30 July 2001

Doctrine for

Health Service Support

in Joint Operations

Joint Publication 4-02
PREFACE

i

1. Scope

This publication delineates requirements

and considerations for the health service

support (HSS) system as well as the HSS

aspects of joint planning, special operations,

and military operations other than war. It also

addresses force health protection, the health

threat, and the requirement for medical

intelligence.

2. Purpose

This publication has been prepared under

the direction of the Chairman of the Joint

Chiefs of Staff. It sets forth doctrine to govern

the joint activities and performance of the

Armed Forces of the United States in joint

operations and provides the doctrinal basis for

US military involvement in multinational and

interagency operations. It provides military

guidance for the exercise of authority by

combatant commanders and other joint

force commanders (JFCs) and prescribes

doctrine for joint operations and training. It

provides military guidance for use by the

Armed Forces in preparing their appropriate

plans. It is not the intent of this publication to

restrict the authority of the JFC from

organizing the force and executing the mission

in a manner the JFC deems most appropriate

to ensure unity of effort in the accomplishment

of the overall mission.

3. Application

a. Doctrine and guidance established in

this publication apply to the commanders

of combatant commands, subunified

commands, joint task forces, and subordinate

components of these commands. These

principles and guidance also may apply when

significant forces of one Service are attached

to forces of another Service or when

significant forces of one Service support

forces of another Service.

b. The guidance in this publication is

authoritative; as such, this doctrine will be

followed except when, in the judgment of the

commander, exceptional circumstances

dictate otherwise. If conflicts arise between

the contents of this publication and the

contents of Service publications, this

publication will take precedence for the

activities of joint forces unless the Chairman

of the Joint Chiefs of Staff, normally in

coordination with the other members of the

Joint Chiefs of Staff, has provided more

current and specific guidance. Commanders

of forces operating as part of a multinational

(alliance or coalition) military command

should follow multinational doctrine and

procedures ratified by the United States. For

doctrine and procedures not ratified by the

United States, commanders should evaluate

and follow the multinational command’s

doctrine and procedures, where applicable and

consistent with US law, regulations, and

doctrine.

S. A. FRY

Vice Admiral, U.S. Navy

Director, Joint Staff

For the Chairman of the Joint Chiefs of Staff:
ii

Preface

JP 4-02

Intentionally Blank
TABLE OF CONTENTS

iii

PAGE

EXECUTIVE SUMMARY ............................................................................................. v

CHAPTER I

FORCE HEALTH PROTECTION

• Overview .................................................................................................................. I-1

• Force Health Protection Pillars .................................................................................. I-2

• Five Phases of Casualty Care Management ............................................................... I-3

CHAPTER II

HEALTH SERVICE SUPPORT OPERATIONS

• Mission .................................................................................................................... II-1

• Objective ................................................................................................................. II-1

• Principles ................................................................................................................. II-1

• Organization ............................................................................................................ II-2

• Relationships and Responsibilities ........................................................................... II-3

• Patient Movement .................................................................................................... II-6

CHAPTER III

HEALTH SERVICE SUPPORT PLANNING

• The Joint Operation Planning Process .................................................................... III-1

• Health Service Support Planning Considerations.................................................... III-1

• Health Service Support Command, Control, Communications, Computers, and

Intelligence Systems............................................................................................ III-9

• Health Service Support in Special Operations ....................................................... III-11

• Health Service Support in US Coast Guard Operations ......................................... III-13

• Health Service Support Planning Factors for Joint Operations............................... III-13

APPENDIX

A Health Threat .................................................................................................... A-1

B Medical Intelligence .......................................................................................... B-1

C Format for Annex Q to an Operation Plan .......................................................... C-1

D Multinational Operations .................................................................................. D-1

E Military Operations Other Than War.................................................................. E-1

F References ......................................................................................................... F-1

G Administration Instructions............................................................................... G-1
iv

Table of Contents

JP 4-02

GLOSSARY

Part I Abbreviations and Acronyms ................................................................... GL-1

Part II Terms and Definitions .............................................................................. GL-4

FIGURE

I-1 National Military Strategy and Force Health Protection Relationship ............. I-1

I-2 Phases of Casualty Care Management ............................................................ I-4

II-1 Health Service Support Principles ................................................................. II-1

II-2 Levels of Health Service Support .................................................................. II-3

III-1 Health Service Support Planning Considerations ......................................... III-2

III-2 Categories of Dental Care Considered During Joint Operation Planning ...... III-7

III-3 Characteristics of Health Service Support Command, Control,

Communications, Computers, and Intelligence Systems ............................ III-9
EXECUTIVE SUMMARY

COMMANDER’S OVERVIEW

•

•

•

•

•

•

v

The primary objectives of

force health protection are

to protect the health of and

provide health service

support to US forces.

Force Health Protection Mission and Objectives

Discusses the Force Health Protection Mission and

Objectives

Provides the Principles of Health Service Support (HSS)

Discusses HSS Planning and Coordination

Discusses Requirements for HSS in Special Operations

Discusses HSS in US Coast Guard Operations

Discusses HSS Command, Control, Communications,

Computers, and Intelligence Systems

The three pillars of force health protection (FHP) are a healthy

and fit force, casualty prevention, and casualty care

management. These pillars correlate to the National Military

Strategy pillars of “Shape”, “Prepare”, and “Respond”. The

FHP mission in joint operations is to minimize the effects of

wounds, injuries, disease, environment, occupational hazards,

and psychological stressors on unit effectiveness, readiness,

and morale. The combatant commander is responsible for the

execution of the FHP mission within his or her area of

responsibility. The success of casualty care management with

limited medical forces in theater is directly dependent upon the

combatant commander’s aggressive enforcement of the first

two pillars. A proactive preventive medicine program and a

phased health care delivery system accomplish the mission

that extends from actions taken prior to and at the point of

injury or illness through the completion of definitive treatment.

FHP in joint operations requires continuous intelligence

gathering and analysis, planning, coordination, and training

to ensure a prompt, effective, and unified health care effort.
vi

Executive Summary

JP 4-02

The principles of health service support (HSS) include the

following.

• Conformity. Integrate and comply with the commander’s

plan.

• Responsiveness. Provide timely access to HSS through

proximity or evacuation.

• Flexibility. Shift HSS resources to meet changing

requirements.

• Mobility. Anticipate the need for rapid movement of

HSS resources to support combat forces during operations.

• Continuity. Provide optimum, uninterrupted care and

treatment.

• Coordination. Ensure that HSS resources are efficiently

employed and used effectively to support the planned

operation.

Proper planning permits a systematic examination of all factors

in a projected operation and ensures interoperability with the

campaign or operation plan. Organization of the HSS system

is determined largely by the joint force’s mission, the medical

threat, medical intelligence, and the theater evacuation policy.

Each commander of a combatant command, subunified

command, and joint task force should appoint a joint force

surgeon (JFS). Combatant command JFSs are responsible for

coordinating and integrating HSS within their theaters. They

need to assess component commands’ HSS requirements and

capabilities, both quantitatively and qualitatively, and provide

guidance to enhance the effectiveness of HSS through shared

use of assets. Distribution of the respective component’s HSS

capabilities (as directed by the geographic combatant

commander) will aid in ensuring efficient use of limited HSS

resources.

Health Service Support Principles

Health Service Support Planning and Coordination

There are six principles of

health service support

(HSS).

Timely, effective planning

and coordination are

essential to ensure

adequate and sustainable

HSS in a theater.
vii

Executive Summary

Timely patient movement plays an important role in HSS.

Patient movement functions include medical regulating, patient

evacuation, and en route medical care (i.e., medical staffing

and patient movement items). Patient movement can be by

surface (land or water) or by air (rotary-wing or fixed-wing

aircraft); however, air is preferred. Initial transport of patients

to the first and second levels of medical care is normally a

Service component responsibility. Army aeromedical

ambulance assets provide dedicated patient movement to and

from Navy hospital ships. Intratheater patient movement is

coordinated by a Theater Patient Movement Requirements

Center (TPMRC). Intratheater forward aeromedical evacuation

may be coordinated by an aeromedical evacuation liaison team.

Patient movement from the theater is a collaborative effort

between TPMRC, the Global Patient Movement Requirements

Center, and the component lift control agency.

The medical estimate includes an analysis of information

pertaining to enemy intentions, allied or coalition partners’

capabilities, limitations, courses of action, environmental

factors, occupational hazards, and potential FHP

consequences associated with a contemplated operation.

The medical estimate includes all FHP facts, assumptions, and

deductions that can affect the operation. Based upon the

medical estimate of the situation, the JFS, in coordination with

the component command surgeons, must plan HSS for the

joint force and develop policies and procedures that can best

support the joint operation.

The nature of special operations requires small, highly skilled,

self-contained teams that can be easily inserted and extracted

by air, sea, and land delivery methods. However, these same

mission requirements mandate that special operations forces’

(SOF) medical personnel possess a variety of enhanced medical

skills that enable them to operate under a multiplicity of

circumstances with limited equipment. To compensate for

deficiencies inherent in SOF HSS capabilities, special operations

HSS planning must integrate conventional support into the

concept of the special operations mission without

compromising the security and objectives. The planning must

also articulate the unique aspects of the operation that will

complicate the delivery of HSS by conventional units.

Health Service Support in Special Operations

Because of the nature of

their missions, special

operations units have a

very limited HSS structure

and a limited number of

medical personnel.
viii

Executive Summary

JP 4-02

United States Coast Guard (USCG) participation in Department

of Defense (DOD) operations may require some HSS from

nearby DOD units, since organic USCG HSS is limited. USCG

helicopters may be utilized in medical evacuations as a lift of

convenience, but they are not normally outfitted with medical

equipment or personnel.

Effective command, control, communications, computers, and

intelligence (C4I) systems are vital to successful HSS. Early

identification of a theater’s C4I system requirements for HSS

connectivity is essential. HSS management information

systems support the information management requirements

of HSS units across the range of military operations. Records,

reports, and integrated systems are required to pass information

and assist in the evaluation of policies and procedures.

HSS provides prompt, effective, and unified health services to

enhance the combat fighting ability of joint forces. HSS in

operations requires continuous planning, coordinating,

synchronizing, and training. HSS is based upon a phased

health services system with varying capabilities of care and

situationally tailored to each operation.

Health Service Support in US Coast Guard Operations

Command, Control, Communications, Computers, and

Intelligence Systems

CONCLUSION

Department of Defense

HSS units may be required

to support US Coast Guard

units.

HSS requires adequate

command, control,

communications,

computers, and

intelligence systems

support.
CHAPTER I

FORCE HEALTH PROTECTION

I-1

1. Overview

a. Force health protection (FHP)

includes all measures taken by the chain

of command and the military health system

to promote, improve, conserve, or restore

the mental or physical well-being of

personnel across the range of military

operations. The three pillars of FHP are a

healthy and fit force, casualty prevention,

and casualty care management. Figure I1 shows the relationship between the pillars

of the National Military Strategy (“Shape”,

“Prepare”, and “Respond”) and the

corresponding pillars of FHP.

b. The geographic combatant

commander is responsible for the

implementation of FHP within his or her

“Better use medicines at the outset than at the last moment.”

Darius Publius, 42 BC

area of responsibility (AOR). The joint

force surgeon (JFS), appointed by the

geographic combatant commander, is

responsible for the coordination and

integration of the health service support

(HSS) mission among the participating

Service components. This ensures that

maximum use and efficiency are attained from

the deployed HSS resources. The success of

casualty care management with limited

medical forces is directly dependent upon the

combatant commander’s aggressive

enforcement of the first two pillars.

c. FHP is accomplished through the

promotion of wellness, physical and mental

conditioning, medical surveillance,

preventive medicine, and the establishment

of a phased health care delivery system.

Figure I-1. National Military Strategy and Force Health Protection Relationship

NATIONAL MILITARY STRATEGY AND FORCE

HEALTH PROTECTION RELATIONSHIP

SHAPE PREPARE RESPOND

FORCE HEALTH PROTECTION

HEALTHY and

FIT FORCE

CASUALTY

PREVENTION

CASUALTY CARE

MANAGEMENT

NATIONAL MILITARY STATEGY

JOINT VISION 2010 FOCUSED LOGISTICS
I-2

Chapter I

JP 4-02

HSS includes, but is not limited to, the

following areas: medical treatment (to include

area support), patient movement,

hospitalization, to include forward resuscitative

surgery, dental services, preventive medicine,

veterinary services, combat stress control and

mental health care services, health service

logistic support, medical laboratory services,

blood collection and distribution, and command,

control, communications, computers, and

intelligence (C4I).

d. FHP employs the right mix of HSS

capabilities, at the right time and at the right

place, to provide effective and efficient care

for US forces. The past HSS concept of

providing definitive care in theater to

maximize returned to duty (RTD) status has

evolved to a concept that provides essential

care in theater to either RTD within the theater

patient movement policy or stabilize for

patient movement to the next level of care,

with enhanced en route medical care and

definitive care. Although this reduces the

medical footprint in theater, it is dependent

on uninterrupted airlift and will place

increased demands on the personnel

replacement system. Increased reliance on

replacements rather than RTD may also affect

unit cohesion.

2. Force Health Protection

Pillars

a. The first pillar of FHP promotes a

healthy and fit force and provides the

commander with an optimally fit Service

member capable of withstanding the

physical and mental rigors associated with

combat and other military operations.

Effective and enhanced quality of life

guards the force against disease and

nonbattle injury (DNBI), combat and

operational stress reactions (COSR), and

other health threats. Wellness requires

continuous attention before, during, and after

deployment to sustain maximum readiness

and operational capability.

• Wellness programs in joint operations

include physical and mental fitness,

health promotion, and environmental

and occupational health. Physical

fitness improves performance through

programs that build and maintain

endurance, strength, flexibility, and good

emotional health. Health promotion

encourages healthy life-styles through

good nutrition, preventive dentistry,

stress management, avoidance of

substance abuse, and the promotion of

health education and healthy family

relationships.

• Physical and emotional fitness, health

promotion, and environmental and

occupational health keep US forces

healthy on and off duty. Aggressive

wellness programs promote quality of

life. Fit military members are less

likely to be injured accidentally, can

more readily withstand exposure to

diseases and excessive stress, and more

promptly heal from wounds or

injuries.

b. The second FHP pillar is casualty

prevention. Casualty prevention focuses

on threats posed by enemy forces and

occupational and environmental health

threats. Failure to counter these threats

jeopardizes mission accomplishment.

