# U.S. Marine Corps (Formerly Mcrp 4-11.1G) Patient Movement Edition July 2013

## Department Of The Navy Office Of The Chief Of Naval Operations

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## Department Of The Navy Office Of The Chief Of Naval Operations And Headquarters, U.S. Marine Corps

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2 May 2016

## Erratum

# To

## Mcrp 4-11.1G Patient Movement

1. Change all instances of MCRP 4-11.1G, *Patient Movement*, to MCRP 3-40A.7, Patient Movement. 2. File this transmittal sheet in the front of this publication.

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## Intentionally Blank Intentionally Blank

July 2013

PUBLICATION NOTICE
ROUTING

1. NTTP 4-02.2M/MCRP 4-11.1G (JUL 2013), PATIENT MOVEMENT, is available in
the Navy Warfare Library and supersedes NTTP 4-02.2M/MCRP 4-11.1G, PATIENT MOVEMENT (MAY 2007). It is effective upon receipt.
2. Summary. NTTP 4-02.2M/MCRP 4-11.1G, PATIENT MOVEMENT addresses Navy
and Marine Corps patient movement capabilities available to the operational commander and prescribes tactics, techniques, and procedures (TTP) for theater operations, mission planning, and training.
3. This publication is a complete revision of the previous publication and should be read
in its entirety.



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## Intentionally Blank List Of Illustrations

Page
No.

## Chapter 1Introduction

Figure 1-1.
Capabilities of Care ........ 1-5

## Chapter 2Patient Movement Operations

| Figure 2-1.    | Navy Patient Movement Flow 2-2         |
|----------------|----------------------------------------|
| Figure 2-2.    | Marine Corps Patient Movement Flow 2-3 |

## Appendix BHealth Service Support Capabilities

| Figure B-1.    | Aircraft Carrier Capabilities and Staffing B-2          |
|----------------|---------------------------------------------------------|
| Figure B-2.    | Amphibious Assault Ship Capabilities and Staffing B-2   |
| Figure B-3.    | Amphibious Transport Dock Capabilities and Staffing B-3 |
| Figure B-4.    | Landing Ship Dock Capabilities and Staffing B-3         |
| Figure B-5.    | Submarine Tender Capabilities and Staffing B-4          |
| Figure B-6.    | Hospital Ship Capabilities and Staffing B-5             |

## Appendix CReports

| Figure C-1.    | Facilities Spot Status Report C-5                          |
|----------------|------------------------------------------------------------|
| Figure C-2.    | Blood Status Report/Request C-6                            |
| Figure C-3.    | Medical Census Report C-8                                  |
| Figure C-4.    | Description of Medical Evacuation Request Preparation C-10 |

## Appendix DExamples Of Status Boards Used In Medical Regulating

| Figure D-1.    | Facilities Spot Status Board Example D-2    |
|----------------|---------------------------------------------|
| Figure D-2.    | Blood Status Board Example D-3              |
| Figure D-3.    | Joining Report Board Example D-4            |
| Figure D-4.    | Medical Regulating Status Board Example D-5 |

## Appendix ECasualty Categorization And Prioritization

| Figure E-1.    | Priority Levels and Criteria for Evacuation Precedence E-1    |
|----------------|---------------------------------------------------------------|
| Figure E-2.    | Goals for Evacuation Time Periods E-2                         |

## Appendix FAfloat And Shipboard Medical Evacuation Checklists

| Figure F-1.    | Afloat Medical Evacuation Checklist F-1           |
|----------------|---------------------------------------------------|
| Figure F-2.    | Shipboard Treatment/Evacuation Team Checklist F-3 |

## Appendix G

Figure G-1.
Ground/Air CASEVAC Platform Capabilities ........ G-1

## Intentionally Blank Preface

NTTP 4-02.2M/MCRP 4-11.1G, PATIENT MOVEMENT (JUL 2013), addresses Navy and Marine Corps patient movement capabilities available to the operational commander and prescribes tactics, techniques, and procedures (TTP) for theater operations, mission planning, and training. It is a complete revision of the previous publication and should be read in its entirety. This NTTP is not intended to prevent an officer who is exercising tactical command from initiating and issuing special instructions. Its primary purpose is to obtain basic uniformity while permitting the development and flexibility required by each tactical situation. Report administrative discrepancies by letter, message, or e-mail to: COMMANDER NAVY WARFARE DEVELOPMENT COMMAND ATTN: DOCTRINE 1528 PIERSEY STREET BLDG O-27 NORFOLK VA 23511-2723 NWDC_NRFK_FLEETPUBS@NAVY.MIL

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## Urgent Change Recommendations

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## Routine Change Recommendations

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## Chapter 1 Introduction 1.1 Mission

The mission of patient movement for health service support (HSS) is to minimize the effect that wounds, injuries, and disease have on unit effectiveness, readiness, and morale. This requires the HSS system to minimize morbidity and mortality for patients who cannot be returned to duty in a timely manner by ensuring prompt evacuation to an appropriate role of care in or out of theater. Consistent with military and logistical operations, HSS operates in a continuum across strategic, operational, and tactical levels and pertains to deployed forces and their sustaining bases. Commanding officers (COs) effectively use their resources to treat, evacuate, and return to duty sick, injured, and wounded Marines and Sailors.

## 1.2 Patient Movement

Patient movement is a system that provides a continuum of care and coordinates the movement of patients from the site of injury or onset of disease, through successive roles of care, to and between medical treatment facilities (MTFs) that can meet the needs of the patient. Patient movement consists of three components: medical regulating, patient evacuation, and en route care. The guiding principle is that patients are moved only as far rearward as the tactical situation dictates and as clinical needs warrant. Prompt movement of patients to the required level of clinical care is essential to prevent morbidity and mortality.

## 1.2.1 Patient Movement Throughout The Range Of Military Operations

The execution of military missions in today's environment entails a joint force structure. The overarching planning process and the consideration for HSS personnel in joint medical operations are discussed in Navy Warfare Publication (NWP) 4-02, Naval Expeditionary Health Service Support Afloat and Ashore, Marine Corps Warfighting Publication (MCWP) 4-11.1, Health Service Support Operations, and Joint Publication (JP) 4-02, Health Service Support. For a more detailed discussion of the planning process for operational forces, see NWP 5-01, Navy Planning, MCWP 5-1, Marine Corps Planning Process, and JP 5-0, Joint Operation Planning. Success in joint operations is driven by a mutual understanding of the joint force medical capability throughout the range of military operations (ROMO), which varies in size, purpose, and combat intensity and extends from military engagement, security cooperation, and deterrence to crisis response, contingency operations, major operations, and campaigns. Since today's U.S. military security environment is often engaged in operations below the threshold of armed conflict, it must be capable of sustaining operations before and after major operations. Across the ROMO, patient movement requirements vary according to the type and scale of operation. Initially, each Service is responsible for organizing, training, and equipping its forces to meet patient movement requirements. Evacuation can require any combination of air, ground, and sea resources. Establishing a seamless evacuation system requires close coordination among the Services on evacuation doctrine employment, concept of operations, modernization and sustainment of equipment and platform capabilities, and interoperability of patient movement items (PMIs). For a more detailed discussion of the range of military operations, see NWP 4-02 and JP 3-0, Joint Operations.

## 1.2.2 Patient Movement Tasks

Patient movement operations, like Service operations, are based on a common-language master menu of tasks, conditions, and measurement subsets for COs of the United States Navy (USN), United States Marine Corps
(USMC), and United States Coast Guard (USCG) to develop Service-specific mission-essential task lists. The Chairman of the Joint Chiefs of Staff Manual (CJCSM) 3500.04 (series), Universal Joint Task List, and the Chief of Naval Operations Instruction (OPNAVINST) 3500.38 (series), Universal Naval Task List, include patient movement tasks identified by the CO at the strategic, operational, and tactical levels. CJCSM 3500.03 (series), Joint Training Manual for the Armed Forces of the United States, describes how mission-essential task lists are developed. Patient movement conditions and planning considerations are discussed in paragraph 3.3. Specific patient movement tasks are listed in appendix A.

## 1.2.3 Joint Support To The Combatant Commander

Intratheater operations are the movement of patients between points within a combatant commander's (CCDR's)
area of responsibility (AOR). Intertheater operations are the movement of patients from the CCDR's AOR to points outside a CCDR's AOR.

## 1.2.3.1 Intratheater Operations

The joint force commander is responsible for developing intratheater patient movement policies in coordination with Service component evacuation representatives. Serving regions in a single geographic CCDR's requirements, intratheater operations are conducted using forces assigned, attached, and made available for tasking to the CCDR. Patients enter the system at the point of injury (POI) or illness and are moved to capabilities of care within the theater. Patients are most likely to enter the joint system for evacuation and medical regulation at the theater hospitalization capability. However, casualties can enter at the forward resuscitative care (FRC)
capability, depending on the type of operation and forces supported. Intratheater patient movement requires a coordinated effort among the Services, coalition MTFs and/or host nation (HN) MTFs, the responsible patient movement requirements center (PMRC), and Service component organic and theater evacuation assets.

## 1.2.3.2 Intertheater Operations

United States Transportation Command (USTRANSCOM) directs policies and procedures for intertheater patient movement and identifies transport resources. Intertheater operations are global and serve the transportation needs of the CCDR outside the AOR and support the conduct of operations within the AOR. Intertheater patient movement is primarily conducted using airlift assets as long evacuation distances may preclude other modes of patient movement in supporting rapid evacuation out of the combatant command (command authority) AOR. However, circumstances permitting, other modes and airlift assets may be used for intertheater patient movement. Patients usually enter the intertheater system from a theater hospitalization capability for movement to a definitive care capability outside the theater of operations and eventually to the continental United States (CONUS). Intertheater patient movement requires a coordinated effort among the Services or HN MTFs and the Global Patient Movement Integration Center (GPMIC) with the supporting PMRCs. Supporting PMRCs include: TPMRC-A [Theater Patient Movement Requirements Center-Americas], TPMRC-E [Theater Patient Movement Requirements Center-Europe], TPMRC-P [Theater Patient Movement Requirements Center-Pacific], and the joint patient movement requirements center (JPMRC). Operations and medical regulating activities have been assigned to USTRANSCOM, command surgeon's office TPMRC-A.

## 1.2.3.3 Defense Support Of Civil Authorities

Within the National Response Framework, the Emergency Support Function (ESF) #8, Public Health and Medical Services Annex, provides the mechanism for coordinated federal assistance to supplement state, local, and tribal resources in response to public health and medical care needs. The Department of Homeland Security (DHS)/
FEMA [Federal Emergency Management Agency] coordinate the implementation of ESF #8 through the ASPHEP [Assistant Secretary of Public Health Emergency Preparedness]. In a major public health or medical emergency, local transportation assets may not be sufficient to meet demand. State or tribal requests for federal medical transportation assistance are executed by ESF #8 in coordination with ESF #1, Transportation Annex. The National Disaster Medical System (NDMS) has three missions: emergency medical care, transportation of patients, and definitive medical care. Four federal partners support these missions: the DHS (the lead federal agency), the Department of Health and Human Services (DHHS), the DVA [Department of Veterans Affairs], and the Department of Defense (DOD) (a supporting federal agency). At the request of DHHS, DOD coordinates and provides support for the evacuation of seriously ill or injured patients to locations where hospital care or outpatient services are available. In conjunction with the NDMS Medical Interagency Coordination Group (MIACG), DOD is responsible for regulating and tracking patients transported on DOD assets to appropriate treatment facilities such as nonfederal hospitals. DOD coordinates patient evacuation from a collection point in or near the incident site to NDMS patient reception areas through the NDMS MIACG. The USNORTHCOM [United States Northern Command] facilitates and identifies requirements for joint patient movement and transportation issues through the MIACG.

For further information on federal assistance in response to major disaster or emergency, refer to NWP 3-29, Disaster Response Operations.

## 1.2.4 Patient Movement Definitions 1.2.4.1 Medical Regulating

Medical regulating is the actions and coordination necessary to arrange for the movement of patients through the roles of care. This process matches patients with a MTF that has the necessary HSS capabilities and available bed space.

## 1.2.4.2 Patient Movement

Patient movement is the act or process of moving a sick, injured, wounded, or other person to obtain medical and/or dental care or treatment. Functions of patient movement include medical regulating, patient evacuation, and en route medical care.

## 1.2.4.3 Patient Evacuation

Patient evacuation is the removal of a patient by a variety of transport means (air, ground, rail, or sea) from a theater of military operation and between HSS capabilities to prevent further illness or injury and to provide additional care and disposition of patients from the military health care system.

## 1.2.4.4 Casualty Evacuation

Casualty evacuation (CASEVAC) is the unregulated movement of casualties that can include movement both to and between medical treatment facilities.

## 1.2.4.5 Medical Evacuation

Medical evacuation (MEDEVAC) refers to United States Army (USA), Navy, Marine Corps, and Coast Guard patient movement using predesignated tactical or logistic aircraft (both fixed wing and rotary wing), boats, ships, and other watercraft temporarily equipped and staffed with medical attendants for en route care.

## 1.2.4.6 Aeromedical Evacuation

Aeromedical evacuation (AE) is the movement of patients under medical supervision to and between medical treatment facilities by air transportation.

## 1.2.4.7 En Route Care

En route care is the continuation of the provision of care during movement (evacuation) between HSS capabilities in the roles of care, without clinically compromising the patient's condition.

## 1.3 Capabilities Of Care

HSS is provided to expeditionary forces using ascending capabilities of care that provide a continuum of essential care starting at the point of illness, injury, or wounding and continuing through evacuation and en route care within the HSS system. Patient movement components are encompassed in the capabilities of care. Patients are directed to a facility with the capabilities required to begin decisive intervention to preserve life, limb, and eyesight, employing medical regulating and en route care. Once stabilized, the patients are either returned to duty or transferred to facilities outside the theater of operations for definitive treatment. Capabilities of care may be bypassed based on the patient's clinical requirements and condition. The concept of care capabilities involves a scope of services and capacity provided within the HSS system bound by the following four interacting factors:


1. Urgency of the patient's needs

2. Requirements for mobility of medical personnel and facilities

3. Capabilities, equipment, and supplies of HSS personnel

4. The workload at each capability relative to its treatment capacity.
Figure 1-1 summarizes the five overarching medical capabilities for HSS based on JP 4-02, Health Service Support. Additionally, JP 4-02 identifies four roles of medical care which align with the North Atlantic Treaty Organization (NATO) roles of care schema per, Allied Joint Publication (AJP) 4-10, Allied Joint Medical Support Doctrine. In coalition or multinational operations, personnel from non-NATO countries could have different interpretations of roles of care. In such circumstances, evacuation of casualties through progressive roles of care may not occur and patients may arrive at a theater hospitalization capability without receiving first responder or FRC.

| Capability                            |
|---------------------------------------|
| Comparable Roles of                   |
| Medical Care*                         |
| First                                 |
| Responder                             |
| Medical care rendered                 |
| at the point of initial               |
| injury or illness                     |
| Self Aid/Buddy Aid                    |
| Hospital Corpsman                     |
| Marine Corps Combat Lifesavers        |
|                                       |
|                                       |
| Role 1                                |
| Ship's Medical Department             |
| Battalion/Wing Aid Station            |
| Forward                               |
| Resuscitative                         |
| Care                                  |
| Forward advanced                      |
| emergency medical                     |
| treatment performed                   |
| close to the point of                 |
| injury (POI)/illness                  |
|                                       |
|                                       |
|                                       |
| Role 2                                |
| Shock Trauma Platoon                  |
| Forward Resuscitative Surgery System  |
| Surgical Company                      |
| Casualty Receiving and Treatment Ship |
| Aircraft Carrier                      |
| Hospital Ship                         |
| Expeditionary Medical Facility        |
|                                       |
| Role 3                                |
| Theater                               |
| Hospitalization                       |
| Modular theater                       |
| hospitals with medical                |
| and surgical capabilities             |
| required to support the               |
| theater                               |
|                                       |
|                                       |
| Role 4                                |
| OCONUS Medical Treatment Facility     |
| CONUS Medical Treatment Facility      |
| Veterans Administration Hospital      |
| National Disaster Medical System      |
| Definitive                            |
| Care                                  |
| Full range of acute,                  |
| convalescent,                         |
| restorative, and                      |
| rehabilitative care                   |
|                                       |
| En Route                              |
| Care                                  |
| Medical treatment                     |
| during movement                       |
| between roles of care                 |
| USN/USMC En Route Care system**       |
| USAF Critical Care Air Transport      |
| (CCAT)                                |

 * This is not an all-inclusive list of medical resources.

** En route care can be used throughout all capabilities of care.

INTENTIONALLY BLANK


## Chapter 2 Patient Movement Operations 2.1 General

To ensure access to the appropriate capability or role of care, patients are moved from shore to ship, from ship to ship, and from ship to shore. Prompt movement of patients to the required clinical care is essential to limit casualty morbidity and mortality.

## 2.2 Navy Forces 2.2.1 Navy Expeditionary Forces Ashore

Navy forces (NAVFOR) ashore use organic capabilities to accomplish CASEVAC and MEDEVAC. If the capability is unavailable, then the inherent Army or Marine Corps patient movement structure is utilized. Refer to chapter 4 for information on Navy patient movement operations and appendix B for HSS capabilities.

## 2.2.2 Navy Forces Afloat

When a patient's health care needs exceed the capabilities of the ship providing primary support, patients are regulated to a higher capability of care as determined by the senior medical department representative (SMDR). Patient movement afloat consists of the full spectrum of patient movement, including medical regulating and patient evacuation. Generally patient movement afloat is located within two HSS structures: strike group operations and dispersed or independent operations. (See figure 2-1 for a depiction of Navy patient movement flow in theater.)

## 2.2.2.1 Strike Group Operations

The inherent FRC capability within the expeditionary strike group (ESG)/amphibious ready group (ARG) and carrier strike group (CSG) provides advanced medical care to the strike group. Patient movement is regulated through the afloat medical regulating system and is conducted through lifts of opportunity ranging from small boats to aircraft. If further patient evacuation is required, the ARG/ESG or CSG coordinates patient movement to the next capability of care. Predeployment planning is essential for determining available medical facilities and evacuation assets in the AOR. Prior to deployment, information packages (commonly known as smart packs) containing this information are developed to facilitate the MEDEVAC process.

## 2.2.2.2 Dispersed And Independent Operations

Patient movement for dispersed and independent operations requires extensive fleet planning and review of the operation order (OPORD) and evacuation policy. The ship's medical personnel stabilize and hold the patient until evacuation is arranged. Patient evacuation is usually coordinated with the current contract provider for TRICARE Global Remote Overseas (TGRO) or with a theater hospitalization capability or MTF. (See paragraph 2.5 for additional information about health care in remote locations.)

## 2.3 Marine Corps Forces

The Marine Corps organization for combat is based on its unique force structure. HSS is a mission area common to every Marine air-ground task force (MAGTF) regardless of the mission. Definitive operational planning for HSS is always an integral part of all MAGTF operations. The inherent flexibility of the MAGTF and the broad spectrum of the potential MAGTF mission calls for equal flexibility in HSS operations. The size, type, and configuration of HSS capabilities needed to effectively support a MAGTF is determined by mission, enemy, terrain and weather, troops and support availabletime available (METT-T).

The theater commander may impose a through regulating policy (previously referred to as a patient skip policy), moving the patient past the next capability of care to a theater hospitalization capability. (See figure 2-2 for a depiction of Marine Corps patient movement flow.) Chapter 5 provides specific information on Marine Corps patient movement operations. For further information on Service HSS capabilities, refer to appendix B.

## 2.4 Health Care In Remote Locations

Units operating in remote locations fall under the direction of the CCDR and the appropriate OPORD. In general, in a country or territory served by a DOD MTF, the MTF is contacted to determine its ability to care for the patient. At sea, or when no U.S. military health care MTF exists, it is customary to evacuate the ill and injured to non-U.S. health care facilities in foreign countries. The TGRO provides urgent and emergent health care through health care contracts and is available to active duty service members regardless of their parent command and TRICARE enrollment status.

## 2.5 Patient Movement And Joint Capabilities Of Care 2.5.1 Point Of Injury Or Illness To Forward Resuscitative Care Capability Operations

The component commands are responsible for CASEVAC from POI or illness to casualty treatment stations, and for casualty movement from the first responder capability to FRC capabilities. CASEVAC is accomplished through dedicated, designated, or opportune ground or air transportation provided by a combination of litter carries, manual carries, ground transportation, and limited air transport (fixed or rotary wing). The Army employs dedicated patient evacuation assets such as ground and air ambulances. If Air Force assets are required at this level, lifts of opportunity may be used. For more information on the use of Air Force assets, see JP 4-02.

## 2.5.2 Forward Resuscitative Care Capability To Theater Hospitalization Capability

Movement from FRC capabilities is a Service component responsibility. The Navy does not operate dedicated evacuation vehicles with the capacity to retrieve casualties from the FRC capability and evacuate to theater hospitalization. When available for tasking, Navy helicopter sea combat squadrons do employ search and rescue medical technicians to provide enhanced medical care during CASEVAC/MEDEVAC. Otherwise, operations may require evacuation by the joint common-user patient movement system. Requests for the joint common-user patient movement system are submitted to the JPMRC for coordination of casualty movement.

## 2.5.3 Theater Hospitalization Capability To Definitive Care Capability Operations

If a patient cannot be returned to duty within the limits of the theater patient movement policy, the originating MTF usually requests a patient to be moved to another MTF for more definitive care and disposition. The originating MTF will submit a patient movement request (PMR), in accordance with (IAW) prescribed procedures using the United States Transportation Command Regulating and Command and Control Evacuation System
(TRAC2ES), the currently recognized patient movement AIS [automated information system], or other prescribed communications systems. PMRs are submitted to an established JPMRC, which validates and regulates movement requirements and coordinates with the theater patient movement requirements center (TPMRC) for intratheater patient movement or with the GPMIC for intertheater patient movement. The JPMRC identifies intratheater patient movement requirements through the JMCC [joint movement control center] to the air mobility division's AE control team, and the TPMRC coordinates with the theater air mobility operations control center to identify theater airlift assets available. The TPMRC also coordinates with TPMRC-A
through GPMIC to identify intertheater patient movement requirements through the USTRANSCOM joint mobility control group.

## 2.5.4 First Responder/Forward Resuscitative Care Capability To Definitive Care Capability

Some joint operations present unique situations when a theater hospitalization capability does not exist. Stabilized casualties enter the joint common-user patient movement system near the first level of formalized medical care and are evacuated directly to a definitive care capability in another theater. In such cases, the component command medical regulating officer submits a PMR to the JPMRC. Movement within CONUS includes redistribution of patients to their home or unit of record. Members discharged from medical care who require movement to their home station instead of the theater are managed through the personnel system in a duty passenger status. The actual process varies and is documented in the OPORD.

## 2.5.5 En Route Care Of Patients Throughout The Capabilities Of Care

En route care involves transitory medical care, patient holding, and staging capabilities during transport of stabilized and/or stabilizing patients through successive medical care capabilities. Essential care initiated prior to evacuation must be continuous in transit to prevent deterioration of the patient's clinical condition. During transport, patients may experience physiologic and hemodynamic fluctuations necessitating close monitoring and timely intervention. As a result, en route care requires appropriately trained medical attendants and the use of standardized, interchangeable, critical care equipment to ensure the evacuation system can successfully transport a patient to a higher capability of care. Patients moving through the patient movement system shall be reevaluated/reassessed post-flight at all interim locations by Service staging or fixed-MTF flight surgeons/attending physicians to identify and address negative changes in clinical status.

## Intentionally Blank Chapter 3 Patient Movement Planning 3.1 General

To be effective, the patient evacuation effort must be well planned and its execution synchronized. This chapter addresses patient evacuation under varying conditions and planning considerations where HSS personnel must be flexible and ready to improvise to meet the demands of unique conditions that present themselves in the operational environment.

## 3.2 Patient Movement Evacuation Considerations

In the context of common joint military language, conditions are used to express variables of the environment affecting task performance. Conditions at all levels of operation are organized into three broad categories: physical environment, military environment, and civil environment. Patient movement may be the HSS capability most affected by conditions and warrants understanding and consideration in the operational environment.

Planners must distinguish how environmental conditions affect the capability to perform patient movement by adapting the requirements to perform patient movement tasks (regulation, evacuation, and en route care) so that patient movement standards, such as those set by the commander, can be met. Paragraphs 3.2.1 through 3.2.3
provide examples of conditions and subconditions used to define elements of the AOR affecting patient movement.

