MCWP 4-11.1 

Health Service Support 

Operations

U.S. Marine Corps

PCN 143 000040 00
DEPARTMENT OF THE NAVY

Headquarters United States Marine Corps

Washington, D.C. 20380-1775

 10 March 1998

FOREWORD

“Corpsman Up!” has echoed across numerous battlefields in

America’s history. To answer this cry, medical personnel

assigned to Marine Corps forces (MARFOR) must be knowledgeable, prepared, and able to provide responsive health service

support (HSS) so Marines can do what they do best: win battles.

Commanders must be aware of HSS requirements and their contributions to mission accomplishment.

Marine Corps Warfighting Publication (MCWP) 4-11.1, Health

Service Support Operations, disseminates information on the

mission, functions, structure, and concept of employment of HSS

units. This publication provides overarching doctrine and establishes a practical approach to HSS from the perspective of the

commander or staff officer who can apply it without any significant medical background.

This publication establishes general guidance that requires judgment in application. Lower-level tactics, techniques, and procedures for specific application will be published in MCRP 4-22B,

HSS Field Reference Guide. This MCWP pertains equally to

small-unit leaders and senior commanders.

MCWP 4-11.1 supersedes Fleet Marine Force Manual (FMFM)

4-50, Health Service Support, dated 19 September 1990.
Reviewed and approved this date.

BY DIRECTION OF THE COMMANDANT OF THE MARINE CORPS

J. E. RHODES

Lieutenant General, U.S. Marine Corps

Commanding General

Marine Corps Combat Development Command

DISTRIBUTION: 143 000040 00
Unless otherwise stated, whenever the masculine or feminine

 gender is used, both men and women are included.

To Our Readers

Changes: Readers of this publication are encouraged to submit

suggestions and changes that will improve it. Recommendations

may be sent directly to Commanding General, Doctrine Division

(C 42), Marine Corps Combat Development Command, 3300

Russell Road, Suite 318A, Quantico, VA 22134-5021 or by fax

to 703-784-2917 (DSN 278-2917) or by E-mail to smb@doctrine div@mccdc. Recommendations should include the following information:

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Additional copies: A printed copy of this publication may be

obtained from Marine Corps Logistics Base, Albany, GA 31704-

5001, by following the instructions in MCBul 5600, Marine

Corps Doctrinal Publications Status. An electronic copy may be

obtained from the Doctrine Division, MCCDC, world wide web

home page which is found at the following universal reference

locator: http://www.doctrine.quantico.usmc.mil.
Health Service Support Operations _______________________ MCWP 4-11.1

Health Service Support Operations

Table of Contents

Page

Chapter 1 Fundamentals

1001 Mission 1-1

1002 Principles 1-2

1003 A Healthy and Fit Force 1-3

1004 Casualty Prevention 1-3

1005 Casualty Care and Management 1-3

1006 Functions 1-4

1007 The Hague and Geneva Conventions 1-5

Chapter 2 Intelligence

2001 Internal Medical Intelligence Sources 2-1

2002 The Armed Forces Medical 2-3

Intelligence Center

Chapter 3 Operations

3001 Marine Corps Forces 3-1

3002 Marine Expeditionary Forces 3-2

3003 Marine Expeditionary Unit 3-7

3004 Phasing Support Ashore 3-8

3005 Capabilities External to the MAGTF 3-11
Health Service Support Operations ________________________ MCWP 4-11.1

Chapter 4 Logistics

4001 Allowance and Source of Logistics 4-2

4002 Individual HSS Equipment 4-5

4003 Routine Resupply 4-5

4004 Combat Resupply 4-5

4005 Patient Movement Items 4-6

4006 Disposal of Materials 4-7

4007 Protection of Medical Supplies 4-8

Chapter 5 Planning

5001 Joint Guidance 5-1

5002 Annex Q, Planning Guidance, 5-2

Medical Services

Chapter 6 Command and Control

 

6001 C2 Organization 6-1

6002 Communications and Information Systems 6-2

6003 Information Management 6-4

6004 MAGTF C2 Centers, Agencies, 6-5

and Facilities

Chapter 7 Preventive Medicine

7001 Pre-Deployment 7-2

7002 Deployment 7-2

7003 Marine Expeditionary Force 7-3

Preventive Medicine Sources 
Health Service Support Operations _______________________ MCWP 4-11.1

7004 Mobile Medical Augmentation 7-4

 Readiness Team

7005 Navy Environmental Health Center 7-4

7006 Additional Resources 7-5 

Chapter 8 Patient Movement

8001 Phases 8-1

8002 Decisionmaking 8-2

8003 Medical Evacuation Assets 8-3

8004 Aeromedical Evacuation Request 8-4

 Procedures

8005 Further Guidance 8-5

Chapter 9 Nuclear, Biological, and Chemical

Defense

9001 Before a Nuclear, Biological, or 9-2

Chemical Attack

9002 During a Nuclear, Biological, or 9-3

Chemical Attack

9003 After a Nuclear, Biological, or 9-3

Chemical Attack

9004 Nuclear Environment 9-4

9005 Biological Environment 9-5

9006 Chemical Environment 9-6

9007 Medical Evacuation 9-6

9008 Personnel Considerations 9-7

 

 
Health Service Support Operations ________________________ MCWP 4-11.1

Chapter 10 Combat Casualty Reporting 

10001 Field Medical Card 10-1

10002 Identification Tags 10-3

10003 Automated Medical Record Technology 10-4

Chapter 11 Training 

11001 Health Service Support Goals 11-1

11002 Training Pipeline 11-3

11003 Commander’s Responsibilities 11-4

11004 Medical Department Officers 11-5

and Senior Enlisted

11005 Types of Training 11-5 

11006 Dental Personnel 11-8

11007 Non-Health Service Support Personnel 11-8

Appendices

A Blood Support A-1

B Authorized Medical and B-1

Dental Allowance Lists

C Glossary C-1 

D References and Related Publications D-1
Chapter 1

Fundamentals

Focus of health service support (HSS) in the past has been on

establishing a large and complex system to maximize returns to

duty. Our current focus emphasizes the provision of far-forward,

mobile, medical and surgical support and stabilization and rapid

evacuation of casualties who are unable to quickly return to duty. 

HSS is a process that delivers on demand to the warfighter a

healthy, fit, and medically ready force; counters the health threat

to the deployed force; and provides critical care and management

for combat casualties. Aided by technological innovation and

logistics, HSS is the employment of medical forces in support of

the warfighter.

HSS supports the National Military Strategy of forward presence

and power projection. HSS strengthens the warfighting commander by providing essential care in the theater and rapid aeromedical evacuation (AE) of casualties to enhanced medical

treatment facilities in the continental United States (CONUS) for

definitive care without sacrificing quality of care. 

1001. Mission

The HSS mission is to minimize the effects that wounds, injuries,

and disease have on units’ effectiveness, readiness, and morale.

The mission is accomplished by a preventive medicine program

that safeguards personnel against potential health risks and by

establishing an HSS system. The system provides support from
1-2 ___________________________________________________ MCWP 4-11.1

the point of wounding, injury, or illness and evacuation to a medical treatment facility that can provide the level of care required

by the patient.

1002. Principles

HSS principles are guides for planning, organizing, managing,

and executing Service support. Seldom will all principles exert

equal influence; usually, one or two will dominate a given situation. Identifying which ones have priority is essential to establishing effective HSS. Joint Pub 4-02, Doctrine for Health

Service Support in Joint Operations, states that each Service

component has an HSS system that encompasses—

• Conformity—the medical plan must integrate and comply

with the commander’s plan. 

• Proximity—the medical plan must provide HSS as close to

combat operations as the tactical situation permits. 

• Flexibility—the medical plan must shift HSS resources to

meet changing requirements. 

• Mobility—the medical plan must anticipate requirements for

rapid movement of HSS units to support combat forces during

operations. 

• Continuity—the medical plan must provide optimum, uninterrupted care and treatment to the wounded, injured, and sick. 

• Coordination—the medical plan must ensure that HSS

resources in short supply are efficiently employed and used

effectively to support the planned operations.
Health Service Support Operations ____________________________ 1-3

1003. A Healthy and Fit Force

HSS promotes wellness and ensures quality of life to strengthen

the human component of military forces against disease and

injury. A healthy force ready to deploy anywhere in the world

and ready to withstand hardship and deprivation assures warfighting commanders of physical and mental readiness. Wellness

requires continuous attention before, during, and after deployment to sustain maximum readiness and warfighting capability.

1004. Casualty Prevention

HSS focuses on both forms of threat: enemy and health. The

enemy threat produces combat casualties, whereas the everpresent threat to health produces disease and nonbattle casualties

and is a major source of morbidity throughout military history.

The enemy threat depends largely on the enemy’s intent to use

force and to inflict casualties. The health threat depends on a

complex set of environmental and operational factors that combine to produce disease and nonbattle injuries. Failure to counter

either threat jeopardizes mission accomplishment and ultimately

achievement of the operational objective. 

1005. Casualty Care and Management

HSS deploys smaller, mobile, and capable elements to provide

essential care in the theater. HSS resources are flexible and

adaptable and can be tailored to missions ranging from major

theater wars to military operations other than war. The major

components of casualty care and management are first response,
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prehospitalization treatment, forward resuscitative surgery, tailorable hospital care, and enroute care. 

1006. Functions

Medical plans must include the following functions into the HSS

concept of operations:

• Health maintenance—routine sick call, physical examination,

preventive medicine, dental maintenance, record maintenance,

and reports submission. 

• Casualty collection—selection of and manning of locations

where casualties are assembled, triaged, treated, protected

from further injury, and evacuated.

• Casualty treatment—triage and treatment (self-aid, buddy aid,

and initial resuscitative care).

• Temporary casualty holding—facilities and services to hold

sick, wounded, and injured personnel for a limited time, usually not to exceed 72 hours. The medical battalion, force service support group, is the only HSS unit staffed and equipped

to provide temporary casualty holding.

• Casualty evacuation—movement and ongoing treatment of the

sick, wounded, or injured while in transit to medical treatment

facilities. All Marine units have an evacuation capability by

ground, air, or sea. 
Health Service Support Operations ____________________________ 1-5

1007. The Hague and Geneva Conventions

The conduct of armed hostilities on land is regulated by the law

of land warfare, which is both written and unwritten. The law of

land warfare is derived from two principal sources: custom treaties and lawmaking treaties such as the Hague and Geneva Conventions. The rights and duties set forth in these conventions are

part of the supreme law of the land. Violation of any convention

is a serious offense. Under the Conventions, the signatories

established the principle of disinterested aid to all victims of war

including those who, through wounds, capture, or shipwreck, are

no longer enemies but are merely suffering and defenseless

human beings. Additional protocols to the Geneva Conventions,

accepted and signed in 1977, established the manner in which the

victims of war are to be treated. The Conventions established

standards of conduct for medical and religious personnel

assigned to aid victims. The United States is a signatory to the

Geneva Conventions of 1949 and has directed its military forces

to abide by its articles. However, future asymmetrical theaters,

especially nonstate actions, may not abide—in fact, probably

will not abide—by the convention accepted by nation states.

Refer to the following sources for principles of international and

domestic law and the status and protection of medical personnel

under both Conventions.

• NWP 1-14M/MCWP 5-2.1/COMDTPUB P5800.7, The Commander’s Handbook on the Law of Naval Operations.

• FM 27-10/FMFM 0-25, The Law of Land Warfare. 

• DA PAM 27-1, Treaties Governing Land Warfare.

(reverse blank)
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Chapter 2

Intelligence

Accurate and timely intelligence—knowledge of the enemy and

the surrounding environment that is needed to support decisionmaking—is a prerequisite for military success. Intelligence is a

fundamental component of command and control that aids the

commander in applying combat power at the decisive time and

place. Intelligence activity is mission-focused. In MAGTF intelligence operations, intelligence operations are determined by the

commander’s intelligence requirements. The resulting intelligence effort provides critical knowledge and understanding

about the enemy and the environment to help the commander

plan and make decisions.