• Enemy Threat. The enemy threat

depends on the enemy’s willingness and

ability to use force (conventional and

nonconventional weapon systems,

munitions, and nuclear, biological, and

chemical (NBC) agents) to produce

casualties. Aggressive HSS enhances

the force’s ability to minimize combat

injuries resulting from continuous

operations, combat stress, and/or

exposure to NBC agents.

• Health Threat. The health threat

depends on a complex set of
I-3

Force Health Protection

environmental and occupational factors

that combine to produce DNBIs and

COSRs and are a serious threat to US

forces. There must be a comprehensive

medical data collection system with

continuous surveillance and preventive

medicine measures (such as

immunization, pretreatment, and

chemoprophylaxis programs and

policies) to continuously counter the

health threat. To manage or reduce

COSR, stress control measures should be

implemented. These measures include

surveying the unit to identify stressors

and excess stress and advising the

commander on interventions. This early

intervention will reduce COSR-identified

personnel requiring additional help, and

lessen the chances of long-term disability

such as posttraumatic stress disorder.

These interventions occur before, during,

and after deployment of forces (see

Appendix A, “Health Threat”).

• A robust health surveillance system is a

critical component of FHP. Deployment

health surveillance includes identifying

the population at risk (through, but not

limited to, pre- and post-deployment

health assessments), recognizing and

assessing hazardous exposures (medical,

environmental, psychological, and

occupational), employing specific

countermeasures, and monitoring health

outcomes.

c. The third FHP pillar, casualty care

management, includes patient care and

movement. It encompasses care provided

from the point of injury through successive

phases of medical care, including definitive

and rehabilitative management in hospitals in

the continental United States (CONUS) and

outside the continental United States

(OCONUS).

3. Five Phases of Casualty Care

Management

The phases of casualty care management

are first responder, forward resuscitative

surgery, theater hospitalization, en route care,

and care outside the theater (see Figure I-2).

These phases ensure that patients receive the

essential care in theater and movement to

definitive care outside the theater as soon as

practical.

a. Phase I — First Responder. The first

response may include self-aid and buddy aid,

Immunizations are a vital part of casualty prevention.
I-4

Chapter I

JP 4-02

combat lifesavers, combat medics, hospital

corpsmen, physician assistants (PAs),

physicians, or other medical personnel. The

first medical responder should have a

working knowledge of the next level of care

available and the patient movement system.

Within this phase, the focus of all health care

providers is to save life and limb and stabilize

the patient sufficiently to evacuate to the next

level of care. A stabilized patient is one

whose airway is secured, hemorrhage is

controlled, shock is treated, and fractures are

immobilized. Threat to life or limb still exists

but has been decreased with medical

intervention. Stabilization is a necessary

precondition for further patient movement.

In combat settings, advance trauma

management may differ significantly in

priorities and procedures from that practiced

in peacetime.

• First Aid. Basic first aid is provided by

the individual (self-aid) or a buddy

(buddy aid). Advanced first aid requires

additional training and includes the

initiation of vascular volume

replacement through the use of

intravenous (IV) fluids. Advanced first

aid is provided by the combat lifesaver.

First aid is the emergency or lifesaving

care given to a sick, injured, or wounded

person when a medically trained

individual is not immediately available.

Every Service member is expected to

know and apply basic lifesaving

measures. Lifesaving measures are

applied to restore breathing and

circulation, to stop bleeding, to help

prevent shock and infection, and to splint

or immobilize fractures.

• Combat Medic and/or Corpsman

Care. Combat medic and/or corpsman

care is the first medical care that a sick,

injured, or wounded individual receives

from a medically trained individual.

Combat medic and/or corpsman care

entails the skillful application of physical

examination techniques; performance of

emergency or lifesaving measures; and

continual observation and care to ensure

that the airway remains open, that

bleeding has ceased, and that shock,

infection, and further injury are

prevented. It involves the effective use

of medical supplies not available to the

first aid provider and arrangement for

patient movement, as appropriate.

• Advanced Trauma Management. This

phase of treatment includes care provided

by personnel (physicians, dentists, PAs,

and nurse practitioners) specifically

trained and equipped for trauma

management. Procedures can include

invasive measures (such as venous cut

downs or chest tubes) required to stabilize

the patient prior to further movement.

b. Phase II — Forward Resuscitative

Surgery. The forward resuscitative surgery

phase is the urgent initial surgery required to

render a patient stabilized enough to withstand

further movement to the next level of care.

Forward resuscitative surgery is typically

performed on patients with signs and

symptoms of initial airway compromise,

difficult breathing, and circulatory shock and

Figure I-2. Phases of Casualty

Care Management

First Responder

Forward Resuscitative

Surgery

Theater Hospitalization

En Route Care

Care Outside The Theater

PHASES OF CASUALTY

CARE MANAGEMENT
I-5

Force Health Protection

who do not respond to initial advanced

trauma management procedures. This

resuscitation and stabilization is dependent

upon far forward lightweight and mobile

surgical units. The capabilities, locations,

and relationships of far forward surgical units

to first responders and to more definitive

levels of care must be clearly delineated and

communicated throughout the joint force.

c. Phase III — Theater Hospitalization.

Theater hospitals will provide essential care

to patients and prepare those who require

higher care for evacuation out of theater.

d. Phase IV — En Route Care. En route

care involves the medical treatment of

A corpsman provides medical care.

patients during movement. This provides

uninterrupted care from the point of injury or

initial illness until the patient arrives at the

next level of care.

e. Phase V — Care Outside the Theater.

Care that is provided outside the theater may

include convalescent, restorative, and

rehabilitative services and normally is

provided by military, Department of Veteran

Affairs, CONUS civilian hospitals, and

commander in chief (CINC)-approved safe

havens. It may include a period of minimal

care and increased physical activity necessary

to restore patients to functional health.
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JP 4-02

Intentionally Blank
CHAPTER II

HEALTH SERVICE SUPPORT OPERATIONS

II-1

1. Mission

The HSS mission in joint operations is

to minimize the effects of wounds, injuries,

diseases, environmental and occupational

hazards, and psychological stressors on

unit effectiveness, readiness, and morale.

This mission is accomplished by a

comprehensive HSS plan and phased

medical care that extends from actions taken

at the point of injury or illness, to movement

from a theater for treatment. The effectiveness

of HSS is measured by its ability to save life

and limb; to reduce the DNBI and COSR

rates; to return patients to duty as quickly and

as far forward in the theater as possible; and

to evacuate patients with minimum delay to

theater hospitals or out of the theater, as

appropriate.

2. Objective

The primary objective of HSS is to

conserve the fighting strength of the forces.

This objective is most effectively achieved

through optimum use and integration of

available HSS assets. HSS in joint

operations requires continuous planning,

coordinating, synchronizing, and training

to ensure a prompt, effective, and unified

health care effort.

3. Principles

Each Service component has an HSS

system that encompasses six health care

principles. Figure II-1 depicts these

principles.

a. Conformity. Conformity with the

combatant commander’s operation plan

“The preservation of the soldier's health should be [the commander's] first

and greatest care.”

George Washington

(OPLAN) is the most fundamental element

for effectively providing HSS. Only by

participating in the development of this plan

can the HSS planner ensure adequate support

at the right time and the right place.

b. Responsiveness. The speed with which

medical treatment is initiated is extremely

important in reducing morbidity and mortality.

The efficient allocation of resources and the

judicious location of medical treatment

facilities (MTFs) must optimize access to care.

c. Flexibility. Since a change in tactical

plans or operations may require redistribution

or relocation of HSS resources to meet the

changing requirements, no more medical

resources should be committed nor MTFs

established than are required to support

expected patient densities.

d. Mobility. Since contact with supported

units must be maintained, HSS elements must

Figure II-1. Health Service

Support Principles

Conformity

Responsiveness

Flexibility

Mobility

Continuity

Coordination

Conformity

Responsiveness

Flexibility

Mobility

Continuity

Coordination

HEALTH SERVICE

SUPPORT PRINCIPLES
II-2

Chapter II

JP 4-02

have mobility comparable to that of the units

they support. Mobility is measured by the

extent to which a unit can move its personnel

and equipment with organic transportation.

e. Continuity. HSS must be continuous

since an interruption of treatment may cause

an increase in morbidity and mortality.

f. Coordination. The objective of this

principle is to ensure that HSS resources in

short supply are efficiently employed and used

effectively to support the planned operation.

Continuous coordination ensures that medical

facilities are not placed in areas that interfere

with combat operations. Additionally,

continuous coordination ensures that the scope

and quality of medical treatment and care meet

professional standards and policies.

4. Organization

HSS is organized into five levels of care

(see Figure II-2).

a. Level I. Level I care consists of care

rendered at the unit level. It includes selfaid, buddy aid, and combat lifesaver skills,

examination, and emergency lifesaving

measures such as the maintenance of the

airway, control of bleeding, prevention and

control of shock, splinting or immobilizing

fractures, and the prevention of further injury.

Treatment may include restoration of the

airway by invasive procedures; use of IV

fluids and antibiotics; and the application of

splints and bandages. These elements of

medical management prepare patients for

RTD or for transportation to a higher level of

care. Supporting medical units are responsible

for coordinating the movement of patients

from supported medical facilities.

b. Level II. At a minimum, Level II care

includes physician-directed resuscitation and

stabilization and may include advanced

trauma management, emergency medical

procedures, and forward resuscitative surgery.

Supporting capabilities include basic

laboratory, limited x-ray, pharmacy, and

temporary holding facilities. Patients are

treated and RTD, or are stabilized for

movement to a MTF capable of providing a

higher level of care. Surface or air movement

is coordinated for transfer to a facility

possessing the required treatment

capabilities. Level II is the first level where

Group O liquid packed red blood cells will

be available for transfusion.

c. Level III. Care is administered that

requires clinical capabilities normally found

in a facility that is typically located in a

reduced-level enemy threat environment. The

facility is staffed and equipped to provide

Helicopters provide mobility for health

care providers.
II-3

Health Service Support Operations

resuscitation, initial wound surgery, and

postoperative treatment. This level of care

may be the first step toward restoration of

functional health, as compared to procedures

that stabilize a condition to prolong life.

Blood products available may include fresh

frozen plasma, Groups A, B, and O liquid

cells and may include frozen Group O red

cells and platelets.

d. Level IV. In addition to providing

surgical capabilities found at Level III, this

level also provides rehabilitative and recovery

therapy for those who can RTD within the

theater patient movement policy. This level

of care may only be available in mature

theaters.

e. Level V. Level V definitive care

includes the full range of acute convalescent,

restorative, and rehabilitative care and is

normally provided in CONUS by military and

Department of Veterans Affairs hospitals, or

civilian hospitals that have committed beds

for casualty treatment as part of the National

Defense Medical System. On occasion,

OCONUS military or allied and/or host

nation hospitals in CINC-approved safe

havens may also be used. This level may

include a period of minimal care and

increasing physical activity necessary to

restore patients to functional health and allow

them to RTD or to a useful and productive

life.

5. Relationships and

Responsibilities

a. Geographic combatant commanders are

ultimately accountable for HSS and for

coordinating and integrating HSS within their

theaters. In joint operations, joint use of

available medical assets will be accomplished

to support the warfighting strategy and

concept of operations.

b. A JFS should be appointed for each

combatant command, subunified command,

and joint task force (JTF). As a specialty

advisor, the JFS may report directly to the joint

force commander (JFC). The JFS coordinates

FHP matters for the JFC. The JFS section

should be jointly staffed and should be of

sufficient size to effectively facilitate the

following.

Figure II-2. Levels of Health Service Support

LEVELS OF HEALTH SERVICE SUPPORT

Definitive, convalescent, restorative, and rehabilitative care normally

provided by the military, Department of Veterans Affairs, Continental

United States civilian hospitals, or commander in chief-approved safe

havens.

Not only surgical capability, as in Level III, but also further therapy

during the recovery and rehabilitative phase

Resuscitation, stabilization, and application of emergency

procedures to prolong life

Care requiring clinical capabilities (surgery)

Self-aid, buddy aid, and combat lifesaver skills

LEVEL V

LEVEL IV

LEVEL III

LEVEL II

LEVEL I
II-4

Chapter II

JP 4-02

• Joint coordination of HSS initiatives.

• Performance of health threat assessment.

• Health service logistic support and blood

requirements.

• Standardization and interoperability.

• Development of the HSS plan and course

of action (COA) analysis.

• Review of subordinate plans and

operations.

• Joint coordination of intratheater patient

movement.

• Theater health surveillance.

c. The combatant command JFS

assesses component command HSS

requirements and capabilities, both

quantitatively and qualitatively, and provides

guidance to enhance the effectiveness of

HSS. The combatant command JFS has

the responsibility to perform the following.

• Advise the combatant commander on all

HSS operations.

• Recommend and monitor preventive

medicine and care provided to the civilian

population and other beneficiaries.

• Assist the combatant commander in

formulating a recommended theater

patient movement policy within the

geographic area.

• Assist the component commands in

identifying HSS requirements and

coordinating cross-Service support,

where practical.

• Advise the combatant commander

concerning the following.

•• The health of the command and other

medical factors that could affect

operations.

•• HSS aspects of combat operations.

•• Intratheater rest, rotation, and

reconstitution policies and procedures.

•• Preventive medicine procedures.

•• Occupational and environmental

health.

Theater hospitals provide a full range of capabilities.
II-5

Health Service Support Operations

•• Joint reception, staging, onward

movement, and integration (JRSOI).

• Monitor and inform the combatant

commander on the status of HSS

resources.

• Inform the combatant commander

concerning the status of and assistance

required by and provided to the civilian

populace, Department of Defense (DOD)

civilian employees, DOD contract

personnel, enemy prisoners of war

(EPWs), nongovernmental organizations

(NGOs), and international organizations

(IOs). Advise supporting civil affairs

forces on humanitarian and civic

assistance (HCA) activities within the

theater.

• Coordinate HSS provided to or received

from, allies, coalition partners, host

nation (HN) military, or other friendly

nations.

• Coordinate medical intelligence

(Appendix B, “Medical Intelligence”)

support for HSS organizations.

• Supervise the activities of the Theater

Patient Movement Requirements Center

(TPMRC) and the Joint Blood Program

Office (JBPO).

• Coordinate support from the Global

Patient Movement Requirements Center

(GPMRC). (The GPMRC is a United

States Transportation Command asset.)

This center is discussed in detail in Joint

Publication (JP) 4-02.2, Joint Tactics,

Techniques, and Procedures for Patient

Movement in Joint Operations.

• Coordinate support from the Armed

Services Blood Program Office

(ASBPO). The ASBPO is responsible

for the coordination of the blood

programs of the military Services and

the combatant commands. The ASBPO

provides an orderly system for

collection, storage, and distribution of

blood products across the range of

military operations. The primary

responsibility of the ASBPO is to ensure

that blood products, in the required types

and amounts, reach the theater in a readyto-use condition.