## 3.2.1 Physical Environment

The physical environment includes natural and manmade elements. The physical environment relevant to patient movement is organized in subcategories of land, sea, and air as follows:


1. Land includes terrain, geological features, manmade terrain features, and landlocked bodies of water.

2. Air includes tropical, subtropical, and arctic climates, and the seasons.

3. Sea includes ocean waters, the ocean bottom, and harbor capacity.

## 3.2.2 Military Environment

The military environment includes factors related to military forces, which include the following categories:


1. Mission

a. Rules of engagement

b. Commander's intent.

2. Forces

a. Forces assigned

b. Interoperability.

3. Command and control

a. Joint/multinational

b. Integration.

4. Intelligence

a. Theater intelligence organization

b. Medical threat.

5. Deployment, movement, and maneuver: Patient movement system responsiveness (theater
evacuation capability)

6. Firepower

7. Protection

a. Air superiority

b. Land superiority

c. Space superiority.

8. Sustainment

a. Facility responsiveness

b. Supply responsiveness

c. Resupply responsiveness.

9. Threat

a. Posture

b. Opposing force size.
 10. Conflict
a. State of conflict

b. Breadth of conflict

c. Type of conflict.

## 3.2.3 Civil Environment

The civil environment includes factors related to populations, their governments, politics, cultures, and economies that impact military operations. The organization of civil conditions includes the following subcategories:


1. Political policies

a. Domestic support

b. Political support

c. Public support.

2. Culture

a. HN stability

b. Foreign government involvement.

3. Economy

a. Population

b. Size of military

c. Gross domestic product.

4. International economic position: Self-sufficiency in economic areas

5. Industry

a. Growth rate

b. Electric production.

6. National potential

a. Transportation

b. Telecommunication infrastructure.

7. Science and technology.

a. Research application

b. Technology production.

## 3.2.4 Impact Of Conditions

Patient movement in operational theaters involves transporting patients to the appropriate capability of medical care in a timely manner. Conditions that military forces encounter must be counteracted to successfully complete the patient movement task. During casualty reception, collection, and movement with en route care, HSS units mimic civilian emergency medical response models in reacting to and mitigating these different conditions through planning.

Initially in operations, HSS units deploy with the medical estimate and an understanding of the medical threat and then establish support commensurate with mission type and scale under current considerations. For example, the environmental conditions dictate plausible evacuation routes and required modes of transport with a timeframe dictated by the commander.

## 3.3 Patient Movement Planning Considerations

The ability to successfully support combat operations requires a thorough mission analysis, a terrain analysis, trained medical personnel, and a thorough HSS estimate. HSS planning follows the same course as planning processes for any other element of operational support. HSS planning must be accomplished in conjunction with overall operational and logistic support planning. The HHS section of the operation plan (OPLAN) or OPORD
must provide specific instructions for evacuation not otherwise addressed in the unit's standard/standing operating procedures (SOPs). For further information on HSS planning, refer to NWP 4-02, Naval Expeditionary Health Service Support Afloat and Ashore; Commander Naval Surface Forces Instruction (COMNAVSURFORINST) 6000.1, Shipboard Medical Procedures Manual; Marine Corps Reference Publication (MCRP) 4-11.1E, Health Service Support Field Reference Guide, MCWP 5-1, Marine Corps Planning Process; MSTP [Marine Air-Ground Task Force Staff Training Program] Pamphlet 5-0.3, MAGTF Planner's Reference Manual; and Field Manual (FM) 8-55, Planning for Health Service Support.

## 3.3.1 General Patient Movement Planning Considerations

As METT-T factors affect the employment of all units, the HSS staff must consider the basic tenets of time, space, and logistics that influence the utilization of patient evacuation assets. These considerations include:


1. Patient's age and medical condition

2. Estimated number of casualties and types

3. Type of weapon systems employed by the enemy, for assessing injury

4. Hospital bed requirements, anticipated patient load, and areas of patient density

5. Availability, locations, and types of supporting MTFs

6. Availability of patient evacuation resources

7. Fire support plan to ensure patient evacuation assets are not dispatched onto routes and at the times
affected by the fire support mission

8. Road network and dedicated patient evacuation routes (contaminated and clean)

9. Weather conditions
 10. Patient movement items (PMIs)
a. Theater PMI exchange policy/PMI centers

b. Return of allied nation and multinational force PMIs.
 11. Blood requirements and availability 12. Medications that require temperature control 13. HN support and agreements; types of services available by HN assets
 14. Evacuation of military working dogs 15. Special operations forces.
a. Evacuation coordinated with theater special operations command

b. Sensitivity of identifying information

c. Separate theater evacuation policy.

## 3.3.2 Mountain Operations

Mountain elevations vary from 1,000 feet to over 16,000 feet and have rapidly occurring weather and temperature changes. Operations in mountainous terrain require procedure modifications to counteract the environmental impact on personnel and equipment. Factors considered in a mountain environment include:


1. Rugged peaks, steep ridges, and deep valleys

2. Few navigable roads

3. Reduced range of communication

4. Unpredictable and severe changes in weather

5. High-altitude physiological impact

6. Endemic diseases and environmental injuries

7. Decreased partial pressure of oxygen affecting patient respiration

8. Availability of landing zones (LZs)

9. Altitude impact on rotary-wing lift capability
 10. Survival and support techniques training.

## 3.3.3 Jungle Operations

Jungle operations degrade equipment and decrease personnel's ability to maneuver. Factors considered in a jungle environment include the following:


1. Few navigable roads

2. Limited availability of LZs

3. Extreme temperature and weather conditions

4. Endemic diseases and environmental injuries

5. Reduced range of communication

6. Decreased air pressure limiting rotary-wing lift capability

7. More frequent hoist operation requirements in thick jungle vegetation where LZs are unavailable.

## 3.3.4 Desert Operations

Deserts are arid and barren regions incapable of supporting human life. Temperatures range from above 136
degrees Fahrenheit (F) to bitter cold. Day to night fluctuations in temperature can exceed 70 F. Desert terrain can have mountains, rocky plateaus, and sandy dunes. Factors considered in a desert environment include the following:


1. Desert terrain and climate vary considerably from location to location. Medical intelligence should be
obtained prior to deployment on operations conducted on desert terrain.

2. Units have long lines of communication and are widely dispersed.

3. Extra water is required for casualties to drink and to cool heat casualties.

4. Units must be able to treat environmental injuries unique to the desert.

5. The effects of wind and sand are interrelated. Sandstorms restrict visibility and hamper movement. Dust
and sand present one of the greatest dangers to the proper functioning of medical and communications equipment.

6. Excessive heat adversely affects the following items:

a. Vehicles and aircraft. Excessive heat causes vehicles to overheat, leading to greater than normal wear.
Aircraft temperature limitations may be reached quickly, resulting in limited use during the hotter parts
of the day.

b. Medical supplies. Heat causes medical supplies to deteriorate. The shelf life of some medical supplies
decreases when stored in hot climates.

c. Medical equipment. Medical equipment must be protected from the effects of heat. It may be protected
using the same techniques as those used to protect communications equipment.

## 3.3.5 Extreme Cold Weather Operations

Operations in the extreme cold have many of the limiting factors found in desert operations. The tundra and glacial areas are harsh, arid, and barren. Temperatures reaching lows of -80 F to -100 F combined with gale force winds make it impossible for humans to survive. Factors considered in a cold weather environment include the following:


1. Extended battle zones that increase evacuation distance and time

2. Extended maintenance for vehicles

3. Proper storage of medical supplies to prevent loss from freezing

4. Few terrain features or road networks

5. Extended hours of darkness at extreme latitudes

6. Unpredictable weather

7. Risk of environmental injuries

8. Regulating patient temperature while treating or awaiting transportation.

## 3.3.6 Patient Evacuation In A Chemical, Biological, Radiological, Or Nuclear Environment

Evacuation of casualties in a chemical, biological, radiological, or nuclear (CBRN) environment forces the CO to consider to what extent medical personnel and evacuation resources will enter the contaminated area. The CO has flexibility in tailoring an evacuation system to meet the tactical situation and to deal with the CBRN environment.

Factors considered in a CBRN environment include the following:


1. Mission-oriented protective posture gear, increased workloads, and the fatigue of battle greatly reduce the
effectiveness of unit personnel.

2. Radiologically contaminated areas require operational exposure guidance.

3. Introducing uncontaminated aircraft into a contaminated area should be avoided. Ground ambulances
should be used instead of air assets as long as their use does not adversely affect the casualty's medical
condition.

4. Effects of weather and time upon contaminants should be weighed before action is taken.
For more information on CBRN and how to respond, refer to JP 3-41, Chemical, Biological, Radiological and Nuclear Consequence Management.

## 3.3.7 Military Operations On Urbanized Terrain

Military operations on urbanized terrain (MOUT) are operations characterized by a three-dimensional battlefield with rubble, readymade fortified fighting positions, and an isolating effect on all combat and support units. The following factors are considered in an urban environment:


1. Using pulleys; special equipment used for lowering casualties from buildings or moving them from one
building to another above the ground includes:

a. Special harnesses

b. Portable block and tackle equipment

c. Lightweight collapsible ladders

d. Grappling hooks

e. Collapsible litters

f. Heavy gloves

g. Casualty blankets with shielding.

2. Reduced range of communication.

3. Alternate forms of communications, such as markers, panels, or field expedients (utility jackets or
T-shirts) indicating the location of the wounded or injured.

4. Transportation operations within urban terrain are complicated and highly canalized by rubble and other
battle damage. Strip maps of evacuation routes should be prepared, when applicable.

5. Medical personnel require special training in the tactics, techniques, and procedures required to operate in a
MOUT environment. They must be trained to cross open areas safely, avoid barricades and mines, enter
and depart safely from buildings, and recognize situations where booby traps and ambushes are likely.

## 3.3.8 Patient Movement Of Contaminated, Contagious/Potentially Exposed Patients

The Centers for Disease Control and Prevention (CDC) and USTRANSCOM are developing strategies for the movement of infectious patients. In a contaminated environment, patients must be decontaminated prior to movement. USTRANSCOM will not transport contagious and contaminated casualties within the aeromedical patient movement system. In rare cases transport may be essential to preserve life or continue critical missions.

Patients known or suspected to be infected with a highly contagious disease should be treated "in-place." HSS
units should contact the geographic combatant commander (GCC), the Service component, and USTRANSCOM
for the latest guidance. Factors to consider when moving an infectious patient include the following:


1. Patients should be transported on a dedicated aircraft with the minimum number of crewmembers.

2. Infectious patients should be positioned as far downwind of cabin airflow as possible.

3. Mechanical ventilators for infectious patients should provide HEPA [high-efficiency particulate air] or
equivalent filtration of airflow exhaust.

4. Whenever possible, noninfectious patients or passengers should not be onboard.

5. The number of medical providers should be limited to those required to provide essential care during the
flight.

6. Infection control measures should focus on source control; engineering controls to limit airborne
dissemination of the virus; containment of the area of contamination, such as designating clean and dirty areas on the aircraft; use of personal protective equipment (PPE); safe work practices to prevent exposure;
and waste disposal.


## Chapter 4 Navy Patient Movement Operations 4.1 General 4.1.1 General Procedures

Patient movement procedures for Navy operations are established by the operational commander (numbered fleet)
and promulgated through classified OPORDs to the ARG/ESG, CSG, amphibious task force (ATF), and independently deployed ships, three to six months prior to deployment. They remain in effect until superseded by new OPORDs or when the ship, ARG/ESG, CSG, or ATF is released or detached from the AOR. All medical intelligence, disease occurrence, force health protection, patient care, and patient movement guidelines are found in the OPORD.

## 4.1.2 Intertheater Patient Movement Procedures

As the Air Force component to USTRANSCOM, Air Mobility Command (AMC) has the lead "executor" role for intertheater patient movement. When the Air Force system is not a viable option, the TGRO treatment system can be used to MEDEVAC unless it is prohibited in the OPORD. TGRO designates a location for patient pickup; and the requesting unit transports the patient to the designated location, such as a beach, a port, or an airfield.

## 4.1.3 General Patient Preparation

Patients do not return to the unit once they leave the AOR unless there is a change to their medical condition and OPORD guidelines. Patients should take with them personal items of value, military ID [identification] card, passport, uniforms, and civilian clothes and should be advised that baggage/weight restrictions apply. Patients'
PPE should be carried through patient movement: however personal or issued weapons are prohibited. The unit can ship the remainder of the patients' belongings or hold belongings until the return to CONUS. The patient's chain of command (COC) is responsible for ensuring the patient is administratively prepared for transport.

The patient and patient escort should be briefed using the Afloat MEDEVAC Checklist. (See figure F-1 in appendix F.) Information should include:


1. Where is the patient going? (Specific command.)

2. To whom does the patient report? (Specific person.)

3. What are the patient's restrictions? (Diet, ambulatory, 24-hour watch.)

4. Does the patient have records? (Ensure all medical/dental records, including labs and x-rays, are given to
the patient/escort.)

5. Who are the points of contact (POCs)? (MTF, physician, Marine Corps/fleet liaison names and numbers.)

6. Who is the patient's emergency contact? (Immediate superior in command (ISIC), medical POC with
number.)

7. Does the patient have a sufficient supply of medication? (Recommend a 710 day supply of medications
for travel.)

8. Is all equipment in working order and properly labeled with medical department information? (Allows
equipment to be tracked and returned to the ship as soon as possible.)

## 4.1.4 General Medical Department Preparation

Medical plans and tasks should be developed according to the OPORD issued by the CCDR. A copy should be obtained from the intelligence or operations officer and should include the following tasks performed by the Medical Department:


1. Develop message templates to report or request patient movement.

2. Develop medical smart packs (information POCs on medical facilities and patient movement assets) for
each port and potential evacuation country or region.

3. Develop a complete MEDEVAC checklist if one is not provided in the OPORD, to include a list of
personnel to notify in case of MEDEVAC. (See figure F-2 in appendix F for the Shipboard Treatment/Evacuation Team Checklist.)

4. Obtain early patient movement approval from the chain of command and from the patient's COC, unless a
delay endangers the patient's life or limb.

5. Set up and practice MEDEVAC and patient movement scenarios to include coordination with organic air
assets.

6. Train the COC and crew.

7. Coordinate a MEDEVAC within the CSG/ESG/ARG through the strike group surgeon and accepting
ship's senior medical officer (SMO).

8. Gain knowledge of key personnel who make the MEDEVAC process work.

9. Ensure that the following personnel-specific tasks are completed:

a. The patient's COC provides uniforms, civilian clothes, personal items, passport, identification card, and
escort.

b. Personnel officers provide the patient's funded orders, unfunded orders, and travel arrangements IAW
the OPORD guidelines and consider cash advancement from unit (disbursing).

c. The air/operations officer sets up air or boat transfer.

d. The communications officer notifies the accepting facility and external COC via message or e-mail
through the SECRET Internet Protocol Router Network (SIPRNET).

e. The weapons officer prepares elevators, if needed and available.

f. The medical regulating control officer (MRCO) tracks the patient until final destination or return
to unit.
 10. Notify U.S. Embassy defense attache if the patient remains hospitalized in the HN.
 11. Notify the husbanding agent of HN, whose medical representative can assist in arranging care, reports, and
medical payment for services rendered.
 12. Notify TGRO.
 13. Notify the COC, medical COC, and next of kin (NOK). 14. Request the CO's final approval to MEDEVAC from ship.

## 4.1.5 Patient Movement Operational Risk Management

Personnel transporting patients should apply operational risk management principles in an effort to enhance overall situational awareness. Medical personnel who accompany patients in flight must have the clinical skills to maintain a consistent level of patient care during all phases of transport and the operational knowledge to ensure the safety of themselves and their patients. These personnel must complete a prescribed training curriculum that addresses clinical stresses of flight, care of patients in the rotary- and/or fixed-wing environment and aircraft egress in case of an emergency or crash landing over ground or water. Patients shall be stabilized prior to transport. The medical staff/medical attendants must ensure an adequate airway and ventilation; control bleeding; optimize blood pressure; heart rate and rhythm; immobilize orthopedic injuries; and plan for en route emergencies. Knowing expected flight times helps to determine how much oxygen, intravenous (IV) fluid, and other supportive supplies are required. Determine whether ambulatory patients should be made litter patients for comfort. To conserve batteries, oxygen, and other supplies, medical staff/attendants must ensure transport equipment passes preflight checks on the aircraft and then should be reserved until prior to takeoff. A last check of the condition and vitals of each patient should also be executed and documented prior to transport. The patients being moved should carry all pertinent lab and x-ray records, including patient summaries. Medical providers should communicate effectively, and other support staff should be familiar with aircraft types available. Patient movement attendants should be outfitted with appropriate PPE such as fire resistant uniform, cranial protection, hearing protection and steel-toed boots; patients should also be outfitted with PPE to the maximum extent allowed by their clinical condition. Patient movement attendants will consider and plan for environmental and operational challenges such as cold, hypoxia, vibration, noise, space limitation, light discipline, diversion, and delay in transport.

## 4.2 Patient Movement Operational Platform Support 4.2.1 Medical Regulating In Support Of An Amphibious Ready Group/Marine Expeditionary Unit

During amphibious operations involving an ARG/Marine expeditionary unit (MEU), medical regulating functions are the responsibility of the MRCO. The MRCO is a Navy Medical Service Corps (MSC) officer trained in medical regulating who serves as a member of the fleet surgical team (FST) staff within the ARG/MEU. The MRCO maintains an informational relationship with the MEU medical planner (a MSC officer trained in medical regulating) to coordinate the theater patient movement plan. Refer to section 4.4.4.7 for roles and responsibilities of the MRCO/medical regulating team (MRT) during amphibious operations.

## 4.2.2 Medical Regulating In Support Of An Expeditionary Strike Group/Amphibious Ready Group/Marine Expeditionary Brigade

In support of operations involving multiple ARGs and/or an ESG, medical regulating functions may be conducted employing an MRT (at least one per ARG). The MRT provides operational support for patient movement and coordinates seaward CASEVAC in the amphibious objective area (AOA) and patient evacuation within the ESG/ARG during underway periods. The designated flagship for the combined task force will release a medical operational task supplement (MEDOPTASKSUP) identifying the senior medical authority afloat (i.e., commander amphibious task force (CATF) surgeon) and the inbound/outbound medical regulators for wartime casualties and the establishment and frequency for the medical regulating network (MEDREGNET). (See appendix C for medical reports used by the MRT and appendix D for status board formats used for patient movement.)
The MRT consists of a MRCO and may also include the medical administrative officer (MAO), a chief petty officer, and one to three corpsmen as deemed necessary to support the mission. Refer to section 4.4.4.7 for roles and responsibilities of the MRCO/MRT during amphibious operations.

## 4.3 Patient Movement Communication Plan


1. The MEDREGNET secure chat provides rapid communications among the MRCO afloat, the patient
evacuation officer (PEO) ashore, MRTs, patient evacuation clerks, and the joint/theater patient movement requirements center (J/TPMRC). It ensures that the MRCO and PEO have current information on the capabilities and status of HSS facilities supporting the operation. The MEDREGNET must be used for
patient movement, medical supplies, blood reporting, and blood and blood product requests within the area
of operations. Units comprising the network are predesignated in the OPLAN/OPORD.

2. USTRANSCOM is the process owner for the management of PMRs. USTRANSCOM does not own any
lift capability. All lift information is submitted into the USTRANSCOM Regulating and Command and Control Evacuation System commonly referred to as TRAC2ES. TRAC2ES is a Web-based system used by transportation and medical planners to support planning and documentation of patient
regulation/movement in the theater of operations. TRAC2ES maximizes the internet while maintaining and
protecting patient privacy and troop strength information. TRAC2ES provides global support throughout
the full operational medical continuum: fixed and deployable medical treatment facilities and Global/Patient Movement Requirements Centers.

3. PMRs are normally submitted through TRAC2ES for patient in-transit visibility (ITV). However when
TRAC2ES is inaccessible, they may also be submitted by facsimile (FAX), voice telephone, radio and/or satellite communications using a standard PMR worksheet. Patient information items required to request patient movement will be determined by the PMRC and will depend on the operational environment.

## 4.4 Patient Movement Operations

During ESG/ARG operations, the Commodore, in consultation with the CATF surgeon, must approve a patient's movement off the vessel. During CSG operations, or in the case of independent deployers, the ship's CO in consultation with the SMO/SMDR must approve a patient's movement off the vessel. The CATF surgeon, SMO, or SMDR, must balance the patient's condition with availability of en route care, urgency of treatment, and proposed aircraft altitude and flight time or surface conditions and transit time. Appendix E provides guidance on casualty categories and prioritization.

## 4.4.1 Independent Ships And Submarines

During patient movement to a shore medical facility, the SMO/SMDR performs the following:


1. Determines whether the patient requires a MEDEVAC

2. When patients are moved to an MTF, the SMO/SMDR performs the following:

a. Coordinates with the operational forces medical liaison (OFML) to establish direct communication
between the ship's SMO and the accepting shore medical facility physician

b. Sends the patient consult to the accepting physician


c. Contacts the OFML:

(1) To verify readiness to receive the patient

(2) To establish that transportation for the patient has been arranged from the rendezvous point to the
hospital.

d. Identifies a POC from the medical team standing by to receive the patient and the patient's
accompanying medical documentation.

3. When patient movement is to an international medical facility, the SMO/SMDR performs the following:

a. Follows guidelines for use by TGRO

b. Determines whether patients are litter or ambulatory and the requirements for medical attendants,
medical equipment, and supplies.

4. Coordinates MEDEVAC with air operations and operations officer

5. Ensures that patients are delivered to the flight deck with required documentation

6. Composes and submits MEDEVAC message

7. Tracks patients' diagnoses, ships, referring physicians, current statuses, locations, and final dispositions.

## 4.4.2 Carrier Strike Group

The CSG uses the carrier-based SMO and the MAO. The carrier SMO is a CSG surgeon who coordinates patient movement with the MAO within the CSG. The ship's CO and SMO/SMDR determine the requirement for patient movement and initiate the request for movement to the carrier.

## 4.4.3 Strike Group Operations 4.4.3.1 Receiving Patients Afloat

1. Patient's ship. The transferring provider notifies the COC of the need to MEDEVAC. The ship's combat
information center (CIC) or its officer of the deck notifies the ESG/ARG or CSG tactical action officer (TAO) and combat information center watch officer (CICWO) using chat or secured radio communication. The TAO and CICWO notify the CATF or CSG surgeon, who then proceeds to the CIC to facilitate communication regarding the patient's condition and treatment/MEDEVAC plan.

2. Receiving ship. The receiving ship ensures the following:

a. The CATF and CSG surgeons communicate directly with the transferring provider and agree to accept
the patient(s).

b. The transferring provider and CATF and CSG surgeons agree on the details of transfer regarding using
litter or ambulatory, and requirements for medical attendants and medical equipment and supplies.

c. The ship's SMO/SMDR ensures the following:

(1) Treatment facilities are prepared IAW assessed condition.

(2) A triage medical team is assembled, if necessary.

(3) The ship's CO and executive officer (XO) are briefed about the MEDEVAC.

d. The patient is either brought into flight deck triage, well deck, or directly into medical as determined by
the SMO in coordination with ESG/ARG combat cargo, air operations, and flight deck control. From the flight deck triage, the patient goes to main medical using the elevator when moving a litter patient and using ladder wells and passageways when moving an ambulatory patient.

e. The MRCO or MAO ensures the following:

(1) Coordination with the TAO, operations officer, and air operations officer to plan MEDEVAC,
taking into account the operational situation and urgency of the MEDEVAC.

(2) The ESG combat cargo and air department are informed if a neck or back injury is involved to
ensure additional precautions are taken when offloading the patient from the helicopter.

(3) Consideration is given to providing trained stretcher bearers from the medical department.

(4) Receipt of medical record or patient consult form from transferring ship.

(5) Patient belongings are received from delivery aircraft.

(6) Close contact is maintained with air operations regarding arrival of MEDEVAC.

(7) 'A' Division is contacted when a flight deck elevator is needed for patient transport.

(8) The ramp door is opened if patient transport will be made via the flight deck ramp.

(9) Return of stretcher, hardware, and personnel to helicopter for return to the transferring ship.

f. The operations officer performs the following:

(1) Coordinates with air operations to contact the transferring ship regarding type of aircraft used for
transport

(2) Contacts air operations regarding type of aircraft, time of arrival, and other pertinent information

(3) Contacts ESG/ARG combat cargo regarding flight deck assistance and stretcher bearers

(4) Coordinates ship movement to arrive at recovery rendezvous.

g. The air operations officer ensures that a ready deck is available for aircraft recovery.