Medical intelligence includes more than just information on disease or other environmental hazards. Raw data must be analyzed

and properly acted on to prevent an adverse operational impact.

Medical intelligence from all sources—internal and external to

the MAGTF—must be assimilated for the commander to have a

complete picture of the medical threat.

2001. Internal Medical Intelligence Sources

Preventive Medicine Section

Most preventive medicine assets organic to the Marine expeditionary force (MEF) are found in the preventive medicine section, headquarters and service (H&S) company, medical
2-2 ___________________________________________________ MCWP 4-11.1

battalion, force service support group (FSSG). This section provides general support to all MEF major subordinate commands.

General support includes identifying information on environmental health, demographics, living conditions, water supply,

waste disposal, insects, diseases, and vector issues of military

importance, as well as evaluating local food sanitation and sight

and hearing conservation programs.

Local Command G-2 Sections

Additional medical intelligence may be requested through G-2

sections of the command element, ground combat element

(GCE), aviation combat element (ACE), and combat service support element (CSSE).

Additional information on intelligence support to medical operations can be found in the intelligence series of the Marine Corps

warfighting publications (particularly MCWP 2-12, MAGTF

Intelligence Production and Analysis). 

Health Service Support Element

The health service support element (HSSE) is often the first to

receive medical intelligence from on-site care providers due to

multiple communications and information links available to sections within the FSSG combat service support operations center

(CSSOC).
Health Service Support Operations ____________________________ 2-3

2002. The Armed Forces Medical Intelligence 

Center

The Armed Forces Medical Intelligence Center (AFMIC) is a

field production activity of the Defense Intelligence Agency. It is

the sole producer of medical intelligence in the Department of

Defense (DOD). AFMIC provides all-source intelligence on—

• Worldwide infectious disease and environmental health risks. 

• Foreign military and civilian health care systems and infrastructure. 

• Foreign biomedical developments and life science technologies of military medical significance. 

AFMIC maintains extensive data bases; monitors foreign

research, development, production, and transitional flow of medical materiel for military interest; and provides intelligence liaison services to key customers. It also conducts in-house and

mobile training, including a medical intelligence fellowship program; serves on numerous intelligence committees and working

groups; and trains military reservists for mobilization assignments. AFMIC’s intelligence products provide direct support to

U.S. military customers for operational planning; development

of policy, doctrine, and training priorities; and medical research

and development.
2-4 ___________________________________________________ MCWP 4-11.1

Queries for medical intelligence support are addressed via the

HSS chain or direct from deploying units to—

Defense Intelligence Agency

Armed Forces Medical Intelligence Center

Fort Detrick 

Frederick, MD 21701-5004

or via message to—

DIRAFMIC FTDETRICKMD.
Chapter 3 

Operations

The Marine Corps organization for combat is based on its unique

assigned force structure. HSS is a mission area common to every

MAGTF, regardless of the mission. Definitive operational planning for HSS is always an integral part of all MAGTF operations.

The inherent flexibility in the MAGTF and the broad spectrum of

potential MAGTF missions call for equal flexibility in HSS execution. The size, type, and configuration of HSS capabilities

needed to effectively support a MAGTF will be determined by

mission, enemy, terrain and weather, troops and support available-time available (METT-T). The following paragraphs provide an organizational framework for command and staff

cognizance within which all HSS operations are executed.

3001. Marine Corps Forces

Marine Corps forces (MARFOR) commanders are responsible

for coordinating and integrating HSS within their area of operations. The MARFOR surgeon, dental officer, medical planner,

and medical administrative officer advise the MARFOR commander on matters relating to the health of the command, medical logistics, patient movement, sanitation, disease surveillance,

medical intelligence, and medical personnel issues, as well as

current and future HSS planning at the MARFOR level. Additional duties include serving as the liaison for the commander in

chief (CINC) and other component surgeons and monitoring

HSS aspects of the time-phased force and deployment data flow.
3-2 ___________________________________________________ MCWP 4-11.1

3002. Marine Expeditionary Forces

MEF commanders are responsible for coordinating and integrating HSS within their area of operations. The MEF surgeon, medical planner, medical administrative officer, preventive medicine

officer, hospital corpsmen, and dental technicians are responsible

for establishing HSS requirements and ensuring the HSS systems

established by MEF major subordinate commands form an integrated and responsive network of support.

The surgeon and the staff also advise the MEF commander on

matters relating to the health of the command, medical logistics,

patient movement, sanitation, disease surveillance, medical intelligence, medical personnel issues, as well as current and future

HSS planning at the MEF level. The MARFOR deals with matters more on the operational level of war, but the MEF is more

focused toward the tactical level.

HSS beyond the organic capabilities of the GCE and ACE are

normally provided by task-organized units of the medical and

dental battalions of the FSSG. Additional support may be needed

from designated casualty receiving and treatment ships (CRTSs),

fleet hospitals, hospital ships, or medical treatment facilities

(MTFs) of other Services. 

Marine Division

The medical staff of the division headquarters has a division surgeon, medical planner/administrator, a psychiatrist, and hospital

corpsmen. Medical staff responsibilities are similar to the MEF’s

but are more specifically related to the activities of the GCE.

When units smaller than divisions deploy as the GCE, the regiment or battalion surgeons assume much of the planning respon-
Health Service Support Operations ____________________________ 3-3

sibility associated with health services in addition to their clinical

responsibilities. Planning occurs on a company or platoon level,

with the hospital corpsmen assisting in the planning. 

Marine Aircraft Wing

The medical staff of the Marine aircraft wing (MAW) headquarters has a wing surgeon, medical planner/administrative officer,

an environmental health officer, industrial hygienist, optometrist,

and hospital corpsmen. Medical staff responsibilities are similar

to the MEF’s but are more specifically related to the activities of

the ACE.

A MAW has four Marine aircraft groups (MAGs). Each MAG

has a flight surgeon and several hospital corpsmen. Each MAG is

supported by a Marine wing support squadron (MWSS) of the

Marine wing support group (MWSG). The MWSS medical staff

has a flight surgeon and hospital corpsmen. The flight surgeon is

the squadron commander’s special staff officer responsible for

the aeromedical safety and HSS for the squadron.

Force Service Support Group

The group surgeon advises the commander on the health of the

command and the adequacy of internal FSSG HSS. The surgeon

also has cognizance over the operation of the group aid station.

There is also a health service support officer (HSSO) who coordinates FSSG HSS support for GCE and ACE units requiring

medical care that exceeds their organic capabilities. The HSSO

serves as the officer in charge of the medical section of the

CSSOC during exercises or operations. The FSSG has the majority of the MEF’s medical capability. It has a medical battalion

with three surgical companies (Surg Co) and eight shock trauma
3-4 ___________________________________________________ MCWP 4-11.1

platoons (STPs) to provide initial resuscitative care for casualties.

There is a dental battalion to provide field dentistry when

deployed and to advise on dental issues. Medical supplies and

equipment for the MEF are managed through the medical logistics company (Med Log Co), supply battalion, which issues the

authorized medical allowance list (AMAL) and authorized dental

allowance list (ADAL) and handles resupply issues. When the

Med Log Co or detachment does not deploy with the CSSE, the

CSSE supply detachment and/or inter-Service support agreement

provides resupply support. 

Medical Battalion

The medical battalion, FSSG is organized to execute HSS functions in support of the MAGTF’s mission. The medical battalion

provides initial resuscitative HSS support to the MEF and is the

only source of organic Marine Corps medical support above the

aid station level. Its primary mission is to perform those emergency medical and surgical procedures that, if not performed,

could lead to death or loss of limb or body function. The battalion’s surgical companies provide initial resuscitative surgical

intervention, temporary casualty holding, ground evacuation support to forward medical elements, and preventive medicine support.

The battalion structure has 260 holding beds and 9 operating

rooms. The medical battalion is made up of an H&S company

and three Surg Co. The H&S company contains 8 STPs that have

10 patient holding beds each. Each Surg Co contains 60 beds and

3 operating rooms.
Health Service Support Operations ____________________________ 3-5

Surgical Company, Medical Battalion, FSSG. The Surg Co (with

support from CSS detachments [CSSDs] to provide power, messing, and transportation) supports regimental-size operations and

receives casualties from units or individuals providing first

response medical treatment. The Surg Co provides MTFs for

resuscitative surgery, medical treatment, and temporary holding

of casualties from supported forces. They also prepare and evacuate casualties whose medical requirements exceed the established theater evacuation policy.

The Surg Co is composed of a—

• Headquarters platoon.

• Triage/evacuation platoon.

• Surgical platoon—contains three surgical sections, each supporting an operating room, each operating room capable of

staffing two 12-hour shifts.

• Holding platoon—contains 3 ward sections, each containing

20 medical/surgical beds.

• Combat stress platoon.

• Services platoon (ancillary)—services two laboratory sections,

two pharmacy sections, and two x-ray sections.

Since the Surg Co is a major link in the chain of evacuation, it

should be located, whenever possible, in close proximity to an

airfield capable of casualty evacuation by fixed-wing aircraft.

Components of the Surg Co may be used to reinforce an STP

(i.e., surgical section) to provide a far forward resuscitative surgery capability.
3-6 ___________________________________________________ MCWP 4-11.1

Shock Trauma Platoon, H&S Company, Medical Battalion, FSSG.

The STP is the smallest, 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 Surg Co, or serve as the forward element of

a surgical company (i.e., triage/evacuation platoon) preparing to

relocate. An STP reinforced with preventive medicine, group aid

station, and dental personnel may also provide HSS to a CSSD or

MEU service support group (MSSG). 

Dental Battalion

The dental battalion, FSSG provides dental services to the MEF.

By attaching task-organized dental sections and detachments to

HSSEs of the MAGTF, battalion personnel maintain dental

readiness during exercises, deployments, operations other than

war, and combat operations.

In an operational environment, the dental battalion’s primary

mission is to provide dental health maintenance with a focus on

emergency care. Personnel from these detachments may also

provide postoperative, ward, central sterilization and supply

room support, and other medical support as determined to be

appropriate by the medical battalion and Surg Co commanders.

The dental battalion commander has additional special staff

officer duties as the MEF and FSSG dental officer. As a special

staff officer, the dental officer advises the commanders on all

professional, administrative, and operational matters in order to

optimize use of dental assets.
Health Service Support Operations ____________________________ 3-7

Medical Logistics Company

The Med Log Co, Supply Battalion, FSSG is a supply operation

directly responsible to the FSSG supply battalion commanding

officer. The Med Log Co—

• Maintains medical equipment.

• Maintains centralized acquisition, storing, and stock rotation.

• Constructs medical supply sets (AMAL/ADAL).

• Resupplies AMAL/ADAL and line-items in support of HSS

units based on specific mission needs.

3003. Marine Expeditionary Unit

Each MEU element deploys with its own organic HSS capability.

HSS above this organic level is provided by an HSS detachment

(HSSD) task-organized from the medical and dental battalions,

FSSG, as part of the MSSG. HSSD structure may include—

• Shock/trauma platoons.

• H&S company, medical battalion elements.

• Med Log Co detachments.

• Dental detachments.

• Surg Co (e.g., triage/evacuation platoons).

The tactical situation ashore will dictate the size of the HSSE

capability ashore. This capability may range from a beach or

helicopter evacuation station staffed by a triage/evacuation platoon to an STP reinforced with sections of a Surg Co.
3-8 ___________________________________________________ MCWP 4-11.1

3004. Phasing Support Ashore

During the movement phase of amphibious operations, the commander, amphibious task force (CATF) has overall responsibility

for HSS services to embarked personnel.

Landing force (LF) HSS personnel aboard ATF ships augment

ATF medical and dental departments by providing care to

embarked LF personnel using ship’s company medical facilities

and supplies. LF Class VIIIA equipment and supplies will not be

used aboard ship unless authorized by the MAGTF commander

in support of an overwhelming emergency.