For a detailed discussion of blood

management, refer to JP 4-02.1, Joint

Tactics, Techniques, and Procedures for

Health Service Logistics in Joint

Operations.

• Prepare the HSS Annex Q to the

OPLAN.

• Prepare patient movement (lift-bed)

requirements based on the casualty

estimates provided by the appropriate

staff.

• Obtain Service specific casualty rate

information to model HSS force structure

and casualty flow for the joint operation.

When the size of the joint operation

warrants, use the most current Chairman

of the Joint Chiefs of Staff (CJCS)-

approved automated medical planning

tools to generate patient requirements and

identify shortfalls in medical force

structure, equipment, and supplies.

• Identify possible requirements for fixedwing patient airlift based on casualty

estimates.

d. The subordinate joint force JFS assesses

component command HSS requirements and

capabilities (both quantitatively and

qualitatively) and provides guidance to

enhance the effectiveness of HSS. The

subordinate joint force JFS has the

responsibility for the following.
II-6

Chapter II

JP 4-02

• Assist the component commands in

identifying HSS requirements and

coordinating cross-Service support,

where practical.

• Advise the subordinate JFC concerning:

•• HSS aspects of combat operations;

•• Preventive medicine;

•• Health of command and other medical

factors that could affect operations;

•• Occupational and environmental

health; and

•• JRSOI.

• Monitor and inform the subordinate JFC

on the status of HSS resources.

• Inform the subordinate JFC concerning

the status of and assistance required by

and provided to the civilian populace,

DOD civilian employees, DOD contract

personnel, EPWs, NGOs, and IOs.

Advise supporting civil affairs (CA)

forces on HCA activities within the joint

force operational area.

• Coordinate HSS provided to or received

from allies, coalition partners, HN

military, or other friendly nations.

• Coordinate medical intelligence

(Appendix B, “Medical Intelligence”)

support for HSS organizations.

• Prepare the FHP HSS Annex Q to the

joint force OPLAN (See Appendix C,

“Format for Annex Q to an Operation

Plan”).

• Prepare patient movement (lift-bed)

requirements based on the casualty

estimates and rates provided by the

appropriate staff.

• Advise the subordinate JFC on all HSS

operations.

• Define and monitor preventive medicine

and care provided to civilian population

and other beneficiaries.

• Assist HSS personnel and facilities to

comply with the 1949 Geneva

Conventions.

e. The combatant commander has directive

authority for logistics within the AOR, to

include the execution of the health service

logistic support mission. One way the

combatant commander may exercise this

authority is by designating one of the Services

within the AOR (normally the predominant

user) as the single integrated medical logistics

manager (SIMLM). The SIMLM’s mission,

roles, and responsibilities for supporting joint

forces must be clearly identified in concept

and operation plans.

Further information on the SIMLM is in JP

4-02.1, Joint Tactics, Techniques, and

Procedures for Health Service Logistics in

Joint Operations.

f. The US Army is the DOD Executive

Agent for veterinary services for all Services

and the advisor to the JFS on all veterinary

affairs. This mission includes the control of

zoonotic diseases, veterinary care of DODowned animals, veterinary laboratory support,

inspection and examination of subsistence

items for quality and, when authorized,

veterinary care for animals belonging to local

indigenous personnel in conjunction with

nation assistance or other operations. Army

Veterinary Corps, Navy Preventive Medicine,

and Air Force Public Health provide food

safety services, assuring food quality.

6. Patient Movement

Timely patient movement plays an

important role in FHP and the design of
II-7

Health Service Support Operations

HSS. Patient movement functions include

medical regulating, patient movement,

patient in-transit visibility, and providing en

route care (e.g., medical staffing and patient

movement items (PMIs), etc.). Patient

movement can be by surface (land or water),

or by air (rotary-wing or fixed-wing aircraft);

however, air is preferred.

a. Initial movement of patients to a theater

hospital has historically been a Service

component responsibility, but patient

movement can be coordinated within an AOR,

as required, by a Joint Patient Movement

Requirements Center. Intratheater forward

aeromedical evacuation (AE) may be

coordinated by an AE liaison team. Army

aeromedical ambulance assets may provide

dedicated patient movement to and from

Navy hospital ships. Intratheater patient

movement is coordinated by a TPMRC.

Patient movement from the theater is a

collaborative effort between the TPMRC,

GPMRC, and the component lift control

agency.

Patient movement procedures in joint

operations are described in JP 4-02.2, Joint

Tactics, Techniques, and Procedures for

Patient Movement in Joint Operations.

b. PMI refers to specific medical

equipment and durable supplies that must be

available to support patient movement. The

mission of the PMI system is to support intransit medical capability by minimizing the

removal of equipment from patients; exchange

PMIs without degrading medical capabilities;

and provide prompt recycling of PMIs.

The PMI system is outlined in JP 4-02.1, Joint

Tactics, Techniques, and Procedures for

Health Service Logistics Support in Joint

Operations.
II-8

Chapter II

JP 4-02

Intentionally Blank
CHAPTER III

HEALTH SERVICE SUPPORT PLANNING

III-1

1. The Joint Operation

Planning Process

The Joint Operation Planning and

Execution System is the policy, procedures,

and automated data processing system

used for developing, coordinating,

reviewing, approving, and disseminating

joint OPLANs. Operational planners must

take many factors into account to select the

best or most appropriate means of performing

a joint force mission. The amount of time

available for planning influences the entire

process. Joint operation planning is comprised

of deliberate and crisis action planning. The

Global Command and Control System

(GCCS) provides the means by which

planners develop and execute OPLANs and

operation orders (OPORDs). The GCCS

furnishes warfighters at all levels with the

needed connectivity, rapid access, flexibility,

and simplicity in operations for a

comprehensive, interoperable, global

command and control (C2) capability.

2. Health Service Support

Planning Considerations

Timely, effective planning and coordination

are essential to ensure adequate and

sustainable HSS in a theater. Proper planning

“A corps of medical officers was not established solely for the purpose of

attending the wounded and sick . . . the labors of medical officers cover a

more extended field. The leading idea, which should be constantly kept in

view, is to strengthen the hands of the Commanding General by keeping his

army in the most vigorous health, thus rendering it, in the highest degree,

efficient for enduring fatigue and privation, and for fighting. In this view, the

duties of such a corps are of vital importance to the success of an army, and

commanders seldom appreciate the full effect of their proper fulfillment.”

Major Jonathan Letterman

Medical Director of the Civil

War Army of the Potomac

permits a systematic examination of all factors

in a projected operation and ensures

interoperability with the campaign plan or

OPLAN (see Appendix C, “Format for Annex

Q to an Operation Plan”). Organization of

the HSS system is determined by the joint

force’s mission, the health threat, medical

intelligence, anticipated number of patients,

duration of the operation, the theater patient

movement policy, available lift, and

hospitalization and movement requirements

(see Figure III-1).

a. Threat. The threat is a composite of

ongoing or potential enemy actions;

occupational, environmental, geographical,

and meteorological conditions; endemic

diseases that can reduce the effectiveness of

the joint force through wounds, injuries,

illness, and psychological stressors; and the

employment of weapons of mass destruction

(WMD). See Appendix A, “Health Threat.”

b. Medical Intelligence. Medical

intelligence is produced from the collection,

evaluation, and analysis of information

concerning the health threats and medical

capabilities of foreign countries that have

immediate or potential impact on policies,

plans, or operations. See Appendix B,

“Medical Intelligence.”
III-2

Chapter III

JP 4-02

c. Patient Movement. Timely patient

movement plays an important role in the

design of HSS. Patient movement is the end

result of the collaborative lift-bed planning,

and involves selection of patients for

movement based on consideration of medical

condition, locating available beds, route

planning, and the selection of movement

platforms and movement control. The HSS

planner should consider using all means of

patient movement.

For further guidance, refer to JP 4-02.2, Joint

Tactics, Techniques and Procedures for Patient

Movement in Joint Operations.

d. Clinical Capabilities and Health

Service Logistic Support. Specific clinical

capabilities, location, health service logistic

supportability, and bed requirements must be

considered when planning HSS and must be

detailed in the respective OPLAN. HSS

planners must consider the following.

• Sufficient personnel with the clinical

capabilities necessary to provide care for

the expected number and types of patients

in the theater.

• Specific clinical capability, relative

mobility, logistic supportability, and the

Figure III-1. Health Service Support Planning Considerations

HEALTH SERVICE SUPPORT

PLANNING CONSIDERATIONS

HEALTH SERVICE

SUPPORT

PLANNING

CONSIDERATIONS

Threat Medical

Intelligence

Patient

Movement

Patient

Movement Items

Medical

Surveillance

Prevention of Stress

Casualties

Mass Casualty Situations

Host-Support Nation

Preventive and

Veterinary Medicine

Clinical Capabilites

and Health Service

Logistic Support
III-3

Health Service Support Planning

necessity to ensure a logical expansion

of capabilities in theater.

• Critical time and distance factors that

impact on morbidity and mortality rates.

• Health service logistic issues, including:

•• Standardization;

•• Use of a SIMLM system;

•• Items requiring special handling;

•• Transportation;

•• Type and quantity of medical supplies

needed;

•• Supply procedures and sustainment

requirements; and

•• Medical equipment maintenance and

support requirements.

• Blood supply and distribution.

e. Patient Movement Items. PMIs are

specific medical equipment and durable

supplies that must be available to support the

patient. Examples of PMIs include

ventilators, litters, patient monitors, and pulse

oximeters. The mission of the PMI system

is to support patients in-transit, to exchange

in-kind PMIs without degrading medical

capabilities, and to provide prompt recycling

of PMIs. It is the originating MTF’s

responsibility to provide the PMIs required

to support the patient during movement. PMIs

accompany a patient throughout the chain of

movement, from the originating MTF to the

destination MTF, whether it is an intratheater

or intertheater transfer. Planners must ensure

that PMIs are available at the correct location

and ready for use and PMI centers are

established (establishment of theater PMI

centers and cells is the responsibility of the

US Air Force). PMI centers are established

to support worldwide theater requirements.

PMI centers will be located at airports of

embarkation and/or debarkation within

CONUS and OCONUS to match AE support

plans. PMI centers and cells will receive,

refurbish (i.e., technical inspection,

calibration, repair, and replenishment of

expendable supplies to maintain a 3-day level

of supplies), redistribute, and return PMIs

collected from MTFs. PMI centers can be

augmented with personnel and equipment

from the other Services; liaison personnel

Planners must account for the medical situation in the operational area.
III-4

Chapter III

JP 4-02

may also be assigned. At the time an MTF

initiates a patient movement request

requiring PMIs, the PMI center and/or cell

will initiate action for the exchange of inkind PMIs.

For further guidance on PMIs, refer to JP

4-02.2, Joint Tactics, Techniques and

Procedures for Patient Movement in Joint

Operations.

f. Preventive Medicine and Medical

Surveillance. Risk assessment and analysis

as well as preventive medicine measures

must be included early in HSS planning.

The theater medical surveillance program is

initiated and the means to counter the health

threats in the operational area are identified

before the forces arrive. Specific preventive

medicine procedures are generally the

responsibility of the component commands.

However, the geographic combatant

commander, with advice from the JFS, may

exercise directive authority and change

component responsibilities based on

operational or geographic considerations.

• Preventive medicine is the

anticipation, communication,

prediction, identification, prevention,

education, risk assessment, and control

of communicable diseases, illnesses

and exposure to endemic,

occupational, and environmental

threats. These threats include nonbattle

injuries, combat stress responses, WMD,

and other threats to the health and

readiness of military personnel.

Communicable diseases include

anthropod-, vector-, food-, waste-, and

waterborne diseases. Preventative

medicine measures include field

sanitation, medical surveillance, pest

and vector control, disease risk

assessment, environmental and

occupational health surveillance, waste

(human, hazardous, and medical)

disposal, food safety inspection, and

potable water surveillance.

• Medical surveillance is defined as the

ongoing, systematic collection of health

data essential to the evaluation,

planning, and implementation of

public health practice, closely

integrated with timely dissemination

of data as required by higher

authority. Theater medical surveillance

is essential for early identification of

health threats within the operational area

in order to prevent, neutralize, minimize,

or eliminate them. The medical

surveillance program must cover all

periods from predeployment, deployment,

redeployment and post deployment. This

information must be included in the

Health Services Support Annex (Annex

Q) to the joint OPLAN and/or OPORD

supporting the operation. A

comprehensive medical surveillance

program includes preventive and

epidemiological activities to ensure that

commanders are kept informed on the

health of the force, health threats,

occupational and environmental threats,

stressors, risks, and available preventive

medicine and stress control measures

before, during, and after deployment.

For further information refer to JP 3-35,

Joint Deployment and Redeployment

Operations, DOD Directive 6490.2, Joint

Medical Surveillance, and DOD

Instruction 6490.3, Implementation and

Application of Joint Medical

Surveillance for Deployments.

•• Protocols are required for vaccines,

chemoprophylaxes, barrier creams,

and pretreatments which are

recommended for deployed forces and

which are not approved for general use

or are not approved for the purpose for

which they are being administered
III-5

Health Service Support Planning

under the Food and Drug

Administration’s guidelines. If the

vaccine or medication is to be

administered without a member’s prior

consent, the Secretary of Defense must

generally obtain a waiver of informed

consent requirements in accordance

with title 10, US Code (USC), section

1107(f).

•• Establishment of a central

repository for all specimens and

samples, to include suspected

biological warfare and chemical

warfare agents and data, must be

coordinated with the Assistant

Secretary of Defense (Health Affairs).

g. Prevention of Stress Casualties.

Prevention of stress casualties and control

of combat and operational stress is a

command and leader responsibility. HSS

and other personnel at all levels play

important supporting roles. A coordinated

program must be planned for the prevention,

treatment, and RTD of combat stress reaction

casualties. Active education, training, and

prevention programs assist with controlling

stress and preparing unit leaders and HSS

personnel to identify and manage stress

reactions in units.

h. Mass Casualty (MASCAL)

Situations. Procedures for handling

MASCALs must be established to include

casualty management resulting from

WMD, combat, or other military

operations. Particular emphasis is placed

on the flexibility of HSS units to respond to

sudden changes in the casualty situation.

Successful management of a MASCAL

situation is a complex task where success

relies as much on well-practiced logistics and

communications as it does on skilled medical

treatment. The JFS must ensure that the

communications, transportation, triage and

emergency management, patient movement,

and health service logistic support

management aspects of the MASCAL plan

are thoroughly rehearsed.

i. Host-Nation Support (HNS). HNS

can be a significant force multiplier. HNS

should be equivalent to US standards or

acceptable to the geographic combatant

commander. The JFS must assess HN

medical capabilities and make

recommendations to the JFC on their use for

deployed US forces. In many operations, HN

blood supplies do not meet US standards of care.

