACRs).
Area support medical company (ASMC) an echelons above division (EAD) asset that provides direct support to the modular division and support to EAD units.
Preventive medicine and COSC assets are also located in the BSMC and ASMC.
Those patients who can RTD within 72 hours (1 to 3 days) are held for treatment.
Patients who are nontransportable due to their medical condition may require resuscitative surgical care from a forward surgical team (FST) collocated with a medical company/troop. (A discussion of the FST is contained in FM 4-02.25.)
This role of care provides medical evacuation from Role 1 MTFs and also provides Role 1 medical treatment on an area support basis for units without organic Role I resources.
2-69. Role 3. At Role 3, the patient is treated in an MTF staffed and equipped to provide care to all categories of patients, to include resuscitation, initial wound surgery, and postoperative treatment. This role of care expands the support provided at Role 2. Patients who are unable to tolerate and survive movement over long distances receive surgical care in a hospital as close to the division rear boundary as the tactical situation allows. This role includes provisions for—
z Evacuating patients from supported units.
z Providing care for all categories of patients in an MTF with the proper staff and equipment.
z Providing support on an area basis to units without organic medical assets.
2-70. Role 4. The continental United States Support Base Role 4.. Role 4 medical care is found in support base hospitals. Mobilization requires expansion of military hospital capacities and the inclusion of Department of Veterans Affairs (VA) and civilian hospital beds in the National Disaster Medical System (NDMS) to meet the increased demands created by the evacuation of patients from the AO. The support- base hospitals represent the most definitive medical care available within the AHS.
z (For the definitive information on the remaining levels of care, see FM 4-02).
E
CHELONS ABOVEB
RIGADEM
EDICALA
UGMENTATIONForward Surgical Team
2-71. The forward surgical team (FST) comprises 20 personnel and has two operating tables along with triage/preoperative and postoperative/recovery capabilities. The FST collocates with the BSMC, but in doing so, it causes the BSMC to reduce its tactical mobility due to the critical nature of the Soldier patients treated by the FST. (See FM 4-02.25 for definitive information on the FST.)
SBCT Organization and Logistics Functions
Forward Support Medical Evacuation Team (FSMT)
2-72. Aeromedical evacuation support should be coordinated with the combat aviation brigade (CAB) prior to operations. Normally these air ambulances are placed in direct support of brigade operations.
Under some scenarios, patients are evacuated by air ambulance from the brigade AO to a supporting role 3 MTF—either a combat support hospital or to a supporting offshore hospital afloat. (See FM 4-02.2 for definitive information on the FSMT.)
Additional Augmentation
2-73. Additional augmentation is provided as required based upon METT-TC factors and may include expanded PVNTMED support, dental services, MEDLOG including blood management, expanded behavioral health (BH)/combat and operational stress control (COSC) support, veterinary services (food inspection, surveillance, and animal care), area medical laboratory (AML) services, and other ancillary support as required. Under conditions of increased CBRN risk, the need for corps augmentation of the AML will become essential. While the RSTA squadron can detect the presence of CBRNE agents to allow an immediate tactical response to a suspected CBRN threat, the confirmatory analysis testing capability of the AML is required to allow for strategic CBRN decision-making and official notification.
SBCT M
EDICALF
ORCES
TRUCTUREBrigade Surgeon Section
2-74. The BSS is assigned to the brigade HHC and operates out of the brigade main TOC. (For definitive information on the SBCT BSS, see FM 3-90.6 and FM 4-02.21.)
Brigade Support Medical Company
2-75. The BSMC is organic and subordinate to the BSB and provides AHS support and operates a Role 2 MTF for the SBCT. The BSMC may be augmented by medical brigade/multifunctional medical battalion unit/elements according to METT-TC factors. (See chapter 5 for more information on the BSMC.)
Subordinate Elements
2-76. The infantry, field artillery, RSTA, and companies permanently assigned to the SBCT receive Role 1 care provided by their own organic medical elements. (See FM 3-90.6, FM 3-20.96, FM 3-21.9, FM 3-21.11, and FM 4-02.4 for additional information on these medical elements.)
2-77. Initial health service support (HHS) response is provided by the company trauma specialist and a trauma specialist assigned to each platoon. A ground ambulance evacuation team with Stryker variant medical evacuation vehicle (MEV) is normally in direct support of each infantry company within the battalion, while the fourth evacuation team with Stryker variant ground ambulance provides an area support role. The platoon’s treatment teams with high mobility multipurpose wheeled vehicle (HMMWV) ambulances (with trailers) operate the BAS, in either a static or mobile mode, to provide unit level HHS consistent with the combat situation.
2-78. When Soldiers are able to return to duty after receiving treatment, the BAS coordinates with the battalion S1 who in turn contacts the respective unit to pick up the Soldier (follow the battalion SOP).
The operational employment of the treatment and evacuation teams depends on the tactical situation.
2-79. The platoon evacuation teams in Stryker MEVs are pre-positioned forward and evacuate casualties from the point of injury to the treatment teams/BAS. The infantry battalion mortar and sniper elements receive HHS on an area support basis from the nearest medical element. Other elements operating in the infantry battalion area receive HHS on an area support basis from the medical platoon.
Elements without organic medical assets must emphasize the use of combat lifesavers within every squad, team, and crew. The infantry battalions receive additional HHS on an area support basis from the brigade medical assets. The BSMC and maneuver battalion medical platoons also possess the medical
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capability to decontaminate and treat CBRNE and potential occupational environmental hazards. Unit commanders are still responsible for providing the necessary personnel to operate the patient decontamination sites.
M
EDICALD
IGITIZATION2-80. The MC4 system will assist the medical operations cell and the BSS in performing their responsibilities through the collection, integration, and transmission of medical information. These sections will have near real-time information on the status of medical units, brigade unit medical readiness information, casualty evacuation, medical supplies, and AHS support. (See appendix C for additional information.)