The senior medical officer of each ATF ship is responsible to the

ship’s commanding officer for HSS to all personnel. If a ship

does not have a medical officer, the embarked LF medical officer

will have to provide HSS while embarked.

The stages described in the following paragraphs and shown in

figure 3-1 represent only notional phasing. Other variations and

combinations resulting from such factors as threat level, mission,

terrain, geography, weather, force at risk, opposing forces, etc.,

are possible.
Health Service Support Operations ____________________________ 3-9

Figure 3-1. Stages of Medical Support in an

Amphibious Operation.
3-10 _________________________________________________ MCWP 4-11.1

Assault Echelon

During the assault phase, HSS ashore is limited to the capabilities of medical sections organic to combat units. First response

medical care for assault forces is provided by self-aid, buddy aid,

and corpsmen of landed rifle platoons. 

When the tactical situation permits, BASs are established and

care from a physician is provided. BASs are normally divided

into two sections with assigned battalion nonmedical litter bearers divided between the two sections. One section lands with the

battalion combat train and provides in-close support to the

assault force. The second section lands with the field train and

establishes interim evacuation stations until relieved by followon HSSEs.

Evacuation stations are then expanded and staffed by the supporting medical battalion, drawing assets from collection and

evacuation sections of STPs or triage/evacuation platoons of surgical companies. When established with the landing force support party (LFSP), the supporting medical battalion constitutes

the beach evacuation section(s) of the LFSP. The primary role of

a beach evacuation station is to evacuate assault force casualties

to designated CRTSs.

When evacuation stations attached to the LFSP become operational ashore, established BASs are relieved to conduct their missions in primary support of parent battalions. Following the

landing of supporting evacuation stations, expansion of HSS

facilities ashore begins.
Health Service Support Operations __________________________ 3-11

Assault Follow-on Echelon

While the majority of CSS capabilities during the AFOE continue to be sea-based, projected HSS capabilities ashore will

expand along with the FSSG’s. Capabilities could be additional

STPs with mobile CSSDs.

When progress of assault units is such that the beachhead is relatively secure, HSS is enhanced from follow-on forces.

Follow-on Forces

HSS shifts its posture to achieve shore-based health care consistent with the expected combat intensity and duration of sustained

operations ashore, independent of sea-based facilities. This phasing is achieved by upgrading capabilities ashore by consolidating

HSS capabilities ashore with those not yet landed.

If a sustained land campaign is envisioned, additional HSS will

normally be provided by fleet hospitals (or other Service equivalent facilities) or hospital ships.

3005. Capabilities External to the MAGTF

Casualty Receiving and Treatment Ships

CRTSs have the largest medical capability of any amphibious

ship in the ATF. A CRTS’s medical spaces include operating

rooms, an intensive care unit, a quiet room, ward beds, and overflow beds. Dental spaces include general dental operating rooms,

a maxillofacial surgery operating room, and a prosthetics lab.

CRTSs require augmentation by Navy medical department per-
3-12 _________________________________________________ MCWP 4-11.1

sonnel to achieve full casualty treatment capability. Casualties

are delivered via helicopter and surface craft. ATF ships suitable

for use as CRTSs are the LHD, LHA, and LPH. The CATF’s

Annex Q, Planning Guidance, Medical Services, will designate

platforms to serve as CRTSs. For medical support capabilities of

these vessels and their potential roles as CRTSs, see Fleet Marine

Force Reference Publication 1-18, Amphibious Ships and Landing Craft Data Book.

Fleet Hospitals

Fleet hospitals are transportable, medically and surgically intensive, and deployable in a variety of operational scenarios. These

HSS assets can be used by theater CINCs, Navy component commanders, and joint task force commanders. Although external

support requirements exist, fleet hospitals are substantially selfsupporting and relocatable. However, relocatability varies with

hospital size. An expedient move would require external transportation equipment. See NWP 4-02.4, Part A, Deployable

Health Service Support Platforms—Fleet Hospitals, for more

information.

Hospital Ships (T-AH)

The T-AH is a floating surgical hospital. Its mission is to provide

acute medical care in support of combat operations at sea and

ashore. Support may be provided to ATFs, joint task forces, and

combined forces. The T-AH is designed to receive patients primarily by helicopter. It has limited capacity for receiving patients

by surface craft.
Health Service Support Operations __________________________ 3-13

Augmentation

Fleet Surgical Teams. Fleet surgical teams (FSTs) are HSS augmentation teams assigned to the fleet CINCs. Combined, the

Pacific and Atlantic fleets have nine teams that are considered

the fleet CINC’s assets in both peacetime and wartime. FSTs

provide medical support to the CINC’s routine deployment medical requirements. Medical support for other peacetime contingencies that cannot be covered by the FSTs will be provided by

mobile medical augmentation readiness teams (MMARTs).

Mobile Medical Augmentation Readiness Teams. MMARTs provide rapid peacetime response teams of pre-identified medical

department personnel trained to augment elements of the operating forces. The Commander Naval Medical Command Instruction 6440.2 series contains a detailed discussion of the MMART.

Medical Augmentation Program. The medical augmentation program (MAP) is the means by which operating forces are brought

to wartime manning levels by personnel augmentation from

CONUS-based activities. MAP is managed by the U.S. Navy

Bureau of Medicine and Surgery (BUMED). In special cases,

staffing may be above authorized staffing or in addition to

authorized billets when directed by the Chief of Naval Operations. Units participating in MAP include CRTSs, MARFOR

HSS units, fleet hospitals, and hospital ships.

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Chapter 4

Logistics

HSS logistics encompasses the procurement, initial issue, management, resupply, and disposition of material required to support medical and dental elements organic to the MARFOR.

Requisitions for Class VIIIA (consumable and equipment) material follow the same channels as other classes of supply. Guidance for planning and procuring Class VIIIB (blood products) is

found in DOD Instruction 6480.4, Armed Services Blood Program Operational Procedures. 

As with all classes of supply, careful consideration should be

given to stockage levels of Class VIIIA material. Commanders

should not be burdened with moving and maintaining excess

material, nor should the need for support ever be delayed because

of inadequate access or lack of responsiveness. When the medical planner is developing and planning for appropriate levels of

Class VIIIA support, the following information is crucial to

ensuring that the entire HSS system is responsive to the commander:

• Concept of operation/scheme of maneuver.

• Combat intensity.

• Duration of the operation.

• Casualty estimates.
4-2 ___________________________________________________ MCWP 4-11.1

4001. Allowance and Source of Logistics 

The MAGTF surgeon advises the MAGTF commander regarding medical and dental material support. Allocation of material is

documented in the table of equipment (T/E); the AMALs/

ADALs; and the normal replenishment supply support. The total

T/E and AMALs/ADALs are designed to support a MEF in an

estimated worst case scenario for a 60-day period of combat. The

quantity of AMALs/ADALs required to support a MEF is determined by the mission requirements of that force. The AMALs/

ADALs are to be allocated to support specific requirements. The

authorizing commander is responsible for funding AMALs/

ADALs above the level prescribed by the Marine Corps order

4400 series.

Table of Equipment 

A unit’s T/E includes items necessary for basic support of the

organization. Examples of this type of equipment include—

• Tentage.

• Vehicles.

• Tools.

• Communications equipment.

• Nuclear, biological, and chemical (NBC) gear.

• Specialized clothing.

• Office equipment.

• Other equipment and supplies, as required.
Health Service Support Operations ____________________________ 4-3

AMALs and ADALs

AMALs and ADALs are specialized equipment and supply

assemblages for medical and dental elements to provide combat

HSS. The medical and dental elements have the capability to provide the following services:

• Trauma management.

• Resuscitative surgery.

• Expeditionary laboratory.

• Pharmacy.

• X-ray.

• Dental.

• Preventive medicine.

• NBC treatment.

• Patient holding.

• Sick call.

• Environmental supplements.

• HSS test and repair systems.

See appendix B for a detailed description of AMALs and

ADALs.

Normal Replenishment Supply Support

HSSEs deploy with their initial issue and the days of supply prescribed by the MAGTF commander. For the first 60 days of

operations, Class VIIIA material beyond this level for the MEF is

maintained by the CSSE and provided to supported units as

required. For operations more than 60 days, medical resupply is
4-4 ___________________________________________________ MCWP 4-11.1

generally provided to the using HSS unit by the CINC’s designated single integrated medical logistics manager (SIMLM) via

the CSSE. 

Single Integrated Medical Logistics Manager

HSS logistics is normally a Service responsibility. However, in

joint operations, a SIMLM system may be designated to provide

central logistical support to all participating Services in the combatant CINC’s area of responsibility. As the dominant user, the

U.S. Army has been formally tasked by the DOD to perform the

peacetime SIMLM mission in the European and Korean theaters.

Under wartime or crisis conditions, the U.S. Army will usually

be the dominant Class VIII user and must plan for the SIMLM

mission.

The SIMLM system encompasses the provision of medical supplies, medical equipment maintenance and repair, blood management, and optical fabrication to all joint forces within the theater

of operations, except Navy combatant ships. 

HSS logistics can be provided to Navy hospital ships for common, demand-supported medical supplies in the later stages of

theater development. Activation of the SIMLM mission depends

on the time-phased force and deployment list supporting the contingency. Air delivery of emergency medical supplies can be

used where and when tactically supportable. The CSSE supply

detachment, which may include portions of Med Log Co, provides Class VIIIA single-item resupply and, eventually, limited

medical repair capabilities to all HSS units of the MAGTF. Supporting combat service support detachments provide medical

resupply to medical units of other MAGTF elements. 
Health Service Support Operations ____________________________ 4-5

4002. Individual HSS Equipment

Hospital corpsmen assigned to combat support units of the

MAGTF are assigned a complete first aid kit as part of their field

gear. These kits may be held by the unit organic supply section

and issued on an as needed basis. The corpsmen’s parent unit

supply section is responsible for ensuring that contents of the

first aid kit are maintained in good condition, and that medications have not exceeded their shelf life. Dental officers will be

issued a dental instrument and supply set (unit-2).

4003. Routine Resupply

HSS personnel needing resupply will forward requisitions to

their unit’s supply section. The supply section will, in turn, pass

the requisition to the supported activities supply system management unit, or if deployed, the supply section of the CSSE. The

CSSE orders, receives, and distributes the required material.

While HSS personnel may be of help in identifying alternate

doses or approved substitutes, care is required in using alternate

sources of supply, other than those already approved by the

Defense Medical Standardization Board or Navy Medical Logistics Command. HSS personnel may also assist in identifying the

location of other U.S. medical facilities where required items

may be obtained. 

4004. Combat Resupply

During embarkation planning, HSS planners determine the number and type of AMALs/ADALs required to support the assault

phase of the operation. Additional Class VIIIA consumable
4-6 ___________________________________________________ MCWP 4-11.1

material will be positioned for deployment with the supply section of the CSSE. After the consumable AMALs/ADALs modules are issued and expended, or when directed, resupply will be

accomplished by normal line item requisition from the supporting CSSE. When stockpiles of MAGTF Class VIIIA are

expended, Class VIIIA will be obtained through the designated

SIMLM provider.

4005. Patient Movement Items 

Patient movement items (PMI) are the medical equipment and

supplies required to support the patient during evacuation, e.g.,

ventilators, vital sign monitors, and blankets. Handling and

return of equipment to the aeromedical evacuation (AE) system

requires a reliable supporting logistics infrastructure to ensure

that PMI are available and serviceable. The plan for a PMI

exchange system and the return of AE equipment and PMI to the

originating MTF should be addressed in the respective operation

plan (OPLAN).

When a patient requires evacuation, the originating MTF has

responsibility to provide the PMI. These items accompany a

patient throughout the chain of evacuation from originating MTF

to destination MTF, whether it is an intra- or intertheater transfer. 