The JFS should make arrangements to store and

use blood products from US-approved sources

even if HN MTFs are planned to support the

Mass casualties can also result from natural disasters.
III-6

Chapter III

JP 4-02

deployed force. HNS may reduce the lift

requirements necessary to deploy HSS to the

joint operations area (JOA).

For further information, refer to JP 5-00.2,

Joint Task Force Planning Guidance and

Procedures.

j. Additional HSS Planning

Considerations. Additional HSS planning

considerations that the JFS must take into

account to support joint operations are as

follows.

• Ensure that an adequate joint medical

communications architecture is

established to provide compatible and

responsive communications for the

military HSS system.

• Ensure that adequate standardization

and interoperability policies are in

place to ensure that all deployable

medical systems supporting joint

operations are interoperable between

Service components.

• Review entitlements, applicable laws,

and regulations for the provision of US

military HSS to nonmilitary beneficiaries

(civilian employees, DOD contractors, or

other nonmilitary participants) and

military and nonmilitary personnel of

another nation. Ensure that policies are

published, disseminated and understood

by all HSS personnel.

• Coordinate HSS requirement in

support of natural disasters.

• Coordinate support with outside relief

agencies (Red Cross, NGOs, and IOs)

in theater to ensure complete visibility

for overall medical situation and

requirements, including integrated

transfer of responsibilities for policies

and procedures.

• Amphibious Task Force. Amphibious

task force HSS planning responsibilities

are closely related to those of the landing

force. Detailed, coordinated, and

parallel planning is required between the

commander of the amphibious task force

and the commander of the landing force.

Each surgeon of these commands has

specific HSS planning responsibilities

that are detailed in JP 3-02, Joint

Doctrine for Amphibious Operations.

• Airborne Operations. Airborne

operations establish a lodgment in an

isolated uncertain or hostile environment.

Detailed, coordinated, and joint planning

is required between the commander of

the airborne task force and the JFC. Each

surgeon of these commands has specific

HSS planning responsibilities that are

detailed in JP 3-17, Joint Doctrine and

Tactics, Techniques, and Procedures for

Air Mobility Operations, and JP 3-18,

Joint Doctrine for Forcible Entry

Operations.

Additional considerations and a detailed

HSS planning checklist can be found in

JP 5-00.2, Joint Task Force Planning

Guidance and Procedures.

k. HSS for Returned US Prisoners of

War (POWs) and Detained Personnel. The

geographic combatant commander establishes

a theater plan on the proper handling and

provision of HSS for returned US POWs and

detained personnel.

l. HSS for EPW. In consonance with

provisions outlined in the Geneva

Conventions, EPWs held by US forces are

afforded the same level of HSS as US forces.

Seriously wounded, injured, or sick EPWs

will be segregated from US, allied, and

coalition patients and will be evacuated from

the combat zone through HSS channels as

soon as possible. The JTF commander must
III-7

Health Service Support Planning

ensure that appropriate security is provided

to guard the EPWs. Medical personnel will

not be used as guards. As much as possible,

medical care of EPWs will be provided by

qualified retained or detained medical

personnel from that same nation.

m. Dental Service

• Joint operations planning must

include the consideration of two

categories of dental services. One

category of dental care is provided within

the operational area and an additional

category in the support base (see Figure

III-2).

• The planning process includes an

evaluation of the size and anticipated

duration of the operation, along with

categories of dental care required to

support the operation.

•• Category I — Operational Care.

Care given for the relief of oral pain,

elimination of acute infection, control of

life-threatening oral conditions

(hemorrhage, cellulitis, or respiratory

difficulties), and treatment of trauma to

teeth, jaws, and associated facial

structures is considered emergency

care. It is the most austere type of care

and is available to Service members

engaged in tactical operations. Common

examples of emergency treatments are

simple extractions, antibiotics, pain

medication, and temporary fillings.

Essential non-emergency care includes

dental treatment necessary to intercept

potential emergencies. This type of

operational care is necessary for

prevention of lost duty time and

preservation of fighting strength.

Personnel in Dental Class 3 (potential

dental emergencies) should be provided

this level of care as the tactical situation

permits. Common examples of essential

non-emergency care are basic

restorations, extractions, interim pulpal

therapy (pulpectomy), treatment of

periodontal conditions, and simple

prosthetic repairs. Essential nonemergency care is consistent with Level

II HSS. Essential non-emergency care

is also intended to maintain the overall

oral fitness of personnel at a level

consistent with combat readiness. Most

dental disease is chronic and recurring.

Oral health status will deteriorate from

the day of deployment if essential care is

not provided by deployed dental support.

Those in Dental Class 2 (untreated oral

disease) should be provided essential

care as the tactical situation and

availability of dental resources permit.

This level of care is the highest category

Figure III-2. Categories of Dental Care Considered During Joint Operation Planning

CATEGORIES OF DENTAL CARE CONSIDERED

DURING JOINT OPERATION PLANNING

Comprehensive Care

Operational Care Operational Care

Comprehensive Care
III-8

Chapter III

JP 4-02

of operational care available in the

operational area and is provided by area

support dental units.

•• Category II — Comprehensive

Care. Treatment to restore an individual

to optimal oral health, function, and

esthetics. Comprehensive dental care

may be achieved incidental to providing

operational care in individuals whose

oral condition is healthy enough to be

addressed by the category of care

provided. This category of care is usually

reserved for HSS plans that anticipate

an extended period of reception and

training in theater. The scope of facilities

needed to provide this level of dental

support could equal that of Level III

medical facilities.

• Planning for dental services must

include the potential for augmenting

the medical effort during MASCAL

situations. Joint operations of limited

size or duration may limit dental services

to predeployment screening, which

eliminates planning for deployment of

dental personnel and equipment.

n. Veterinary Service

• The US Army is the DOD Executive

Agent for veterinary support for the

Services. In some instances, support is

also provided to allies and/or coalition

partners, HN agencies, and other federal

agencies. The appropriate mix of

veterinary units provides support. These

units are tasked-organized to support

food safety and quality assurance, and

the health care mission for governmentowned animals. Services include sanitary

surveillance for food source and storage

facilities, and procurement, surveillance,

and examination of foodstuffs for food

safety. The veterinary unit through the

geographic combatant commander is

responsible for publication of a directory

of approved food sources for the

operational area.

• When deployed in military operations,

veterinary support and preventive

medicine capabilities reduce the

vulnerability of multinational and US

forces to DNBI. The CONUS-based

force projection forces require an early

veterinary and preventive medicine

presence in the operational area wherever

subsistence, bottled water, and/or ice are

procured, shipped, stored, or issued.

Procurement of fresh foods and

beverages is supported by veterinary

personnel through sanitary inspection of

local food establishments in the

operational area. Food inspection is

necessary to ensure food safety, quality

assurance, and adequate food hygiene.

The potential of food-borne disease, the

threat of NBC contamination of

subsistence, the need to assess the

zoonotic endemic disease threats, and the

need to provide health care to military

working dogs all require an early

veterinary presence throughout the entire

operational area. To ensure protection

of the force against the threats identified

above, veterinary services must be active

participants in all joint and multinational

operations.

• Comprehensive veterinary medical and

surgical programs are required to

maintain the health of governmentowned animals. Veterinary animal health

care provides an effective combat

multiplier by providing complete medical

care to all military working dogs

supported in the operational area and by

monitoring endemic animal disease

threats of military significance.

Veterinary personnel work closely with

Army, Air Force, and Navy preventive

medicine units to provide coordinated

FHP support.
III-9

Health Service Support Planning

For additional information on

veterinary services, see field manual

(FM) 8-10-18, Veterinary Services.

3. Health Service Support

Command, Control,

Communications,

Computers, and Intelligence

Systems

Effective C4I systems are vital to

successful HSS in joint operations. HSS

functions depend upon responsive C4I

systems to tie all aspects of support together

and allow JTF commanders to direct,

monitor, and be proactive in decisionmaking

as situations develop (see Figure III-3).

a. C2 of HSS organizations normally

rests with the component commands. The

JFS will recommend C2 relationships based

on mission, enemy, terrain and weather,

troops and support available, and time

available.

b. Early identification of a theater’s C4I

system requirements for HSS connectivity

is essential. At a minimum, HSS

communications must support reliable,

constant communications within a theater,

from the theater to CONUS, and link the most

forward HSS elements in the theater through

each level in the phased HSS system, through

the Service component command’s

headquarters or JTF headquarters to the final

Figure III-3. Characteristics of Health Service Support Command, Control,

Communications, Computers, and Intelligence Systems

CHARACTERISTICS OF HEALTH SERVICE SUPPORT

COMMAND, CONTROL, COMMUNICATIONS,

COMPUTERS, AND INTELLIGENCE SYSTEMS

Command and control of health

service support organizations

normally rests with the

component commands.

Early identification of a theater’s

command, control, communications,

computers, and intelligence system

requirements for health service

supports connectivity is essential.

Records and reports are

required to pass information

and assist in the evaluation of

policies and procedures.
III-10

Chapter III

JP 4-02

destination MTF. The success of HSS

operations depends upon reliable

communications over dedicated and parallel

systems. HSS communications planners,

working with the joint force command,

control, communications, and computer

systems directorate (J-6), must identify

frequencies and encryption sets and/or codes

that are common between Service component

support forces assigned to HSS missions. If

no commonality exists, then planners should

consider assigning a component to develop a

theater communications plan that ensures

adequate communications support to all

components. A theater communications plan

should be formulated during deliberate

planning. This is done through complete and

detailed descriptions of systems and systems’

requirements (frequency, classification, etc.)

in all Service documents and consolidated in

a joint OPLAN or operation plan in concept

format.

• Patient movement vehicles and aircraft

must be equipped with the proper

communications equipment to facilitate intheater communications in support of HSS

operations. The component command

HSS units must plan to provide the

necessary communications equipment.

• Long-haul telecommunications services

will be provided through the Defense

Information Services Network and its

component systems, the Defense

Switched Network, Defense Data

Network, Automated Digital Network

(and its follow-on replacement, the

Defense Message System), Secure

Internet Protocol Router Network,

Nonsecure Internet Protocol Router

Network, and the Defense Satellite

Communications System.

• All frequency requirements for organic

equipment must be coordinated with the

JFC’s J-6 staff. All HSS should be

developed and certified to operate on

the Global Combat Support System.

• Theater medical information programs

must be timely, accurate, and relevant.

They must cover the following:

•• Theater medical information;

•• Blood management;

•• Patient tracking and movement;

•• Health service logistic support; and

•• Medical surveillance.

c. Records and reports are required to pass

information and assist in the evaluation of

policies and procedures. The combatant

command surgeon (a JFS) will determine the

amount and nature of HSS information essential

to the geographic combatant commander and

forward appropriate reporting guidelines to any

subordinate JFSs or component command

surgeons. These subordinate surgeons will

consolidate their command or component

reports and forward them to the unified

command surgeon.

Medical information in itself is not

classified. However, medical information

can become an operations security

(OPSEC) indicator in the context of a

particular military operation. OPSEC

measures to reduce or eliminate these

indicators may entail restrictions on medical

information dissemination and are detailed

in OPLANs or OPORDs. OPSEC measures

may require encryption of medical

information for transmission. However,

hospital ships may not possess or use a

classified code for their radios or other means

of communications without risking loss of

their Geneva Conventions protections.

Patient information is sensitive and prudent

measures must always be taken to protect
III-11

Health Service Support Planning

patient confidentiality pursuant to the Privacy

Act of 1974 and consistent with international

law. This is one area in which the JFS and

his or her staff should seek legal advice to

ensure that a hospital ship or other medical

unit retains its protected status under the

Geneva Conventions while still complying

with US law.

4. Health Service Support in

Special Operations

a. General. Special operations forces

(SOF) are specially organized, trained, and

equipped forces of the Army, Navy, and Air

Force that conduct unconventional

warfare, direct action, special

reconnaissance, foreign internal defense,

combatting terrorism, psychological

operations, CA, counterproliferation of

WMD, and information operations. SOF

missions are often highly classified and

conducted in remote and/or denied settings.

The nature of SOF missions requires small,

highly skilled, self-contained teams that can

be easily inserted and extracted by air, sea,

and land. HSS of special operations units

is characterized by an austere structure

and a limited number of medical personnel

with enhanced medical skills, to include

emergency treatment, advanced trauma

management (ATM), preventive medicine

and limited veterinary and dental care.

The primary focus of SOF HSS is to provide

Level I and II essential care and sustain

casualties until force extraction from the

operational area. Consequently, joint medical

planners must develop a flexible medical

structure linking the required conventional

health care pillars as far forward as the joint

special operations task force, forward

operations bases, and intermediate staging

bases. Critical support requirements include

forward surgical support, blood and blood

products, and linkage to strategic air

movement.

b. Organic HSS Capability

• Medical planning. The United States

Commander in Chief, Special Operations

Command, provides SOF to the

supported commanders. To provide the

necessary unity of command, each

geographic combatant commander has

established a subordinate unified

command to serve as the functional

special operations command (SOC). The

SOC component commander coordinates

conventional HSS packages to augment

SOF organic medical capability.

• SOF HSS. SOF enlisted medical

personnel receive enhanced medical

training that allows independent duty

capabilities which exceed those of their

conventional counterparts.

• Operational detachments

•• Army special operations forces

(ARSOF) HSS assets assigned to special

forces teams and Ranger companies are

capable of providing Level I care.

ARSOF support units have surgeons,

flight surgeons, PAs, emergency medical

technicians (EMTs), and medics to

provide Level I capabilities. CA units

have no organic HSS. CA battalions have

medical personnel assigned, but are

organized to provide advice and expertise

to the supported missions and not HSS

to the force. Medically trained personnel

of CA battalions provide assistance in

identifying and assessing foreign public

and private health systems, to include

health and sanitation systems, agencies,

personnel, and facilities. CA specialists

work with nongovernmental and

international health organizations to

rehabilitate or develop functional health

and sanitation systems within the AOR.

The other organic HSS capabilities of
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Chapter III

JP 4-02

preventive medicine, laboratory,

veterinary, and dental support are

located in the special forces groups

(SFGs). A health service logistic

capability exists in SFGs, Ranger

battalions, and SOF support units.

Because ARSOF possess no organic

medical movement capability, SOF units

often depend on casualty evacuation

(CASEVAC). CASEVAC is the

transport of casualties by nonmedical

units, utilizing nonmedical assets

without en route medical care.