## 4.4.3.2 Patient Movement Ashore

The CATF and CSG surgeons, the MAO and MRCO, and the operations officer have the following duties and responsibilities for patient movement ashore:
1. The CATF and CSG surgeons perform the following:


a. The ship's CO, or Commodore in the event of ESG/ARG operations, makes the decision that a patient
needs MEDEVAC based on the recommendation of the surgeon.

b. If movement is to an MTF, the OFML, in collaboration with the MAO/MRCO, arranges direct
communication between the ship's SMO and physician at the accepting shore medical facility and sends
the patient consult to this physician.

c. If movement is to an international medical facility, follow guidelines for use by TGRO. (See paragraph
2.5 for additional information about health care in remote locations.)

d. Coordinate with primary providers to make the following medical determinations:

(1) Litter v. ambulatory

(2) Requirements for medical attendants

(3) Requirements for medical equipment/supplies.

2. The MRCO or MAO performs the following:

a. Creates and/or maintains the applicable AOR medical smart pack and establishes contact with
supporting PMRC for AOR

b. Enters PMRs into TRAC2ES for all patients requiring evacuation.

## Note

For Urgent/Priority patients, contact the supporting PMRC for assistance.


c. Contacts the OFML for MEDEVAC needs.

d. Coordinates MEDEVAC with air operations and operations officer.

e. Contacts OFML to verify when the hospital is ready to receive the patient and when transportation from
rendezvous point to hospital has been established.

f. Identifies a POC from the medical team standing by to take the patient and ensures that patient records
accompany the patient.

g. Ensures patient is delivered to flight deck with required documentation.

h. Contacts ESG/ARG combat cargo or air operations who will be loading the patient onto the helicopter.

i. Tracks patient, diagnosis, ship, referring physician, current status, location, and final disposition.

j. Composes and submits the MEDEVAC message.

k. If the patient is from ship's company, or attached to a ship comprising the CSG, the MAO notifies the
patient's COC. If the patient is from embarked units of the ESG/ARG, the MRCO notifies the patient's
COC.

3. The operations officer performs the following:

a. Obtains location coordinates

b. Contacts air operations to ready deck and fuel

c. Based on medical severity, composes and submits operations report NAVY BLUE message.

## 4.4.4 Amphibious Operations

During the phases of a conventional amphibious operation, patient movement functions and respective agency responsibilities include a preparation phase, a CATF surgeon, and a landing force (LF) surgeon.

## 4.4.4.1 Preparation Phase

Personnel in charge of planning and conducting medical regulating functions must closely coordinate their actions. The ATF surgeon (CATF surgeon) or LF surgeon (MEU surgeon), and supporting HSS staff must realize that patient movement depends upon coordination with other staff directorates besides HSS. The OPLAN and OPORD, including applicable appendices, must address medical regulating, patient evacuation, and en route care.

Patient movement can only be accomplished with the support of other elements of the task force (TF) and LF.

## 4.4.4.2 Amphibious Task Force Surgeon

The ATF and MEU surgeons are responsible for the formulation of the Services' patient movement system. Their responsibilities include the following:


1. Addressing the patient movement system in the OPLAN to provide policies and guidance for the operation,
including the theater evacuation policy when it is not stated in a higher echelon OPLAN.

2. Ensuring that a casualty receiving and treatment ship (CRTS) is designated in the OPLAN and has the
necessary HSS augmentation assets onboard.

3. Ensuring that the OPLAN communications annex establishes a MEDREGNET and procedures for the
conduct of patient movement among ships of the TF.

4. Ensuring that the HSS plan and the air plan address requirements for the MRT/MRCO to be collocated
with the aviation control agency and provide liaison or augmentation to the J/TPMRC to ensure reliable
communications during operations. The alternate medical regulating control agencies and subordinate medical regulators must have the same relationship with the subordinate aviation control agencies.

5. Ensuring that the OPLAN identifies patient movement assets aboard the primary control ship (PCS)
and secondary control ship (SCS).

6. Reestablishing and maintaining network control of the MEDREGNET until operational control (OPCON)
is passed ashore to the commander, landing force (CLF).

7. Identifying and requesting personnel augmentation to staff the medical regulating system, including
the J/TPMRC.

8. Requesting that the Air Force aeromedical evacuation liaison team (AELT) and mobile aeromedical
staging facility (MASF) facilitate evacuations out of the AOA.

9. Identifying the ATF MRCO and other ATF patient movement staff members.
 10. Ensuring that all members of the ATF patient movement system have been trained and understand the
procedures employed in the patient movement system before being assigned as a team member.
 11. Monitoring patient movement throughout the operation.

## 4.4.4.3 Landing Force Surgeon

The LF surgeon coordinates and plans LF patient evacuation and medical regulating to ensure a seamless transition with the ATF patient movement system. The LF surgeon must be prepared to assume patient movement responsibilities when OPCON passes ashore to the CLF. The LF surgeon:


1. Ensures the medical appendix of the LF OPORD addresses the patient movement system in sufficient
detail to ensure a seamless transfer of the patient movement system ashore, when appropriate

2. Ensures HSS assets (organic HSS units) are clearly identified and move ashore with appropriate serials

3. Ensures the communications plan includes activating and operating the MEDREGNET

4. Ensures the air plan and embarkation plan contain provisions for collocating the LF PEO and alternate LF
PEO with the primary and alternate air control agencies, respectively

5. Ensures patient movement personnel are assigned to each HSS facility ashore and that they embark on the
same ship/boat and land in the same serial as that unit

6. Ensures procedures are in place that permit the LF command post to alert the LF PEO of large numbers of
patients being evacuated from the forward areas

7. Ensures the G/S-3 (operations) coordinates task organization and the landing plan, the G/S-4 (logistics) for
embarkation, air officer for helicopter operations, and the G/S-6 (communications) officer for
communication support

8. Ensures all members of the LF patient evacuation team (PET) have been trained and understand the proper
procedures for patient movement

9. Ensures monitoring of patient movement throughout the operation.

## 4.4.4.4 Patient Movement Preparations

Initial preparations and placement of patient movement personnel takes place within the ATF and LF. Patient movement involving multiple ARGs within the ATF includes the following preparations:


1. The designated inbound MRT (per the MEDOPTASKSUP) is located on the CATF flagship (e.g., PCS)
and is collocated with the CATF surgeon. MRTs are also established on the SCS and each additional CRTS within the ATF. The designated inbound MRT has direct access to the MEDREGNET and functions as
network command and control for patient movement until control is transferred ashore, and is collocated with the aviation control agency of the TF.

2. All MRTs must have effective and reliable communications with the CIC. MRTs must receive current
information regarding patients requiring surface craft evacuation to a CRTS or the use of service craft to evacuate patients. After receiving information from the CIC, the inbound MRT informs the flagship CATF
surgeon of patients requiring evacuation. The CATF surgeon will make the determination as to which ship will receive casualties.

3.  The MRCO, in conjunction with the ATF surgeon, develops a patient loading plan for the ATF
CRTS(s).

4. The MRCO develops procedures for transporting patients to HSS facilities.

5. The MRCO establishes procedures for initiating either radio or message traffic regarding patient evacuation.

6. The MRCO/MRT receives and transmits information regarding HSS capabilities, patient evacuation status,
and other information over the MEDREGNET.

7. The inbound MRT maintains a spot status board on HSS facility status and capabilities.

8. The ship medical department notifies the MRCO whenever a change in status occurs in their department,
such as a change in new patient or transferred patient status.

## 4.4.4.5 Patient Movement Preparation Within The Landing Force


1. The MAGTF logistics combat element (LCE) provides patient evacuation personnel assets (LF PEO
and PET) for the LF.

2. The LF PEO embarks on the same ship and lands in the same serial as the LF direct air support center
(DASC).

3. Once ashore, the LF PEO collocates with the LF DASC. If collocation is not possible, the location of the
LF PEO is adjacent to that of the LF DASC. The LF PEO must have effective and reliable communication
with the LF DASC.

4. The LF PEO guards the MEDREGNET and monitors requests for patient evacuation.

5. The LF PEO has reliable communication via the MEDREGNET with each LF PEO located at the various
LF HSS facilities, with the LF alternate PEO, the ATF MRCO, and the J/TPMRC.

6. The LF PEO with the evacuation station communicates with the MRCO and may serve as a relay station
when communications deteriorate between the LF PEO and MRCO.

7. The evacuation station has reliable communications with air and surface elements of the landing support
battalion.

8. The alternate LF PEO's relationship with the alternate LF DASC is identical to the relationship between
the LF PEO and LF DASC. The same requirements apply to embarkation, landing, location, and communications.

9. The LF PEO and PET monitor air and surface evacuation networks continuously and act on requests from
network control for patient movement.
 10. The evacuation station functions as the collection, triage, emergency treatment, and evacuation agent for
patients received on the beach or in the LZ.
 11. The evacuation station establishes communications with the beachmaster element helicopter support team
(HST).

a. The LF PEO maintains a duplicate master facility spot status board for the LF.

b. The LF PEO is prepared to assume the duties of MEDREGNET control when OPCON shifts ashore
with the CLF.

c. The LF communications section provides the LF PEO and PET with the proper communication
equipment, classified materials, publications, and supporting services.

d. The LF communications section provides the LF PEO with telephone connectivity to the LF telephone
system.

e. The LF communications section provides communication links between the evacuation stations,
beachmaster, and shore party commander.

## 4.4.4.6 Executing Patient Movement During Amphibious Operations

As ship-to-shore movement progresses, beach evacuation stations (BESs) and helicopter evacuation stations
(HESs) are established at beach and landing zones and are collocated with the shore party and HST by the landing force support party. The shore party or HST relays MEDEVAC requests from the BES or HES. Requests from the BES are processed by the PCS MRCO via the MEDREGNET to advise the CATF surgeon of the request. The CATF surgeon recommends a CRTS that is capable of receiving and treating the casualties and the transportation mode. With PCS or helicopter support center (HSC) detachment concurrence for transportation, the PCS MRCO
advises the CRTS of incoming casualties and mode of transportation. Requests from the HES are processed by the PET collocated with the primary amphibious air traffic control center (AATCC). A helicopter is normally provided for urgent and priority precedence casualties located at the HES. With HSC detachment and PCS concurrence for transportation, the PET relays all information to the PCS MRCO who advises the CRTS of incoming casualties and mode of transportation. Prior to the establishment of a BES or HES, casualties may be placed onboard helicopters or in medical boats as lifts of opportunity. In this case, the helicopter or medical boat advises the primary AATCC or PCS of the MEDEVAC situation. The primary AATCC or PCS acting on the advice of the ATF surgeon directs the helicopter or medical boat to a CRTS. CRTSs provide periodic facilities spot status reports to the ATF MRCO to maintain the master facility spot status board current. As the assault progresses, the LF establishes MTFs ashore to augment the CRTSs.

When hospital ships enter the AOA and are within helicopter range, the ATF or LF MRCO directs casualties to the hospital ship. When the LF medical regulating control center is established and air control has been passed to the DASC, control of medical regulating may be formally passed ashore to the CLF. With medical regulating control ashore, CRTSs and MTFs ashore advise the LF medical planner of their current capabilities through facilities spot status reports. For further information on how Navy and Marine Corps planners execute the movement of personnel, equipment, and supplies from ships to shore in support of the LF, see NTTP 3-02.1M/MCWP 3-31.5, Ship-to-Shore Movement.

## 4.4.4.7 Medical Regulating Control Officer/Medical Regulating Team Responsibilities During Amphibious Operations


1. Receive and validate PMRs through radio communication, MEDREGNET, secure e-mail or chat, plain old
telephone system (POTS), or FAX.

2. Monitor patient movement activities and provide daily reports/situation reports (SITREPs) on matters such
as patient movement issues, overall and daily patient movement, and information on specific patients (as
requested).

3. Forward patient movement requirements to the appropriate transportation agency (JPMRC/TPMRC) for
patient movement mission execution.

4. Coordinate CRTS capabilities and patient status with other CRTS MRTs for patient movement of
casualties and stabilized patients.

5. Establish or coordinate with the TPMRC for the appropriate destination treatment facility and mode of
travel.

6. Maintain patient movement reporting and tracking procedures to include the following at a minimum:

a. Reporting of available assets (lifts and beds).

b. Designation of destination MTFs and an appropriate mode of transport.

c. ITV for both patients and related PMI.

7. Advise ATF surgeon on capabilities and limitations of supporting patient movement operations.

8. Coordinate with the ATF N-1 (Personnel) for mutual exchange of information.

9. Once the LF is established ashore, maintain close liaisons among the DASC, the air operations, combat
cargo, administration department, MTF units, facilities in theater, and theater patient movement command
and control elements.

## 4.4.4.8 Termination Of Amphibious Operations

The CATF may withdraw with the concurrence of the CLF when the forward line of own troops extends inland and the logistical support base is well established. At this point, responsibility for HSS falls on the CLF and is exercised through the LF surgeon. An AELT attached to the MASF can be assigned to assist the LF. Patient evacuation and regulating out of theater will be coordinated with the TPMRC.

## 4.4.5 Navy Forces Ashore

NAVFOR ashore utilize the medical resources of the Army or Marine Corps joint force land component commander and have been combined under the Navy Expeditionary Combat Command (NECC), the functional command that centrally manages current and future readiness, resources, manning, training, and equipping of the Navy's expeditionary forces. HSS personnel and equipment are organic to each component of NAVFOR ashore with a range of medical capabilities including first responder and FRC. The range of medical capabilities is accomplished by a hospital corpsman and medical officers assigned to the unit, and by the establishment of a battalion aid station (BAS) when deployed. The medical department organization consists of a SMO/SMDR, a hospital corpsman, and litter bearers.



## Chapter 5 Marine Corps Patient Movement Operations 5.1 General

Patient movement involves a synchronized system of evacuating patients only as far rearward in the continuum of care as the patient's medical needs dictate using limited HSS assets, with each asset complementing the capabilities of the others. Appendix E provides guidance on casualty categories and prioritization.

## 5.2 Patient Movement Organization And Relationships 5.2.1 Patient Evacuation Team Operations 5.2.1.1 Patient Evacuation Team Operations Afloat

The commander, amphibious task force (CATF) controls medical regulating until OPCON passes ashore. The CATF exercises command and control of medical regulating through the TF medical regulating officer via the CATF surgeon. Commander, landing force (CLF) exercises command and control of patient movement through the PET via the LF surgeon. Detailed coordination and planning is required to effect this transition. Normally, requesting units make CASEVAC requests by radio to the AATCC on the helicopter direction net when control is sea-based or under the DASC and on the tactical air request (TAR)/helicopter request (HR) net when command and/or net control has been passed ashore. The air officer will then consult with the ATF MRCO when sea-based, and the LF PEO or PET when ashore, for recommendations on the best medical facility.

## 5.2.1.2 Patient Evacuation Team Operations Ashore

When conducting operations ashore, the PET coordinates patient movement by ground or air transport or a combination of the two, from POI to FRC and between various roles of care. The DASC and PET receive patient evacuation requests via the nine-line MEDEVAC request (see figure C-4, appendix C) over the tactical air request/helicopter request net or alternate communication route. The PET then determines the appropriate means of patient movement and destination HSS facility. If air is the appropriate evacuation means, the DASC coordinates air support. If ground evacuation is required or more appropriate, the PET informs the requesting unit to coordinate patient movement with the G-4 or LCE and will assist as necessary. The PET will track all patient movement through completion of the mission. Depending on the size of the operation, the PET might only assume responsibility for patient movement from POI to FRC, and the Marine logistics group (MLG) health service support element (HSSE)/medical support operations center (MSOC) or higher regulating authority will assume movement above FRC. This should be decided prior to deployment and written into the annex Q (Medical Services) of the OPLAN or OPORD.

## 5.2.1.3 Patient Evacuation Team Structure

The PET consists of the operations section within the medical battalion and reports to the MSOC prior to deployment. The LF surgeon will maintain an OPCON relationship with the PET. The PET is designed to be
located with the DASC, but can be located within other units to facilitate patient movement. This should be decided prior to deployment and written into the annex Q (Medical Services) of the OPLAN or OPORD.


1. A PET can be located with the Marine air-ground task force movement control center (MMCC) for ground
patient movement.

2. A PET can be located with the tactical air control center.

## 5.2.1.4 Patient Evacuation Team Staffing

The PET is made up of Navy personnel from the medical battalion and is augmented, when deployed, with two Marine radio operators from the communications company, MLG. The PEO is a Navy Medical Department Staff Corps officer trained in medical regulating. Usually, two PEOs are assigned to the PET. The senior PEO also functions as the PET officer in charge (OIC). If other PETs are deploying, additional personnel may be required.

It is the responsibility of the MLG HSSE to coordinate augmentation requests for additional support.

## 5.2.1.5 Roles And Responsibilities Of Patient Evacuation Team Personnel


1. PET officer in charge. This position has responsibility for the PET and works closely with the MSOC to
coordinate the theater patient movement plan. The OIC coordinates the work of the PET chief, patient
evacuation clerks, and Marine radio operators, and establishes and maintains close liaison with the DASC officers, the MAGTF air officers, the MAGTF G-1, the PEOs of HSS treatment units and facilities in theater, and theater patient movement command and control (C2) elements. The OIC functions as the shift
PEO and is responsible for all patient movement while on duty during the shift.

2. PET chief. This position is responsible for the enlisted Sailors and Marines of the PET and assists the PET
OIC in administrative requirements, including personnel, equipment, supply management, and patient
evacuation record keeping. The PET chief functions as the shift PEO while on duty and coordinates with
DASC and MAGTF senior enlisted leaders.

3. Patient evacuation clerks. Five enlisted hospital corpsmen, including one chief petty officer, trained in
medical regulating are the patient evacuation clerks, whose responsibilities include:

a. Monitoring and communicating on the MEDREGNET, SIPRNET and Nonsecure Internet Protocol
Router Network (NIPRNET) e-mails, the secure field telephone, and iridium (satellite) phone

b. Updating patient movement logs and electronic facility spot status boards as new information becomes
available

c. Updating the PET's display map of theater HSS assets

d. Printing and filing hard copies of the patient movement log and electronic facility spot status board

e. Sending periodic updated patient movement log as directed in rotation reports per annex Q or OPORD.

f. Assisting the shift PEO in deciding the destination HSS asset and means of transportation for all
casualties within the PET's geographic AOR.

4. Radio operator and maintenance Marines. The PET includes one Marine radio operator and one Marine
radio maintenance technician. The Marines are responsible for establishing/maintaining, packing, and troubleshooting all PET communication equipment and establishing/maintaining communication on the MEDREGNET.

5. PET medical regulators. The PET functions as a liaison with the theater medical regulating officers to
obtain information for commanders. All PET medical regulators (PEO/OIC, PET chief, and patient
evacuation clerks) maintain broad situational awareness of the following:

a. Current tactical situation, including disposition of friendly forces, offensive posture, and hostile threats,
which is predictive of casualty load and estimated geographic locations where casualties can be
expected

b. Evacuation and emergency medical logistics missions planned and underway

c. Availability of en route care and CASEVAC team

d. Dedicated and designated air and ground evacuation assets available

e. Weather conditions (flyable or not) at HSS facilities and airfields where air evacuation assets are
stationed

f. Last 24 hours of SITREPs from medical commands located in the PET's AOR

g. Location and status of HSS treatment facilities in theater, including LZ information and status, and
status of specialty equipment and specialists at those facilities

h. Points of contact

i. Shared responsibility during their shifts for deciding the destination HSS asset and means of
transportation for all casualties within that PET's AOR.

## 5.2.1.6 Patient Evacuation Team Table Of Equipment

The PET table of equipment allows clear communication with all medical elements within the battlespace. The PET guards the MEDREGNET at all times. An MRC-138 radio high-mobility multipurpose wheeled vehicle (HMMWV) with its antenna or a field expedient antenna and AN/GRA-39 remote provides the required communication distance and power necessary for the MEDREGNET. Additionally, the PET uses SIPRNET
medical regulating chat, SIPRNET and NIPRNET e-mails, iridium (satellite) phones, and the secure field telephone. Rolling stock includes one MRC-138 radio HMMWV for personnel transport with one M-101A trailer for gear.

## 5.2.2 Ground Casualty Evacuation Organization 5.2.2.1 Ambulance Driver

Ambulance drivers and medical corpsmen are responsible for the ambulance at all times. The ambulance driver performs maintenance on the vehicle and is responsible for reporting major deficiencies to the section chief or supervisor. The ambulance driver and corpsman perform emergency medical interventions and provide emergency medical treatment in addition to driving. The ambulance driver performs the following tasks to provide maximum safety and welfare for the patients:


1. Ensures the patient is secured to the litter prior to loading

2. Ensures operational readiness and responsiveness accomplished by maintaining and using authorized
equipment aboard the ambulance, including:

a. Litters

b. Blankets

c. Splints

d. Medical expendables

e. Flashlights

f. Auxiliary fuel

g. Decontamination equipment.

3. Ensures the required information, tools, and equipment are obtained to navigate to the pickup location, including
a map, tactical overlays, map coordinates, a compass, and position locator equipment, when available

4. Prepares the ambulance for patient loading and unloading

5. Assists litter bearers in patient loading and unloading

6. Performs property exchange when patients are loaded or unloaded

7. Provides emergency transport of medical personnel, medical supplies, and blood and blood products

8. Acts as a messenger for medical channels.

## 5.2.2.2 Hospital Corpsman As Assistant Driver

The hospital corpsman acts as an assistant driver and performs the following duties:


1. Reviews information on the field medical card and becomes familiar with the condition of each patient
being evacuated

2. Coordinates with individual(s) in charge for special instructions in the care and treatment of patients
en route

3. Provides emergency medical treatment

4. Provides periodic checks of patients while en route

5. Supervises and assists in loading and unloading the ambulance

6. Assists the ambulance driver with land navigation and guides the driver when backing and moving off
roads and when under blackout conditions.

## 5.2.3 Air Casualty Evacuation Organization

The air CASEVAC organization coordinates CASEVAC activities with other combat units, administrates supply requirements of the CASEVAC medical team, maintains CASEVAC mission records, and manages a quality assurance process for continuing improvement in CASEVAC operations.

## 5.2.3.1 Casevac Medical Team

The core of CASEVAC medical operations is the CASEVAC medical team, which consists of two or more providers staffing the CASEVAC aircraft. The CASEVAC medical team is responsible for the following:


1. Ensures CASEVAC aircraft is properly equipped to carry out the CASEVAC mission

a. All gear on the minimal equipment list is loaded on the aircraft

b. All battery-powered equipment is fully charged

c. All oxygen tanks are full

d. Litters are appropriately configured for efficient loading and unloading of patients

e. All medical flight gear and medical equipment are fully functional

2. Completes CASEVAC run sheets in a timely and accurate fashion

3. Triages and manages the patient load

4. Communicates relevant patient information to the pilot in command

5. Makes recommendations if deviation from the destination is issued by the DASC/PET

6. Assists in the patient loading and unloading

7. Assists in managing the LZ.

## 5.2.3.2 Casevac Team Leader

During each shift, one corpsman assumes the role of medical team leader. The medical team leader is directly responsible for supervising the conduct of all CASEVAC missions during the shift and for ensuring the missions proceed smoothly. The team leader assumes the following additional responsibilities:


1. Supervises the turnover of all CASEVAC gear during the change of shift, including maintaining all logs
for narcotics and gear transfer

2. Ensures the prompt replenishment of supplies expended during CASEVAC missions

3. Ensures all battery-powered medical equipment is charging when not in use or staged aboard aircraft

4. Monitors aeromedical factors in all CASEVAC pilots and aircrew and reports signs of fatigue to the
CASEVAC surgeon.

## 5.2.3.3 Casevac Leading Petty Officer

The leading petty officer (LPO) of the CASEVAC squadron's medical department normally holds the position of CASEVAC LPO and is appointed by the CASEVAC surgeon. When CASEVAC operations within a region involve only one squadron, the squadron's CASEVAC LPO may fill the responsibilities of the AOR CASEVAC LPO. The CASEVAC LPO's duties include the following:


1. Creates and submits schedules for medical teams to the squadron's operations department to be added to
the squadron's daily flight schedule.

2. Collects and compiles all CASEVAC run sheets.

3. Collects and maintains statistics of all CASEVAC providers pertaining to flight time, number of missions
flown, number of patients cared for, and instances of patient management that required a high level of medical skill, courage, and resourcefulness.