The Services will include and maintain initial quantities of PMI

in the appropriate medical assemblages.
Health Service Support Operations ____________________________ 4-7

4006. Disposal of Materials

Disposal of soiled, contaminated, or other unserviceable Class

VIIIA items must be accomplished with due consideration for

the safety of U.S. forces and local civilian populations.

Disposal must also be in compliance with local and international

laws, ordinances, or customs governing such disposal whenever

operations allow. When disposal takes place in the U.S. or its territories, Class VIIIA disposal is coordinated with the local office

of the Defense Reutilization Marketing Office. Peacetime disposal overseas is coordinated under the guidance of the Defense

Reutilization Marketing Office or supporting CSSE.

When the tactical situation permits during combat operations, the

safest method of field disposal is burning, followed by deep

burial (over 6 feet). The burial site must be located at a safe distance from watersheds and populated areas. Responsibility for

neutralization and disposal of clothing, equipment, and dressings

removed during NBC decontamination processes resides with

the command’s NBC officer.

Disposal of body parts, tissues, and Class VIIIB blood and blood

products obtained during operative or diagnostic procedures is,

preferably, accomplished in the same manner as used by local

medical facilities. Alternative disposal by burning or deep burial

requires prior authorization and specific guidance of higher

authority. Prior coordination with local health authorities and

religious leaders should be accomplished whenever possible.
4-8 ___________________________________________________ MCWP 4-11.1

4007. Protection of Medical Supplies

Medical material and supplies are protected under the law of land

warfare and the Geneva Conventions. However, when medical

material and supplies are mixed with combat supplies, they lose

the protection afforded by these covenants. Marking of medical

material and supply storage areas with the red cross of the

Geneva Conventions is a tactical decision to be made by the area

commander. The Geneva Conventions and the law of land warfare prohibit the destruction of medical material and supplies that

must be abandoned in a retrograde movement occasioned by

enemy action or other tactical considerations.
Chapter 5

 Planning

HSS planning occurs at all levels of command and organizations

across the range of military operations. All commanders are

responsible for the health and welfare of their troops. All commanders have HSS staffs that plan from the strategic level of war

through the tactical level of war.

5001. Joint Guidance

Chairman of the Joint Chiefs of Staff Manual (CJCSM) 3122.03,

Joint Operation Planning and Execution System, Volume II,

Planning Formats and Guidance, sets forth administrative

instructions and formats to develop OPLANs of combatant commands, subunified commands, joint task forces, and their subordinate component commands. It may also be applied when

significant forces of one Service are attached to forces of another

Service.

OPLANs, concept plans (CONPLANs), functional plans, and

operation orders (OPORDs) prepared by commanders to fulfill

tasks assigned in the joint strategic capabilities plan (or otherwise directed by the Chairman of the Joint Chiefs of Staff) will

conform to the guidance contained in CJCSM 3122.03. To facilitate communications on operation planning among military

headquarters, commanders will standardize the format and content of other appropriate plans according to CJCSM 3122.03.
5-2 ___________________________________________________ MCWP 4-11.1

5002. Annex Q, Planning Guidance, Medical 

Services 

Guidance for medical services is located in Annex Q, Planning

Guidance, Medical Services, of OPLANs, CONPLANs, functional plans, and OPORDs. Annex Q identifies requirements and

provides guidance to subordinate commanders and their HSS

planners. The following are sample HSS appendices to Annex Q:

• Appendix 2, Joint Blood Program.

• Appendix 3, Hospitalization.

• Appendix 4, Patient Movement.

• Appendix 6, Medical Logistics (Class 8A) System.

• Appendix 7, Preventive Medicine.

• Appendix 8, Medical Command, Control, and Communications.
Chapter 6

Command and Control

Command and control (C2) for HSS is the combination of HSS

organizations, people, communications systems, architecture,

and medical information which provides the commander timely

information to make decisions. C2 for HSS entails all functions

necessary for medical units to rapidly execute HSS functions in

response to the needs of the supported unit.

There are four major C2 areas:

• C2 organization.

• Communications and information systems.

• Information management.

• MAGTF C2 centers, agencies, and facilities. 

In combination these areas develop, process, and disseminate

orders and information to subordinate units and provide the

means to receive and implement orders from a higher authority.

All of these areas interact to produce effective and harmonious

actions.

6001. C2 Organization

HSS is a part of every level of the MAGTF. Communications

assets available vary. HSS shares these assets with other warfighting functions. In the Marine Corps, the same radios that

carry fire support or command information will also carry medi-
6-2 _____________________________________________________________________ MCWP 4-11.1

cal information. The same telephones and switches that commanders use are also used by HSS personnel. There is no

“separate” or “dedicated” medical network in the tactical Marine

Corps communications architecture. Rather, the architecture supports “common users” who share its resources.

Units responsible for providing detachments which support C2

for HSS operate under the staff cognizance of the G-6/S-6 (communications and information systems officer) of the supported

unit. Marines assigned to these units, in concert with the personnel assigned to the G-6/S-6 sections and HSS organizations,

ensure that an effective communications and information systems (CIS) network is planned, installed, operated, and maintained.

6002. Communications and Information Systems

CIS provide management and decision support tools for the HSS

commander and staff to collect, transport, process, disseminate,

and protect voice, data, and information.

CIS include tactical single channel VHF, SHF, HF, and UHF

radios; tactical and commercial telephones; multichannel digital

systems; satellite communications; cryptographic equipment;

and data systems for classified and unclassified local area network/wide area network (LAN/WAN) connectivity. All of these

systems are used by common units and are allocated in accordance with the commander's priorities.
Health Service Support Operations ______________________________________ 6-3

To improve interoperability, increase efficiency, and reduce

costs, DOD has mandated that the Services move to a common

set of information systems and services. This implementation is

occurring with the fielding of the Global Command and Control

System (GCCS) and the implementation of the defense information infrastructure (DII) common operating environment (COE).

HSS uses the Joint Operation Planning and Execution System

(JOPES) for planning and execution under GCCS. JOPES combines joint policies, procedures, personnel, training, and a reporting structure supported by automated data processing on GCCS.

The medical analysis tool (MAT) is the HSS requirements generator and analysis tool supported by GCCS at the Marine Corps

component level for planning and execution of HSS.

MEF

CIS support for HSS organizations will be provided by communications battalion. The G-6/S-6 must plan for connectivity

among the division, wing, and FSSG as well as external communications with organizations in the joint arena.

Division

CIS support for HSS personnel will be provided by communications company, H&S battalion.

Wing

CIS support for HSS personnel will be provided by the Marine

Wing Communications Squadron (MWCS) and Marine Wing

Support Group (MWSG).
6-4 _____________________________________________________________________ MCWP 4-11.1

FSSG

CIS support for HSS personnel will be provided by communications company, H&S battalion and communications platoon,

medical battalion.

Deployed MEF

CIS support for HSS personnel will come from both the Navy

CIS system and communications battalion.

6003. Information Management

HSS has traditionally been supported by a variety of information

systems and procedures that aided the user in the collection, analysis, presentation, and storage of information. Systems used

unique hardware and software configurations that performed specialized functions. These systems typically were unable to access

or share data and information with other systems. New designs

have been developed that consolidate as well as improve accessing and sharing information. This migration has continued under

the auspices of the Theater Medical Information Program

(TMIP). 

TMIP's mission is to provide integrated automation of the theater

medical environment. TMIP provides a global capability linking

HSS information data bases and integration centers that are

accessible to the warfighter while engaged in any mission. The

link is essential to aid theater commanders to make time-sensitive decisions critical to the success of their operations. The link

is accomplished by integrating the GCCS with the Global Combat Support System. TMIP integrates HSS capabilities under a
Health Service Support Operations ______________________________________ 6-5

joint concept of operations to assist the HSS commander/theater

surgeon and to support the delivery of responsive combat medical care. TMIP establishes the means to combine existing, developing, and future medical information. 

TMIP's C2 capabilities collect medical information about personnel, medical units, facilities, equipment, supplies, and training

during alert/mobilization, deployment/sustainment, and reconstitution/redeployment. Information is received, processed, displayed, and analyzed to generate and publish plans and orders.

TMIP enables the assessment of personnel medical status and the

readiness and capabilities of the HSS units. The program provides the required information links to HSS organizations and

enables rapid decisionmaking on—

• Medical capabilities assessment and sustainability analysis.

• Medical threat/intelligence.

• Combat casualty care.

• Medical logistics. 

• Blood management.

• Patient movement.

• Manpower/training.

6004. MAGTF C2 Centers, Agencies, and Facilities

The main MAGTF C2 center, agency, or facility for HSS will be

found in the combat service support operations center (CSSOC)

of the FSSG. The CSSOC is the agency within the CSSE and
6-6 _____________________________________________________________________ MCWP 4-11.1

subordinate CSS units that controls and coordinates the day-today operations of the CSS organization. At the FSSG, the

CSSOC is operated by the G-3/S-3. Within the ACE, these duties

are performed by the G-4/S-4 at the MWSG/MALS/MWSS levels.

The CSSOC’s are centrally organized around the functional

areas of supply, health services, maintenance, engineer, transportation, and services. The CSSOC controls the CSS radio nets and

has direct telephone lines to subordinate units, supported units,

and higher headquarters. 
Chapter 7

Preventive Medicine

Disease and nonbattle injuries can have a rapid and widespread

impact on the effectiveness of our military organizations. The

devastation of disease and environmental hazards on personnel is

not isolated to the people of a Third World developing nation.

Throughout history, military forces have lost more personnel to

disease and nonbattle injuries than to wounds sustained in combat. During the Civil War, more Federal soldiers died from disease than wounds. Approximately 44,238 were killed in battle;

49,205 died of wounds; and 186,216 died of disease.

Preventive medicine efforts can dramatically reduce the incidence of disease during military operations. Proactive preventive

medicine measures should be incorporated into all levels of care.

Real-time disease surveillance data should be used to brief commanders on potential medical and environmental threats and on

the effectiveness of preventive medicine measures. 

Prevention of disease and nonbattle injuries is a critical function

of the HSSE. Naval Medical (NAVMED) P-5010, BUMED

Manual of Naval Preventive Medicine, prescribes specific preventive medicine measures.
7-2 ___________________________________________________ MCWP 4-11.1

7001. Pre-Deployment 

Specific preventive medicine taskings and efforts to be conducted before deployment include—

• Collecting and disseminating environmental and epidemiological information on the theater of operations to the supported

commander, HSS units, and MAGTF elements that might be

affected, for use in planning and action as changes occur.

• Recommending personnel augmentation requirements to support the OPLAN.

• Recommending immunizations and other preventive measures

to counter medical threats within the theater of operations and

in-transit staging points.

• Training individuals (through unit training) in personal

hygiene, personal protective measures, protection equipment,

and field sanitation practices.

• Assisting medical units in completing pre-deployment requirements (immunization, preventive medicine threat briefings,

and permethrin treatment of clothing) and in preparing for

embarkation of preventive medicine equipment.

7002. Deployment

Specific preventive medicine taskings and efforts to be conducted while deployed include—

• Disseminating militarily significant preventive medicine information to commanders and HSS units in the theater of operation.
Health Service Support Operations ____________________________ 7-3

• Providing technical oversight on food service operations and

procurement.

• Providing oversight and testing at water points and bulk water

storage areas.

• Conducting disease vector and pest surveillance and control

when feasible.

• Maintaining environmental health and pest control equipment.

• Conducting weekly disease and injury surveillance at all battalions and squadrons. 

7003. Marine Expeditionary Force Preventive 

Medicine Sources

The MEF surgeon’s staff includes a physician (the preventive

medicine officer) with special expertise in preventive medicine

and public health. This physician is responsible to the MEF commander and MEF surgeon for coordinating preventive medicine

efforts among the division, the wing, and the FSSG.