Utilization of vehicles of opportunity for

transport of casualties may be necessary.

•• Naval special operations forces’

(NAVSOFs’) organic capabilities include

Level I HSS for the unit. Health care

and medical movement beyond Level I

are supported by various Navy

conventional units, such as the floating

platform from which the team is staged,

or Army and Air Force conventional

units providing medical support on an

area basis. Additionally, conventional

Navy and Marine Corps units with

organic Level II capability can provide

HSS to the NAVSOF units. AE is not

available and must be provided by

supporting units. NAVSOF units have

no preventive medicine, laboratory,

veterinary, or dental support. NAVSOF

units deploy with basic loads of medical

supplies and can be resupplied.

•• Air Force special operations forces

(AFSOF) HSS capabilities are aligned

with AFSOF operational units and

consist of SOF medical elements (flight

surgeons, PAs, and independent duty

trained EMTs-paramedics) trained to

perform CASEVAC, to include medical

stabilization and emergency intervention

in-flight utilizing aircraft of opportunity.

In addition, AFSOF forces include

pararescue specialists. Although they

may be EMTs, paramedics are trained

for pre-hospital trauma life support (and

in some cases, advanced trauma life

support), pararescue specialists on

special tactics teams are not medical

assets under Geneva Conventions and

are not counted against medical billets.

AFSOF have Level I and limited Level

II capability, to include emergency

medicine, ATM, CASEVAC for SOF

units, preventive medicine, medical

intelligence, field laboratory, limited

biological warfare and chemical warfare

agent treatment, and short-term patient

holding and staging capabilities.

Mission requirements may dictate

deploying a stand-alone personnel

package and/or utilizing medical rapid

response deployment kits or in

conjunction with a SOF air transportable

treatment unit.

c. SOF Health Service Support Planning

• The goal of special operations HSS

planning is twofold: first, provide

integrated, augmented conventional

support into the concept of the special

operations mission without compromising

the objectives; second, articulate the

unique challenges of the operation that

will complicate the delivery of HSS by

conventional units. The SOF HSS must

ensure that the conventional HSS planner

understands these aspects. The

conventional HSS planner must translate

SOF-unique requirements into the

conventional HSS infrastructure best

suited to support the mission.

• Unique challenges of HSS to SOF must

be incorporated into HSS planning at the

theater JFS staff level, with full

knowledge and concurrence of SOC

planning staff. (SOC components are

authorized HSS planners and command

surgeons during full mobilization.) HSS
III-13

Health Service Support Planning

must be planned and coordinated with

subordinate joint force elements by the

theater JFS staff.

• The JFS and theater SOC and/or SOF

component HSS planners develop

comprehensive operational area-specific

plans to support the special operations

mission planning and execution cycle.

Essential aspects of these plans link SOF

with conventional HSS. Additionally,

strategic and operational circumstances

may require arrangement for HN

hospital support for special operations

missions terminating in friendly

territories within a theater.

• Typically, casualties will be evacuated

by pre-planned team extraction on SOF

platforms.

• Consider a modified movement

(extended) policy for SOF to allow

longer recovery periods and to permit

efficient RTDs.

• Segregate SOF casualties from the

conventional patient population to

facilitate debriefing.

• SOF entry to the conventional HSS

system normally will occur at the first

MTF of admission.

Refer to JP 3-05.1, Joint Tactics,

Techniques, and Procedures for Joint

Special Operations Task Forces

Operations, for detailed SOF-unique

HSS planning considerations.

5. Health Service Support in US

Coast Guard Operations

a. General. The US Coast Guard (USCG)

frequently supports DOD operations, both in

CONUS and OCONUS. USCG support may

consist of cutters with helicopters, land-based

port security units, and coastal patrols with

small boats. These individual units may be

assigned to different Service components or

commands, and often they must rely on

resources, including HSS from other units.

The resources should be provided by the

nearest Service component.

b. USCG HSS Capability

• USCG HSS is limited to partial Level I

capability. Small boats on coastal patrols

will have an EMT only. Each cutter will

have one independent duty corpsman,

and each port security unit will have a

PA.

• Helicopters deployed aboard cutters are

designed as surveillance platforms and

lack medical equipment of any kind.

They may be used in CASEVAC

situations.

6. Health Service Support

Planning Factors for Joint

Operations

In addition to coordinating joint force

HSS requirements, HSS planning for joint

operations involves other major

considerations, including coordinating HSS

requirements with other combatant

commands, allied, and other friendly forces.

The tool approved for calculating medical

requirements is the medical analysis tool

(MAT). MAT is an automated application

program that takes Service-specific casualty

rates, admission rates, and population at risk

(PAR) from time-phased force and

deployment data (TPFDD), deliberate

planning, theater patient movement policy,

and merges those figures to generate joint

medical requirements. The planners then

perform a risk assessment and COA analysis

to assess the most effective use of medical

forces. MAT produces credible medical

requirements for beds, patients to be
III-14

Chapter III

JP 4-02

evacuated, Class VIII (both medical

resupply and blood), losses to be

replaced, and numbers of hospital

admissions. In addition, it provides

medical requirements for PAR reports,

planning factors used, and bed

capabilities (as compared to bed

requirements) report. The MAT can

input a PAR report from the TPFDD, and

merge Service scenarios to create a joint

scenario. Services are responsible for

generating and maintaining casualty rates

for contingency operations. JFSs should

obtain Service-specific casualty rates

through the combatant command.

a. Theater Patient Movement Policy

• The theater patient movement policy is

set by the Secretary of Defense (SecDef)

in coordination with the geographic

combatant commander prior to OPLAN

execution. Upon execution, the

geographic combatant commander

adjusts the theater patient movement

policy as needed.

• The theater patient movement policy is

executed by the CINC. The theater patient

movement policy delineates the maximum

number of days that patients may be held

within the command for treatment prior to

further movement or RTD. Patients who

cannot be RTD within the specified number

of days are evacuated to the next higher

level of care for further treatment. Shorter

movement policies within the theater

reduce theater bed requirements and

increase the number of beds required

elsewhere. Shorter movement policies also

increase movement requirements. The

theater patient movement policy is flexible

and can change as the tactical situation

dictates.

• In accordance with SecDef policy and

CJCS guidance, the patient movement

policy is normally 7 days for the combat

zone and a combined total of 15 days

for the combat zone and

communications zone. This does not

imply that a patient must be held in

theater for the entire period. Patients

not expected to RTD within the number

of days expressed in the theater patient

movement policy will normally be

evacuated:

•• As soon as their medical condition

permits or when local stabilization

capabilities have been reached; or

•• When medical authorities have

determined that travel will not aggravate

their medical condition (at a minimum,

patients will have their airway secured,

bleeding stopped, shock treated, and

fractures stabilized); and

•• When suitable receiving MTFs and

transportation have been arranged.

b. Estimate for Theater HSS

Requirements. The estimate for theater HSS

requirements is based on empirical data

accumulated for each Service for the major

categories of patients wounded-in-action and

DNBI. Planning factors, such as the theater

patient movement policy, bed availability,

casualty rates, admission rates, and the patient

movement delay policy are analyzed to

calculate HSS theater requirements.

Empirical data includes:

• PAR;

• Patient movement delay;

• Average length of stay;

• Percent evacuated; and

• Dispersion factors. Dispersion factors are

contained in the Joint Strategic
III-15

Health Service Support Planning

Capabilities Plan, Health Service

Planning Guidelines. These guidelines

should be used as defaults for all CJCSdirected planning factors.

c. Planning Factor for Class VIII(b)

Blood Products. The planning factor for

blood products in a theater is 4.0 units of liquid

red blood cells per initial admission. This

factor accounts for all blood use through all

levels of care. An appropriate breakout is 1.0

unit per wounded in action and/or nonbattle

injury at Level I, 2.0 units at Level II and 1.0

unit at Levels III and IV. The receipt,

storage, and distribution of blood products

require special consideration and

procedures to ensure a coordinated effort and

maximum use of communications, storage

facilities, and transportation. The Air Force

component will staff and operate blood

transshipment centers (BTCs). The centers

are located at major airfields, and blood

products are managed by the JBPO or area

JBPO. One or more BTCs are located in each

joint force AOR and/or JOA.

See JP 4-02.1, Joint Tactics, Techniques, and

Procedures for Health Service Logistics

Support in Joint Operations, for detailed

information on Class VIII supplies and blood

support operations.
III-16

Chapter III

JP 4-02

Intentionally Blank
APPENDIX A

HEALTH THREAT

A-1

1. General

A health threat is the composite of all

ongoing or potential enemy actions and

environmental conditions that could reduce

the effectiveness of friendly forces. These

actions and conditions include wounds,

injuries, or diseases. Information to assess

the medical threat caused by enemy actions

should be obtained from the Intelligence

Directorate (J-2) and Operations Directorate

communities.

2. Elements of the Health

Threat

a. Infectious diseases which occur naturally

are also referred to as endemic diseases.

Historically, infectious diseases have been

responsible for four times more casualties

than battle injuries. Many naturally

occurring infectious diseases have short

incubation periods. They may cause

significant numbers of casualties within the

first 48 hours of a deployment or contact.

Other infectious diseases with longer

incubation periods may not create casualties

for several weeks. Some examples of

militarily significant, naturally occurring

infectious disease threats are as follows.

• Acute upper respiratory diseases

• Acute diarrheal diseases

• Viral hepatitis

• Japanese encephalitis

• Scrub typhus

• Malaria

• Sexually transmitted diseases

• Leishmaniasis

• Leptospirosis

• Arbovirus infections (dengue, sandfly

fever)

• Hemorrhagic fever with renal syndrome

• Schistosomiasis

b. Extreme environmental conditions in

the form of heat, cold, high humidity, and high

altitude can pose significant health hazards

to an unacclimated, unprepared, and poorly

conditioned military force. Employment of

US forces in areas where these conditions

exist without adequate opportunity for

acclimatization may significantly decrease

combat performance.

c. Conventional warfare munitions

include small arms, high velocity weapons,

rockets, bombs, artillery, bayonets, and other

wounding devices, either individual or crewserved. This threat may be encountered in

all geographic areas and can be employed

by adversaries across the range of military

operations. Research and development in

smart munitions and extended range artillery,

coupled with more powerful high explosives,

will increase the threat from these types of

weapons. Area denial munitions are likely to

be present and pose a major psychological and

physical threat. Wounds from booby traps,

mines, and nontraditional weapons can also

be encountered.

d. Biological warfare is the employment

of biological agents to produce casualties

in humans or animals or cause damage to

plants or materiel. The intentional use of

these disease-causing organisms (pathogens),

toxins, or other agents of biological origin is
A-2

Appendix A

JP 4-02

designed to weaken resistance to attack and

reduce the will and/or the ability to wage war.

• Historically, biological warfare has

primarily involved the use of pathogens

to sabotage food and water supplies and

spread disease among populations.

These pathogens may fall into one of the

following categories:

•• Naturally occurring, unmodified

infectious agents;

•• Toxins, venoms, and their biologically

active fractions;

•• Modified infectious agents; and

•• Bioregulators and physiologically

active compounds.

• Biotechnology is a tool for the

production of biological warfare

agents. Naturally occurring infectious

organisms can be made more virulent and

drug resistant and could possibly be

manipulated to render protective vaccines

ineffective. Such developments could

greatly complicate the ability to detect

and identify biological warfare agents

and the ability to operate in areas

contaminated by these agents or while

under biological attack. The causative

agents for anthrax, tularemia, plague, and

cholera, as well as botulinum toxin,

staphylococcus, enterotoxin, and

mycotoxin, are believed to have been

adopted as biological warfare agents by

potential US adversaries. The reports of

the use by the former Soviet Union of

toxins in Southeast Asia have heightened

the concerns of possible future use of

biological agents.

e. Chemical warfare is the employment

of chemical agents to produce casualties in

humans or animals, or to secure terrain.

As a result of confirmed chemical warfare

agent use by Iraq against Iranian forces and

probable use by the former Soviet Union in

Afghanistan, there is continuing heightened

interest in the use of chemical munitions and

delivery methods. Nerve and blister agents

appear to be the agents most available in

developing countries. Agents which could

be employed by numerous conventional

weapons systems include:

• Nerve agents — O-Ethyl SDiisopropylaminomethyl

Methylphosphonothiolate (VX), thickened

VX, sarin, and thickened soman;

• Vesicants (thickened lewisite and a

mustard and lewisite mixture);

• Choking agents (phosgene); and

• Cyanogens— (hydrogen cyanide and

cyanogen chloride).

Toxic industrial chemical and material

contamination poses a significant

environmental threat to joint and multinational

forces, not because of the weaponization of

chemical munitions but as a result of the

collateral effects accompanying conventional

destruction. This is particularly true in densely

populated, built-up industrialized regions.

f. Directed-energy weapons focus

radiation on a target to induce electronic,

thermal, or structural and human

(particularly eye) damage and can cause

mission failure. The radiation is composed

of three types: radio frequency, laser, and

charged particle beam. There have been

numerous reports of personnel sustaining eye

damage while using optic devices and being

exposed to a bright flashing light emanating

from warships or other sources. These reports

suggest an increasing threat from lasers to both

air and ground forces.

g. Blast effect weapons, such as fuel air

explosives, represent an emerging medical
A-3

Health Threat

threat. Gas-filled body organs, such as ears,

lungs, and digestive tract, are the most

susceptible to primary blast injury. This

emerging threat may result in lower lethality

but a greater number of wounded and a

significantly increased medical workload.

h. Strategic deployability of US forces is

a major element of US political and military

strategy. Forces may be required to operate

without rest for extended periods of time

during mobilization, staging, airborne

transportation, and combat insertion into

hostile areas. Modern combat, with its

increased lethality, rapid maneuvers,

technological skill requirements, exposure to

NBC weapons, and day or night all-weather

operations, will stress personnel to their

endurance limits. Under these conditions,

the significance of stress as a major

contributor of casualties cannot be

overstated.

i. Flame and incendiary systems include

napalm and white phosphorus for aerial

delivered bombs. Possible uses of flame and

incendiary weapons include the clearing of

difficult defensive positions such as caves,

bunkers, buildings, and soft shelter or

vehicular targets. Flame has also been used

quite effectively in previous conflicts in an

antitank role.

j. The primary nuclear warfare threat

was the Soviet Union. However, open-source

information suggests that other countries have

developed a nuclear weapons capability.