4. Ensures that the squadron's operations department maintains a current roster of all providers flying on
CASEVAC missions. This roster must include the providers' names, ranks, and social security numbers so that all providers can be documented on a naval flight information record at the conclusion of each mission.

5. Supervises the squadron's stock of CASEVAC equipment and supplies, and submits timely requests for
replenishments.

6. Maintains custody records for storage and use of narcotics.

## 5.2.3.4 Wing Surgeon


1. Roles and responsibilities of the wing surgeon include the following:

a. Provides leadership and supervision to all medical providers participating in a squadron's CASEVAC
mission.

b. May fill the responsibilities of the AOR CASEVAC surgeon when CASEVAC operations within a
region involve one squadron.

c. Ensures that all medical care rendered during CASEVAC missions meets the standards of care
appropriate for the environment.

d. Collects and reviews CASEVAC run sheets.

e. Identifies problems encountered during missions and develops solutions to the problems.

f. Collects and disseminates MTF information to medical providers and the squadron operations
department. MTF information includes locations and capabilities of FRC, theater hospitalization facilities in the region, and the availability of a subspecialty at only one site. This information directly impacts in-flight triage and subsequent flight vectoring decisions.

g. Forwards CASEVAC run sheet data to the AOR CASEVAC surgeon or appropriate collecting agency.

h. Functions as liaison between the squadron and receiving medical facilities, especially when
communications or patient transfer procedures fail.

i. Reviews selected CASEVAC missions with the PET with a goal of continually improving coordination
and cooperation between the PET and CASEVAC team.

j. Reviews and supervises custody records for the storage and use of narcotics.

k. Ensures CASEVAC providers are prepared for missions by periodically assessing their level of medical
knowledge, providing medical instruction on relevant topics, and debriefing complex missions.

2. Monitoring personnel professionalism. The wing surgeon should work to maintain an environment
designed to constantly improve the CASEVAC system similar to the approaches of the FAA [Federal
Aviation Administration]  or Naval Safety Center. Encouraging the practice of self-reporting errors is a
tool to prevent errors from being repeated. The wing surgeon should advise providers that reporting errors
made in the conduct of a mission will not be met with disciplinary reprisal. Nonpunitive approaches to
correcting errors or the events that led to an error will be pursued. While managing the providers on the
teams, the wing surgeon may encounter individuals who do not possess the clinical capability, personality, or aeronautical adaptability to adequately staff CASEVAC missions.

3. Monitoring psychological stress. The wing surgeon monitors the psychological impact of missions on
providers. The wing surgeon identifies a provider's psychological state, observes and identifies changes, determines underlying causes, and intervenes to reduce the level of stress the provider is encountering.
In addition to operational fatigue, other stresses impacting the CASEVAC provider's emotional state include:


a. Guilt over a patient who died during transport

b. Nightmares triggered by the visions of profound trauma

c. Frustration that in-flight triage recommendations were not followed

d. Fear resulting from a flight that became dangerously close to hostile fire or mishap

e. Distraction generated by the provider's own uncertainty as to whether a particular case was managed
appropriately.

## 5.2.3.5 Helicopter Aircraft Commander

The helicopter aircraft commander (HAC) is responsible for safe conduct and flight and mission success, and makes the final decision on where an aircraft travels. Medical personnel onboard do not have final authority for where CASEVAC patients are delivered. To arrive at a destination decision, the HAC must consider aircraft factors, information provided by medical personnel, and information from the DASC/PET squadron intelligence and operations officers. Instances of medical teams failing to demonstrate respect for flight decisions made by the HAC or section leader should be reported to the appropriate level SMO or CO.

## 5.3 Patient Movement Command And Control Organization 5.3.1 Medical Support Operations Center 5.3.1.1 Medical Support Operations Center Responsibilities

The MSOC is staffed by the MLG HSSE and functions within the MLG command center (CC), which supports forward and rear CCs. The MSOC is responsible for the following:


1. Establishes patient evacuation procedures

2. Advises the commanding general and MLG

3. Facilitates the distribution of Class VIII (A/B) supplies

4. Collects, analyzes, and distributes medical data from all HSS units to higher authority and supported units.

## 5.3.1.2 Medical Support Operations Center Communications

The MSOC monitors patient movement in the MLG. The MSOC has communication links with the following:


1. DASC

2. Subordinate elements

3. Surgical companies (SCs)

4. Forward resuscitative surgery system (FRSS) units

5. Shock Trauma Platoons

6. Theater hospitalization MTFs

7. CRTS in the AOA.

## 5.3.1.3 Coordinating Patient Movement


1. The PET interfaces with the MAGTF aviation combat element (ACE) through the air liaison officer
(ALO). The PET or DASC provides aeromedical input into the planning and coordination of the patient
evacuation mission.

2. For ground evacuation, the PET interfaces with the MSOC in the MLG CC and with HSSEs in the LCE
headquarters (HQ) for efficient and effective patient movement.

## 5.3.2 Direct Air Support Center

The DASC is the principal air control agency for the direction of air operations directly supporting ground forces.

It processes and coordinates requests for immediate air support, including MEDEVAC, and coordinates air missions requiring integration with ground forces and other supporting arms. Additionally, the DASC serves as the primary processing point for all MEDEVAC requests.

## 5.3.3 Marine Logistics Group Air Liaison Officer

The ALO is a naval aviator with a secondary function as an air officer/forward air controller. The ALO is responsible for providing aviation liaison to the MLG in all matters pertaining to intratheater airlift, air fires, aviation planning (including HSTs), and air delivery. The ALO supports the force protection/fires section for targeting, local security and close air support requirements, and the MSOC in patient movement; and registers air tasking order requests for future designated patient evacuation standby aircraft.

## 5.3.4 Movement Control Organizations

At the direction of commander, Marine Corps forces, the Marine expeditionary force (MEF) activates a series of movement control agencies, both at the operational and tactical levels. These organizations help the MAGTF commander move forces to deploy/redeploy and function in the same manner during both peacetime and periods of conflict.

## 5.3.4.1 Marine Air-Ground Task Force Deployment And Distribution Operations Center

The Marine air-ground task force deployment and distribution operations center (MDDOC) provides the MEF
commander with the ability to control and coordinate all deployment activities. The MDDOC coordinates with USTRANSCOM and the transportation operating components regarding transportation requirements, priorities, and allocations. The operating components are the Military Sealift Command, AMC, and Surface Deployment and Distribution Command.

## 5.3.4.2 Marine Air-Ground Task Force Movement Control Center

The principle focus of the MMCC is to allocate, schedule, and coordinate ground transportation requirements based on the MEF commander's priorities. It requires significant augmentation to exercise command, control, and enforcement over movement control. The MMCC supports the planning and execution of MAGTF movements and reports directly to the MDDOC. The MMCC may be augmented by base, station, HN, or other organizations.

Separate MMCCs support units or elements moving from separate geographic areas.

## 5.3.4.3 Unit Movement Control Center

Every deploying unit down to the battalion, squadron, and company level activates a unit movement control center (UMCC). UMCCs may consist of a single individual.

## 5.3.5 Aeromedical Evacuation Liaison Team

The Air Force AELT provides support between the forward user and the aeromedical evacuation system (AES) in the form of operational and clinical interface. This support may occur at locations that do not otherwise have Air Force personnel, such as far forward/bare bases and shipboard. The flight nurse liaison assists the local medical unit to prepare patients for flight. The administrative officer is responsible for working with the airlift center and aerial port elements to ensure that the aircraft is properly configured and that equipment pallets, patients, and support personnel are properly manifested on the AE mission. The communications personnel may be integrated into the airlift operations element supporting flight line operations or the wing operations center. Establishing a communication network with airlift operations is essential for rapid evacuation. When an AELT is collocated with the MEF, the AELT is able to provide the following:


1. Communication link between MEF patient movement entities and the AES

2. Coordination of MEF PMRs and subsequent movement activity between the AECC [aeromedical
evacuation control center] and the MEF

3. Reporting of requirements for special equipment and/or medical attendants to accompany casualties during
flight.

## 5.3.6 Mobile Aeromedical Staging Facility

The MASF provides rapid-response patient staging, limited holding, and emergent AE crew support capability.

The MASF provides forward support with the smallest footprint and is usually the AE element used in support of special operation forces. The MASF is located at or near airheads capable of supporting conventional mobility airlift and may be augmented with additional personnel and equipment to increase patient staging capability as needed. It can serve as the entry point of MEF patients into the Air Force AES when collocated.

## 5.4 Patient Movement Communication Plan 5.4.1 Movement

Primary communication for movement control and coordination is a combination of radio, SIPRNET (chat, e-mail, and Web), and the secure field telephone. Point of wounding and BAS communication to the battalion command element is primarily through radio or field telephone. In addition, communication between the battalion/regimental COC and the DASC is through the tactical air request/helicopter request (TAR/HR) net or field telephone. The MSOC communicates with the DASC/PET, LCE HQ, and forward units through SIPRNET, secure field telephone, and/or radio. The MSOC maintains a C2PC [command and control personal computer] Web-based map overlay that communicates current locations of all casualty care and movement assets.

## 5.4.2 Medical Regulating Network

The MEDREGNET is used as a communications link to pass pertinent patient information and to serve as a means of communication between all HSS units. The network is used for passing reports and spot status on FRC beds when other communication is not available. The PET, the LCE HQ, and the SCs should guard this network. The MLG MSOC serves as net control. Communications over the MEDREGNET are usually secure with frequencies published in the OPLAN or annex K of the OPORD. The MEF trains personnel assigned to perform patient evacuation/medical regulating functions, such as monitoring the MEDREGNET 24 hours per day, submitting reports, and maintaining medical logs. Patient evacuation personnel and the MEF must have reliable access to the MEDREGNET and establish internal procedures to monitor the network and to maintain required logs.

## 5.4.3 Patient Evacuation Team Record Keeping And Documentation

The PET maintains electronic and hard copy information documenting all activities, to include PET coordinated patient evacuation missions and information from the supporting HSS units pertinent to patient evacuation and medical regulating. Appendix C provides the medical reports utilized by the PET. The following information must be documented:


1. Watch stander information.

a. Name

b. Rank

c. Duty times and dates.

2. Facility spot status board. A copy of a facility spot status board (such as an Excel spreadsheet) is saved
electronically and printed at the beginning of each shift, every four hours, and periodically as facilities' statuses change significantly. Appendix D provides the patient movement status board formats.
The facility spot status board should be updated when the PET receives the following:


a. A facility spot status report or medical SITREP on any HSS asset

b. Confirmation of a patient evacuation mission departing any HSS asset with patients onboard

c. Confirmation of CASEVAC or MEDEVAC mission arriving at any HSS asset with patients onboard.
3. Mission tracking board. The following information should be recorded on a mission tracking board (such
as an Excel spreadsheet) for all helicopter and ground evacuation missions:

a. Date

b. Time request received

c. Time mission launched

d. Ground/sea vehicle type

e. Air dedicated/air lift of opportunity vehicle type

f. Mission call sign

g. Air request number

h. Air mission number

i. Number of urgent patients each mission

j. Number of urgent surgical patients each mission

k. Number of priority patients each mission

l. Number of routine patients each mission

m. Total patients each mission

n. Pickup unit

o. Pickup location grid coordinates

p. Dropoff unit

q. Pickup time

r. Dropoff time

s. Elapsed time from request receipt to dropoff

t. Nationality of patients

u. Miscellaneous remarks.

4. Reports. A copy of all reports obtained by the MSOC and PET must be saved electronically and the hard
copies printed. The reports most relevant to patient movement are found in appendix D.

## 5.5 Patient Movement Operations 5.5.1 Command And Control And Intratheater Patient Movement

This process refers to medical regulating and the movement of patients through capabilities of care within a CCDR's AOR. Medical personnel regulate the flow of patients based on available bed capacity and medical requirements.

## 5.5.1.1 Theater Medical Regulating

The theater commander may perform C2 from first responder capability through the definitive care capability by the theater MRCO, or as directed. The MLG health service support officer (HSSO) is responsible for coordinating with the theater MRCO for medical regulating patients from FRC capability Marine Corps MTFs to higher-level MTFs. Additionally, the MLG HSSO may be required to perform medical regulating until a J/TPMRC is established. Detailed information is listed in the OPLAN or OPORD (appendix 1 to annex Q and/or appendix 9 to annex D).

## 5.5.1.2 Sea Based Medical Regulating

While C2 is sea based, the JFMCC/TF/ARG surgeon is responsible for patient movement and medical regulating and coordination with the J/TPMRC.

## 5.5.1.3 Medical Regulating Ashore

When OPCON passes ashore, responsibility for evacuation of casualties is assumed by the accepting unit. The MLG HSSO is responsible for planning and coordinating CASEVAC, providing trained personnel to function as the LF MRCO and PET to the control authorities for aviation and ground transportation, and providing medical regulation. The MEU medical planner/HSSO is responsible for coordinating the same with the ACE, the battalion landing team (BLT), and the combat logistics battalion (CLB).

## 5.5.2 Command And Control And Intertheater Patient Movement 5.5.2.1 Intertheater Patient Movement

The J/TPMRC is responsible for coordinating intertheater patient movement (strategic AE and medical regulating) of casualties from theater hospitalization capability medical facilities. If an AELT is provided, it will be under the direction of the LF MRCO and utilized to coordinate fixed-wing intratheater and intertheater AE of patients. (See appendix B for more information on patient movement transportation assets.)

## 5.5.2.2 Sea Based Intertheater Patient Movement

Patient movement can occur directly into the intertheater patient movement system based on access, availability regulating requirements, and IAW the established C2 structure.

## 5.5.2.3 Patient Movement Ashore

When command and/or net control has been passed ashore, requests will be directed to the DASC for MEF and Marine expeditionary brigade (MEB) operations and the air support element (ASE) or DASC for MEU operations on the TAR/HR network. The helicopter director consults with either the ESG/ARG MRCO when sea based or the LF MRCO, through the PET located in the ASE/DASC when ashore, for primary and alternate MTFs, location, availability, LZ coordinates, radio frequencies, and ensures the designated facility has the capability commensurate with the casualty's condition. During MEF and MEB operations, the MLG HSSO, located in the MSOC of the combat service support operations center (CSSOC), supervises the LF MRCO, who oversees two PETs. The primary PET is collocated with the DASC; the secondary PET may be collocated with the MMCC, also in the CSSOC. During MEU
operations, the LF MRCO is the MEU medical planner. The LF MRCO coordinates with the ESG/ARG MRCO, J/TPMRCO, and if provided, the AELT. The LF MRCO maintains the master medical facility spot status board, controls the MEDREGNET, and maintains the patient movement log. The MMCC PET is responsible for coordinating ground evacuations of casualties in coordination with the MMCC and supporting patient tracking. The MMCC PET maintains a duplicate medical facility spot status board and is prepared to assume the responsibilities of the primary PET.

## 5.5.3 Ground Casualty Evacuation

Based on the criticality of the casualties and the availability of air assets, the PET may direct casualty movement using ground assets. Rearward medical units go forward to pick up casualties. Ground evacuation is divided into two stages:


1. Stage 1 is movement from division units to the direct support (DS) LCE unit. The DS LCE unit has STPs, a
FRSS, or combination of both. The PET will contact the LCE HQ in DS of division units and provide MEDEVAC request form information to coordinate ground transportation. The LCE plans and coordinates the movement with the regimental HQ and determines the requirements for an ambulance exchange point
(AXP).

 Patients evacuated by ground transport to the LCE should be treated and either returned to duty or
evacuated to the rear. The LCE HQ immediately notifies the PET and the MSOC of the disposition of the casualties over the SIPRNET, secure field telephone, or the MEDREGNET.

2. Stage 2 movement is from the DS LCE unit to the general support (GS) LCE unit with FRC capability. The
PET contacts the MLG MSOC or GS LCE HQ and provides MEDEVAC request form information to
coordinate ground transportation. The MLG MSOC/MMCC and GS LCE coordinates the movement with
the DS LCE HQ and determines requirements and location for an AXP.

## 5.5.3.1 Ground Ambulances

Ground ambulances are vehicles designed for carrying patients, and are staffed with a driver/corpsman qualified in basic emergency medical treatment procedures. They are dedicated assets for the medical mission and are organic to HSS units that evacuate sick, injured, and wounded Marines and Sailors by ground ambulance.

Appendix G, figure G-1, includes the litter, ambulatory and attendant capacity for the various ground ambulance and ground vehicles of opportunity. The Geneva Conventions stipulate that ground ambulances be clearly marked with the distinctive Red Cross emblem on a white background. Camouflaging or not displaying the Red Cross emblem can result in the loss of the protections afforded under the Geneva Conventions. Guidance regarding the camouflage of medical units, vehicles, and aircraft on the ground is contained in Standardization Agreement 2931, Camouflage of the Red Cross and Red Crescent on Land in Tactical Operations.

Field units may operate military field ambulances on paved and secondary roads, trails, and cross-country terrain. Field ambulances operating in the forward areas of the CZ [combat zone]must possess mobility and survivability comparable to the units being supported. Current field ambulance variations include the HMMWV D 1001, HMMWVD 1002 (soft 18 top) and the MRAP CAT II ISS. These ambulances are used to evacuate patients from frontline units to BASs.

## 5.5.3.2 Ambulance Loading And Unloading

In loading and unloading ambulances, litter patients are moved carefully. Details of the loading and unloading procedures vary slightly depending on the number of bearers, the presence or absence of a medical corpsman, and the type of vehicle. The procedures for ambulance loading and unloading are as follows:


1. Patients usually are loaded headfirst except when they have head injuries. Patients placed headfirst, in the
direction of travel, are less likely to experience motion sickness, nausea, and noise from rear doors opening
and closing. Loading patients headfirst protects them from further injury in the event of a rear-end collision.

2. When a patient requires en route care for an injury to one side of the body, it may be necessary to load the
patient feet first to make the injured side readily accessible from the aisle. Patients with wounds of the
chest or abdomen and those receiving IV fluids are loaded in lower berths to provide gravity flow. For ease
of loading and patient comfort, patients wearing bulky splints should be placed on lower berths.

3. A three-man team is required to load and unload the ambulance. The sequence for loading four litter
patients in the berths is upper right, lower right, upper left, and lower left.

4. The most seriously injured patients are loaded last to ensure they are the first to be taken out of the
ambulance. The sequence for unloading is the reverse of loading.

5. The loading/unloading team must ensure that straps and equipment do not inhibit litter loading operations.

6. When patients are picked up from several locations, loading the least seriously injured patient first and the
most seriously injured patient last cannot always be applied. A previously loaded patient should not be
unloaded in order to maintain the loading sequence.

7. The receiving MTF must be made aware of the most seriously injured patients.

8. When loading more than two litter patients, the upper litter rack patients must be loaded first. Injury may
result if litter patients are loaded in lower racks first.

9. When unloading more than two litter patients, lower litter rack patients must be unloaded first.

## 5.5.3.3 Rules For Employment Of Ambulance And Ambulance Personnel


1. The use of ambulances is restricted to the transportation of the following three categories:

a. Sick or injured personnel

b. Medical personnel

c. Class VIII supplies/equipment and blood.

2. Medical personnel assigned to the ambulances will:

a. Adhere to the tactical CO's standards for uniforms, camouflage, and other requirements identified in the
supported unit's tactical SOP

b. Participate in the medical training being conducted at the supported medical element

c. Assist with patient treatment

d. Perform preventive maintenance checks on vehicles

e. Ensure vehicles are restocked with required Class VIII supplies, full of fuel, and ready for the next
evacuation mission.

3. Medical personnel assigned to the ambulances that are positioned with the supported medical element will
not:

a. Be required to perform duties such as mess duty, detainees or perimeter guards, or drivers of other than
the assigned vehicle

b. Violate the provisions of the Geneva Conventions.

## 5.5.4 Air Casualty Evacuation 5.5.4.1 Phase I

Evacuation via air is the preferred method for transferring critically wounded patients whose survival depends on immediate surgery. Rotary-wing units shall initiate patient evacuation by submitting the nine-line MEDEVAC request to the PET via internet relay chat client for Microsoft windows chat. These requests are then forwarded to the DASC over the TAR/HR network for air evacuations. In conjunction with the DASC, the PET determines when AE is used based on the patient's condition and air asset availability. The DASC records the information from the MEDEVAC request on an assault support request (ASR) form and then passes it to the PET. The PET reviews the spot status board and coordinates with the MSOC to recommend an evacuation mode and a destination MTF. The DASC personnel can accept or reject the PET's recommendation based on tactical circumstances and availability of transportation assets. If rejected, the PET
coordinates with the MSOC or the LCE to recommend either alternative destination MTFs or the use of ground movement assets. Coordination between the PET, DASC, LCE, and MSOC ensures that the patient receives appropriate care, that no MTF is overloaded, and that the tactical situation is not negatively impacted. DASC personnel record the destination MTF on their ASR form and dispatch a helicopter for the CASEVAC mission. DASC personnel will contact the battalion or LCE HQs and inform them of the estimated time of arrival of the helicopter at the designated LZ, relay any special coordinating instructions, and identify destination facility. The PET notifies the MSOC and destination MTF over SIPRNET e-mail, secure field telephone, or MEDREGNET of the patient evacuation mission. Timely notification of the destination MTF is essential to ensure the PET can prepare to receive the incoming casualties and transport them from their LZ. The PET and MSOC will record required information in their respective patient movement logs and will monitor the CASEVAC mission until the casualties are received at the destination MTF.

## 5.5.4.2 Phase Ii

The AELT will register the MLG requirements with the JPMRC, who will designate fixed-wing lift and a destination facility. Upon notification by the JPMRC, the AELT will notify the SC/MSOC/PET when the patient must be moved to the airfield or MASF for AE. The supporting LCE/MSOC/MMCC will coordinate the use of Marine Corps transportation assets (ground or air) to move patients to the designated MASF for evacuation out of theater.

Air evacuation is accomplished for urgent and urgent surgical category patients. Use of air assets for CASEVAC depends on METT-T. Within the MEF, the MLG HSSE, in conjunction with the MLG MMCC, plans for MEDEVAC aircraft. In most cases, the limited number of aircraft in the Marine Corps inventory precludes the assignment of dedicated aircraft, which are externally marked with a red cross and reserved to support the MEDEVAC mission. All Marine Corps rotary-wing and utility aircraft have the capability to perform the CASEVAC mission. The effectiveness and efficiency of HSS is enhanced by air evacuation to:


1. Remove patients from otherwise inaccessible areas

2. Circumvent fixed defenses and natural obstacles

3. Deliver medical supplies and blood products

4. Provide a means of rapid evacuation

5. Provide emergency airlift of medical personnel, equipment, and supplies.

## 5.5.4.3 Landing Zone Considerations

LZs for CASEVAC operations are the responsibility of the supported unit. BASs are responsible for establishing the LZ for CASEVAC operations. LZ selection criteria for the CASEVAC LZ are location, marking, communications, capacity, and obstacles.


1. Location. The LZ must be in close proximity to the aid station but at a distance that will not interfere with
aid station operations. Casualties may have to be carried by hand to the waiting aircraft. Establish the LZ downwind from the aid station, if possible, to prevent blowing dust on the aid station. A minimum distance of 150 meters should be acceptable to keep aircraft from interfering with aid station operations.

2. Marking. LZ markings must be visible from the air. During daylight operations the LZ can be marked
using a visual signal (VS)-17 panel, smoke, or signal mirror. If a VS-17 panel is used, ensure it is visible
from the air. At night, an inverted Y is used to designate the aircraft touchdown point. However, this may not be visible from the air. LZs should have a far recognition signal, such as a swinging chemlight or
strobe light for easier locating.

3. Communications. Maintaining air-to-ground communications between the aircraft and the LZ will make
movement times faster and assist the aircraft in locating the LZ.

4. Capacity. LZ selection is based on the number and type of aircraft that will be used for the CASEVAC
operation. The LZ size will determine the number of aircraft that can be landed at one time to load casualties.

5. Obstacles. LZs should be free of obstacles such as cables, wires, antennas, large rocks, excessive slope, and
large ruts making the location unsuitable. Obstacles that cannot be cleared from the location should be marked. If communications are maintained with the aircrew, LZ hazard advisories should be provided to the crews.

## 5.5.4.4 Landing Zone Criteria

Small unit leaders should be proficient in selecting and marking pickup zones (PZs)/LZs and in providing terminal guidance to aircraft. Each helicopter requires a different size PZ/LZ, and each area needs to be on level ground. Lighting conditions affect the size of the LZ for each helicopter: daylight zones should be 100 feet larger than the diameter of aircraft rotor blades and night zones should be 150 feet larger than the diameter of aircraft rotor blades. There are three major considerations in evaluating the landing area:


1. The height of obstacles determines the approach angle. The higher the obstacle, the larger the area required
for the helicopter to land. When tactically feasible and the aircraft is properly equipped, the only option is a hoist operation. A hoist operation takes longer to accomplish, and the aircraft is a more exposed target.