Most preventive medicine assets organic to the MEF are found in

the FSSG’s preventive medicine section of the medical battalions’ H&S company. The section is responsible for providing

general support to all MEF commands. Support includes identifying information regarding environmental health factors; demographics; living conditions; water supply; waste disposal;

insects; diseases and vector issues of military importance, and

evaluating local food sanitation, sight, and hearing conservation

programs.
7-4 ___________________________________________________ MCWP 4-11.1

7004. Mobile Medical Augmentation 

Readiness Team 

During peacetime, any operational commander may request preventive medicine MMART assistance from the Chief of Naval

Operations (N931) via the operational chain of command. 

7005. Navy Environmental Health Center 

The Navy Environmental Health Center, located in Norfolk, VA,

supports operational units. It conducts—

• Risk screening.

• Data evaluation.

• Exposure assessments.

• Toxicity assessments.

• Health risk evaluations.

• Health and safety planning.

• Environmental risk communication workshops and seminars.

The Navy Environmental Health Center and its supporting activities establish and disseminate preventive medicine and environmental protection policy recommendations for BUMED. Field

activities in direct support of the Center follow:

• Navy Environmental Preventive Medicine Units—provide

updated disease information on areas of the world or specific

countries, public health and preventive medicine issues, and

occupational health and safety support to military forces.
Health Service Support Operations ____________________________ 7-5

• Navy Disease Vector Ecology and Control Centers—provide

technical and specialized services in the field of disease vector

surveillance and control, as well as providing vector control

training to various agencies of the federal government. These

centers test and evaluate vector control equipment and techniques, collect, summarize, and disseminate disease vector and

health threat information. This diverse mission includes a special emphasis on contingency response in the event of armed

conflicts, military operations other than war, and operational

support of both fleet and shore activities.

• Forward Deployed Laboratory—can quickly identify infectious and biologic threats to the deployed force. During contingency operations, the task force commander may request the

support of this deployable, advanced public health laboratory

(NWP 4-02, Operational Health Service Support).

7006. Additional Resources

The Naval Medical Research and Development Command conducts basic clinical and applied field research directly related to

military requirements and operational needs. It is located in

Bethesda, MD.

The Naval Medical Research Institute provides research related

to immediate operational problems, which include heat stress

research that leads to exposure limits for hot-humid shipboard

environments; safety equipment, including protective clothing,

flight goggles, safety belts, and repellents for insect vectors of

disease and sharks. It is also located in Bethesda, MD.

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Chapter 8 

 Patient Movement

Patient movement is a casualty management system. It is

designed to coordinate the movement of casualties from site of

injury or onset of disease through successive levels of care to a

facility that can provide the appropriate level of treatment.

Prompt movement of casualties through the evacuation system to

treatment facilities is essential to decrease morbidity and mortality of battlefield casualties. If casualties occurred at regular intervals, in constant numbers, at predetermined locations, and with

predictable injuries, their movement would require little or no

coordination. Patient movement is a vital support factor that must

be planned. Personnel must be trained on equipment and procedures in advance of operations in the field. 

8001. Phases

Coordination of casualty movement is especially critical during

operations when casualties must be moved from shore to task

force ships. When properly followed, the medical regulating process ensures that patients move only as far rearward in the continuum of care as their health needs dictate which, in turn,

assures the efficient and effective use of the limited HSS assets

available to the MAGTF. Patient movement may occur in two

phases:

• Evacuation—the movement of patients between point of

injury or onset of disease to a facility that can provide the necessary treatment capability. 
8-2 ___________________________________________________ MCWP 4-11.1

• Medical regulating—the process of selecting destination

MTFs with the necessary HSS capabilities for patients being

medically evacuated in, between, into, and out of different theaters of geographic combatant commands and CONUS.

8002. Decisionmaking

Degree of care for the sick and wounded in any area of combat is

greatly influenced by prevailing tactical situations. Conditions

are seldom static, and success in combat must remain the primary

goal of combat, combat support, and combat service support

units. This environment requires a dynamic casualty management decisionmaking process which must be applied at all HSS

units and in the patient movement system. 

Casualty Sorting (Triage)

An effective process of casualty sorting, also referred to as triage, is basic to the successful operation of a patient movement

system. Rapid evaluations must be made to identify which

patients need immediate resuscitation and which patients can tolerate delay in treatment. Deciding which patients should be

moved after initial treatment to other medical facilities is of

equal importance. 

Medical Management

Under combat conditions, the flow of sick and wounded puts

variable pressure on capabilities of medical facilities. Incoming

casualties necessitate the movement of stable casualties who can

be evacuated. Close coordination between clinical and administrative services must be maintained to achieve effective manage-
Health Service Support Operations ____________________________ 8-3

ment of individual casualties. Medical officers who are

responsible for decisions on movement of individual casualties

must work closely with administrative officers charged with

implementing patient movement for evacuation. Underlying all

considerations is the basic objective of preserving life and limb.

8003. Medical Evacuation Assets 

The assigned mission dictates the number and types of aircraft

assigned to accomplish all assault support tasks. This mission,

along with the limited number of aircraft in the Marine Corps

inventory, precludes the assignment of dedicated aeromedical

evacuation (AE) aircraft in most cases. All Marine Corps rotary

wing transport and utility aircraft have the capability to perform

an AE mission. Allocation of aircraft to perform the AE mission

would be at the discretion of the MAGTF commander. Assets are

designated to perform AE through implied mission tasking or by

assuming a standby posture. 

Prior planning is essential to ensure proper allocation of aircraft

to support AE missions. Within the MEF, the FSSG HSSE, in

conjunction with the FSSG logistics movement coordination

center (LMCC), plans for medical evacuation aircraft. The

LMCC air liaison officer is the direct link to the MAW for identification of medical evacuation missions in the air tasking order.

In the absence of an AE capability, casualty evacuation is accomplished using any surface (water or ground) transportation available (ground ambulance, five-ton truck, small boat, landing craft

air cushion). 
8-4 ___________________________________________________ MCWP 4-11.1

Evacuation concepts used by the Marine Corps are defined as the

following:

Dedicated medical evacuation assets are patient movement

assets configured for medical evacuation, externally marked with

a red cross, and specifically reserved to support the medical

evacuation mission. Dedicated medical evacuation assets are

authorized protection under the Geneva Conventions. 

Designated medical evacuation assets are nonmedical patient

movement assets, not externally marked with a red cross, but

configured and allocated for patient movement. Designated medical evacuation assets are not afforded protection under the

Geneva Conventions. 

8004. Aeromedical Evacuation Request 

Procedures

Normally, when control is seabased, units request AE by radio to

the helicopter direction center using the helicopter direction net.

When command and/or net control has been passed ashore, units

request AE from the direct air support center using the tactical air

request/helicopter request net. The air officer will then consult

with either the ATF medical regulating control officer when seabased or the LF patient evacuation officer when ashore for a recommendation of the best medical facility to care for the patient.

In operations where dedicated AE assets are assigned, the direct

air support center will make liaison with the units responsible to

provide AE.
Health Service Support Operations ____________________________ 8-5

AE missions are classified as preplanned or immediate. Both

types of support are delivered in response to specific requests via

the assault support request. 

AE missions from Marine Corps MTFs to theater hospitals will

be coordinated by the patient evacuation/patient movement section, FSSG, in coordination with the HSSE, the CSSOC, LMCC,

and the theater patient movement requirements center.

8005. Further Guidance

NWP 4-02.2 Vol. 1, Patient Movement, provides a general summary of the HSS system and the specific tactic, techniques, and

procedures (TTP) for naval expeditionary force medical regulating. For joint operations, refer to Joint Pub 4-02.2, Joint Tactics,

Techniques, and Procedures for Patient Movement in Joint

Operations.

(reverse blank)
Chapter 9

 Nuclear, Biological, and Chemical 

Defense

All military personnel must be prepared to operate in a contaminated environment. HSS personnel must also be prepared to provide patient care in an NBC environment. Decontamination of

patients and transportation assets causes evacuation delays, making first aid and patient care even more critical. Since the staffing

of HSS units is based on conventional warfare requirements,

these units will be taxed in their ability to provide effective HSS. 

NBC actions cause high casualty rates, materiel losses, obstacles

to maneuver, and contamination. Mission-oriented protective

posture (MOPP) levels 3 and 4 result in body heat buildup,

reduced mobility, and degraded visual, touch, and hearing

senses, ultimately reducing unit effectiveness. 

Contamination is a major problem in providing HSS in an NBC

environment. To maximize the unit’s survival and effectiveness,

commanders must take action to avoid NBC contamination by

making maximum use of alarm and detection equipment and unit

dispersion; overhead shelters, shielding materials, and protective

covers; collective protection shelters; and chemical agent resistant coatings. 

On a contaminated battlefield, the focus is on keeping the Marine

in the battle. Effective and efficient triage, emergency treatment,

decontamination, and contamination control in the operational
9-2 ___________________________________________________ MCWP 4-11.1

area save lives, assure prompt evacuation, and maximize the

return-to-duty rate. 

9001. Before a Nuclear, Biological, or Chemical 

Attack 

Before an NBC attack, HSS personnel must train to survive the

attack, to operate the MTF in the environment, and to effectively

care for NBC casualties. HSS personnel must keep their immunizations current, use available preventive treatment against suspected agents, pretreat for suspected agents, and have antidotes

and essential Class VIIIA supplies readily available for known or

suspected chemical or biological agents.

The best defense for HSS personnel is to protect themselves,

their patients, Class VIIIA supplies, and equipment by following

contamination avoidance procedures. HSS personnel must

ensure that stored Class VIIIA supplies and equipment are in

protected areas or in their storage containers with covers in place.

One method of protecting supplies and equipment is to keep

them in their shipping containers until needed. When time permits after receiving warnings that an NBC attack is imminent or

that a downwind hazard exists, HSS personnel should seek protected areas such as basements, culverts, and ravines for themselves and their patients. 
Health Service Support Operations ____________________________ 9-3

9002. During a Nuclear, Biological, or Chemical 

Attack 

HSS personnel and their patients should remain in the best available protected areas and take up positions within the shelter that

are away from windows and other openings. They move out of

these positions only when notified that it is safe to do so. In the

absence of higher authority, HSS personnel use caution in their

movements. 

9003. After a Nuclear, Biological, or Chemical 

Attack 

HSS personnel must survey their equipment to determine the

extent of damage and their capabilities to continue the mission.

Initially, patients from nuclear detonations will be suffering thermal burns or blast injuries. Also, HSS personnel may expect disorientation in patients and other HSS personnel. 

Normally, radiation-induced injuries are observed within a few

hours or days of the attack. Chemical agent patients manifest

their injuries immediately upon exposure to the agent. However,

blister agent patients can show signs of exposure immediately or

up to 14 days later. Biological agent patients may not show any

signs of illness for hours to days after exposure. 

All patients receiving treatment must be checked for NBC contamination. Patients are decontaminated before treatment to

reduce the hazard to HSS personnel, unless life- or limb-threatening conditions exist. Patients requiring treatment before decontamination are treated in the HSS area of the decontamination
9-4 ___________________________________________________ MCWP 4-11.1

station. Cardiac arrest, massive hemorrhage, and respiratory distress are conditions that may require treatment in the decontamination area. 

9004. Nuclear Environment 

The HSS unit must continue its support mission in a nuclear

environment by preparing protective shelters. Well-constructed

foxholes with overhead cover and expedient shelters (reinforced

concrete structures, basements, railroad tunnels, or trenches) provide good protection from nuclear attacks. Armored vehicles also

provide protection against both the blast and radiation effects of

nuclear weapons. Casualties generated in a nuclear attack will

likely suffer multiple injuries (combinations of blast, thermal,

and radiation injuries) which complicate HSS. Nuclear radiation

casualties fall into three categories.

The irradiated casualty has been exposed to ionizing radiation

but is not contaminated. These casualties are not radioactive and

pose no radiation threat to medical care providers. Casualties

who have suffered exposure to initial nuclear radiation fit into

this category. 