Planners expect a minimum of 10 to 20

percent casualties within a division-size force

that has experienced a nuclear strike. This

percentage may be a low estimate, since

proximity to ground zero is the critical

factor in determining weapon effects on the

force. In addition to casualties, a nuclear

weapon detonation can generate an

electromagnetic pulse that will result in

catastrophic failure of some electronic

equipment components (including patient

support equipment).

k. Enemy uses of radioactive material or

radiological dispersal devices (RDDs) in

operational areas pose a new threat to

deployed US forces. These devices or

radioactive material can create areas of

radioactivity without causing the blast or

thermal effects of nuclear weapons. US forces

can be exposed to potentially hazardous levels

of radiation in an otherwise conventional

operational environment. Terrorists,

assassins, individuals sympathetic to a specific

country’s views, or opposing forces can

disperse radioactive material or employ

RDDs. Planners must consider the possibility

of radioactive material and/or RDDs being

used against US forces in future operations.

The casualty load generated by this potential

hazard can overwhelm an MTF, especially in

immature theaters and military operations

other than war (MOOTW) environments.

l. Disease Surveillance and Reporting.

Joint Staff directives require all deployed

military organizations to have a medical unit

to conduct disease and nonbattle injury

surveillance; track incidence and trends of

diseases, injury, and health conditions of

military operational significance; and provide

real-time risk reduction recommendations to

commanders.

3. The Threat to HSS

Personnel and Operations

a. Commanders can anticipate

increased casualty densities among HSS

personnel over those experienced in most

previous conflicts. Health threat elements

with the greatest potential for force

degradation during combat operations are as

follows.

• Battle injuries because of artillery, small

arms, and fragmentation weapons.
A-4

Appendix A

JP 4-02

• Casualties caused by combat stress.

• The collective effects of NBC, RDDs,

and conventional weapons.

• Premeditated attack upon HSS units,

personnel, or Class VIII supplies.

• The continually increasing range of

indirect fire weapons.

• The enhanced wounding capability

and destructiveness of munitions and

weapon systems.

• Significant increases in casualty densities

that cause local or general overloads of

the HSS system, resulting in physical

and psychological stress.

• Infectious diseases, temperature

extremes, and toxic industrial chemicals

and/or materials.

b. Enemy combat operations in friendly

rear areas may interdict lines of

communications and disrupt necessary

health service logistic activities. This

disruption will produce a serious negative

effect on the ability of personnel to retrieve

and evacuate wounded, injured, and sick

personnel and deliver health care. Although

enemy combat operations may threaten the

HSS combat mission by disrupting HSS

operations or threatening the survival of HSS

personnel, they are not considered for the

purposes of this publication to be medical

threats.

c. Prolonged periods of intense,

continuous operations will tax HSS

personnel to the limit of their psychological

and emotional endurance. This stress and

fatigue will cause both quantitative and

qualitative degradation in the ability of the

HSS system to deliver health care at a

sustained level. The proper training of

dental personnel in procedures such as

taking vital signs and performing minor

surgery may allow for augmentation of the

medical staff, and provide some temporary

relief.

d. HSS units are not expected to be the

primary target for NBC attacks; however,

logistic base complexes may be prime

candidates for such enemy operations. As

elements of logistic complexes, HSS

organizations must anticipate collateral

contamination from attacks on adjacent

facilities. Forward HSS assets have an even

higher probability of being required to operate

in or near areas contaminated by NBC

weapons. Decontamination of casualties is

normally the responsibility of the Service unit

by nonmedical personnel; however, medical

personnel should be prepared to conduct

decontamination operations for those early

casualties arriving at the MTF who have not

been previously decontaminated. This

ensures that medical units can provide

treatment of casualties. Patient decontamination

sites may be located in the general proximity

of MTFs to ensure that medical supervision

of patient decontamination is available.
APPENDIX B

MEDICAL INTELLIGENCE

B-1

1. General

a. The Defense Intelligence Agency

(DIA) develops and disseminates medical

intelligence. The two major intelligence

categories of primary use to the HSS planner

are general medical intelligence (DOD

Directive 6420.1R, Armed Forces Medical

Intelligence Center) and medical intelligence.

Armed Forces Medical Intelligence Center

(AFMIC), Fort Detrick, Maryland, is the sole

producer of medical intelligence for DIA.

AFMIC currently produces and disseminates

finished intelligence products via studies,

message traffic, compact disk-read only

memory (CD-ROM), and on-line electronic

systems.

b. DOD military medical personnel

frequently use the term medical intelligence

incorrectly to mean any medical information

of military importance; however, the term

“medical intelligence” officially refers to

intelligence on medical and related matters.

By this definition, medical intelligence

includes only finished intelligence products

produced by an authorized intelligence agency

such as AFMIC through the intelligence cycle.

Medical intelligence is intended to provide

HSS operations and planning staffs with

basic guidance for understanding, acquiring,

using, and applying intelligence and

intelligence systems in the conduct of HSS

operations, medical threat analysis and

management, threat-based concept

development, medical research, and doctrine

development. Other sources of medical

information may be used in assessing

potential threats (e.g., US Army and Air

Force preventive medicine units and Naval

environmental and preventive medicine units,

Defense Pest Management Information

Analysis Center, and the World Health

Organization).

2. Medical Estimate of the

Situation

a. The medical estimate’s purpose is to

provide an analysis of HSS information

pertaining to enemy intentions, allied or

coalition partner’s capabilities, limitations,

COAs, and potential HSS consequences

associated with a contemplated operation.

The HSS estimate may be written or oral.

b. The HSS estimate will include all HSS

facts, assumptions, and deductions that can

affect the operation. The JFS must be

familiar with the concept of operations and

obtain medical intelligence concerning the

theater from indigenous sources, the

supporting intelligence activity, AFMIC, and

national intelligence agencies. The JFS must

conduct a thorough evaluation of the enemy

situation, the friendly situation, and the

theater from the standpoint of effects on the

health of the joint force and HSS operations.

c. Prior to deployment, the JFC should

ensure that a predeployment vulnerability

assessment has been conducted. These

assessments will normally include a medical

member qualified to evaluate the safety and

vulnerability of local food and water sources,

perform an epidemiological risk assessment,

evaluate local medical capabilities, perform a

vector-pest risk assessment, determine the

adequacy of hygiene in local billeting and

public facilities, industrial contaminants (past

and present), and perform an environmental

risk assessment coordinated with the engineer

baseline environmental survey.

d. The medical estimate is an analysis

of the health threat and HSS capabilities

to determine vulnerabilities and estimated

requirements of the joint force.
B-2

Appendix B

JP 4-02

• Patient estimates are calculated to

determine requirement, distribution of

medical assets, PAR, possible

MASCALs, and patient movement. The

JFS consults Service wartime planning

references to assist in determining

requirements for the operation. Hospital

estimates and other support requirements

are derived from these data.

• Having determined the HSS

requirements, the JFS considers the

resources that are readily available to

meet the requirements. Maximum use

of available personnel, supplies and

equipment, and joint use of facilities

promote effectiveness of the command’s 

HSS. Considering support requirements

and resources available, the JFS

determines the proposed COA that

can be supported.

• The JFS identifies shortfalls that may

impact on the JTF COA development and

selection.

e. Based upon the medical estimate of the

situation, the JFS, in coordination with the

joint force component command surgeons,

must plan for HSS policies and procedures

that can be best adapted to the joint

operation. In many instances, existing

standing operating procedures can be used

with little or no modification. In other

instances, entirely new procedures may have

to be developed and implemented. Standards

must be established to deal with the type and

timing of physical, dental, and mental

examinations and inspections necessary to

ensure that personnel in the theater or those

arriving are fit for duty. Physical standards

are normally Service-specified; however, the

geographic combatant commander may direct

additional or special requirements based on

operational, geographic, or climatic

conditions.

3. Significance of Medical

Intelligence

a. Accurate and timely intelligence is a

critical combat support tool for planning,

executing, and sustaining military operations.

It is equally important in achieving

optimum planning, execution, and

sustainment of HSS operations, the medical

readiness of the command, and the overall

combat readiness of the unit.

b. At the strategic level, the objective is

to contribute to the formulation of national

and military strategies. At the operational

level, intelligence focuses on the joint

campaign and operations. At the tactical

level, intelligence is oriented toward the

specific operational area and a given operation

in greater detail. Intelligence, properly used

and applied, can become a powerful force

multiplier by providing the critical essential

elements of information required to assist HSS

staffs.

4. Sources of Medical

Intelligence

AFMIC Products. Most AFMIC

products commonly used by HSS planners

fall into the category of recurring, finished

intelligence. These products include (but are

not limited to) the following.

a. Infectious disease risk assessments

(IDRAs), which assess the risk from

infectious diseases of operational military

significance on a country-by-country basis

worldwide. IDRAs are available on

INTELINK and INTELINK S. (For access

to INTELINK and INTELINK S

programs, contact your intelligence officer.)

b. Environmental health risk

assessments (EHRAs), which assess

environmental health risks of military
B-3

Medical Intelligence

significance on a country-by-country basis

worldwide. EHRAs are available on

INTELINK.

c. Medical, environmental, disease

intelligence, and countermeasures CDROMs provide worldwide infectious disease

and environmental health risks hyperlinked

to the joint Service-approved countermeasure

recommendations, military and civilian health

care delivery capabilities, operational

information, disease vector ecology

information, and reference data.

d. Health service assessments are

designed to provide consumers the bottomline assessment of the health service

capabilities of a country, with limited

descriptive data and examples relating only

to critical elements of the civilian and military

health care systems. The studies are produced

on countries with a validated production

requirement by an intelligence consumer, or

with a high potential for US force deployment.

e. The AFMIC’s quick reaction support

responds to time-sensitive, quick reaction

intelligence production and support

requests for operational contingencies. Quick

reaction tasking is normally accepted by

AFMIC if the requirements of the task can be

completed in a maximum of 40 personnel

hours of analytical work. Requests are

accepted telephonically (open and secure

communications) and by direct

correspondence or message format.

Whenever possible, formal methods of

communications are encouraged. The JFS

should request medical intelligence via their

J-2.

f. AFMIC Wire, which is a current

intelligence document, presenting analysis of

newly reported information of potential

interest to consumers. In addition to the

scheduled wire, special wires are produced

periodically, generally on topics of immediate

interest to deployed or deploying forces.

g. Disease Occurrence World Wide, which

provides time-sensitive updates to the IDRAs.

It is published weekly as an unclassified

message, with a classified supplement, if

necessary.

h. Communications with AFMIC. The

request for information is a way of asking

AFMIC for answers to questions that are not

found in published studies. Generally, a

request for information is a project requiring

40 or fewer hours for AFMIC to complete.

Request for information should be directed

through command J-2 to AFMIC.

• Mailing address:

Director, Armed Forces Medical

Intelligence Center (Operations)

1607 Porter St

Fort Detrick, MD 21702-5004

• Message: DIRAFMIC FT DETRICK

MD//OPS//
B-4

Appendix B

JP 4-02

Intentionally Blank
APPENDIX C

FORMAT FOR ANNEX Q TO AN OPERATION PLAN

C-1

____________

 (Classification)

Headquarters

Location

Date, time, and zone

ANNEX Q TO ______________ OPLAN ________ ( )

HEALTH SERVICE SUPPORT( )

( ) REFERENCES:

a. Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in

Armed Forces in the Field, 12 August 1949.

b. Geneva Convention for the Amelioration of the Condition of the Wounded, Sick, and

Shipwrecked Members of Armed Forces at Sea, 12 August 1949.

c. Geneva Convention Relative to the Treatment of Prisoners of War, 12 August 1949.

d. Geneva Convention Relative to the Protection of Civilian Persons in Time of War, 12

August 1949.

e. JP 3-11, Joint Doctrine for Operations in Nuclear, Biological, and Chemical (NBC)

Environments.

f. JP 4-01, Joint Doctrine for the Defense Transportation System.

g. JP 4-02, Doctrine for Health Service Support in Joint Operations.

h. JP 4-02.1, Joint Tactics, Techniques, and Procedures for Health Service Logistics Support

in Joint Operations.

i. JP 4-02.2, Joint Tactics, Techniques, and Procedures for Patient Movement in Joint

Operations.

j. JP 4-04, Joint Doctrine for Civil Engineering Support.

k. JP 4-05, Joint Doctrine for Mobilization Planning.

l. Center of Military History Publication 83-3, Emergency War Surgery: 2d US Revision of

the Emergency War Surgery North Atlantic Treaty Organization (NATO) Handbook, 1988.
C-2

Appendix C

JP 4-02

1. ( ) Situation

a. ( ) General.

• ( ) Purpose. To provide a concept of operations, assign tasks, and provide guidance to

ensure an effective HSS system to support the operations envisaged in the OPLAN.

• ( ) Applicability. Refer to TASK ORGANIZATION, OPLAN. List other commands to

which this appendix applies.

b. ( ) Enemy Forces. Annex B (Intelligence).

c. ( ) Friendly Forces. Summarize capabilities (including weapon systems that may influence

the HSS system mission).

d. ( ) Assumptions. List key assumptions affecting HSS planning.

e. ( ) Limitations. List key limiting factors affecting HSS capability.

2. ( ) Mission. State a clear, concise statement of the overall mission of the HSS

system

3. ( ) Execution

a. ( ) Concept of Operations. Describe the overall concept of HSS to meet mission

requirements.

• ( ) Transition. State the concept of transition from peacetime HSS posture to wartime.

• ( ) Responsibility and command relationships. State component command’s responsibility.

Indicate responsibility and scope of HSS of US forces under operational control of other

than US commanders and allied forces to provide HSS for each other’s combatants.

• ( ) Hospitalization. Describe the concept of operations for hospitalization. Include a

brief assessment of initial in-theater HSS treatment capabilities.

• ( ) Patient movement (to include validating, regulating, and movement). Describe the

overall concept of patient movement (land, sea, and air).

• ( ) Host-nation support. Address HN HSS-availability and assess the status of these

activities.

• ( ) Adjunct HSS. If applicable, address the following: EPWs, civilian internees, detainees,

formerly captured US military personnel, evasion and recovery operations, noncombatant

evacuation operations, and civil affairs. Outline the concept to provide HSS and treatment

as well as personnel and material support.
C-3

Format for Annex Q to an Operation Plan

• ( ) Joint blood program. Outline the concept for blood components support and resupply.

• ( ) Preventive medicine, medical surveillance, and combat stress control. Describe the

concept for support.

• ( ) Theater patient movement policy. State the objective theater patient movement policy

(to establish requirements) and the supportable policy.

• ( ) Medical regulating. Outline the concept for medical regulating to, within, and from

the theater.

• ( ) Dental services. Include the scope and responsibility for dental services in each

operational area.

• ( ) Veterinary services. As dictated by the mission.