2. Clear debris and obstacles for a 50-meter radius of the LZ. Ensuring LZs in a combat environment are clear
of debris within a 50-meter radius may not be possible. Helicopters produce high winds causing rotor washed debris to be thrown, injuring personnel and damaging equipment. Additional safety precautions for
ground personnel include:

a. Protecting eyes and patients from flying debris.

b. Remaining clear of helicopter rotor blades and the tail rotor at all times.

c. Exercising extreme caution on a sloped LZ because it may be difficult to see the spinning blades.
Approaching from the upslope side could result in decapitation.

Failure to observe safety precautions may result in injury or death.


3. Increased wind and the loss of wind affect helicopter power. Corpsmen must consider weather/wind factors
that affect aircraft performance to achieve successful patient evacuation missions.

a. A helicopter's hover ceilings are lower on a hot day than for a helicopter with the same gross weight
and power settings on a day with standard temperatures.

b. More casualties can be loaded onboard helicopters at higher altitudes with higher aircraft gross weights
when the temperature is cool.

c. Wind is a major factor in improving lift performance when considered with other factors, such as enemy
positions and smoke drift, in accomplishing a successful patient evacuation. Understanding terrain wind flows enables corpsmen to:

(1) Select the best LZ

(2) Anticipate safer helicopter approach/departure routes

(3) Anticipate the impact of LZ obstacles, such as tall trees, tall buildings, and power lines

(4) Provide valuable wind direction/estimated velocity information to aircrews.

d. There are two major considerations in cold-weather patient evacuation operations:

(1) Restricted visibility from blowing snow (whiteout) during helicopter landings

(a) Improve restricted visibility by using smoke grenades or other objects distinguishable in color
(pine boughs, painted jerry cans, or emergency kit) placed or planted as a reference point in the
LZ. Smoke will aid in determining wind direction and speed. Do not use white smoke unless it is the only smoke available.


(b) To prevent snow blindness and to protect the eyes from rotor-wash-caused debris, colored
glasses or goggle inserts should be worn.

(2) The adverse effect of cold temperatures (wind chill) on the casualties and ground personnel loading
casualties.

e. Hot-weather patient evacuation operations may cause reduced power available in the aircraft, limiting
the capability to hover out of ground effect. Hovering straight up and down may require a larger LZ. Flight crews may have restricted visibility (in desert areas) from blowing sand (brownout) near the point of touchdown and should wear goggles or glasses to prevent eye injuries.
For more information on LZs, refer to MCWP 3-11.4, Helicopterborne Operations.

## 5.5.4.5 Landing Zone Procedures


1. Daylight landing procedures:

a. Determine the LZ marking method, such as smoke or panel method.

b. Do not use smoke until requested by aircrew. The enemy may launch the same-colored smoke and
confuse pilots of the correct LZ location.

c. Ensure day glow panel markers (VS-17) are well secured to the ground when used to identify the LZ.
Securing the markers to the ground will prevent them from being blown into the rotor system of the helicopter.

2. Night landing procedures:

a. Maintain light discipline at night. Helicopter pilots and crew require the use of night-vision equipment.

b. Turn on only the lights required to mark the LZ. Additional lighting requirements are directed by the
helicopter crew.

c. Vehicle headlights may be used to light the LZ when directed by the pilot. In peacetime and in exercise
environments, vehicle headlight use is possible before CASEVAC or MEDEVAC arrives to aid the flight crew in locating the LZ. Ensure the headlights cast a glow on the anticipated touchdown point of
the LZ to prevent blinding the pilots. Ensure the vehicles do not obstruct the LZ.

d. Do not use smoke unless requested by the aircrew.

e. Use chemlight to mark the boundaries of the LZ and remove any obstacles that may impair a safe
landing.

## 5.5.4.6 Prepare And Load Casualties


1. Protecting casualties.

a. Aircraft safety considerations. The litter and ambulatory casualties, the unit representative going with
the casualties in peacetime, and those associated with loading casualties must be protected from the effects of the rotor blades, engine exhaust, and engine noise.

b. Loading and unloading instructions. Most directions in loading casualties will be given by hand signals
so roles should be established and understood before aircraft arrival. The corpsman should direct
Marines tasked with loading casualties to protect themselves and the casualties prior to the arrival of the aircraft for the following reasons: it is quieter (unless taking fire), instructions can be heard and understood, and there is no time to accomplish this once the aircraft is on the deck. Aircraft present a large target in an LZ.


c. Chill factor. Human efficiency is reduced as temperature drops and reduced sharply as temperature
drops below -18 C (0 F). The human body is continually producing heat internally and losing it
externally to the environment. Wind increases this heat loss particularly on exposed flesh. If the ambient
air temperature is below freezing, the wind velocity removes heat from the body surface more rapidly than it can be replaced, and frostbite may occur. Ground personnel, casualties exposed to rotor wash, or flight crew at open hatches are particularly susceptible. Clothing or materiel which stops or reduces the
wind gives a degree of protection to the covered area. Wet clothing has a reduced insulating value and
results in heat loss nearly equal to that of exposed flesh. A person's skin (including casualties') shall not
be exposed for any length of time under the rotor blast of a helicopter when in an arctic climate. Exposed skin may freeze in as little as 30 seconds.

d. Aircraft exhaust hazard/ear protection zone areas. Corpsmen should be aware of aircraft engine exhaust
hazards and ear protection zone areas to minimize casualty exposure.

2. Approaching the aircraft.

a. Keep vehicles, nonessential personnel, and animals clear of the helicopter unless instructed by the
aircrew.

b. Never approach the helicopter unless directed by the aircrew. Medical personnel, if onboard, will come
to the patient unless under fire.

c. Keep the area around the casualties clear to allow the corpsman to work more efficiently.

d. Send a unit representative to secure personal belongings when the patient is admitted to the hospital.
This will not occur in combat.

e. Ensure the casualties are well protected from the elements, have received medical treatment, and have
adequate IV fluid (if required). Medical tags should be properly filled out and well secured to prevent
loss due to rotor or prop wash.

3. Requesting unit's responsibility. A patient evacuation request places the following responsibilities on
the requesting unit:

a. Ensure tactical situation permits evacuation.

b. Ensure casualties and casualty information are ready when the request is submitted.

c. Provide an English-speaking representative at the pickup site when evacuation is requested for
non-U.S. personnel.

d. Receive backhauled medical supplies.

e. Move casualties to the safest aircraft approach/departure point.

f. Ensure ground personnel are familiar with principles of helicopter operations.

## 5.5.4.7 Planning Backhaul Of Casualties During Vertical Assault Operations

During vertical assault operations, the MAGTF and ACE staffs plan for the use of lifting aircraft to backhaul casualties from the LZ. The MAGTF commander plans for support from CASEVAC and MEDEVAC aircraft.

Flying CASEVAC aircraft during the air assault may conflict with the ongoing operation. The staff will plan for CASEVAC operations by the assaulting aircraft. On air assaults with multiple lifts, the staff uses the lifting aircraft to pick up casualties during successive lifts. On single-lift air assaults, aircraft are designated to remain on standby for CASEVAC operations, usually at central forward arming and refueling points, such as the LZ or an established holding area. The backhaul of casualties on a vertical assault is a critical mission for the utility helicopters and requires detailed planning. The MAGTF command element (CE) and major subordinate command representatives must be involved in the planning stages of the air assault. If the commander's intent is to backhaul casualties, the planning must include the following considerations:


1. Casualty locations. The assault unit commander should designate an LZ to receive casualties, which
facilitates rapid movement and minimizes aircraft LZ ground time. Members of the air assault TF should
know the designated casualty point location upon arrival. This will allow focus on the casualty point and ground personnel will be prepared to accept casualties.

2. Signaling. Night operations provide a challenge for casualty backhaul operations. Evacuation planners
should use light signals to indicate that aircraft arriving at the LZ should prepare to accept casualties.

3. Communications. Communications on a predesignated radio network can alert the flight to backhaul
casualties from the LZ.

4. Designated area for dropping off casualties. The assault unit commander must determine where to transport
casualties during a vertical assault and develop a plan for the use of CASEVAC helicopters. Casualties
dropped off by lifting aircraft are loaded on CASEVAC aircraft for transportation to higher-level care facilities.

 Considerations for selecting a casualty collection point include the following:

a. Select a secure site with medical personnel ready to accept casualties. The site should be selected so that
it does not interfere with a vertical assault.

b. Aircraft conducting casualty backhaul will separate from the serial at some point. The assault unit
commander must be prepared to affect the bump plan if the aircraft carrying casualties does not return to
the LZ for the next lift.

c. Aircraft arriving at the LZ full of casualties may cause confusion. Troops may be loading into the same
aircraft from which casualties are unloading.

## 5.5.4.8 Air Requirements Plan

The MSOC will submit air evacuation designated standby aircraft requirements to the MLG ALO 72 hours in advance to ensure that helicopters are available for patient movement. MSOC SOPs consider the standby asset need based on the following parameters:


1. The greater the distance from the POI to first resuscitative care, the lower the survival rate of casualties
requiring surgery, and the greater the died of wounds percentage.

2. The greater the distance from the POI to first resuscitative care, the less efficient are helicopter and ground
transportation, and the more helicopters or ground vehicles are required.

3. The efficiency of helicopter litter casualty transport depends on the following factors:

a. Evacuation distance (time)

b. Maximum litter capacity of the helicopter

c. Range without refueling

d. Helicopter airspeed

e. Diversion distance (time) required for refueling

f. Number of aircraft requiring refueling, such as gunship escorts.

4. Staging helicopters, vehicles, and en route care teams forward reduces response times and facilitates
optimal care while it utilizes lifts of opportunity, which increases effective transportation asset use.

5. The prevention of motion sickness, hypothermia, and other conditions that will be affected by low-altitude
travel.

## 5.5.5 En Route Care Considerations

The Marine Corps en route care system (ERCS) is an essential follow-on for the FRSS. The ERCS is capable of providing medical care for two critically injured/ill, but stabilized, patients for 2 hours during flight. ERCS
provides a capability to support expeditionary maneuver warfare by meeting an operational requirement to evacuate patients up to 240 nautical miles using opportune medium lift aircraft. ERCS will be employed when the tactical situation requires prompt transport of critically injured/ill patients from forward surgical and treatment elements to the shore- or sea-based treatment facilities. Less critically injured/ill patients will be transported using current protocols.

## 5.5.5.1 Modes Of Transportation Considerations

The Marine Corps ERCS must be flexible and able to integrate with various modes of transportation, rotarywing/fixed-wing aircraft, and sea transport platforms. Important transportation factors of en route care are availability, mode, operational range, space, and lift limitations. Tactical factors must also be considered at each level of planning and implementing en route care.

## 5.5.5.2 En Route Care Equipment

En route care requires the use of state-of-the-art, lightweight, critical care equipment, ensuring the evacuation system can successfully transport a patient from a FRC capability (i.e., shock trauma platoon (STP), FRSS, SC) to a theater hospitalization capability. En route care equipment will be standardized throughout the system, assuring rapid equipment exchanges and forward resupply, and will comply with flight-testing requirements.

## Appendix A Patient Movement Task List A.1 Universal Joint Task List


1. SN 1.1.5, Determine Impact of Environmental Conditions on Strategic Mobility

2. SN 1.2.6, Conduct Redeployment or Retrograde of Personnel and Equipment from Theater

3. SN 1.2.8, Provide Global Patient Movement

4. SN 3.3.6, Determine National Residual Capabilities

5. SN 4.3.3, Coordinate Defense-wide Health Services

6. SN 6.6.4, Expand Health Service Support

7. SN 8.1, Support Other Nations or Groups

8. SN 8.2.3, Support Evacuation of Noncombatants from Theaters

9. ST 4.2.2, Coordinate Health Service Support
 10. ST 4.2.2.2, Coordinate Patient Evacuation from Theater 11. ST 4.3.1, Establish and Coordinate Movement Services within Theater 12. OP 1.6, Conduct Patient Evacuation 13. OP 4.4.3, Provide Health Services 14. OP 4.4.3.2, Manage Flow of Casualties in the Joint Operations Area 15. OP 4.4.3.3, Manage Health Services Resources in the Joint Operations Area 16. OP 4.4.5, Train Joint Forces and Personnel 17. OP 4.5.2, Supply Operational Forces 18. OP 4.5.3, Recommend Evacuation Policy and Procedures 19. OP 6.2.6, Conduct Noncombatant Evacuation Operation (NEO) 20. TA 6.4, Conduct Noncombatant Evacuation

## A.2 Navy Tactical Task List


1. NTA 1.2.8, Conduct Tactical Reconnaissance and Surveillance

2. NTA 4.7.8, Provide Humanitarian Support

3. NTA 4.8.1, Support Peace Operations

4. NTA 4.12, Provide Health Services

5. NTA 4.12.1, Perform Triage

6. NTA 4.12.3, Provide Surgical and Inpatient Care

7. NTA 4.12.5, Provide Patient Movement

8. NTA 4.12.5.1, Coordinate Patient Movement

9. NTA 4.12.7, Maintain Records
 10. NTA 4.12.9, Train Medical and Nonmedical Personnel 11. NTA 4.12.10, Provide Health Services in Support of Humanitarian and Civic Assistance
 12. NTA 4.12.11, Provide Medical Staff Support 13. NTA 4.12.13, Provide Emergency Medical Services 14. NTA 4.12.17, Provide Forward Resuscitative Care 15. NTA 4.12.19, Provide En Route Care 16. NTA 4.13, Conduct Recovery and Salvage 17. NTA 6.5.1, Provide Disaster Relief

## A.3 Marine Corps Task List


1. MCT 1.6.6.7, Conduct Humanitarian Assistance (HA) Operations

2. MCT 4.5, Provide Health Services

3. MCT 4.5.1, Conduct Health Maintenance

4. MCT 4.5.2, Perform Casualty Collection

5. MCT 4.5.3, Conduct Casualty Treatment

6. MCT 4.5.4, Conduct Temporary Casualty Holding

7. MCT 4.5.5, Conduct Casualty Evacuation

8. MCT 4.5.6, Conduct Mass Casualty Operations

9. MCT 4.5.8, Conduct Medical Regulating
 10. MCT 4.6.1.7, Provide Civil Affairs Support 11. MCT 6.3, Perform Consequence Management

## Appendix B Health Service Support Capabilities B.1 Introduction

The information contained in this appendix provides an overview of medical assets organic to Navy and Marine Corps forces. For the Navy, additional information on HSS assets for specific unit/ship classes is found in NWP 4-02, Naval Expeditionary Health Service Support Afloat and Ashore, and OPNAVINST 3501 (series), Projected Operational Environment (POE) and Required Operational Capabilities (ROC). For the Marine Corps, additional information on HSS assets is found in MCRP 5-12D, Organization of Marine Corps Forces; MCWP 4-11.1, Health Service Support Operations; and MCRP 4-11.1E, Health Service Support Field Reference Guide. At the joint level, for guidance on joint patient movement refer to JP 4-02, Health Service Support.

## B.2 Navy Forces Afloat B.2.1 Carrier Strike Group

The CSG is a naval task force composed of an aircraft carrier (CVN) and supporting combatant ships capable of conducting strike operations. The notional CSG elements are CVNs, guided missile cruisers, destroyers, frigates, attack submarines, and replenishment ships. The mission of the CVN is to operate offensively in a high-density, multithreat environment as an integral member of a CSG or expeditionary strike force, and to provide credible, sustained forward presence, conventional deterrence, and support aircraft attacks in sustained operations. CVN
capabilities and staffing are shown in figure B-1.

## B.2.2 Expeditionary Strike Group

The ESG is a tactical organization of surface and subsurface combatants, maritime aviation, and assault shipping to transport troops and their equipment for expeditionary operations. The notional ESG elements are an amphibious assault ship (LHD/LHA), amphibious transport docks, surface combatants (guided missile cruisers, destroyers, or frigates), and an attack submarine.

## B.2.2.1 Amphibious Ready Group

A Navy task organization formed to conduct amphibious operations.

## B.2.2.2 Amphibious Assault Ship

The mission of the LHD/LHA is to operate offensively in a high density, multithreat environment as an integral member of the amphibious strike force or group; function as primary landing ships for MEFs; and function as the CRTS when the FST is embarked. The CRTS requires the Health Services Augmentation Program (HSAP)
augmentees to provide full expanded HSS capabilities. The LHD/LHA capabilities and staffing for the WASP and TARAWA classes are shown in figure B-2.

| CV/CVN Capability                                                        | Nimitz Class Staffing    |   Ford Class Staffing  |
|--------------------------------------------------------------------------|--------------------------|------------------------|
| Operating Rooms                                                          | 1                        |                     1  |
| Intensive Care Unit Beds                                                 | 3                        |                     3  |
| Ward Beds                                                                | 48                       |                    32  |
| Ancillary Capabilities                                                   |                          |                        |
| Laboratory, x-ray, pharmacy, preventive medicine, biomedical repair,     |                          |                        |
| aviation physical examinations, radiation health, spectacle fabrication, |                          |                        |
| pyschology, physical therapy, and substance abuse rehabilitation program |                          |                        |
| (SARP) screening.                                                        |                          |                        |
| Complement (Ship's Company                                               |                          |                        |
| and Air Wing)                                                            |                          |                        |
|                                                                          |                          |                        |
| Medical Corps                                                            | 6*                       |                     6  |
| Dental Corps                                                             | 5                        |                     5  |
| Nurse Corps                                                              | 2                        |                     2  |
| Medical Service Corps                                                    | 5                        |                     5  |
| Hospital Corpsmen                                                        | 45**                     |                    38  |

*   Includes embarked physicians **  Includes two SARP counselors attached to the medical department

| LHD/LHA Capability                   | Ship/FST Staffing    | Ship/FST/HSAP Staffing    |
|--------------------------------------|----------------------|---------------------------|
| Operating Rooms                      | 1                    | 4                         |
| Intensive Care Unit Beds             | 3                    | 15                        |
| Ward Beds                            | 12                   | 45                        |
| Ancillary Capabilities               |                      |                           |
| Laboratory, blood bank, x-ray,       |                      |                           |
| pharmacy, preventive medicine,       |                      |                           |
| biomedical repair, aviation physical |                      |                           |
| examination                          |                      |                           |
| Laboratory, blood bank, x-ray,       |                      |                           |
| pharmacy, preventive medicine,       |                      |                           |
| biomedical repair, aviation physical |                      |                           |
| examination                          |                      |                           |
|                                      |                      |                           |
| SHIP                                 | FST*                 | HSAP                      |
| Complement                           |                      |                           |
| Medical Corps                        | 2                    | 3**                       |
| Dental Corps                         | 1                    |                           |
| Nurse Corps                          |                      | 3**                       |
| Medical Service Corps                | 1                    | 1                         |
| Hospital Corpsmen                    | 19                   | 9                         |

*   The FST officer in charge can be 2XXX
**  Includes certified registered anesthesiologist or nurse anesthetist

## B.2.2.3 Amphibious Transport Dock

The mission of the amphibious transport dock, or LPD, is to transport and land Marines and their equipment and supplies by embarked landing craft or amphibious vehicles augmented by helicopters. The LPD SAN ANTONIO
class contains enhanced C2 features and a robust communications suite that improves its ability to support embarked landing forces, a MAGTF, and joint and friendly forces. It is equipped with operating rooms (ORs) and ward beds without the staffing capability. Figure B-3 shows LPD capabilities and staffing for the AUSTIN and the SAN ANTONIO classes.

## B.2.2.4 Dock Landing Ship

The mission of the landing ship dock, or LSD, is to transport and land Marines, and their equipment and supplies either by embarked landing craft or amphibious vehicles augmented by helicopters, and to support amphibious operations including landings by way of landing craft air cushion. Figure B-4 lists LSD capabilities and staffing for the HARPERS FERRY and WHIDBEY ISLAND classes.

## B.2.3 Submarine Tender

The mission of the submarine tender (AS) is to provide at-sea support capability. Figure B-5 lists submarine tender capabilities and staffing.

## B.2.4 Surface Combatants

The surface combatant shipscruiser, destroyer, and frigatehave limited HSS capabilities and staffing. Their ancillary capability consists of one basic laboratory. Hospital corpsmen are made up of one independent duty corpsman (IDC) and one junior hospital corpsman (HM).

| LPD Capability                           | Austin Class         | San Antonio Class     |
|------------------------------------------|----------------------|-----------------------|
| Operating Rooms                          | 0                    | 1                     |
| Ward Beds                                | 17*                  | 24*                   |
| Ancillary Capabilities                   | Laboratory and x-ray | Laboratory and x-ray  |
| Complement                               |                      |                       |
| Medical Corps                            | 1                    | 1                     |
| Dental Corps                             | 1                    | 1                     |
| Hospital Corpsmen                        | 9                    | 15                    |
| * Capability requires augmented staffing |                      |                       |
| LSD Capability               |                      |
|------------------------------|----------------------|
| Ward Beds (2 isolation beds) | 8*                   |
| Ancillary Capabilities       | Laboratory and x-ray |
| Complement                   |                      |
| Medical Corps                | 1                    |
| Dental Corps                 | 1                    |
| Hospital Corpsmen            | 5                    |

* Capability requires augmented staffing

| AS Capability                            |                                 |
|------------------------------------------|---------------------------------|
| Operating Rooms                          | 2*                              |
| Ward Beds                                | 12*                             |
| Ancillary Capabilities                   | Laboratory, x-ray, and pharmacy |
| Complement                               |                                 |
| Medical Corps                            | 1                               |
| Dental Corps                             | 3                               |
| Hospital Corpsmen                        | 18                              |
| * Capability requires augmented staffing |                                 |

## B.2.5 Hospital Ship

Hospital ships provide a mobile, flexible, and responsive afloat medical and surgical care capability. The Hospital Ship Program consists of two ships, U.S. Naval Ship (USNS) MERCY (T-AH 19) and USNS COMFORT (T-AH
20). The program is the responsibility of Commander, Military Sealift Command (COMSC) as the type commander (TYCOM) for both the ships. Each ship is an afloat medical treatment facility containing 12 fully equipped operating rooms. T-AHs are afloat trauma hospitals designed to deliver theater hospitalization capability in support of combat, foreign humanitarian assistance (FHA) operations, both afloat and ashore, and Department of Defense Support to Civil Authorities (DSCA). Functioning under the provisions set forth in the Geneva Conventions, they have the capability, when fully manned that is comparable to a continental United States general hospital. HSS capabilities and staffing for the T-AHs are shown in figure B-6. For further information on the hospital ship, refer to NTTP 4-02.2, Hospital Ships.

## B.3 Navy Forces Ashore

NAVFOR ashore have been combined under the NECC, the functional command that centrally manages current and future readiness, resources, manning, training, and equipping of the Navy's expeditionary forces. There are HSS personnel and equipment organic to each NAVFOR ashore component. The range of medical capabilities includes first responder and FRC accomplished by a hospital corpsman and medical officers assigned to the unit, and by the establishment of a BAS when deployed. The organization of HSS consists of the SMO, the SMDR, a hospital corpsman, and litter bearers. The physicians serve at the group level in general medical officer and diving medical officer positions.

## B.3.1 Senior Medical Officer

The unit's SMO is designated as the department head for the medical department. In addition to those duties prescribed by Navy Regulations for a head of department, the SMO is responsible, under the CO, for maintaining the health of all attached personnel, conducting inspections, and advising the CO with respect to health and sanitation affecting the command. The SMO is responsible for ensuring that all medical providers attached to the unit are properly credentialed and privileged and that they exercise only those clinical privileges that can be reasonably supported by the ship's medical capabilities. The SMO is responsible for all medical department materiel onboard and will be in charge of the sick and injured. The SMO may be required to give medical support to other units, including training and oversight of all medical department personnel.

| T-AH Capability                                             | Staffing    |
|-------------------------------------------------------------|-------------|
| Operating Rooms                                             | 12          |
| Intensive Care Unit Beds                                    |             |
| 88 (includes 20 postsurgical recovery beds and 11 Isolation |             |
| beds with critical care capability)                         |             |
| Intermediate Care Beds                                      | 400         |
| Minimal Care Beds                                           | 500         |
| Ancillary Capabilities                                      |             |
| Laboratory, blood bank, x-ray [includes computerized axial  |             |
| tomography (CAT) scan and angiography suite], pharmacy      |             |
| Complement (staffing up to 1,000 beds)                      |             |
| Medical Corps                                               | 66*         |
| Medical Service Corps                                       | 20*         |
| Nurse Corps                                                 | 127*        |
| Hospital Corpsmen                                           | 700*        |
| Nonmedical Officers                                         | 13*         |
| Nonmedical Enlisted                                         | 243*        |
| Dental Corps                                                | 4*          |
| * Numbers may vary depending on mission                     |             |

## Note

Figure B-6 does not reflect the entire complement of capabilities for the hospital ship.