The externally contaminated casualty has radioactive dust and

debris on clothing, skin, or hair. This presents a “housekeeping”

problem to the MTF similar to the lice-infested patient arriving at

a peacetime MTF. However, this contamination may present a

threat to HSS personnel. The externally contaminated casualty is

decontaminated at the earliest time consistent with required medical care. Lifesaving care is always rendered before decontamination. 
Health Service Support Operations ____________________________ 9-5

The internally contaminated casualty has ingested or inhaled

radioactive materials, or radioactive material has entered the

body through an open wound. The radioactive material continues

to irradiate the casualty internally until radioactive decay and

biological elimination removes the radioactive isotope. Attending HSS personnel are shielded, to some degree, by the patient’s

body. Inhalation, ingestion, or injection of quantities of radioactive material sufficient to present a threat to medical care providers is highly unlikely. 

9005. Biological Environment 

A biological attack may be difficult to recognize because frequently it does not have an immediate affect on exposed personnel. HSS personnel must monitor for biological warfare

indicators such as—

• An increase in disease incidences or fatality rates.

• A sudden presentation of an exotic disease.

• Other sequential epidemiological events, especially when presented in lines of communications. 

Passive defensive measures (such as immunizations, good personal hygiene, physical conditioning, use of arthropod repellents,

use of protective mask, and practice of good sanitation) lessen

the effects of most biological intrusions. 

Commanders of MTFs must enforce contamination control to

prevent injury to HSS personnel and to preserve the MTF’s

integrity. Incoming patients and equipment must be surveyed for

contamination. Ventilation systems in medical treatment facili-
9-6 ___________________________________________________ MCWP 4-11.1

ties without collective protection shelters must be turned off if

biological or chemical exposure is imminent. 

Decontamination of most biologically contaminated patients and

equipment can be accomplished with soap and water.

Patients exposed to a biological agent may require observation

and evaluation to determine necessary medications, isolation, or

treatment. 

9006. Chemical Environment 

Handling chemically contaminated patients presents a great challenge to HSS units. The vapor hazard associated with contaminated patients may require HSS personnel to remain at MOPP

level 4 for long periods; therefore, HSS personnel must locate

clean areas to set up their MTF. The MTF should operate in a

contaminated environment only until HSS personnel have the

time and means to move to a clean area. 

9007. Medical Evacuation

An NBC environment forces the unit commander to consider

what evacuation assets will be committed to the contaminated

area. If operating forces are in a contaminated area, most or all of

the medical evacuation assets will operate there. However,

efforts should be made to keep some ambulances free of contamination. 
Health Service Support Operations ____________________________ 9-7

There are three basic modes of evacuating casualties: personnel,

ground vehicles, and aircraft. Commanders must recognize the

constraints NBC warfare places on casualty evacuation during

operations and then plan and train to overcome these deficiencies. 

9008. Personnel Considerations 

Medical treatment requirements increase when operating in an

NBC contaminated environment. As a result, HSS personnel

reinforcement and replacement may be necessary. Plans for HSS

following an NBC attack must include efforts to conserve available HSS personnel and ensure their best use. HSS personnel

provide emergency medical treatment or advanced trauma management and more definitive treatment as time and resources permit. However, to provide definitive care, they must be able to

work in a shirt-sleeved environment, not in MOPP levels 3 or 4.

Non-HSS personnel conduct search and rescue operations for the

injured or wounded; they also provide immediate first aid and

decontamination. 

(reverse blank)
Chapter 10

 Combat Casualty Reporting

Commanders must be thoroughly familiar with combat casualty

reporting procedures. The G-1/S-1 section of a command is

responsible for submitting prompt, accurate, and complete casualty reports to higher headquarters. In combat operations, unit

corpsmen and MTFs are primary sources of individual casualty

data. Casualty reporting in the MARFOR is addressed in MCO

P3040.42, Marine Corps Casualty Procedures Manual, and

other local guidance in the 3040 series. The system described in

these directives is essentially one in which personnel losses,

regardless of cause, are reported through the chain of command

to a central location. Figure 10-1 illustrates the flow of casualty

information from medical personnel and MTFs upward through

the chain of command.

10001. Field Medical Card

Hospital corpsmen at the unit level usually provide the first written information on a casualty through the use of a U.S. Field

Medical Card (DD Form 1380). The field medical card (FMC) is

a casualty tag printed in a set which provides a tough original

copy for attaching to the casualty (whether wounded or

deceased). A carbon copy is retained by the hospital corpsman

rendering initial treatment.
10-2 _________________________________________________ MCWP 4-11.1

Figure 10-1. Combat Casualty Reporting in the Marine 

MEF

MAR DIV FSSG MAW 

REGIMENTAL

HQ

STP/SURG CO

(MED BN DET)

MARINE AIR 

GROUP 

HQ

BATTALION

HQ

BATTALION 

AID STATION

FLIGHT 

LINE/SQUADRON 

AID STATION

COMPANY

HQ

BATTALION/DET

HQ

SQUADRON/

BATTALION

HQ

UNIT CORPSMAN BATTALION/DET

AID STATION

SQUADRON/

BATTALION

AID STATION
Health Service Support Operations __________________________ 10-3

Expeditionary Force. 

The purpose of the FMC is to establish patient accountability and

to provide a means to document assessment of condition and

treatment rendered by HSS personnel. The FMC is used as an

emergency medical tag for all casualties at the time they are initially treated in the field or field medical facility. The completed

FMC is an important medical record that will accompany the

casualty through the continuum of care. It is also an administrative document that may contain the most dependable information

a commanding officer may have regarding a casualty in his unit.

Our North Atlantic Treaty Organization allies, by formal agreement, use FMCs containing the same essential information as

recorded on the U.S. card. 

10002. Identification Tags

Identification tags (dog tags) are essential to casualty identification and recording. Each Service member is issued a chain and

two tags to be worn at all times. Tags contain the member’s

name, social security number, blood type, Service component,

religious preference, and protective mask size. The member and

the unit are both responsible for ensuring that all information is

current and accurate. See BUMED Instruction 6150.35, Medical

Warning Tags, for more information.

Both identification tags remain with a casualty at all times,

except when remains are buried in the combat area. One tag is

attached to the grave marker, and the other tag stays with the

deceased. Joint Pub 4-06, Joint Tactics, Techniques, and Proce-
10-4 _________________________________________________ MCWP 4-11.1

dures for Mortuary Affairs in Joint Operations, provides detailed

procedures for handling deceased personnel.

10003. Automated Medical Record Technology

New automated systems will play a significant role across the

range of medical operations. One such device is the portable

information carrier (PIC) that stores personal information about

its owner. The PIC is a hand-carried, abridged electronic medical

record which will serve as the primary repository of individual

readiness data such as deployability status, casualty prevention

training, medical history, and demographic information. This

technology will give the care provider electronic read/write capability to record care given to the patient. This technology will

enhance combat casualty care and patient tracking capability by

interfacing with command and control systems being developed

to track patients’ movement, assess logistics requirements, and

manage medical surveillance. 
Chapter 11

 Training

The primary goal of all military training is to achieve and maintain the highest level of preparation possible, thereby developing

confidence among the troops and ensuring a high state of readiness. The importance of training as a means of enhancing combat

readiness is equally important to HSS personnel. This is especially true given the greatly reduced peacetime staffing of HSS

units and the difficulty of obtaining realistic, hands-on trauma

training. 

Reaching this essential state of readiness requires the medical

department to contend with unique circumstances and conditions, including manning levels and the coordinated availability

of training. In peacetime, the majority of operating forces’ units

are manned at slightly more than two-thirds of their mobilization

strength, while HSS units are generally manned only with half of

the personnel required to carry out their wartime mission.

Authorized manning levels fill only about 10 percent of medical

corps and nurse corps billets within medical battalions. The end

result is that upon mobilization more than half of the medical

personnel assigned to operating forces HSS units will be augmentees with greatly varying degrees of field medical skills and

experience. 

11001. Health Service Support Goals

These manning and training capability constraints require that

training efforts be directed toward developing a nucleus of per-
11-2 _________________________________________________ MCWP 4-11.1

sonnel highly skilled in the techniques of establishing and effectively operating HSS facilities in the field. This nucleus, when

mobilized, becomes the core of each field medical unit and faces

the formidable task of receiving large numbers of augmentees

and shaping them into effective health delivery teams. It is not

possible to lay out a training program which would be applicable

to all HSSEs due to geographic, climatic, and mission variation.

Individual commanders of HSS units and other key medical

department personnel must structure training in light of achievable goals and limiting factors. 

Increased Individual Readiness

Efforts to increase and maintain readiness should extend beyond

currently assigned personnel and incorporate augmentees into all

training evolutions to the maximum degree funds and scheduling

will permit. Surgeons and other key personnel should encourage

commanders to involve identified augmentation personnel in

exercises when possible. In addition to enhancing individual

training, this practice will aid in fostering a sense of unit identity

and cohesiveness.

Standardized Methods and Procedures 

This is a necessary goal which is elevated to paramount importance because it must be done before mobilization. Augmentees

must be familiar with and able to depend on well-developed

standing operating procedures in the form of desktop procedures

and procedural manuals. The importance of this goal cannot be

overly stressed.
Health Service Support Operations __________________________ 11-3

Increased Operational Effectiveness Through Higher 

Levels of Individual and Collective Experience 

HSS is basic to all operations. Medical department personnel

must, to the maximum degree possible, be involved in all phases

of every exercise. The necessity of this involvement is easily and

often overlooked in peacetime due to budgetary and time constraints.

11002. Training Pipeline

The following training courses are essential to the development

of effective, efficient, and successful HSS personnel. Course

quota management and control are under the cognizance of

BUMED.

Field Medical Service School 

There are two Field Medical Service Schools (FMSSs), one at

Camp Lejeune, North Carolina, and the other at Camp Pendleton,

California. The mission of these Marine Corps schools is to prepare Navy medical department personnel for service with the

MARFOR. Before reporting to the MARFOR, all medical

department personnel (officer and enlisted) not having previous

field medical service training shall attend an appropriate course

of instruction at one of the schools. Both schools teach—

• The role and requirements of HSS units in the field.

• Military tactical and defensive techniques closely related to

field HSS.
11-4 _________________________________________________ MCWP 4-11.1

• HSS planning and concepts for officers and senior petty officers, including medical estimates, medical staff planning, and

logistics support.

• MARFOR and MAGTF organization.

• The use and handling of designated table of organization

weapons for medical department personnel.

Combat Casualty Care Course 

Before reporting to the MARFOR, all medical department officers who are clinical providers (i.e., medical corps, dental corps,

nurse corps) shall attend a course of instruction in advanced

combat life support. In combat support operations, nonphysician

health care providers may be required to assist medical officers

in presurgical preparation and wound management. Training is

available through the Defense Medical Readiness Training Institute, Fort Sam Houston, Texas.

11003. Commander’s Responsibilities

Commander’s are responsible for ensuring that all command personnel receive appropriate training in both military and technical

subject areas, including emergency medical training of nonmedical personnel and the continued training of medical department

personnel in field medical practices and related military subjects.

Commanders develop, conduct, and evaluate individual and collective HSS training based on training standards published by the

Marine Corps Combat Development Command (MCCDC).

When standards have not been published, unit commanders

ensure training is based on this MCWP and other doctrinal, tacti-
Health Service Support Operations __________________________ 11-5

cal, and technical publications approved for Navy and Marine

Corps use.

11004. Medical Department Officers and Senior 

Enlisted

The division and wing surgeons maintain staff supervision of all

medical training programs, including exercise planning and execution, for medical department personnel assigned to their

respective subordinate commands. Within the FSSG, the group

surgeon and dental officer, in coordination with the G-3, exercises staff cognizance of all general medical training programs.

Medical and dental battalion commanders are responsible for all

battalion training programs including internal planning and execution. The FSSG HSSO exercises staff cognizance of FSSG

planning and exercises. All medical department officers and

senior hospital and dental corps conduct and/or supervise the

training of hospital corpsmen and dental technicians.