• ( ) Other areas. As dictated by the mission.

b. ( ) Tasks. Identify joint responsibilities of subunified, joint task force, and component

commanders for HSS.

c. ( ) Coordinating Instructions. Outline the required key intracommand coordination (for

example, personnel, Joint Transportation Board, and engineering support).

4. ( ) Administration and Logistics

a. ( ) HSS Materiel. Describe the general concept for supply and resupply support, including

single manager (if applicable), regionalization, and procedures for cross-leveling and

redistributing HSS materiel and policies for local acquisition.

b. ( ) Reports. State what and how to format all HSS reports.

5. ( ) Command and Control

a. ( ) Command. Ensure HSS C2 is fully consistent with the overall command structure.

b. ( ) HSS Communications. Briefly describe how to transmit HSS information within and

from the theater. Identify any dedicated secure or unsecure communication requirements and

capability.

t/

General

Commander in Chief
C-4

Appendix C

JP 4-02

Appendices:

1 — Patient Movement Requirement System

2 — Joint Blood Program

3 — Hospitalization

4 — Return to Duty

5 — Health Service Logistics (Class VIII A) System

6 — Preventive Medicine

7 — HSS Command, Control, Communications, and Computers

8 — Host-Nation Support

9 — HSS Sustainability Assessment

10 — HSS Intelligence Support to Military Operations

11 — Veterinary Service

12 — HSS Planning Responsibilities and Task Identification

13 — Medical Laboratory Services

(Classification)

Headquarters

Location

Date, time, and zone
APPENDIX D

MULTINATIONAL OPERATIONS

D-1

1. Health Service Support in

Multinational Operations

General. General logistic support doctrine

applies equally to HSS. Multinational support

operations are complicated by a number of

characteristics that impact fundamentally

upon the provision of HSS.

a. Unique nature of every individual

operation.

b. Geographic, topographic, and climatic

variations of the operational area.

c. Numbers of individual nations involved

in each operation.

d. Variations in national standards of HSS

and equipment.

e. Language and communications

differences.

f. Political complexity and dynamic nature

of each operational scenario.

g. Mission of medical support forces.

h. Differences in individual national

objectives and/or restrictions for participation

in operations and integration of overall

mission goals.

i. Medical staffs face unique problems

affecting the health of multinational personnel

deployed on operations. Therefore,

operational HSS requires clearly defined and

distinctive guidance. JFCs and staff should

determine which guidance and/or standards

to follow in multinational operations.

j. HSS plans must be tailored to each

operation and meet the demands of geography,

individual national needs, language, and

communication difficulties. Plans must be

capable of rapid implementation, but at the

same time be flexible enough to manage

rapidly changing operational demands.

k. Every deployed multinational force must

have a surgeon and/or chief medical officer

(CMO) who has direct access to the

multinational force commander (MNFC).

l. Each deployed national contingent that

has HSS personnel must have a single

designated individual who has the clinical

responsibility for all national HSS matters.

Under North Atlantic Treaty Organization

terminology, this person is known as the

national Senior Medical Officer.

2. Multinational Operations

Principles

Contributing nations retain ultimate

accountability for the health of their forces,

but, the MNFC will normally share the

responsibility for or have an interest in the

health of assigned forces. To meet this

requirement, the MNFC needs appropriate

HSS staff available at the early stages of

planning HSS for an operation.

a. International Conventions for the

Treatment of the Sick and Wounded. HSS

for operations will comply with provisions of

the Geneva Conventions. Persons entitled

under the terms of the Conventions shall,

without discrimination, receive medical

treatment on the basis of their clinical needs

and the availability of HSS resources.
D-2

Appendix D

JP 4-02

b. Standards of HSS. Operational HSS

to multinational forces must meet standards

that are acceptable to all participating nations.

Care provided to US forces participating in a

multinational operation must meet US

standards.

c. Estimation of Medical Risk.

Estimation of medical risk and the associated

casualty rates is the responsibility of the

individual nation with HSS advice of the

multinational operational staffs.

d. Multinational Levels of HSS. In

multinational operations, there are four levels

of HSS that should be available to all

multinational forces. They are organized on

a progressive basis. Levels of HSS will be

provided appropriately to a particular

operation. Policy for national contributions

will generally be as follows.

• Level I — National responsibility.

• Level II — National and/or Lead Nation.

For the United States, Level II is a

national responsibility.

• Level III — National and/or Lead Nation.

For the United States, Level III is a

national responsibility.

• Level IV — National and/or Force

Provided (Contracted). For the United

States, Level IV is a national

responsibility.

3. Health and Fitness Entry

Standards

To qualify to participate in the

multinational force (and for subsequent

multinational resourced medical treatment,

patient movement, and personal disability

compensation), national contingents and

individuals allocated or contracted to

multinational operations must meet the basic

standards of individual health and physical

fitness laid down by the CMO staff.

4. Statement of Requirement

HSS requirements are to be determined by

the appropriate MNFC in consultation with

contributing nations and the HSS planning

staff. HSS resources will be specified as those

necessary to prevent and control DNBI and

to collect, evacuate, and treat casualties.

5. National Structure

National HSS systems should be retained

as an organic force structure to the

contributing nation’s forces as much as

possible. However, HSS planners must seek

to take advantage of economies of scale which

may be achieved from multinational concepts

such as lead nation responsibilities, role

specialization, and mutual assistance.

6. Provision of Resources

Contributing nations bear ultimate

responsibility for ensuring the provision of

HSS to their forces allocated to multinational

operations. This may be discharged in a

number of ways, including agreements with

other nations or the appropriate multinational

planning staffs and MNFCs.

7. Treatment of Entitled

Personnel

From the outset of an operation, policy must

be established regarding the entitlement of

non-US military and/or nonmilitary staffs and

other authorized personnel in-theater and for

all medical treatment other than emergency

measures.

8. HSS Liaison

HSS planning staffs are to ensure that

methods are established to provide regular and
D-3

Multinational Operations

efficient liaison between national contingents

and theater HSS resources, particularly

monitoring inpatients at Levels III and IV,

and for all intratheater and intertheater

patient movement.

9. HNS Capability

The HNS resources available in the

operational area are the key to determining the

size and capability of the HSS organization that

the multinational force must establish. The more

HNS available for use, the less that has to be

found from contributing nations. Overall, a

mixture of medical intelligence analysis and onthe-ground reconnaissance assesses HNS

capabilities. A key issue will be the standards

of HSS available, compared to the multinational

force and national contingent criteria.

10. Considerations

a. Maximum effort must be made to tailor

HSS mission requirements. HSS planners

must find a balance of capabilities. An

example may be to organize a single nation

to provide a particular function, such as AE,

for all contingents.

b. Establishing the patient movement

policy is a command decision of each nation.

HSS and logistic staffs will advise. The force

theater surgeon (sometimes known as the

multinational CMO) will promulgate

recommendations and will monitor the

established patient movement policy.

c. C4I. Comprehensive and effective C4I

is fundamental to the HSS plan. It begins

prior to deployment, with the establishment

of a competent HSS planning team at the

multinational force headquarters. It is also

crucially dependent upon the following.

• Clearly established lines of accountability

and control agreed to by all participating

contingents.

• Liaison at every level including HNS and

any NGOs and IOs in theater.

d. Preventive Medicine Capability. The

expertise to manage preventive medicine

responsibilities must be made available at all

levels. The requirement will be for preventive

medicine units as well as individual experts.

The provision of this capability lends itself

well to a lead nation approach. The shape and

size of in-theater preventive medicine

capability will be dictated primarily by the

following.

• The size of the multinational force to be

supported, its dispersal, and the theater

topography.

• The capability of national contingents to

implement preventive measures

independently.

• The responsibility to ensure that

personnel are prepared and

appropriately trained in field preventive

medicine measures prior to

deployment to an operation. This must

include the necessary pretreatments,

chemoprophylaxes, barrier creams, and

immunizations.

•• Recommendations for pretreatment,

immunization, and chemoprophylaxis for

the multinational force will be made by

the CMO during the initial planning

stage, but it remains the responsibility of

each nation ultimately to ensure that its

personnel are adequately protected.

•• A multinational force policy must be

issued as early as possible regarding the

prophylaxis measures that must be taken

by all individuals deploying into the

operational area. Instructions must cover

measures to be taken prior to

deployment, while in-theater, and during

post-deployment.
D-4

Appendix D

JP 4-02

• It is a national responsibility to maintain

high standards with regard to the

provision of food and water, as well as

field sanitation standards.

•• JFS and/or CMO will inspect and

audit national measures to ensure that

acceptable standards are maintained in

these areas.

•• Minimum standards acceptable to all

participating nations must be maintained

if the MTFs are to be used to support

personnel outside the respective national

force.

e. The CMO’s force hygiene officer is

responsible for coordinating preventive

medicine services such as regional spraying

or vector control and advising on placing local

population centers and/or facilities off limits.

f. Education on prevention of diseases is a

national responsibility.

11. Patient Movement in

Multinational Operations

The theater patient movement policy,

known in some nations as a holding policy, is

the key to balancing the treatment capability

available at each level of care against the

required medical patient movement assets.

The provision of resources will be coordinated

by the multinational force HSS planning staff,

but will comprise assets from a number of

sources, including HNS. Theater medical

patient movement requires careful planning

and an acquisition cross-Service agreement.

a. Patient movement from point of injury

to Level I — National responsibility.

b. Patient movement from Level I to Level

II/III — National, Force, and Lead Nation.

c. Patient movement to Level IV — Force,

National, and Lead Nation.

12. Personnel in Multinational

Operations

a. National contingents will be

expeditiously notified through designated

national liaison points of contact of individuals

that become critically injured and/or ill or die.

b. Medical obligations under international

law will be particularly crucial to the

management of non-force personnel such as

EPWs, civilian refugees, detainees, and nonforce combatants. HSS plans must detail the

degree of care to be offered to these groups

and how continuity of care is to be provided,

when needed.

c. Only urgent medical treatment, within

the capability of the deployed multinational

medical force and not otherwise available, will

be offered to civilian refugees.

• Detainees and non-force combatants

may receive urgent medical treatment in

force MTFs, but are unlikely to remain

in Level III or be evacuated to forceprovided Level IV MTFs for continuing

treatment. An alternative source of

definitive treatment must be organized

as part of the overall HSS plan.

• National law will concern a range of

issues, particularly regarding the

provision of medical evidence for

inquiries into deaths and severe injury.

13. Health Service Logistics in

Multinational Operations

The holding, issuing, and accounting for

all medical, dental, and veterinary supplies

(equipment, pharmaceutical, and

consumables) to a multinational force is a

major undertaking. It is a joint responsibility

of the CMO and the chief health service

logistics officer, whose offices must cooperate

to create a system with the necessary

reliability, flexibility, and speed. The supply
D-5

Multinational Operations

of blood and blood products to multinational

operations is a complex and sensitive issue,

stemming from the wide disparity of standards

between nations and the legal constraints

incumbent upon some of them. Consequently

it is considered as a separate function within

health service logistics. The availability of

blood and blood products is essential for

management of the seriously injured and sick.

For the majority of multinational operations,

this will require its provision at Level III and

at Level II if providing resuscitative surgical

care.

a. For multinational operations, the general

principle is that national contingents should

be responsible for the supply of blood to their

own injured and sick. In reality, this is not

always a practical proposition. The

requirement must, therefore, be that all blood

and blood products used in-theater comply

with internationally agreed upon standards.

Where a particular nation cannot accept this

as policy, they must organize their own system

of supply at national expense.

b. The most cost-effective and rational

approach is for the force HSS planning staffs

to coordinate supplies through the lead nation,

using supplies from a nation whose blood and

blood products are acceptable to all

contingents.

Refer to JP 4-02.1, Joint Tactics, Techniques,

and Procedures for Health Service Logistics

Support in Joint Operations.

14. Legal Issues in

Multinational Operations

a. Both international and national law,

particularly concerning the medical

management of refugees, detainees, and nonentitled civilians, must be considered in

multinational operations. JFSs should be

particularly sensitized to the limits imposed

by title 10, USC, which outlines under what

conditions non-DOD beneficiaries can receive

medical treatment from US medical forces.

b. Any pathological materials and/or

tissues taken in the course of conducting an

autopsy or preparing a death certificate must

be turned over to the decedent’s national

representative. Human remains are returned

through designated mortuary affairs

personnel. In addition to the legal issues, there

are many cultural differences with regard to

the disposition of deceased personnel.
D-6

Appendix D

JP 4-02

Intentionally Blank
APPENDIX E

MILITARY OPERATIONS OTHER THAN WAR

E-1

1. HSS in Military Operations

Other Than War

a. The health threat is traditionally

evaluated for its impact on US forces alone.

When preparing for and conducting

operations during MOOTW, elements of the

health threat to the indigenous population,

allied and coalition forces, US Government

employees, DOD contractors and, as

appropriate, IOs and NGOs must also be

assessed. The impact of the health threat

as a contributing factor to social, political,

and economic stability in both peace and

other operational environments must be

considered. The general environment in

which these types of operations are conducted

ranges from peaceful, developing countries

with no apparent internal or external

instabilities to countries with limited resources

and a poorly led population assailed by active

insurgent movements, diseases, and

dependency on foreign humanitarian

assistance (FHA).

b. Within MOOTW, US efforts may

focus on foreign internal defense operations

such as security assistance, FHA, or HN

logistic support. These operations are often

conducted in areas where social services have

been disrupted, resulting in poor sanitation,

inadequate food and water distribution, civil

disturbances, and general civil unrest.

Significant health threats are likely to be

naturally occurring endemic and epidemic

diseases, uncontrolled distribution of

hazardous wastes and hazardous materials,

and environmental extremes.

c. In general, areas where assistance teams

and units may be employed will likely have a

very low standard of living and high incidence

of endemic and epidemic diseases. US forces

serving in these areas will enter with very little,

if any, natural immunity to endemic diseases.

The degree of cultural and social interaction

required to support the mission, as well as the

sharing of food, quarters, and recreational

facilities with local nationals, will increase

exposure of US personnel to diseases endemic

to the host country. For the most part,

assistance operations will last a relatively

extended period of time (past 30 days) and

will increase the risk of contracting the

endemic disease.

d. In MOOTW environments, insurgent

or terrorist forces may not recognize

protection afforded to MTF and HSS

personnel by the Geneva Conventions.