## B.3.2 Senior Medical Department Representative

A senior hospital IDC serves in the absence of a medical officer, is designated the unit's SMDR, and functions as the unit's primary care provider. The IDC works for a physician preceptor. The SMDR assumes the technical medical responsibilities of a unit's medical officer as defined in paragraph B.3.1, as qualifications allow. The SMDR is responsible to the CO for the following:


1. Care of the sick and injured

2. Sanitation and hygiene of the command

3. Health of personnel

4. Preparation of medical reports and records

5. Maintenance of medical supplies and equipment

6. Training of medical and nonmedical personnel.

## B.3.3 Hospital Corpsman

Hospital corpsmen from each unit are responsible for the following:


1. Providing first aid for casualties

2. Preparing patients for evacuation

3. Ensuring preventive medicine is practiced

4. Making recommendations to the unit commanders concerning rigorous programs of field sanitation and
personal hygiene

5. Providing immediate treatment of minor ailments.

## B.3.4 Litter Bearer

A litter bearer group operates under the direction of the medical department. Litter bearers are Sailors assigned by the unit commander, not part of the battalion medical section. Early designation of litter bearers is essential for training in the proper techniques of casualty handling.

## B.4 Marine Corps

The Marine Corps operating forces are organized into MAGTFs for conducting combat operations. The type of MAGTF HSS would be supporting is dictated by the contingency. The three types of MAGTFs are a Marine expeditionary unit (MEU), Marine expeditionary brigade (MEB), or a Marine expeditionary force (MEF). Each MAGTF, regardless of size, is a combination of forces made up of the following four elements:


1. The command element (CE) has C2 of the MAGTF; personnel can be sourced from any of the supporting
units.

2. The ground combat element (GCE) consists of MARDIV personnel.

3. An aviation combat element (ACE) consists of Marine aircraft wing (MAW) personnel.

4. The logistics combat element (LCE) consists of MLG personnel.
HSS personnel and equipment are organic to each MAGTF element. HSS elements are sized and equipped to support personnel and mission requirements when assigned to a MAGTF.

## B.4.1 Command Element

The MEF CE medical staff consists of the MEF surgeon, MEF medical planner, MEF preventive medicine officer, MEB medical planner, operations chief, preventive medicine chief, and administrative chief. The MEF
CE provides routine and emergency HSS by using its major subordinate command's HSS personnel. The MLG CE medical staff consists of a group surgeon, a group aid station, and an HSSE. The group surgeon functions as a special staff officer advising the MLG commander on matters relating to the health of the MLG personnel. The group surgeon provides clinical oversight of the group aid station, which provides internal HSS to the MLG. The HSSE serves as the principal HSS planner for the MLG and coordinates the requirements for HSS and Class VIII A and B supplies required above the organic capabilities of the GCE and the ACE. The HSSO manages the HSSE and serves as the principal planner for the MLG.

## B.4.2 Ground Combat Element

The GCE of a MAGTF is comprised of MARDIV units sized to the mission. A MARDIV is the GCE for a MEF, a Marine regimental landing team (RLT) is the GCE for a MEB, and a Marine BLT is the GCE for an MEU. The division CE medical staff consists of the division surgeon, a psychiatrist, a medical administrative officer, an environmental health officer, and enlisted staff to provide administrative support, training, and senior enlisted leadership to all subordinate medical personnel within the division. The division surgeon functions as a special staff officer who advises the division commander on all matters relating to the health of the division, including HSS requirements and the allocation of medical resources.

## B.4.2.1 Regimental Aid Station

The regimental aid station (RAS) contains all medical support organic to the regimental HQ company. Because there is only one medical officer and three hospital corpsmen, the RAS is unable to meet the same level of casualty flow as a BAS, which has more medical personnel. The RAS is augmented by its own battalion personnel or from nondeploying regiments within the division. It can be reinforced by an STP or FRSS, as indicated in annex Q of the OPLAN or OPORD. The mission of the RAS is to:


1. Coordinate and support medical care to the rifle battalions, attached units, and company HQ.

2. Coordinate CASEVAC from the battalions and attached units to the appropriate next level of medical care.

3. Provide limited medical care to the personnel of company HQ.

4. Consolidate casualty and illness reports from attached units and forward them to the regimental command
post and to higher headquarters (HHQ). The regimental HQ medical staff consists of the regimental
surgeon, the regimental senior chief hospital corpsman, the chief hospital corpsman preventive medicine technician, and the hospital corpsman third class.

a. The regimental surgeon is a special staff officer, a planner, organizer, teacher, supervisor, and advisor in
addition to duties in patient treatment. The regimental surgeon advises the regimental commander and
staff on all matters pertaining to the health of the regiment and performs other duties as directed by the regimental commander. The surgeon directs the activities of the RAS.

b. The regimental senior chief hospital corpsman is the administrative and chief medical assistant to the
regimental surgeon.

c. The chief hospital corpsman preventive medicine technician advises the regimental surgeon and the
regimental commander on preventive medicine issues.

d. The hospital corpsman third class serves as ambulance driver, radio communicator and medical supply
technician for the RAS, and maintains medical and dental records of personnel attached to company HQ.

## B.4.2.2 Battalion Aid Station

The BAS is staffed by the following personnel:


1. Medical staff. The medical staff of an infantry battalion or battalion medical platoon consists of 2 medical
officers and 65 hospital corpsmen.

a. Battalion surgeon. One medical officer in an infantry battalion is designated as the battalion surgeon, a
special staff officer who advises the battalion commander on matters pertaining to the health of the battalion. The battalion surgeon supervises patient treatment, plans, organizes, trains the battalion medical staff, and performs other duties as directed by the battalion commander.

b. Assistant battalion surgeon. The second medical officer in an infantry battalion is designated as the
assistant battalion surgeon. Duties include direct, managing, and supervising the operation of the BASs and additional duties as directed by the battalion surgeon.

c. Aid station. The aid station, consisting of 21 of the 65 hospital corpsmen in an infantry battalion, is
assigned to the BAS under the supervision of the assistant battalion surgeon. This group is capable of splitting into two sections to operate two separate BASs. The battalion surgeon heads the second aid
station.

d. Company medical teams. The remaining 44 hospital corpsmen assigned to the battalion medical platoon
are divided into 4 groups called company medical teams. A company medical team of 11 HMs is assigned to each of four companies; the three infantry companies and the Weapons Company.
The team is responsible for the following:


(1) Provides first aid for casualties

(2) Prepares patients for evacuation

(3) Ensures preventive medicine is practiced

(4) Makes recommendations to the unit commanders concerning rigorous programs of field sanitation
and personal hygiene

(5) Provides immediate treatment of minor ailments.

e. Company corpsman. The senior hospital corpsman from each company medical team is designated as
the company corpsman and is assigned to the company HQ. The remaining corpsmen are designated platoon corpsmen.

## Note

Field ambulance service and CASEVAC procedures are contained in the battalion SOP or in the administrative/logistics order. Emergency casualty evacuation, special medical assistance, and other medical matters not specifically covered in battalion SOPs or administrative/logistics orders are requested through the S-4 (logistics) officer.


f. Litter bearer group. Early designation of litter bearers is essential for training in the proper techniques of
casualty handling. A litter bearer group operates under the supervision of the battalion surgeon. Litter bearers are Marines assigned by the battalion or regimental commander not part of the battalion medical
section.
2. Nonmedical personnel. While not part of the RAS, BAS, or other MTF, several nonmedical personnel are
required for the provision of medical services. The senior Marine commander assigns the duties for handling
the provision of medical services, which temporarily operates under the supervision of the organization senior
surgeon. The following specific nonmedical personnel perform medical service duties:

a. Combat lifesavers. CLS Marines are trained to assist the corpsman in providing advanced life saving
skills that include hemorrhage control, airway management, and shock management.

b. Litter bearers. Litter bearers are vital for the survival of the casualty, maintenance of good morale, and
preventing loss of firepower to the assaulting platoons and companies. Early designation of litter bearers
is essential for proper training in casualty handling procedures.

c. Ambulance drivers. Two ambulance drivers from the motor transport section will be assigned during
operations and exercises. This allows the medical personnel to be used most efficiently in the
performance of medical duties. Hospital corpsmen are also trained to drive vehicles.

d. Armorers/Security. Security personnel must search and disarm all patients brought to the MTF before
being admitted. Armorers collect and secure confiscated weapons. Enemy prisoners of war (EPWs) must be guarded while in the MTF. Medical personnel attending to the sick and wounded must not be used for securing weapons or guarding prisoners.

e. CBRN patient decontamination personnel. All patients must be decontaminated before entering the
MTF. Nonmedical personnel must be identified to assist in the decontamination of patients. There are
insufficient medical personnel available to do both emergency medical treatment and patient decontamination. These personnel are trained in patient decontamination procedures in advance of the
OPORD.

f. Religious personnel. A chaplain and religious programs specialist are at the MTF when casualties are
being received.

## B.4.3 Aviation Combat Element

The ACE of a MAGTF is comprised of MAW units (fixed-wing and/or rotary-wing) to support the mission. A
MAW is the ACE for a MEF; a Marine aircraft group (MAG) is the ACE for a MEB; and a Marine aircraft squadron/or composite squadron is the ACE for a MEU. HSS personnel are assigned to the primary subordinate organizations in the MAW. The Marine wing support group (MWSG) and Marine wing support squadron
(MWSS) provide aid station capability for expeditionary airfield operations. The wing CE medical staff consists of the wing medical officer or wing surgeon, a medical administrative officer, an environmental health officer, an industrial hygienist, and enlisted personnel. The wing medical officer or wing surgeon functions as a special staff officer, advising the wing commander on all matters relating to the health of the wing, including the development of medical policies for the wing, training of medical and nonmedical personnel, HSS requirements, and allocation of medical resources. The remainder of the wing surgeon's staff is responsible for medical planning, logistics, coordination of administrative functions, maintenance of records, and personnel administration. A group medical section for each MAG HQ consists of a medical officer and two hospital corpsmen. The MAG medical officer carries out the wing surgeon's policies, performs duties in support of the MAG personnel, and is a special advisor to the MAG commander. The MWSG includes 4 MWSSs with organic (from the unit) medical assets consisting of 2 medical officers, 31 to 32 hospital corpsmen, and the equipment and supplies to establish a squadron aid station. The MWSS aid station is capable of providing routine sick call; aviation medicine;
preventive medicine; and laboratory, radiology and pharmacy services. Each flying squadron within a MAG has a medical section consisting of a flight surgeon and a number of hospital corpsmen depending on squadron type. The squadron medical section provides a pool of trained in-flight corpsmen for CASEVAC missions and conducts routine sick call and other aviation medical functions. In order to centralize organization and support, squadron medical personnel normally work in conjunction with the MWSS aid station.

## B.4.4 Logistics Combat Element

The LCE is a core element of the MAGTF and is responsible for the combat service support necessary to accomplish the MAGTF mission. LCEs are further defined in the four types of MAGTFs. The LCE for a MEF is a MLG, the LCE for a MEB is a combat logistics regiment (CLR), and the LCE for an MEU is a CLB. The mission of LCE HSS is to sustain the fighting ability of the MAGTF, to return as many casualties to duty as soon as possible, and to stabilize and prepare for evacuation of casualties whose length of stay is expected to exceed the MAGTF evacuation policy. This mission is accomplished through the operation of a BES and/or HES organized to provide emergency treatment, to collect casualty evacuation, and to provide preventive medicine services.

## B.4.5 Medical Battalion

Within the MEF, the medical battalion is the only source of forward resuscitative care. Their primary purpose is to provide initial resuscitative and surgical treatment that, if not performed, could lead to loss of life, limb, or eyesight. Emergency care that includes initial resuscitation is continued and, if necessary, additional emergency measures are instituted that do not go beyond immediate necessities. These units have a short-term holding capability. In garrison and during routine deployments, the medical battalions use organic staff. When increased medical manning levels are required for contingencies or training exercises, units can be brought to wartime manning through Health Services Augmentation Program (HSAP). The medical battalion provides direct and general HSS to the MEF to sustain the combat effort. Tasks include:


1. Provide role II care, to include initial resuscitative care, resuscitative surgery, and temporary holding of
casualties.

2. Provide medical regulating services.

3. Provide preventive medicine support.

4. Assist in the collection, analysis, and dissemination of medical intelligence.

5. Provide the medical elements for the establishment of casualty decontamination and treatment stations.

6. Provide medical support for the management of mass casualties and combat stress casualties.
The medical battalion is a subordinate command to the Marine logistics group (MLG). It is organized to execute HSS functions in support of the MAGTF's mission. The medical battalion provides initial resuscitative HSS to the MEF and is structured to facilitate task organization for operations conducted to support the MEF. The medical battalion consists of a Headquarters and Service (H&S) company and two to four surgical companies (SC)
depending on the battalion. Each SC contains surgical platoons with an FRSS, STP, laboratory, x-ray, and ward for temporary casualty holding and ERCS capable of managing patients at the STP and the ward.

For further information about the FRSS, refer to MCRP 4-11.1E, Health Service Support Field Reference Guide.

## B.4.5.1 Headquarters And Service Company, Medical Battalion

H&S company consists of the battalion headquarters personnel and administration, intelligence, operations, logistics, communications, a chaplain section, and a preventive medicine section. The headquarters company section includes a surgical company with two surgical platoons and a combat stress platoon.

The mission of H&S company is to provide C2 and command support functions for medical battalion. It also provides collecting, clearing, and evacuation of casualties through the surgical platoons and comprehensive preventive medical services to all supported units. Tasks include:


1. Command support functions for the operation of the battalion, to include personnel administrative support
for assigned Marine Corps personnel, supply, maintenance, and transportation support.

2. Medical regulating and medical data coordination.

3. Medical specialist augmentation to the companies of the battalion.

4. Preventive medicine support to the MEF.

## B.4.5.2 Surgical Company, Medical Battalion

The surgical company provides general HSS to the MEF to include capabilities of care for temporary medical/surgical treatment and holding of casualties. A surgical company supports a regimental or MEB-sized force. Tasks include:


1. Establish facilities for resuscitative surgery, medical treatment, and temporary hospitalization of casualties.

2. Be prepared to receive casualties from the next forward role of care in the evacuation chain.

3. Prepare for evacuation of casualties whose medical requirements exceed the established theater evacuation
policy.

4. Provide and coordinate MEDEVAC for the landing force.

5. Provide medical support to personnel of other Services and nations as provided in applicable regulations
and agreements, and provide humanitarian care as required by international law.
The surgical company plans, coordinates, and supervises assigned functions of medical support for the battalion.

It is structured to facilitate task organization for operations conducted by the battalion to support the MEF, MEB, or any combination of smaller MAGTFs. The surgical company consists of a headquarters platoon and 4 surgical platoons. An attached dental platoon provides dental support and will assist in the triage, care, and evacuation of casualties. Combat stress capabilities are available in the battalion and can be task organized from H&S Company if given the mission. The SC is designed to allow mobility and flexibility in deployment. A surgical company may be divided into smaller sections to task-organize the support. This facilitates deploying a platoon or section in the assault echelon and the remaining capability in the assault follow-on echelon (AFOE) shipping. In a displacement and relocation evolution, it may be expedient to move platoons and sections in leapfrog fashion, to provide maximum continuity of patient care. Transportation is limited to ground ambulances. H&S company, medical battalion provides or coordinates motor transport support. MLG provides support for displacement or relocation.

## Note

The SC is a major link in the chain of evacuation. When practical the SC can be located in close proximity to an airfield capable of casualty evacuation by rotary- or fixed-wing aircraft.

## B.4.5.3 Shock Trauma Platoons

The STP provides direct medical support to the MEF to include collecting, clearing, and evacuating of casualties from supported MEF elements for resuscitative treatment care and temporary holding of casualties. Tasks include:


1. Establish and operate clearing stations, as required.

2. Establish medical treatment facilities for resuscitative treatment and temporary holding of casualties.

3. Provide and coordinate medical evacuation.

4. Provide medical support to personnel of other services and nations as provided in applicable regulations
and agreements and provide humanitarian care as required by international law.
The STP is the most mobile medical support platoon of the medical battalion. It can serve as a beach evacuation station, reinforce a battalion aid station (BAS), operate as an intermediate casualty collecting and clearing point between forward medical elements and the SC, or serve as the forward element of a SC (i.e., triage/evacuation platoon) preparing to relocate. Organizational vehicles provide ground mobility. Each collecting and evacuation section has 2 tactical ambulances (M997) for collecting casualties from the next forward medical support area and the stabilization section has 2 Medium Tactical Vehicle Replacements (MTVR) to move the STP personnel and equipment.

The STP stabilization section provides the nucleus for a 10 flow through cot (litter) facility. The stabilization section also provides evacuation stations for emergency treatment, triage, and ambulance transfer points. While a degree of mobility is sacrificed in providing a patient treatment facility, the STP must keep pace with the mobility and flexibility demanded by MAGTF operations while maintaining the capability to evacuate casualties and move to support BASs and the MAGTF elements it serves.

## B.4.6 Dental Battalion

The dental battalion is the source of dental services to the MEF. By attaching scalable task-organized dental sections and detachments to elements of the MAGTF, dental battalion personnel ensure dental readiness and optimize health during exercises, deployments, stability operations, and combat operations. The dental battalion consists of a headquarters and service company and 3 dental companies from which task-organized, operational dental support is provided to the MEF, MEB, or any combination of smaller MAGTFs.

## B.5 Theater Support B.5.1 Theater Patient Movement Requirements Center

The TPMRC is a joint activity assigned to USTRANSCOM to support the GCC, providing medical regulating, clinical validation, patient in-transit visibility (ITV), patient movement planning, and execution support to respective theaters. The TPMRCs communicate intratheater patient movement requirements with respective air mobility operations command centers and Service components responsible for executing the mission. TPMRCs generate operational AE plans for the theater and coordinate medical regulating and movement with supporting activities, AE elements, and MTF activities to ensure seamless patient movement and ITV. TPMRCs coordinate intertheater AE requirements with USTRANSCOM, GPMIC, and 618th Air and Space Operations Center (TACC) for planning, execution, and integration with theater patient movement systems.

## B.5.2 Patient Movement Item System

The PMI system supports patient ITV, exchange of in-kind PMIs without degrading medical capabilities, and recycling of PMIs. The originating MTF is responsible for notifying the PMRC for special medical equipment needs for patient transport. PMIs are medical equipment and durable supplies that must be available to support the patient, including ventilators, litters, patient monitors, and pulse oximeters. The Air Force CCDR is responsible for the establishment of theater PMI centers and cells. The PMIs accompany a patient throughout the chain of movement, from the originating MTF to the destination MTF, whether it is an intratheater or intertheater transfer. PMI centers are established to support worldwide theater requirements. PMI will be pre-positioned at designated locations that insert patients into the patient movement system.

PMI centers will be located at aerial ports of embarkation and/or debarkation or other strategic locations within CONUS and outside the continental United States (OCONUS) to match AE support plans. The PMI centers and cells will receive, refurbish, redistribute, and return items collected from MTFs. Refurbishing includes technical inspection, calibration and repair. At the time an MTF initiates a PMR requiring PMIs, the unit sending the patient should evaluate their on-hand balances of PMI and determine if more equipment is required to meet PMI needs. If a shortfall exists the unit should submit a request for additional PMI to the supporting PMI center and/or cell. Equipment sent with evacuated patients or transferred patients should be documented on the expeditionary medical facility's (EMF) equipment records for auditing and accountability in accordance with the applicable Navy Medicine (NAVMED) and Bureau of Medicine and Surgery (BUMED) instructions.

PMIs are tracked using the patient movement item tracking system (PMITS). The use of PMITS is mandatory for asset visibility and tracking of PMIs to provide accurate information to allow proactive support to deployed organizations.

For further guidance on the PMI system refer to BUMED INST 4081.1, Return of Patient Movement Items to Theatre and use of Patient Movement Item Tracking System; NAVMED P-5132, Equipment Management Manual; and JP 4-02. PMITS training can be accessed online at the MHS Learn Web site: https://mhslearn.csd.disa.mil.

## B.5.3 Strategic Aeromedical Evacuation

USTRANSCOM is responsible for intertheater/strategic evacuation. Strategic AE capabilities may consist of dedicated and/or opportune aircraft equipped and medically staffed for patient evacuation. The Air Force is the lead Service for strategic AE. Expeditionary HSS units must coordinate AE with an AELT and an aeromedical staging facility (ASF) or MASF. These are medical staging facilities established by the Air Force in theater for the purpose of coordinating entry of patients into the theater AE system and temporarily holding patients prior to strategic AE. Patients will be transported to these facilities for evacuation. Upon request, the Air Force will assign an AELT to a hospital ship. The AELT will provide coordination services for strategic AE.

## B.5.4 Evacuation Requests

Various communication forms and formats such as voice, radio, and message are used by each Service to request initial evacuation. To request further evacuation, a PMR is submitted by the medical facility patient administration or medical regulating office to the appropriate PMRC. The PMRC evaluates the request for necessity, acuity, eligibility, priority, and mode. PMRs are submitted through TRAC2ES for ITV. PMRs may be submitted by facsimile, voice telephone, radio and/or satellite communications, using a standard PMR worksheet, when TRAC2ES is inaccessible. TRAC2ES "Mobile" can be used if inserted media is authorized. Patient information items required to request patient movement are determined by the PMRC and depend on the operational environment. Intertheater operations are global. They serve the transportation needs of the combatant command (CCMD) outside the AOR and support the conduct of operations within the AOR. USTRANSCOM directs policies and procedures for intertheater patient movement and identifies transport resources. Currently, intertheater patient movement is conducted using airlift assets as long evacuation distances may preclude other modes of patient movement in supporting rapid evacuation out of the CCMD AOR. Patients are most likely to enter the intertheater system from a theater hospitalization capability for movement to a definitive care capability outside the theater of operations or eventually to CONUS. Intertheater patient movement requires a coordinated effort among the Services or HN MTFs, responsible PMRCs, GPMIC, and transportation agencies.

## Intentionally Blank Appendix C Reports C.1 Submitting Reports

All reports may be transmitted by SIPRNET e-mail or as voice reports on secure field telephone, secure iridium phone, or over the MEDREGNET. General guidelines, OPLANs, OPORDs, and HHQ policy provide criteria for submitting reports.

## C.1.1 Afloat Report

Afloat reports are submitted to the strike group surgeon, EMF reporting senior or higher authority, with a copy to the MRT.

## C.1.2 Ashore Report

The ashore report is submitted to the MSOC or higher authority with a copy to the PET. The MSOC forwards the report to all major subordinate commands, and the MEF posts them to the SIPRNET Web page.

## C.2 Medical Situation Report

The medical SITREP, submitted daily, provides a common operating picture on the status of HSS assets of Navy and Marine Corps operating forces. (See paragraphs C.4 through C.8 and figures C-1 through C-4 for report formats and report/request voice templates.)

## C.3 Admissions Report

MTFs with holding beds and cots submit an admission report to HQ daily that identifies patients admitted to the MTF within a 24-hour period. Depending on the volume of patients, the requirement to submit this report may change to every 12 hours.

## C.4 Medical Joining Report

MTFs submit a medical joining report when they become operational. The following is an example of a joining report:

FM:
[NAME OF UNIT]
TO:
NAVY [STRIKE GROUP/EMF REPORTING SENIOR]

MARINE CORPS [MSOC]
INFO:  NAVY [MRT]
MARINE CORPS [PET/MEF]
SUBJ: MEDICAL JOINING REPORT REF:
(A) NTTP 4-02.2M
RMKS/1. PER THE REFERENCES, THE MEDICAL JOINING REPORT FOR THE [NAME OF UNIT] IS SUBMITTED.