11005. Types of Training

Individual Training

Individual training may be conducted in a formal school or at the

member’s command. This training prepares an individual to perform specific tasks related to general military duties or assigned

specialties. Medical department personnel who regularly perform

duties of their occupational specialty develop increased confidence and proficiency. Individual training may include first aid

and cardiopulmonary resuscitation (CPR) as well as more formal
11-6 _________________________________________________ MCWP 4-11.1

programs such as the Plans, Operations, and Medical Intelligence

Course; the Joint Medical Planners Course; the Landing Force

Medical Staff Planning Course; and the Medical Regulating

Course.

Unit Training

Unit training prepares an individual to function within a unit and

as part of a cohesive element. Such elements may include teams,

platoons, sections, companies, or whatever size is feasible.

MARFOR unit training is normally conducted afloat or in a field

environment and involves the entire organization, including

assigned HSSEs. Unit training has proven most effective when

conducted in a simulated combat environment. These exercises

entail setting up treatment facilities in the field and treatment of

simulated casualties. Other field units such as infantry battalions,

regiments, and combat support and combat service support organizations conduct field training exercises that involve HSS personnel organic to those units.

Exercises

Training exercises provide a realistic training environment,

allowing HSS personnel to apply and refine their field medical

skills as well as expand their knowledge and skills in the following areas:

• LF organization and communications.

• HSS functions in the field.

• Deployment procedures, including combat loading of HSS

equipment.

• Sanitation standards for shipboard and field troops.
Health Service Support Operations __________________________ 11-7

• Ship-to-shore operations.

• Casualty evacuation.

• Mass casualty training.

• HSS supply and resupply.

• Operations in severe environments.

• Special problems in the amphibious objective area.

Nuclear, Biological, and Chemical Training

Readiness training for patient decontamination, patient care, and

NBC defense may be conducted at individual or unit level. Training in medical procedures associated with NBC casualties cannot

be adequately addressed in on-the-job training but requires the

participation of instructors specifically trained in the subject

area. (See FMFM 11-11, Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries.)

Preventive Medicine Training

HSS personnel in all MARFOR units must receive instruction in

the recognition of diseases and environmental hazards that may

occur within a specific area of operations. Emphasis should be

placed on personal and unit-wide preventive medicine measures

at all levels. Division, group, and wing surgeons should periodically review contingency plans, with emphasis on identifying

measures necessary to effectively prevent disease and other

health hazards. This information should be incorporated into

training programs for medical department personnel.
11-8 _________________________________________________ MCWP 4-11.1

Logistics and Supply Training

The Marine Corps and Navy supply systems are sufficiently different to invalidate most information in Navy training manuals

with regard to its applicability to the Marine Corps system. Unit

commanders with a health care mission must ensure Navy personnel are sufficiently trained in basic procedures to operate

within the Marine Corps supply system.

11006. Dental Personnel

Enlisted dental personnel assigned to the MARFOR receive the

same basic FMSS training as hospital corpsmen, but rate specific

training for their individual Navy enlisted classification codes.

During casualty overload, dental personnel perform roles in combat casualty care. Training emphasis should be placed on increasing skills in combat casualty care and trauma management,

including training in the designated roles of preoperative preparation and wound management for dental officers and ward

corpsmen duties and central sterilization duties for dental technicians. 

11007. Non-Health Service Support Personnel

HSS personnel are responsible for training non-HSS personnel in

subjects such as CPR, first aid, buddy aid, personal hygiene, field

sanitation, and preventive medicine. 

All non-HSS personnel (including chaplains and religious programs enlisted personnel) should receive extensive training in

first aid procedures, self-aid, buddy aid, and personal decontami-
Health Service Support Operations __________________________ 11-9

nation. Field Manual (FM) 21-11, First Aid for Soldiers, and the

Marine Corps Institute’s Marine Battle Skills Training Handbook

series list and explain subjects that must be taught.

Personnel should be indoctrinated in specific personal protection

and disease prevention topics as described in FM 21-10, Field

Hygiene and Sanitation, and NAVMED P-5010.

Marine Corps supply personnel in key positions shall be provided training in procedures that enable them to provide medical

supply support when deployed. Training should encompass interfacing with the SIMLM system.

Further information on the availability and applicability of specific individual or unit HSS training can be found by addressing

Director, Training and Education Division, MCCDC, or Director,

Operational Readiness and Training Division, BUMED.

 (reverse blank)
Appendix A

Blood Support

Formally established as the Military Blood Program in 1952 by

Presidential Order as part of the National Blood Program,

today’s Armed Services Blood Program (ASBP) consists of

approximately 116 blood banks and blood donor centers worldwide, including 43 Food and Drug Administration (FDA)

licensed blood donor centers. The ASBP mission is to provide

quality blood products, blood substitutes, and services for all

worldwide customers in peace and war. The ASBP is a joint program operated by the military Services and coordinated by the

Armed Services Blood Program Office (ASBPO).

The ASBPO is a joint health agency charted to monitor the

implementation of blood program policies established by the

Assistant Secretary of Defense (Health Affairs) (ASD[HA]) and

to coordinate the blood programs of the military Services (Army,

Air Force, and Navy) and the unified commands as directed in

DOD Instruction 6480.4, Armed Services Blood Program Operational Procedures. The ASBPO provides standardization among

the Services and enhances the total blood distribution system in

peace and war. The U.S. Army Surgeon General, on behalf of the

Secretary of the Army, serves as the executive agent for the

ASBPO for administrative support and staff supervision. The

Joint Chiefs of Staff, by Memorandum of Understanding, are

responsible for the review and provision of guidance in all matters regarding blood support in joint operational planning. The

ASD(HA) provides policy guidance to the ASBPO. All of the

ASBP elements function together to successfully operate the

Military Blood Program. 
A-2 __________________________________________________ MCWP 4-11.1

Blood support for the MARFOR is provided by the Navy’s

Blood Program (NBP). The NBP ensures operational readiness

to both the Navy and MARFOR through a viable blood program

which meets and exceeds standards of practice. The NBP oversees 30 Navy blood banks worldwide. Of those 30, 19 are with

blood donor centers (BDCs). The NBP operates under the FDA

License Number 635. The responsible head is the Surgeon General of the Navy/Chief, Bureau of Medicine and Surgery. The

alternate responsible head is the Assistant Chief for Operational

Medicine and Fleet Support, Bureau of Medicine and Surgery. 

Armed Services Whole Blood Processing 

Laboratory 

An Armed Services Whole Blood Processing Laboratory

(ASWBPL) is a USAF-managed, tri-service-staffed, central

repository for liquid and frozen blood required in peacetime,

contingencies, and war. An ASWBPL releases blood to unified

commands upon approval by the ASBPO. Theater MTFs may

not go directly to the ASWBPL for blood. ASWBPLs—

• Retype blood for A, B, and O blood types and Rh only.

• Pack, ice, and prepare blood for shipment to the theater. 

• Maintain a peacetime inventory of 250 units of liquid blood

for use as a rapid response requirement. 

Joint Blood Program Office

The Joint Blood Program Office (JBPO) is responsible for the

joint blood program management in a theater of operations. The
Health Service Support Operations ___________________________ A-3

JBPO functions as part of the unified command surgeon’s office

but may establish an Area Joint Blood Program Office (AJBPO)

for regional blood management. The JBPO—

• Works directly for the unified command surgeon. The JBPO

may augment the surgeon’s staff of the Commander, Joint

Task Force.

• Serves as the central point of contact to ASBPO.

• Coordinates joint blood products requirements and capabilities

in the theater of operations. Major assessment areas for a

JBPO are manpower, training levels, and supplies.

• Coordinates requirements, distribution, and facilities. The

JBPO ensures blood is where it’s needed. The JBPO quickly

determines how to get blood to forward units and Navy ships

as well as MTFs.

• Monitors shortfalls within the unified command, including

supplies for collection, deglycerolization, distribution, and

transfusion of blood/blood products.

• Ensures readiness by having a distribution system, exercises,

and training. Other theater staff members (AJBPO, blood support unit [BSU], and MTF officers) may need further training

on coordinating with medical planners or transportation officers to anticipate blood/supply needs, making transportation

arrangements, or using liquid/frozen products. 

• Ensures compliance with ASBP policies, FDA regulations,

American Association of Blood Banks standards in peacetime,

contingencies, and war.

• Serves as the unified command subject matter expert on determining blood requirements based on Joint Staff casualty pro-
A-4 __________________________________________________ MCWP 4-11.1

jections and maintaining blood in medical sustainment

analysis.

• Provides the joint blood concept; coordinates with logistics,

transportation, and communications personnel on the Joint

Staff for the unified command; and prepares appendix 2 to

Annex Q, Planning Guidance, Medical Services. 

Area Joint Blood Program Office 

AJBPOs can be established within the theater of operations during war or special operations. An AJBPO coordinates requirements and distribution of blood products to support BSUs and

MTFs in a specific area, regardless of the Service component.

Not all operations will require establishing an AJBPO. An

AJBPO may not be a blood bank specialist but will have most of

the same responsibilities as the JBPO and may need training and

additional guidance from the JBPO. 

Blood Transshipment Centers 

A blood transshipment center (BTC) is the central receiving

point for blood shipments from the ASWBPL and for issue to the

BSUs. A BTC can store and process up to 7,200 units of liquid

blood daily. A BTC is usually staffed and operated by USAF personnel at a major airhead. BTC blood products are managed by

the JBPO or AJBPO (if established). One or more BTCs may be

located in each theater of operation. Not all theaters of operations

will require the use of a BTC. BTCs—

• Inspect blood received from the ASWBPL or other blood

agencies, blood products depots, or other BTCs.
Health Service Support Operations ___________________________ A-5

• Store, ice, and re-ice blood and perform quality control.

• Issue blood to BSUs or other component blood users.

• Prepare daily blood reports for JBPO and blood shipment

reports for receiving BSU.

Transportable Blood Transshipment Centers 

Transportable Blood Transshipment Centers (TBTCs) are

mobile, modular, and can be transported into the theater of operations at a site designated by the theater commander. Although

TBTCs have the capacity to store frozen blood products, they can

deploy with or without those products. Based on theater commanders decisions, the ASBP will have six TBTCs available as

blood program elements and one for training deployable personnel.

Blood Products Depots 

Blood products depots (BPDs) are located within the unified

command to maintain large quantities of frozen blood products

for use during armed conflicts or emergencies requiring medical

support. These prepositioned stocks of frozen blood products are

intended to fulfill initial wartime blood surge requirements until

mobilization of CONUS assets can catch up to demand. Subsequent liquid blood supplies will come from CONUS blood donor

centers and will be shipped via the ASWBPL and the BTCs.

BPDs are single Service staffed and operated, but the blood products are for use by all components in potential theaters of conflict. Blood maintained at BPDs is managed by the JBPO via the
A-6 __________________________________________________ MCWP 4-11.1

AJBPO. Not all unified commands and theaters of operations

will require or have a BPD. BPDs—

• Store frozen blood products until required. 

• Issue blood as directed by the JBPO via the AJBPO. 

• Thaw and deglycerolize frozen red cells and distribute to

BSUs.

Blood Supply Units

Blood supply units (BSUs) receive, store, and distribute blood

within the theater of operations. BSUs are required to provide a

5-day storage supply of blood products based on MTF proposed

requirements and blood reports.

BSUs can provide support in a specific geographical area regardless of Service components and can support up to 12 MTFs designated by the JBPO. 

The following units/facilities can serve as a BSU: Army blood

platoon, Navy fleet hospital, naval amphibious assault vessels,

T-AH hospital ships, MTFs, and BPD, when designated. 

BSUs provide storage capabilities that maintain temperature

requirements for liquid blood.