2. NUMBER OF DEDICATED OPERATING ROOMS

3. NUMBER OF OTHER OPERATING AREAS EQUIPPED WITH SUITABLE EQUIPMENT NEEDED
FOR THE PERFORMANCE OF BASIC SURGICAL PROCEDURES

4. NUMBER OF FIXED X-RAY MACHINES

5. NUMBER OF PORTABLE X-RAY MACHINES

6. NUMBER OF REFRIGERATORS SUITABLE FOR WHOLE BLOOD STORAGE/TOTAL CAPACITY
OF REFRIGERATORS IN BLOOD UNITS

7. NUMBER OF BLOOD UNITS ON HAND LISTED BY ABO/RH TYPES

8. NUMBER OF ICU BEDS AVAILABLE

9. NUMBER OF OTHER BEDS AVAILABLE

10. NUMBER OF OVERFLOW BEDS SUITABLE FOR CASUALTY CARE

## C.5 Facilities Spot Status Report And Voice Template C.5.1 Facilities Spot Status Report

Upon request of higher authority, MTFs submit a facilities spot status report to identify changes and ensure that HHQ has the most current information for making patient movement decisions. The following is an example of a facilities spot status report: FM:
[NAME OF UNIT]

TO:
NAVY [STRIKE GROUP/EMF REPORTING SENIOR]

MARINE CORPS [MSOC]
INFO: NAVY [MRT]
MARINE CORPS [PET/MEF]
SUBJ: FACILITIES SPOT STATUS REPORT AS OF [DTG] REF:  (A) NTTP 4-02.2M RMKS/1. PER THE REFERENCES, THE FACILITIES SPOT STATUS REPORT FOR THE [NAME OF UNIT] IS SUBMITTED. ALPHA: [OPERATING BEDS] BRAVO: [BEDS OCCUPIED] CHARLIE: [MAJOR ORS] CHARLIE ONE: [PATIENT BACKLOG] CHARLIE TWO: [HOURS BACKLOG] DELTA: [MINOR OPERATING ROOMS] DELTA ONE: [PATIENT BACKLOG] DELTA TWO: [HOURS BACKLOG] ECHO: [PATIENTS FOR LATERAL TRANSFER] FOXTROT: [PATIENTS FOR EVACUATION OUT OF AOR] GOLF: [REMARKS]. NOTES: Lines ECHO and FOXTROT must be coded by patient type: Burn (SB) Cardio-Thoracic (SSC) Gen Surgery (SS) Medical (MM)
Neurosurgery (SSN) OB/GYN (SG)
Ophthalmology (SSO) Oral/Maxillofacial (SSM) Orthopedic (SO) Pediatric (MC) Psychiatric (MP) Spinal Cord (SC) Urology (SSU)

## C.5.2 Voice Template For Facilities Spot Status Report

"[Addressee], this is [Originator]. Over." "[Originator], this is [Addressee]. Over." "This is [Originator]. Request spot status report. Over." "Roger. Status report for [Addressee] follows. Break." [DTG]: _____________ [UNIT CALL SIGN]: _____________ LINE ALPHA [OPERATIONAL BEDS]: _________ LINE BRAVO [BEDS OCCUPIED]: ________
LINE CHARLIE ONE [MAJOR SURG BACKLOG # PATIENTS]: _______
LINE CHARLIE TWO: [MAJOR SURG BACKLOG # HOURS]: ________ DELTA ONE [MINOR SURG BACKLOG # PATIENTS]: _______ DELTA TWO: [MINOR SURG BACKLOG # HOURS]: _______ ECHO: [PATIENTS FOR LATERAL TRANSFER]: ______ FOXTROT: [PATIENTS FOR EVAC OUT OF AOR]: _______ GOLF: [REMARKS] ___________________________________________________________________________________________ ___________________________________________________________________________________________ _______ "HOW COPY. OVER."

## Facilities Spot Status Report


FM:       (MTF) TO:       (MRCO)
FACILITIES SPOT STATUS REPORT AS OF (DTG) SPOT STATUS REPORT AS OF (DTG)
ALPHA:
(OPERATING BEDS)

BRAVO:
(BEDS OCCUPIED)

CHARLIE:
(MAJOR ORs) CHARLIE ONE: CHARLIE TWO: (PATIENT BACKLOG) (HOURS BACKLOG)
DELTA:
(MINOR ORs) DELTA ONE:
DELTA TWO: (PATIENT BACKLOG)
(HOURS BACKLOG)
ECHO:
(PATIENTS FOR LATERAL TRANSFER)
FOXTROT:
(PATIENTS FOR EVAC OUT OF AOR)
OUT OF AOA)
GOLF:
(REMARKS)

NOTES:

1.  OMIT LINES NOT CHANGED FROM PREVIOUS REPORT. INITIAL REPORT MUST INCLUDE ALL
LINES.

2.  LINES E AND F MUST BE CODED.

## C.6 Blood Status Report/Request


BLOOD STATUS REPORT/REQUEST


FM:       (UNIT)
TO:       (CATF/CLF)
SUBJ:   BLOOD STATUS REPORT/REQUEST


1.  PASS TO BLOOD PROGRAM OFFICER.


PROGRAM OFFICER (CODE LINE) (ITEM)
(NOTE)
ALPHA ONE:
(DTG AT END OF REPORTING PERIOD)

2
ALPHA TWO:
(UNIT/FACILITY REPORTING)


ALPHA THREE:
(UNIT LOCATION IF CHANGED)
1, 6
BRAVO ONE:
(NUMBER OF UNITS ON HAND)
1, 3
BRAVO TWO:
(EXPIRATION DATE BY ABO/RH OF LATEST)
1, 3
CHARLIE ONE:
(TOTAL UNITS TRANSFUSED DURING PERIOD)

1
CHARLIE TWO:
(TOTAL UNITS EXPENDED DURING PERIOD)

1
DELTA ONE:
(EST NO. UNITS REQUIRED NEXT 10 DAYS)
1, 7
DELTA TWO:
(EST NO. UNITS BY ABO/RH NEXT 10 DAYS)
1, 3, 7
DELTA THREE:
(DESIRED DELIVERY DATE)

1
DELTA FOUR:
(DESIRED DELIVERY DESTINATION)
1, 4, 5
DELTA FIVE:
(RECEIVING OFFICIAL AT DESTINATION)
1, 5
NOTES:


1.  OMIT LINES NOT APPLICABLE.


2.  REPORT PERIOD IS AS OF 2400 LOCAL.


3.  IF THE BRAVO AND DELTA LINES NEED TO BE USED MORE THAN ONCE TO REPORT DIFFERENT NUMBERS OF UNITS, GROUPS, TYPES, ETC., INFORMATION WILL BE REPORTED BY SEPARATING WITH A "/."


EXAMPLE:
BRAVO ONE:                10/20/30 BRAVO TWO:                 A+/B+/O+ BRAVO THREE:             10JAN/11JAN/12JAN


THIS IS INTERPRETED AS: ON HAND 10 UNITS A+ EXP DATE 10 JAN/20 UNITS B+ EXP DATE 11 JAN/30 UNITS O+ EXP DATE 12 JAN.


4.  REPORT DESIRED DELIVERY DESTINATION ONLY IF DIFFERENT FROM LINE ALPHA THREE.


                                                          BLOOD STATUS REPORT/REQUEST


## Notes (Continued):

5.  REPORT RECEIVING OFFICIAL ONLY IF OTHER THAN LABORATORY PERSONNEL.


6.  REPORT UNIT LOCATION IN GRID COORDINATES WHEN POSSIBLE AND ONLY IF CHANGED FROM LAST REPORT.


7.  NORMALLY, ESTIMATED REQUIREMENTS WILL BE FOR THE DAY FOLLOWING THE LAST DAY OF SUPPLY ON HAND AND ON ORDER. SUPPLY LEVELS WILL BE ANNOUNCED IN APPROPRIATE PLANS AND ORDERS.

## C.7 Medical Census Report Medical Census Report


FM:       (UNIT) TO:       (CATF/CLF)
SUBJ:   MEDICAL CENSUS REPORT FOR MEDICAL REGULATING OFFICER
ALPHA:
(MEDICAL UNIT REPORTING) *SEE NOTES 1, 5
BRAVO:
(LOCATION IF CHANGED)
CHARLIE:
(DTG AT END OF REPORT PERIOD) *SEE NOTE 2
DELTA: DELTA ONE:
DELTA TWO: DELTA THREE:
(TOTAL OPERATING BEDS AT END OF REPORTING) *SEE NOTE 3 (ICU BEDS)
(INTERMEDIATE CARE BEDS) (MINIMAL CARE BEDS)
ECHO:
(TOTAL PATIENTS ADMITTED DURING PERIOD AND BY SERVICE/CIVILIAN/POW) *SEE NOTE 4
FOXTROT: FOXTROT ONE: FOXTROT TWO: FOXTROT THREE:
(TOTAL BEDS UNOCCUPIED AT END OF PERIOD) (ICU BEDS UNOCCUPIED) (INTERMEDIATE CARE BEDS UNOCCUPIED) (MINIMAL CARE BEDS UNOCCUPIED)
GOLF:
(TOTAL PATIENTS REMAINING AT END OF PERIOD BY SERVICE/CIVILIAN/POW) *SEE NOTE 4
HOTEL:
(TOTAL PATIENTS RETURNED TO DUTY DURING PERIOD)
INDIA:
(TOTAL PATIENTS EVACUATED DURING PERIOD)
JULIET:
(TOTAL DEATHS IN FACILITIES DURING PERIOD BY SERVICE/CIVILIAN/POW) *SEE NOTE 4
KILO: KILO ONE:
KILO TWO:
(PATIENTS REQUIRING EVACUATION) *SEE NOTE 4 (PATIENTS READY FOR EVAC NOT PREVIOUSLY REPORTED)
(PATIENTS READY FOR EVAC PREVIOUSLY REPORTED BUT NOT
EVACUATED)
LIMA:
(UNUSUAL INCIDENCE OR OCCURRENCE OF DISEASE OR INJURY)
MIKE:
(TOTAL OUTPATIENT VISITS DURING PERIOD)
NOVEMBER:
(UNRESOLVED MEDICAL LOGISTICAL PROBLEMS)

## Notes:

1. SUBMITTED INITIALLY BY EVERY MTF WHEN IT BECOMES OPERATIONAL. 2. SUBSEQUENTLY, ALL MTFs MUST SUBMIT REPORT DAILY AT 0500.

## Medical Census Report Notes (Continued):

3. WHEN REPORTING DELTA LINES, REPORT ONLY THOSE BEDS SET UP AND READY TO RECEIVE PATIENTS.

4. SUBMIT ONLY THOSE LINES REFLECTING A CHANGE FROM THE PREVIOUS REPORT. 5. SUBMITTED IN ADDITION TO THE SPOT STATUS REPORT.

## C.8 Nine-Line Evacuation Request

| LINE ITEM                        | FORMAT         |
|----------------------------------|----------------|
| SOURCE                           |                |
| REASON                           |                |
| From map                         | Unit leader(s) |
| To provide required patient      |                |
| pickup coordinates. To allow     |                |
| coordinating unit to plan route  |                |
| in the event of multiple patient |                |
| pickups.                         |                |
| 1. Location of                   |                |
| pickup site                      |                |
| Encrypt the grid                 |                |
| coordinates of the pickup        |                |
| site. When using the             |                |
| DRYAD Numeral Cipher,            |                |
| the same "SET" line will be      |                |
| used to encrypt the grid         |                |
| zone letters and the             |                |
| coordinates. To preclude         |                |
| misunderstanding, a              |                |
| statement is made that           |                |
| grid zone letters are            |                |
| included in the message          |                |
| (unless unit SOP specifies       |                |
| its use at all times).           |                |
| From signal                      |                |
| operation                        |                |
| instruction                      |                |
| 2. Radio                         |                |
| frequency                        |                |
| call sign, and                   |                |
| button                           |                |
| Encrypt the frequency of         |                |
| the radio at the pickup site,    |                |
| not a relay frequency. The       |                |
| call sign, and suffix if used,   |                |
| of the pickup site POC           |                |
| may be transmitted in the        |                |
| clear.                           |                |
| From                             |                |
| evaluation                       |                |
| of patient(s)                    |                |
| 3. Number of                     |                |
| patients by                      |                |
| precedence                       |                |
| Report only applicable           |                |
| information and encrypt          |                |
| the brevity codes:               |                |
| AURGENT                         |                |
| BURGENT-SURG                    |                |
| CPRIORITY                       |                |
| DROUTINE                        |                |
| ECONVENIENCE.                   |                |
| If two or more categories        |                |
| must be reported in the          |                |
| same request, insert the         |                |
| word BREAK between               |                |
| each category.                   |                |
| 4. Special                       |                |
| equipment                        |                |
| required                         |                |
| From                             |                |
| evaluation                       |                |
| of patient or                    |                |
| situation                        |                |
| Encrypt the applicable           |                |
| brevity codes:                   |                |
| ANone                           |                |
| BHoist                          |                |
| CExtraction equipment           |                |
| DVentilator.                    |                |
Radio telephone operator
To provide means of communication between evacuation vehicle and requesting unit while en route (e.g., obtain additional information or change in situation or directions).
Medic or senior person present
To assist in prioritizing missions by unit controlling the evacuation vehicles.
Medic or senior person present
To ensure proper equipment is onboard the evacuation vehicle prior to the start of the mission.
| LINE ITEM                   |
|-----------------------------|
| NORMAL                      |
| SOURCE                      |
| REASON                      |
| 5. Number of                |
| patients by                 |
| type                        |
| From                        |
| evaluation                  |
| of patient(s)               |
| Report only applicable      |
| information and encrypt the |
| brevity code:               |
| L - Litter                  |
| A - Ambulatory              |
|                             |
| If requesting MEDEVAC for   |
| both types, insert the word |
| BREAK between the litter    |
| entry and the ambulatory    |
| entry.                      |
| 6. (Wartime)                |
| Security of                 |
| pickup site                 |
| From                        |
| evaluation                  |
| of the                      |
| situation                   |
| Encrypt the brevity codes:  |
| NNo enemy troops in        |
| area                        |
| PPossible enemy troops     |
| in area (approach with      |
| caution)                    |
| EEnemy troops in area      |
| (approach with caution)     |
| XEnemy troops in area      |
| (armed escort required).    |
| From                        |
| evaluation                  |
| of patient                  |
| 6. (Peacetime)              |
| Number and                  |
| type of wound,              |
| injury, or                  |
| illness                     |
| Specific information        |
| regarding patient wounds    |
| by type (gunshot or         |
| shrapnel). Report serious   |
| bleeding and patient blood  |
| type, if known.             |
| 7. Method of                |
| marking pickup              |
| site                        |
| Based on                    |
| situation                   |
| and                         |
| availability                |
| of materiel                 |
| Encrypt the brevity codes:  |
| APanels                    |
| BPyrotechnic signal        |
| CSmoke signal              |
| DNone                      |
| EOther.                    |
| 8. Patient                  |
| nationality and             |
| status                      |
| From                        |
| evaluation                  |
| of patient                  |
| The number of patients in   |
| each category need not be   |
| transmitted. Encrypt only   |
| the applicable brevity      |
| codes:                      |
| AU.S. military             |
| BU.S. civilian             |
| CNon-U.S. military         |
| DNon-U.S. civilian         |
| EEnemy POW.                |
Medic or senior person present
To ensure the appropriate number of evacuation vehicles are dispatched to the pickup site
and are configured to carry the patients requiring evacuation.
Unit leader
To assist the evacuation crew in assessing the situation and to provide definitive guidance to
the evacuation vehicle while en route (e.g., specific location of enemy for aircraft planning approach).
Medic or senior person present
To assist evacuation personnel in determining treatment and special equipment required.
Medic or senior person present
To assist the evacuation crew in identifying the pickup location. Do not transmit the color of panels or smoke until the evacuation vehicle contacts the unit prior to its arrival. For security, the crew identifies the
color and the unit verifies it.
Medic or senior person present
To assist in planning for destination facilities security. Ensure that an English-speaking representative is present at the pickup site.
| LINE ITEM                        |
|----------------------------------|
| NORMAL                           |
| SOURCE                           |
| REASON                           |
| From                             |
| situation                        |
| Medic or                         |
| senior person                    |
| present                          |
| To assist in planning the        |
| mission (e.g., type of           |
| evacuation vehicle, date, time). |
| 9. (Wartime)                     |
| Nuclear,                         |
| biological, or                   |
| chemical                         |
| contamination                    |
| Include this line only when      |
| applicable. Encrypt the          |
| applicable brevity codes:        |
| NNuclear                        |
| BBiological                     |
| CChemical.                      |
| 9. (Peacetime)                   |
| Terrain                          |
| description                      |
| From area                        |
| survey                           |
| Personnel at                     |
| site                             |
| To allow evacuation personnel    |
| to assess route/avenue of        |
| approach into area, especially   |
| if hoist operation is required.  |
| Include details of terrain       |
| features in and around           |
| proposed landing site. If        |
| possible, describe               |
| relationship of site to          |
| prominent terrain features       |
| (e.g., lake, mountain,           |
| tower).                          |

## Appendix D

# Examples Of Status Boards Used In Medical Regulating

Four status boards are used in the medical regulating process: the Facilities Spot Status Board; the Blood Status Board; the consolidated Joining Report Board; and the Medical Regulating Status Board. (See figures D-1 through D-4.) These boards provide the medical regulator and other HSS staff personnel with the capability to view current medical regulating issues and their statuses at a glance. Traditionally status boards have been constructed of thermoplastic mounting on a sheet of 1/2-inch plywood. Current status boards are developed using Excel spreadsheets.

Data is recorded using a grease pencil or erasable marking pen. Regulators can make copies of the status board templates contained in this appendix to develop a running log of events throughout the entire operation. Regulators record information on the status boards and appropriate changes as they occur. The changes are then stored in a binder.

## Note

Facilities will report their status every 24 hours, at a minimum. During periods of increased operations, report status more frequently but no less than every 6 hours.



UNIT CALL SIGN


A. Operating Beds


B. Beds Occupied


C. Major OR


OR BacklogPatients


OR BacklogHours of Surgery


D. Minor OR


OR BacklogPatients


OR BacklogHours of Surgery


E. Patients Ready for Evacuation


F. Patients Evacuated Out of the Operational Area


G. Remarks


ACTUAL BLOOD STATUS as of _____________________________  (TIME AND DATE)
REPORTING UNIT


A-Positive


A-Negative


B-Positive


B-Negative


O-Positive


O-Negative


AB-Positive


AB-Negative


Number of Walking Blood Donors (ABO/Rh Types)


Refrigerators


TOTAL UNITS


JOINING REPORT STATUS as of ____________________________  (TIME AND DATE)
REPORTING UNIT

1. Number of Dedicated ORs

2. Number of Other (Minor) ORs

3. Number of Fixed x-ray Units

4. Number of Portable x-ray Units

5. Number of Blood Units on Hand

6. Number of Blood Refrigerators and Capacity

7. Number of Walking Blood Donors on Hand

8. Number of Intensive Care Beds

9. Number of Other Sickbay Beds


10. Number of Overflow Beds


11. Number of Medical Officers/Dental Officers/Physician
Assistants (by Navy Officer Billet Classification (NOBC))
12. Number of Hospital Corpsmen (by Navy Enlisted
Classification (NEC))


13. Number of Embarked/Augmented HSS Personnel
(by Unit/Corps/NOBC/NEC)

## Note

Create enough boxes to contain the required patient diagnostic codes specified in the OPLAN.

MEDICAL REGULATING STATUS as of _________________________   (TIME AND DATE)
HSS
FACILITY
BEDS/BEDS
OCCUPIED
(SEE
NOTE)
(SEE
NOTE)
(SEE
NOTE)
(SEE
NOTE)
(SEE
NOTE)
(SEE
NOTE)
ACTIVE REQUESTS FOR
PATIENT MOVEMENT
URGENT/PRIORITY/
ROUTINE

/


/
/

/


/
/

/


/
/

/


/
/

/


/
/
MASF/ASF
/


/
/
Returned to Duty

REMARKS/NOTES
Died of Wounds


Intratheater Evacuations

Intertheater Evacuations

TOTALS

As of 0001 ______ (Date)

INTENTIONALLY BLANK


## Appendix E Casualty Categorization And Prioritization E.1 Evacuation Precedence

Assignment of patient evacuation precedence is made by the senior military person present. This decision is based on the advice of the senior medical person at the scene, the patient's condition, and the tactical situation. Evacuation precedence provides the supporting medical unit and controlling HQ with information used in determining priorities for committing their evacuation assets. For this reason, correct assignment of evacuation precedence cannot be overemphasized. Patients are evacuated as soon as possible, consistent with available resources and pending missions. Figure E-1
lists the categories of precedence and the criteria used in their assignment. Figure E-2 lists the evacuation categories and approximate evacuation time periods.

| PRIORITY                                                           | PRECEDENCE                                 | CRITERIA    |
|--------------------------------------------------------------------|--------------------------------------------|-------------|
| I                                                                  | Urgent*                                    |             |
| Patients that                                                      | require emergency, short-notice evacuation |             |
| within a maximum of one hour:                                      |                                            |             |
| to save life, limb, and eyesight                                   |                                            |             |
| to prevent serious complications of the injury, serious illness,   |                                            |             |
| or permanent disability.                                           |                                            |             |
| IA                                                                 | Urgent-Surgical*                           |             |
| Patients that                                                      | require forward surgical intervention:     |             |
| to save life/limb and to stabilize for further evacuation within a |                                            |             |
| maximum of one hour.                                               |                                            |             |

*NOTE: It may be necessary, in some cases, to skip a medical capability and evacuate a patient directly to a greater medical capability in order to increase the survivability of the patient. To do so, the patient must be stable enough to endure the additional flight time to the greater medical capability. This may result in an overall MEDEVAC time which exceeds the 60 minute standard for Urgent/Urgent Surgical patients but is justifiable to ensure patients are evacuated to the right level of care based on their injuries.

| II                                                                | Priority                                   |
|-------------------------------------------------------------------|--------------------------------------------|
| Patients that                                                     | require prompt evacuation within a maximum |
| of four hours:                                                    |                                            |
| to prevent the medical condition from deteriorating to            |                                            |
| an urgent precedence,                                             |                                            |
| to prevent unnecessary pain or disability,                        |                                            |
| to provide required treatment not available locally.              |                                            |
| III                                                               | Routine                                    |
| Patients who                                                      | do not require immediate medical attention |
| and whose condition is not expected to deteriorate significantly. |                                            |
| Evacuation should be made within 24 hours.                        |                                            |
| IV                                                                | Convenience                                |
| Patients for whom                                                 | evacuation                                 |
| of medical convenience rather than necessity.                     |                                            |
| CATEGORY    | ARMY            | NAVY            | MARINE CORPS    | AIR FORCE           |
|-------------|-----------------|-----------------|-----------------|---------------------|
| Urgent      | Within 1 Hour   | Within 1Hour    | Within1 Hour    | As Soon As Possible |
| Priority    | Within 4 Hours  | Within 4 Hours  | Within 4 Hours  | Within 24 Hours     |
| Routine     | Within 24 Hours | Within 24 Hours | Within 24 Hours | Within 72 Hours     |

## Note

The categories of evacuation precedence are urgent, priority, and routine. The evacuation time periods are flexible, mission dependent, and vary greatly among the types of evacuation assets used by the Services.

## E.2 Triage

Triage is the categorization of casualties for the priority of treatment and evacuation. It is one of the most important tasks in casualty care, requiring the most informed judgment, knowledge, and courage. Triage is a continuing process. The individual assigned should be the most capable and experienced health care provider available.

## E.2.1 Principles Of Triage

The following are principles of triage:


1. Accomplish the greatest good for the greatest number of casualties.

2. Employ the most efficient use of available resources.

3. Return personnel to duty as soon as possible.

## E.2.1.1 Triage Factors

The following are triage factors:


1. Number of casualties requiring treatment.

2. Medical resources available to treat casualties (to include personnel and equipment).

3. Attention toward easily treated conditions.

a. Rapid and accurate assessments.

b. Continuous reassessment and retriage of all casualties.

## E.2.1.2 Categories Of Casualty Triage

The first formal triage establishes the patient's category. These categories are color coded and are recognized as follows:


1. Category I. Immediate (Red Tag). This category includes all compromises to a patient's ABCs. If
immediate medical attention is not provided, the patient will die. These medical procedures should not be time consuming and should concern only those casualties with high chance of survival. Examples include:

a. Airway compromise. Performing an emergency cricothyroidotomy for an obstructed airway

b. Breathing compromise. Performing a needle thoracentesis to decompress a tension pneumothorax

c. Circulation compromise. Applying a tourniquet to an arterial bleed.