BSUs can produce ice for shipping and re-icing of blood in the

theater. They can also store frozen blood products, including

fresh frozen plasma and frozen red cells. A BSU’s ability to

obtain and store dry ice provides the means to ship fresh frozen

plasma to MTFs.
Health Service Support Operations ___________________________ A-7

BSUs can collect blood in emergencies, but this is not encouraged due to the lack of capability to perform testing for infectious diseases. Refer to the emergency donor section for protocol

regarding blood drawn in theater.

BSUs can support MTFs as designated/determined by the JBPO.

(reverse blank)
A-8 __________________________________________________ MCWP 4-11.1
Appendix B

 Authorized Medical and Dental 

Allowance Lists

HSS authorized medical allowance lists (AMALs) and authorized dental allowance lists (ADALs) are configured in assemblages such as equipment and supply. The equipment assemblage

contains equipment and reusable materiel required to establish

the basic function of the assemblage (e.g., an operating room).

The supply assemblage contains consumable material to support

the function in treating a designated number of casualties or to

perform a specific task. For readiness purposes, an equipment

module may be stored in combination with its corresponding

supply module. The materiel listed in each AMAL/ADAL is the

minimum amount to be maintained. 

Marine Corps Order 4400 series contains AMAL and ADAL

procurement policies and procedures. Policies and procedures

include assembly, maintenance, levels of supply, and distribution

of materiel. AMALs and ADALs are maintained and resupplied

by the medical logistics company, supply battalion, FSSG.

Numbers and Nomenclatures

AMAL 618—Laboratory Equipment. Equipment and reusable

materiel required to establish a laboratory capable of hematology, microbiology, urinalysis, and chemical testing.
B-2 __________________________________________________ MCWP 4-11.1

AMAL 619—Laboratory Supply. Consumable supplies required

to perform hematology, microbiology, urinalysis, and chemical

testing for 100 patients.

AMAL 627—X-ray Equipment. Equipment and reusable materiel required to establish one x-ray room and processing facility.

AMAL 649—X-ray Supply. Consumable supplies required to

provide x-ray support for 100 patients at 10 films per patient.

AMAL 629—Pharmacy Equipment. Equipment and reusable

materiel required to establish a pharmacy.

AMAL 630—Pharmacy Supply. Consumable supplies required

to provide pharmacy support for 1,000 patients in six 5-day packages for a total of 30 days.

AMAL 631—Shock Surgical Team/Triage Equipment. Equipment and reusable materiel required to establish a basic shock

trauma surgical team or triage to receive, resuscitate, sort, and

temporarily hold casualties.

AMAL 632—Shock Surgical Team/Triage Supply. Consumable

supplies required to receive, resuscitate, sort, and temporarily

hold 50 casualties with major wounds and to provide basic line

corpsman resupply.

AMAL 633—Ward Equipment. Equipment and reusable materiel required to establish a 20-bed unit.

AMAL 634—Ward Supply. Consumable supplies required to

provide ward support for 100 bed days-to-patient.
Health Service Support Operations ___________________________ B-3

AMAL 635—Aid Station Equipment. Equipment and reusable

materiel required to support one division, wing, group, engineer,

or battalion aid station. 

AMAL 636—Aid Station Supply. Consumable supplies required

to provide aid station support, initial resuscitation, and stabilization of 50 casualties with major wounds prior to evacuation, and

to resupply basic line corpsman.

AMAL 637—Preventive Medicine Equipment. Equipment and

reusable materiel required to establish a preventive medicine section. The section provides technical preventive medicine advice;

inspects food service operations, waste disposal, water potability

and sources, and vector control; coordinates control measures

required for communicable diseases; and monitors and assists

immunization programs.

AMAL 638—Preventive Medicine Supply. Consumable supplies

required to provide support of the preventive medicine effort to

the MEF in twelve 5-day packages for a total of 60 days. 

AMAL 639—Operating Room Equipment. Equipment and reusable materiel required to support an operating room for performing major surgical procedures, administering general anesthesia,

sterilizing materiel, and maintaining sterile material.

AMAL 640—Operating Room Supply. Consumable supplies

required to provide operating room support for 25 surgical cases.
B-4 __________________________________________________ MCWP 4-11.1

ADAL 662—Field Dental Operatory. Equipment and reusable

materiel required to establish a dental clinic in the field. Consumable supplies required to provide emergency, diagnostic, and preventive maintenance dental care for 400 patients.

AMAL 684—Geographic Supplement. Consumable supplies and

reusable materiel required to accommodate special mission- and

geographic-related requirements for a MEF in twelve 5-day

packages for a total of 60 days.

AMAL 685—Cold Weather Supplement. Consumable supplies

and reusable materiel required to accommodate special missionand geographic-related requirements in areas where cold-related

injuries are likely to occur. 

AMAL 686—Hot Weather Supplement. Consumable supplies

and reusable materiel required to accommodate special missionand geographic-related requirements into areas where heatrelated injuries are likely to occur. 

AMAL 687—NBC Individual. Materials required for the individual to conduct primary decontamination and treatment in an

NBC environment. 

AMAL 688—NBC Unit. Materials required for the units to conduct primary and secondary decontamination and treatment in an

NBC environment. 
Health Service Support Operations ___________________________ B-5

AMAL 691—Med Log Test/Repair Equipment. Equipment and

reusable materiel required to perform testing, calibration, and 3d

and 4th echelon maintenance of medical/dental equipment.

AMAL 692—Med Log Test/Repair Supply. Consumable supplies required to accommodate a medical repair section in the

testing, calibration, and 3d and 4th echelon maintenance of medical/dental equipment.

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Appendix C

Glossary

ACE ....................................................... aviation combat element

ADAL ....................................... authorized dental allowance lists

AE ...........................................................aeromedical evacuation

AFMIC...................... Armed Forces Medical Intelligence Center

AJBPO ..................................... Area Joint Blood Program Office

AMAL.................................... authorized medical allowance lists

ASBP ......................................... Armed Services Blood Program

ASBPO............................ Armed Services Blood Program Office

ASD (HA)..........Assistant Secretary of Defense (Health Affairs)

ASWBPL ...................................... Armed Services Whole Blood

 Processing Laboratory

ATF ............................................................ amphibious task force

BAS ...............................................................battalion aid station

BDC ...............................................................blood donor centers

BPD.......................................................... Blood Products Depots

BSSG .............................................brigade service support group

BSU.................................................................. blood support unit

BTC.................................................... blood transshipment center

BUMED.................. U.S. Navy Bureau of Medicine and Surgery

CATF......................................commander, amphibious task force

CINC..............................................................commander in chief

CJCSM..................Chairman of the Joint Chiefs of Staff Manual

CLF ......................................................commander, landing force

COMDTPUB ........Commandant Publication (U.S. Coast Guard)

CONPLAN................................................................ concept plan

CONUS................................................. continental United States
C-2 __________________________________________________ MCWP 4-11.1

CPR............................................... cardiopulmonary resuscitation

CRTS.................................. casualty receiving and treatment ship

CSSE...........................................combat service support element

CSSOC......................... combat service support operations center

DOD......................................................... Department of Defense

 FDA

Food and Drug Administration

FLAS............................................................ flight line aid station

FM...........................................................U.S. Army field manual

FMC..................................................................field medical card

FMFM................................................ Fleet Marine Force manual

FMSS ............................................. Field Medical Service School 

FSSG..................................................force service support group

FST...................................................................fleet surgical team

GCCS ............................... Global Command and Control System

GCE .........................................................ground combat element

GCSS ..........................................Global Combat Support System

H&S .......................................................headquarters and service

HSS ............................................................ health service support

HSSD ......................................health service support detachment

HSSE.............................................health service support element

HSSO ..............................................health service support officer

JBPO .................................................Joint Blood Program Office

LAN .................................................................local area network

LF............................................................................. landing force

LFSP .................................................. landing force support party

LHA ........................... amphibious assault ship (general purpose)
Health Service Support Operations ___________________________ C-3

LHD ................................amphibious assault ship (multipurpose)

LMCC ............................ logistics movement coordination center

LPH......................................amphibious assault ship (helicopter)

MAG ........................................................... Marine aircraft group

MAGTF .......................................... Marine air-ground task force

MAP...........................................Medical Augmentation Program

MARFOR......................................................Marine Corps forces

MAW............................................................ Marine aircraft wing

MCCDC.............Marine Corps Combat Development Command

MCO ..............................................................Marine Corps order

MCPP.......................................... Marine Corps planning process

MCWP ..............................Marine Corps warfighting publication

Med Log Co ........................................medical logistics company

MEF ...................................................Marine expeditionary force

METT-T...................mission, enemy, terrain and weather, troops

and support available-time available

MEU.....................................................Marine expeditionary unit

MMART................ mobile medical augmentation readiness team

MOPP....................................mission-oriented protective posture

MSSG................................................MEU service support group

MTF ..................................................... medical treatment facility

MWSS.......................................... Marine wing support squadron

NAVMED ............................................................... naval medical

NBC ..........................................nuclear, biological, and chemical

NBP............................................................. Navy Blood Program

NWP......................................................naval warfare publication

OPLAN ...................................................................operation plan

OPORD.................................................................operation order
C-4 __________________________________________________ MCWP 4-11.1

PIC .................................................... portable information carrier

PMI ....................................................... primary movement items

SHF ..............................................................super high frequency

SIMLM ....................single integrated medical logistics manager

STP..............................................................shock trauma platoon

Surg Co .............................................................surgical company

TBTC ....................... Transportable Blood Transshipment Center

T/E ...................................................................table of equipment

TMIP...................................theater medical information program

TTP ........................................tactics, techniques, and procedures

USAF .......................................................United States Air Force

USMC ...............................................United States Marine Corps

VHF .............................................................. very high frequency

WAN ................................................................wide area network
Appendix D

References and Related

 Publications

Chairman of the Joint Chiefs of Staff Manual (CJCSM) 

3122.03 Joint Operation Planning and Execution System

Volume II, Planning Formats and Guidance

Joint Publications

4-02 Doctrine for Health Service Support in Joint

Operations

4-02.2 Joint Tactics, Techniques, and Procedures for 

Patient Movement in Joint Operations

4-06 Joint Tactics, Techniques, and Procedures for 

Mortuary Affairs in Joint Operations

Department of Defense (DOD) Instruction

6480.4 Armed Services Blood Program Operational

Procedures

Navy Publications

Navy Warfare Publications (NWPs)

1-14M Commander’s Handbook of the Law of Naval 

Operations

4-02 Operational Health Service Support
D-2 __________________________________________________ MCWP 4-11.1

4-02.2 Patient Movement

4-02.4 Part A Deployable Health Service Support

Platforms—Fleet Hospitals

NAVMED

P 5010 BUMED Manual of Naval Preventive

Medicine

Bureau of Medicine and Surgery (BUMED) Instruction

6150.35 Medical Warning Tags

COMDTPUB

P5800.7 The Commander’s Handbook on the Law of 

Naval Operations

Marine Corps Publications

Marine Corps Doctrinal Publication (MCDP)

2 Intelligence

Marine Corps Warfighting Publication (MCWP)

2-12 MAGTF Intelligence Production and Analysis 

5-12.1 The Commander’s Handbook on the Law of 

Naval Operations
Health Service Support Operations ___________________________ D-3

Fleet Marine Force Manuals (FMFMs)

0-25 The Law of Land Warfare

4-50 Health Service Support

5-30 Assault Support

11-11 Treatment of Chemical Agent Casualties and 

Conventional Military Chemical Injuries

Fleet Marine Force Reference Publication (FMFRP)

1-18 Amphibious Ships and Landing Craft 

Data Book

Marine Corps Handbooks

Marine Battle Skills Training Handbook

Marine Corps Orders (MCOs)

P3040.42 Marine Corps Casualty Procedures Manual

4400 Series Supply/Materiel

Army Publications

Field Manuals (FMs)

21-10 Field Hygiene and Sanitation

21-11 First Aid for Soldiers

27-10 The Law of Land Warfare

Department of the Army Pamphlet (DA PAM)

27-1 Treaties Governing Land Warfare

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