2. Category II. Delayed (Yellow Tag). This category includes any injury that may be serious and potentially
life threatening. The patient may require extensive and intensive treatment but is not expected to significantly deteriorate over several hours. Patients in this category can safely wait until Category I patients have been stabilized. Examples include:

a. Compensated shock

b. Fractures, dislocations, or injuries causing circulatory compromise

c. Severe bleeding controlled with a tourniquet or other means

d. Open fractures and dislocations

e. Abdominal, thoracic, spinal, or head injuries

f. Uncomplicated major burns.

3. Category III. Minimal (Green Tag). This category, also called the walking wounded, includes patients with
injuries that require treatment but are unlikely to deteriorate over the next few days. These individuals have relatively minor injuries and can effectively care for themselves or can be helped by untrained personnel.
Examples include:

a. Minor lacerations

b. Abrasions

c. Fractures of small bones

d. Minor burns and strains.

4. Category IV. Expectant (Black Tag). This category is comprised of patients whose treatment would be
time consuming and extremely complicated coupled with a low chance of survival. The extent of their
treatment depends on available supplies and manpower. These patients should not be abandoned;
every effort should be devoted to their comfort. Once all immediate and delayed patients are treated,
expectant patients are retriaged and treated based on remaining medical supplies and personnel. Examples include:

a. Cardiac arrest from any cause

b. Massive brain/head trauma

c. Second- or third-degree burns over 70 percent of body surface area

d. Massive exposure to radiation.

## E.2.2 Treatment Priorities

After the first and formal triage, Category I, Immediate (Red Tag), patients are further triaged into treatment priorities. The most severely injured immediate patients are treated first.

## E.2.2.1 First Priority

The first-priority casualties suffer from one or more of the following conditions:


1. Asphyxia

2. Respiratory obstruction from mechanical causes

3. Open/tension pneumothorax

4. Maxillofacial wounds

5. Shock due to major external hemorrhage

6. Major hemorrhage

7. Visceral (abdominal) injuries

8. Cardio/pericardial injuries

9. Massive muscle damage
 10. Major fractures 11. Multiple wounds 12. Severe burns over 20 percent of body surface area.

## E.2.2.2 Second Priority

The second-priority casualties suffer from one or more of the following conditions:


1. Visceral (abdominal) injuries with perforations of the intestinal tract, wounds of the genitourinary tract, or
thoracic wounds without asphyxia

2. Vascular injuries needing repair

3. Closed cerebral injuries with increasing levels of consciousness

4. Burns under 20 percent of body surface area involving face, hands, feet, and genitalia.

## E.2.2.3 Third Priority

The third-priority casualties suffer from one or more of the following conditions:


1. Soft-tissue wounds without major muscle damage

2. Minor fractures and dislocations

3. Injuries of the eye

4. Maxillofacial injuries without asphyxia

5. Burns under 20 percent of body surface area.

## Appendix F Afloat And Shipboard Medical Evacuation Checklists F.1 Afloat Medical Evacuation Checklist


Discharge orders, en route orders, and prescriptions

Prepare to talk with NOK; NOK information

Nurse (Name):


Patient is ready to leave per NTTP 4-02.2M, Navy appendices

Patient records and baggage tags prepared

Records Checklist:

Funded TAD Orders

Service Record

Pay Advance

Medical Record

Dental Record

Narrative Summary

Consult

Labs/x-rays

Inpatient Record Copy

Valuables

Fill prescriptions


Uniform, civilian clothes, identification card, passport, and toiletries accompany the patient

## Smdr/Mrco (Name):


Notify chain of command and medical authority

Debrief; include blue and green side administrative and disbursing personnel

Arrange for orders through personnel

Make flight arrangements with AATCC

Pick up checks or advances from Disbursing

Prepare MEDEVAC MSG within 24 hours of MEDEVAC

Enter information into database

Start patient tracking

## F.2 Shipboard Treatment/Evacuation Team Checklist

| TASK DESCRIPTION                                                                           |
|--------------------------------------------------------------------------------------------|
| Approval to MEDEVAC (SMO/SMDR)                                                             |
|                                                                                            |
| 1. Recommendation/concurrence to MEDEVAC from provider, CSG/ESG/ATF surgeon,               |
| SMDR, and accepting physician (afloat or ashore, civilian or military).                    |
|                                                                                            |
| 2. Permission to MEDEVAC from AOR patient movement center.                                 |
|                                                                                            |
| 3. Agreement to MEDEVAC from TGRO (if using contractor provider network).                  |
|                                                                                            |
| 4. Permission to MEDEVAC obtained from the patient's COC.                                  |
|                                                                                            |
| 5. Recommendation to evacuate obtained from the provider's COC.                            |
|                                                                                            |
| Administrative Issues. Administrative Officer and Patient's COC                            |
|                                                                                            |
| 1. Funded orders for a period of 30 days for patient and attendant/escort                  |
| (consider cash advancement) (Administrative Officer).                                      |
|                                                                                            |
| 2. Proper attire (civilian and military) (COC).                                            |
|                                                                                            |
| 3. Personal items (shaving gear, dental paste, toothbrush, etc.) (COC).                    |
|                                                                                            |
| 4. Patient identification (military identification card and/or passport if available).     |
|                                                                                            |
| 5. Patient luggage (maximum two pieces: seabag less than 70 lbs. and a carry-on).          |
|                                                                                            |
| Air Operations, Supply, Communication(s) Officers (AIR OPS/SUPPO/COMMO)                    |
|                                                                                            |
| 1. Send naval message (drafted by the medical provider) to MEDEVAC and/or ask for          |
| assistance and/or notify numbered fleet and nearest MTF (COMMO).                           |
|                                                                                            |
| 2. Provide e-mail/chat capabilities to provider (SIPRNET/NIPRNET) if naval message is not  |
| indicated (COMMO).                                                                         |
|                                                                                            |
| 3. Provide telephone capabilities as necessary (COMMO).                                    |
|                                                                                            |
| 4. Set up air and/or ship-to-ship and/or boat evacuation (AIR OPS).                        |
|                                                                                            |
| 5. Set up ground transportation if ship is in port or medical for local ambulance (SUPPO). |
|                                                                                            |
| Notification and Patient Tracking (SMDR/MRCO/XO)                                           |
|                                                                                            |
| 1. Notify numbered fleet surgeon (naval message/e-mail/telephone) (SMDR/MRCO).             |
|                                                                                            |
| 2. Notify ISIC medical (SMDR/MRCO).                                                        |
|                                                                                            |

3. Notify nearest MTF (naval message/e-mail/telephone) (SMDR/MRCO).


4. Notify fleet liaison of receiving or closest MTF (naval message/e-mail/telephone)
(SMDR/MRCO).

5. Notify U.S. Embassy Defense Attache Office if patient remains hospitalized in the HN
(naval message/e-mail/telephone) (SMDR/MRCO).


6. Notify husbanding agent medical representative of HN, if in port. Medical representative
will assist in arranging care, reports, and medical payment of services rendered (SMDR/MRCO).
| TASK DESCRIPTION                                                                       |
|----------------------------------------------------------------------------------------|
| 7. Notify NOK, if indicated (XO/Command Master Chief or Senior Marine Corps Unit Rep). |
| If possible, allow patient to speak with NOK.                                          |
|                                                                                        |
| 8. Notify SMO/accepting physician/hospital/clinic (SMDR/MRCO).                         |
|                                                                                        |
| 9. Initiate patient tracking (SMDR/MRCO).                                              |
|                                                                                        |
| 10. Send situation report and safety message to appropriate agencies, if indicated     |
| (SMDR/XO).                                                                             |
|                                                                                        |

## Brief The Patient And/Or Escort (Smdr/Smo)

1. Where is the patient going? Specify installation/command.

2. To whom does the patient report? Specify person's name.

3. What is/are the patient's restriction(s)? Diet, ambulatory, litter, 24/7 watch (if psych).

4. Enough medication for travel period? Recommend 710 days.

5. Enough medical supplies available for travel period?


6. Latest documentation of current medical problems, including medical/dental, labs,
x-rays, physician orders, international certificate of vaccinations, etc.? Give to patient or escort.
7. List POCs. Ship, hospital, MTF, physician, and fleet liaison names and numbers given to
patient or escort.

8. Provide name and number of patient's emergency contact, if available. Normally, ISIC
medical POC.

9. Provide a full itinerary with final and all known intermediate destinations.

10. Write all of above information and include in records to be given to patient/escort.


## Equipment (Medical Team)

1. Verify supplies needed for the patient (dressings, bandages, etc.).

2. Verify all equipment is fully operational (i.e., batteries fully charged and electrical cords
and plug adaptors present and functioning) if required.

3. Label all equipment with the ship's name and address. (Easier to claim at completion of
MEDEVAC.)


## Appendix G

| TYPE                             | SERVICE       |   LITTER  |   AMBULATORY  | ATTENDANTS    |
|----------------------------------|---------------|-----------|---------------|---------------|
| AIRCRAFT                         |               |           |               |               |
| UH-60A Blackhawk                 | USA           |        7  |            7  | 1 Medic       |
| CH-47 Chinook                    | USA           |       24  |           33  | 2 Medic       |
| UH-1Y Huey                       | USMC          |        6  |           10  | 1 Corpsman    |
| CH-46 Sea Knight                 | USMC          |       15  |           22  | 2 Corpsmen    |
| CH-53D Sea Stallion              | USMC          |       24  |           37  | 2 Corpsmen    |
| CH-53E Super Stallion            | USMC          |       24  |           37  | 2 Corpsmen    |
| V-22 Osprey                      | USMC          |       12  |           24  | 2 Corpsmen    |
| MEDICAL GROUND VEHICLES          |               |           |               |               |
| M996 HMMWV                       | USA/USMC      |        2  |            3  | 1 Corpsman    |
| M997 HMMWV                       | USA/USMC/USAF |        4  |            8  | 1 Corpsman    |
| M1035 HMMWV                      | USA/USMC/USAF |        2  |            3  | 1 Corpsman    |
| MRAP CAT II ISS                  | USMC          |        2  |            4  | 1 Corpsman    |
| VEHICLES OF OPPORTUNITY (GROUND) |               |           |               |               |
| LAV 25                           | USMC          |        0  |            4  | Crew only     |
| LAVL                             | USMC          |        4  |            7  | 1 Corpsman    |
| MK 23 (7-Ton Truck)              | USMC          |       10  |           20  |               |

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## References

The development of NTTP 4-02.2M/MCRP 4-11.1G (DEC 2012) is based upon the following sources.


 AJP 4-10, Allied Joint Medical Support Doctrine

 BUMED INST 4081.1, Return of Patient Movement Items to Theatre and use of Patient Movement Item
Tracking System

 CJCSM 3500.03 (series), Joint Training Manual for the Armed Forces of the United States

 CJCSM 3500.04 (series), Universal Joint Task List (UJTL)

 COMNAVSURFORINST 6000.1, Shipboard Medical Procedures Manual

 DODI 5154.06, Armed Services Medical Regulating

 DODI 6000.11, Patient Movement

 U.S. Department of Homeland Security (DHS), National Response Framework

 Emergency Support Function Annexes


Emergency Support Function #1, Transportation Annex


Emergency Support Function #8, Public Health and Medical Services Annex

 FM 8-55, Planning for Health Service Support

 JP 1-02, Department of Defense Dictionary of Military and Associated Terms

 JP 3-0, Joint Operations

 JP 3-41, Chemical, Biological, Radiological and Nuclear Consequence Management

 JP 4-02, Health Service Support

 JP 5-0, Joint Operation Planning

 MCRP 4-11.1E, Health Service Support Field Reference Guide

 MCRP 5-12D, Organization of Marine Corps Forces

 MCWP 3-11.4, Helicopterborne Operations

 MCWP 4-11.1, Health Service Support Operations

 MCWP 5-1, Marine Corps Planning Process

 Marine Air-Ground Task Force Staff Training Program (MSTP) Pamphlet 5-0.3, MAGTF Planner's
Reference Manual

 NAVMED P-5132, Equipment Management Manual

 NTRP 1-02, Navy Supplement to the DOD Dictionary of Military and Associated Terms

 NTTP 3-02.1M/MCWP 3-31.5, Ship-to-Shore Movement

 NWP 4-02, Naval Expeditionary Health Service Support Afloat and Ashore

 NWP 3-29, Disaster Response Operations

 NWP 5-01, Navy Planning

 OPNAVINST 3500.38/MCO 3500.26/USCG COMDTINST 3500.1 (series), Universal Naval
Task List (UNTL)

 OPNAVINST 3501 (series), Projected Operational Environment (POE) and Required Operational
Capabilities (ROC)

 Standardization Agreement (STANAG) 2931, Camouflage of the Red Cross and Red Crescent on Land in
Tactical Operations

 MHS Learn Web site, https://mhslearn.csd.disa.mil

## Glossary

aeromedical evacuation (AE). The movement of patients under medical supervision to and between medical
treatment facilities by air transportation. (JP 1-02. Source: JP 4-02)
casualty evacuation (CASEVAC). 1. The unregulated movement of casualties that can include movement
both to and between medical treatment facilities. (JP 1-02. Source: JP 4-02) 2. The movement of the sick,
wounded, or injured. It begins at the point of injury or the onset of disease. It includes movement both to and between medical treatment facilities. All units have an evacuation capability. Any vehicle may be used to evacuate casualties. If a medical vehicle is not used it should be replaced with one at the first opportunity. Similarly, aeromedical evacuation should replace surface evacuation at the first opportunity. (MCRP 5-12C)
casualty receiving and treatment ship. In amphibious operations, a ship designated to receive, provide
treatment for, and transfer casualties. (JP 1-02. Source: JP 3-02)
definitive care. Care rendered to conclusively manage a patient's condition, such as full range of preventive,
curative acute, convalescent, restorative, and rehabilitative medical care. (JP 1-02. Source: JP 4-02)
en route care. Continuation of the provision of care during movement (evacuation) between the health service
support capabilities in the roles of care, without clinically compromising the patient's condition. (JP 1-02. Source: JP 4-02)
first responder care. The health care capability that provides immediate clinical care and stabilization to the
patient in preparation for evacuation to the next health service support capability in the continuum of care.
(JP 1-02. Source: JP 4-02)
forward resuscitative care (FRC). Care provided as close to the point of injury as possible based on current
operational requirements to attain stabilization, achieve the most efficient use of life-and-limb saving medical
treatment, and provide essential care so the patient can tolerate evacuation, which is known as Role 2 care in the North Atlantic Treaty Organization doctrine. (JP 1-02. Source: JP 4-02)
Global Patient Movement Integration Center (GPMIC). A joint activity for the development of policy and
standardization of global patient movement with the responsibility for the synchronization of current and future operational patient movement plans to identify available assets and validate transport to bed plans.
medical evacuation (MEDEVAC).  1. Refers to Army, Navy, Marine Corps, and Coast Guard patient
movement using designated tactical or logistic aircraft, boats, ships, and other watercraft temporarily equipped
and staffed with medical attendants for en route care. (Source: NTRP 1-02) 2. The timely and efficient
movement of the wounded, injured, or ill while providing en route medical care to and between medical treatment facilities. (Source: MCRP 5-12C)
medical regulating. The actions and coordination necessary to arrange for the movement of patients through
the roles of care and to match patients with a medical treatment facility that has the necessary health service support capabilities and available bed space. (JP 1-02. Source: JP 4-02)
opportune lift. That portion of lift capability available for use after planned requirements has been met.
(JP 1-02. Source: JP 4-02)
patient evacuation. The removal of a patient by a variety of transport means (air, ground, rail, or sea) from a
theater of military operation and between health service support capabilities to prevent further illness or injury
and to provide additional care and disposition of patients from the military health care system.

(NTRP 1-02. Source: NA)

patient movement. The act or process of moving a sick, injured, wounded, or other person to obtain medical
and/or dental care or treatment. Functions include medical regulating, patient evacuation, and en route medical care. (JP 1-02. Source: JP 4-02)
patient movement items (PMIs). The medical equipment and supplies required to support patients during
aeromedical evacuation, which is part of a standardized list of approved safe-to-fly equipment. (JP 1-02. Source: JP 4-02)
patient movement policy. Command decision establishing the maximum number of days that patients may
be held within the command for treatment. (JP 1-02. Source: JP 4-02)
patient movement requirements center (PMRC). 1.A joint activity that coordinates patient movement by
functionally merging of joint medical regulating processes, Services' medical regulating processes and patient
movement evacuation requirements planning (transport to bed plan). (JP 1-02. Source: JP 4-02). 2. Term used
to represent any theater or joint patient movement requirements center function.
stabilized patient. A patient whose airway is secured, hemorrhage is controlled, shock treated, and fractures
are immobilized. (JP 1-02. Source: JP 4-02)
stable patient. A patient for whom no inflight medical intervention is expected but the potential for medical
intervention exists. (JP 1-02. Source: JP 4-02)
theater hospitalization capability. Essential care and health service support capabilities to either return the
patient to duty and/or stabilization to ensure the patient can tolerate evacuation to a definitive care facility outside the theater, which is known as Role 3 in North American Treaty Organization doctrine.
(JP 1-02. Source: JP 4-02)
theater patient movement requirements center (TPMRC). The activity responsible for theater-wide
patient movement and coordination with Medical treatment facilities to identify the proper treatment/ transportation assets required. The activity coordinates with the Global Patient Movement Integration Center which shall provide global oversight, implement policy, and standardization for the regulation, clinical standards, and safe movement of uniformed services and other authorized, or designated patients.

## List Of Acronyms And Abbreviations

AATCC
amphibious air traffic control center
ACE
aviation combat element (USMC)
AE
aeromedical evacuation
AELT
aeromedical evacuation liaison team
AES
aeromedical evacuation system
AIR OPS
air operations officer
AJP
Allied joint publication
ALO
air liaison officer
AMC
Air Mobility Command
AOA
amphibious objective area
AOR
area of responsibility
ARG
amphibious ready group
AS
submarine tender
ASE
air support element
ASF
aeromedical staging facility
ASR
assault support request
ATF
amphibious task force
ATO
air tasking order
AXP
ambulance exchange point
BAS
battalion aid station
BES
beach evacuation station
BLT
battalion landing team
BUMED
Bureau of Medicine and Surgery (USN)
C2
command and control
CASEVAC
casualty evacuation
CATF
commander, amphibious task force
CBRN
chemical, biological, radiological, and nuclear
CC
command center
CCAT
critical care air transport
CCDR
combatant commander
CCMD
combatant command
CE
command element (MAGTF)
CIC
combat information center
CICWO
combat information center watch officer
CJCSM
Chairman of the Joint Chiefs of Staff manual
CLB
combat logistics battalion (USMC)
CLF
commander, landing force
CLR
combat logistics regiment (USMC)
CO
commanding officer
COC
chain of command
COMMO
communications officer
COMNAVSURFORINST
Commander, Naval Surface Forces instruction
CONUS
continental United States
CRTS
casualty receiving and treatment ship
CSG
carrier strike group
CSSOC
combat service support operations center
CVN
aircraft carrier, nuclear
DASC
direct air support center (USMC)
DHHS
Department of Health and Human Services
DHS
Department of Homeland Security
DOD
Department of Defense
DS
direct support
DTG
date-time group
EMF
expeditionary medical facility
ERCS
en route care system
ESF
emergency support function
ESG
expeditionary strike group
FAX
facsimile
FM
field manual (Army)
FRC
forward resuscitative care
FRSS
forward resuscitative surgery system
FST
fleet surgical team
GCC
geographic combatant commander
GCE
ground combat element (MAGTF)
GPMIC
Global Patient Movement Integration Center
GS
general support
H&S
headquarters and service
HAC
helicopter aircraft commander
HES
helicopter evacuation station
HHQ
higher headquarters
HM
hospital corpsman
HMMWV
high-mobility multipurpose wheeled vehicle
HN
host nation
HQ
headquarters
HSAP
Health Services Augmentation Program
HSC
helicopter support center
HSS
health service support
HSSE
health service support element
HSSO
health service support officer
HST
helicopter support team
IAW
in accordance with
IDC
independent duty corpsman
ISIC
immediate superior in command
ITV
in-transit visibility
IV

intravenous
JP
joint publication
JPMRC
joint patient movement requirements center
J/TPMRC
joint/theater patient movement requirements center
LCE
logistics combat element (MAGTF)
LF
landing force
LHA
amphibious assault ship (general purpose)
LHD
amphibious assault ship (multipurpose)
LPD
amphibious transport dock
LPO
leading petty officer
LSD
dock landing ship
LZ
landing zone
MAG
Marine aircraft group
MAGTF
Marine air-ground task force
MAO
medical administrative officer
MARDIV
Marine division
MASF
mobile aeromedical staging facility
MAW
Marine aircraft wing
MCRP
Marine Corps reference publication
MCT
Marine Corps task
MCWP
Marine Corps warfighting publication
MDDOC
Marine air-ground task force deployment and distribution
operations center
MEB
Marine expeditionary brigade
MEDEVAC
medical evacuation
MEDOPTASKSUP
medical operational task supplement
MEDREGNET
medical regulating network
MEF
Marine expeditionary force
METT-T
mission, enemy, terrain and weather, troops and support


availabletime available (USMC)
MEU
Marine expeditionary unit
MIACG
Medical Interagency Coordination Group
MLG
Marine logistics group
MMCC
Marine air-ground task force movement control center
MOUT
military operations on urbanized terrain
MRCO
medical regulating control officer (USN)
MRT
medical regulating team
MSC
Medical Service Corps
MSOC
medical support operations center
MTF
medical treatment facility
MWSG
Marine wing support group
MWSS
Marine wing support squadron
NATO
North Atlantic Treaty Organization
NAVFOR
Navy forces
NDMS
National Disaster Medical System
NECC
Navy Expeditionary Combat Command
NIPRNET
Nonsecure Internet Protocol Router Network
NOK
next of kin
NTTP
Navy tactics, techniques, and procedures
NWP
Navy warfare publication
OCONUS
outside the continental United States
OFML
operational forces medical liaison
OIC
officer in charge
OPCON
operational control
OPLAN
operation plan
OPNAVINST
Chief of Naval Operations instruction
OPORD
operation order
OR
operating room
PCS
primary control ship
PEO
patient evacuation officer (USMC)
PET
patient evacuation team
PMI
patient movement item
PMITS
patient movement item tracking system
PMR
patient movement request
PMRC
patient movement requirements center
POC
point of contact
POE
projected operational environment
POI
point of injury
POTS
plain old telephone system
PPE
personal protective equipment
PZ
pickup zone
RAS
regimental aid station
ROMO
range of military operations
SARP
substance abuse rehabilitation program
SC
surgical company
SCS
secondary control ship
SIPRNET
SECRET Internet Protocol Router Network
SITREP
situation report
SMDR
senior medical department representative
SMO
senior medical officer
SOP
standard operating procedure (Navy); standing operating procedure


(Marine Corps)
STP
shock trauma platoon
SUPPO
supply officer
T-AH
hospital ship
TAO
tactical action officer
TAR/HR
tactical air request/helicopter request
TF

task force
TGRO
TRICARE Global Remote Overseas
TPMRC
theater patient movement requirements center
TPMRC/A
Theater Patient Movement Requirements Center-Americas
TRAC2ES
Transportation Command Regulating and Command and Control


Evacuation System
UMCC
unit movement control center
USA
United States Army
USAF
United States Air Force
USCG
United States Coast Guard
USMC
United States Marine Corps
USN
United States Navy
USNS
United States Naval Ship
USTRANSCOM
United States Transportation Command
VS
visual signal
XO
executive officer

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## List Of Effective Pages

| Effective Pages          |
|--------------------------|
| 1 thru 18                |
| 1-1 thru 1-6             |
| 2-1 thru 2-6             |
| 3-1 thru 3-8             |
| 4-1 thru 4-12            |
| 5-1 thru 5-20            |
| A-1, A-2                 |
| B-1 thru B-14            |
| C-1 thru C-12            |
| D-1 thru D-6             |
| E-1 thru E-4             |
| F-1 thru F-4             |
| G-1, G-2                 |
| Reference-1, Reference-2 |
| Glossary-1, Glossary-2   |
| LOAA-1 thru LOAA-8       |
| LEP-1, LEP-2             |
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| JUL 2013                 |
| JUL 2013                 |
| JUL 2013                 |
| JUL 2013                 |
| JUL 2013                 |
| JUL 2013                 |
| JUL 2013                 |
| JUL 2013                 |
| JUL 2013                 |
| JUL 2013                 |
| JUL 2013                 |
| JUL 2013                 |
| JUL 2013                 |
| JUL 2013                 |
| JUL 2013                 |
| JUL 2013                 |

## Intentionally Blank