HSS activities may be perceived as prime

targets by these groups, especially if these

facilities are perceived as making a major

contribution to the HN government. MTFs

will also be vulnerable to theft and raids on

Class VIII supplies by insurgents or terrorists

for their own support or to support black

market activities.

e. In some situations, the in-country

components of the US logistic system in

support of US assistance forces will be

austere. Often the HSS structure will require

reliance on contracting from local sources for

food, water, sanitation, public health, and

health industry resources if in compliance with

regulatory and policy guidance. Procurement

of fresh foods and beverages and contracting

of food storage facilities are supported by

veterinary personnel through sanitary

inspection of local food establishments in the

operational area. Coordination with

Commander in Chief, US Transportation

Command for intertheater patient movement

can be greater in MOOTW scenarios than in

war. US Navy and US Marine Corps

transportation assets may be used to support

all aspects of HSS in MOOTW, based on the
E-2

Appendix E

JP 4-02

availability and proximity to coastal waters.

When tarmacs are available, coordination with

US Air Force transportation should be

considered when time is a factor. These

circumstances will demand comprehensive

HSS planning. HSS planning must be based

on current, accurate medical intelligence and

include the total involvement of the Country

Team prior to the execution of operations.

For additional information on MOOTW, refer

to JP 3-07, Joint Doctrine for Military

Operations Other Than War.

f. Legal issues during MOOTW may

concern both international and national

law.

• Medical obligations under international

law will be particularly crucial to the

management of non-force personnel

such as EPWs, civilian refugees,

detainees, and non-force combatants.

HSS plans must detail the degree of care

offered to these groups and how

continuity of care is to be provided, when

needed.

•• Urgent medical treatment, not

otherwise available, will be offered to

civilian refugees and is dependent upon

the operational situation.

•• Detainees and non-force combatants

may receive urgent medical treatment in

force MTFs, but are unlikely to remain

in Level III or be evacuated to force Level

IV MTFs for definitive treatment. An

alternative source of definitive treatment

must be organized as part of the overall

HSS plan.

• National law will concern a range of

issues, particularly regarding the

provision of medical evidence for

inquires into deaths and severe injury.

g. Financial issues for consideration

during MOOTW include:

• The size and shape of HSS resources

available to support the HSS concept of

operations;

• Maintenance costs, particularly the

provision of medical materiel, resupply,

and patient movement; and

• Donated medical supplies, eligibility

determination, credentialing, malpractice

suits, and reimbursement procedures for

HSS and supplies.
APPENDIX F

REFERENCES

F-1

The development of JP 4-02 is based upon the following primary references.

1. Multinational Documents

a. NATO STANAG 2068, Emergency War Surgery (Edition 4) (Amendment 3), 17 October

1991.

b. Geneva Convention for the Amelioration of the Condition of the Wounded and Sick in

Armed Forces in the Field, 12 August 1949.

c. Geneva Convention for the Amelioration of the Condition of the Wounded, Sick, and

Shipwrecked Members of Armed Forces at Sea, 12 August 1949.

d. Geneva Convention Relative to the Treatment of Prisoners of War, 12 August 1949.

e. Geneva Convention Relative to the Protection of Civilian Persons in Time of War, 12

August 1949.

2. DOD Publications

a. DOD Directive 6420.1R, Armed Forces Medical Intelligence Center (AFMIC), 30

September 1996.

b. DOD Directive 6490.2, Joint Medical Surveillance, 30 August 1997.

c. DOD Instruction 6480.4, Armed Services Blood Program (ASBP) Operational

Procedures.

d. DOD Instruction 6490.3, Implementation and Application of Joint Medical Surveillance

for Deployments, 7 August 1997.

e. DOD Publication 5200.2-R, Personnel Security Program, January 1987.

f. DOD Regulation 515.21-M1,

3. Joint Publications

a. JP 0-2, Unified Action Armed Forces (UNAAF).

b. JP 1-0, Doctrine for Personnel Support to Joint Operations.

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

d. JP 3-02, Joint Doctrine for Amphibious Operations.
F-2

Appendix F

JP 4-02

e. JP 3-05.3, Joint Special Operations Operational Procedures.

f. JP 3-07, Joint Doctrine for Military Operations Other Than War.

g. JP 3-17, Joint Tactics, Techniques, and Procedures for Air Mobility Operations.

h. JP 3-33, Joint Force Capabilities.

i. JP 3-35, Joint Deployment and Redeployment Operations.

j. JP 3-50.2, Doctrine for Joint Combat Search and Rescue (CSAR).

k. JP 3-50.21, Joint Tactics, Techniques, and Procedures for Combat Search and Rescue.

l. JP 3-57, Joint Doctrine for Civil-Military Operations.

m. JP 3-57.1, Joint Doctrine for Civil Affairs, (under development).

n. JP 4-01, Joint Doctrine for the Defense Transportation System.

o. JP 4-02.1, Joint Tactics, Techniques, and Procedures for Health Service Logistics Support

in Joint Operations.

p. JP 4-02.2, Joint Tactics, Techniques, and Procedures for Patient Movement in Joint

Operations.

q. JP 4-04, Civil Engineering Support.

r. JP 4-05, Joint Doctrine for Mobilization Planning.

s. JP 5-00.2, Joint Task Force Planning Guidance and Procedures.

t. CJCSI 3110.03, Logistics Supplement to Joint Strategic Capabilities Plan, 1 March

1999.

4. Army Publications

a. FM 8-10-18, Veterinary Services.

b. FM 8-55, Planning for Health Service Support, 9 September 1994.

5. Navy and Marine Corps Publications

NAVMAT P-4000-2 Series.
F-3

References

6. Air Force Publications

a. AFI 41-106, Medical Readiness Planning and Training, 1 March 1999.

b. USAF War and Mobility Plan (WMP 1), Volume 1, Medical Service Annex F, Sept. 97.
F-4

Appendix F

JP 4-02

Intentionally Blank
APPENDIX G

ADMINISTRATIVE INSTRUCTIONS

G-1

1. User Comments

Users in the field are highly encouraged to submit comments on this publication to:

Commander, United States Joint Forces Command, Joint Warfighting Center Code JW100,

116 Lake View Parkway, Suffolk, VA 23435-2697. These comments should address

content (accuracy, usefulness, consistency, and organization), writing, and appearance.

2. Authorship

The lead agent for this publication is the US Army. The Joint Staff doctrine sponsor for

this publication is the Director for Logistics (J-4).

3. Supersession

This publication supersedes JP 4-02, 26 April 1995, Doctrine for Health Service Support

in Joint Operations.

4. Change Recommendations

a. Recommendations for urgent changes to this publication should be submitted:

TO: HQDA WASHINGTON DC//DASG-HCD-D//

INFO: JOINT STAFF WASHINGTON DC//J7-JDETD//

Routine changes should be submitted to the Director for Operational Plans and Joint

Force Development (J-7), JDETD, 7000 Joint Staff Pentagon, Washington, DC

20318-7000, with info copies to the USJFCOM JWFC.

b. When a Joint Staff directorate submits a proposal to the Chairman of the Joint

Chiefs of Staff that would change source document information reflected in this

publication, that directorate will include a proposed change to this publication as an

enclosure to its proposal. The Military Services and other organizations are requested

to notify the Director, J-7, Joint Staff, when changes to source documents reflected in

this publication are initiated.

c. Record of Changes:

CHANGE COPY DATE OF DATE POSTED

NUMBER NUMBER CHANGE ENTERED BY REMARKS

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________
G-2

Appendix G

JP 4-02

5. Distribution

a. Additional copies of this publication can be obtained through Service publication

centers listed below (initial contact) or the USJFCOM JWFC in the event that the joint

publication is not available from the Service.

b. Only approved joint publications and joint test publications are releasable outside

the combatant commands, Services, and Joint Staff. Release of any classified joint

publication to foreign governments or foreign nationals must be requested through the

local embassy (Defense Attaché Office) to DIA Foreign Liaison Office, PSS, PO-FL,

Room 1A674, Pentagon, Washington, DC 20301-7400.

c. Additional copies should be obtained from the Military Service assigned

administrative support responsibility by DOD Directive 5100.3, 1 November 1988,

Support of the Headquarters of Unified, Specified, and Subordinate Joint Commands.

Army: US Army AG Publication Center SL

1655 Woodson Road

Attn: Joint Publications

St. Louis, MO 63114-6181

Air Force: Air Force Publications Distribution Center

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Navy: CO, Naval Inventory Control Point

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Coast Guard: Commandant Coast Guard (G-OPD), US Coast Guard

2100 2nd Street, SW

Washington, DC 20593-0001

Commander

USJFCOM JWFC Code JW2102

Doctrine Division (Publication Distribution)

116 Lake View Parkway

Suffolk, VA 23435-2697

d. Local reproduction is authorized and access to unclassified publications is

unrestricted. However, access to and reproduction authorization for classified joint

publications must be in accordance with DOD Regulation 5200.1-R, Information

Security Program.
GLOSSARY

PART I — ABBREVIATIONS AND ACRONYMS

GL-1

AE aeromedical evacuation

AFMIC Armed Forces Medical Intelligence Center

AFSOF Air Force special operations forces

AOR area of responsibility

ARSOF Army special operations forces

ASBPO Armed Services Blood Program Office

ATM advanced trauma management

BTC blood transshipment center

C2 command and control

C4I command, control, communications, computers, and

intelligence

CA civil affairs

CASEVAC casualty evacuation

CD-ROM compact disk read-only memory

CINC commander in chief

CJCS Chairman of the Joint Chiefs of Staff

CMO chief medical officer

COA course of action

CONUS continental United States

COSR combat and operational stress reactions

DIA Defense Intelligence Agency

DNBI disease and nonbattle injury

DOD Department of Defense

EHRA environmental health risk assessment

EMT emergency medical technician

EPW enemy prisoner of war

FHA foreign humanitarian assistance

FHP force health protection

FM field manual

GCCS Global Command and Control System

GPMRC Global Patient Movement Requirements Center

HCA humanitarian and civic assistance

HN host nation

HNS host-nation support

HSS health service support
GL-2

Glossary

JP 4-02

IDRA infectious disease risk assessment

IO international organization

IV intravenous

J-2 intelligence directorate of a joint staff

J-6 command, control, communications, and computer systems

directorate of a joint staff

JBPO Joint Blood Program Office

JFC joint force commander

JFS joint force surgeon

JOA joint operations area

JP joint publication

JRSOI joint reception, staging, onward movement, and integration

JTF joint task force

MASCAL mass casualty

MAT medical analysis tool

MNFC multinational force commander

MOOTW military operations other than war

MTF medical treatment facility

NAVSOF Naval special operations forces

NBC nuclear, biological, and chemical

NGO nongovernmental organization

OCONUS outside continental United States

OPLAN operation plan

OPORD operation order

OPSEC operations security

PA physician assistant

PAR population at risk

PMI patient movement item

POW prisoner of war

RDD radiological dispersal device

RTD returned to duty

SecDef Secretary of Defense

SFG special forces group

SIMLM single integrated medical logistics manager

SOC special operations command

SOF special operations forces

TPFDD time-phased force and deployment data

TPMRC Theater Patient Movement Requirements Center
GL-3

Glossary

USC United States Code

USCG United States Coast Guard

VX nerve agent (O-Ethyl S-Diisopropylaminomethyl

Methylphosphonothiolate)

WMD weapons of mass destruction
aeromedical evacuation. The movement of

patients under medical supervision to and

between medical treatment facilities by air

transportation. (JP 1-02)

aeromedical evacuation liaison team. An

Air Force medical team that provides

enhanced liaison support between the

forward user and the aeromedical

evacuation system. The aeromedical

evacuation liaison team provides

operational, clinical, and communications

links necessary to prepare patients for flight,

and initiates fixed wing evacuation of

casualties. Also called AELT. (This term

and its definition are applicable only in the

context of this publication and cannot be

referenced outside this publication.)

casualty. Any person who is lost to the

organization by having been declared dead,

duty status—whereabouts unknown,

missing, ill, or injured. (JP 1-02)

casualty category. A term used to

specifically classify a casualty for reporting

purposes based upon the casualty type and

the casualty status. Casualty categories

include killed in action, died of wounds

received in action, and wounded in action.

(JP 1-02)

casualty evacuation. The movement of

casualties. It includes movement both to

and between medical treatment facilities.

Any vehicle may be used to evacuate

casualties. Also called CASEVAC. (This

term and its definition are approved for

inclusion in the next edition of JP 1-02.)

casualty status. A term used to classify a

casualty for reporting purposes. There are

seven casualty statuses: (1) deceased, (2)

duty status—whereabouts unknown, (3)

missing, (4) very seriously ill or injured,

(5) seriously ill or injured, (6)

incapacitating illness or injury, and (7) not

seriously injured. (JP 1-02)

casualty type. A term used to identify a

casualty for reporting purposes as either a

hostile casualty or a nonhostile casualty. (JP

1-02)

combat and operational stress. The

expected and predictable emotional,

intellectual, physical, and/or behavioral

reactions of Service members who have

been exposed to stressful events in war or

military operations other than war. Combat

stress reactions vary in quality and severity

as a function of operational conditions, such

as intensity, duration, rules of engagement,

leadership, effective communication, unit

morale, unit cohesion, and perceived

importance of the mission. (This term and

its definition are approved for inclusion in

the next edition of JP 1-02.)

combatant command. A unified or specified

command with a broad continuing mission

under a single commander established and

so designated by the President, through the

Secretary of Defense and with the advice

and assistance of the Chairman of the Joint

Chiefs of Staff. Combatant commands

typically have geographic or functional

responsibilities. (JP 1-02)

combat service support. The essential

capabilities, functions, activities, and tasks

necessary to sustain all elements of

operating forces in theater at all levels of

war. Within the national and theater logistic

systems, it includes but is not limited to the

support rendered by Service forces in

ensuring the aspects of supply,

maintenance, transportation, health

services, and other services required by

aviation and ground combat troops to

GL-4 JP 4-02

PART II — TERMS AND DEFINITIONS
permit those units to accomplish their

missions in combat. Combat service

support encompasses those activities at all

levels of war that produce sustainment to

all operating forces on the battlefield. Also

called CSS. (JP 1-02)

combat zone. 1. That area required by

combat forces for the conduct of operations.

(JP 1-02)

command and control. The exercise of

authority and direction by a properly

designated commander over assigned and

attached forces in the accomplishment of

the mission. Command and control

functions are performed through an

arrangement of personnel, equipment,

communications, facilities, and procedures

employed by a commander in planning,

directing, coordinating, and controlling

forces and operations in the

accomplishment of the mission. Also called

C2. (JP 1-02)

communications zone. Rear part of theater

of war or theater of operations (behind but

contiguous to the combat zone) which

contains the lines of communications,

establishments for supply and evacuation,

and other agencies required for the

immediate support and maintenance of the

field forces. Also called COMMZ. (JP

1-02)

directed energy. An umbrella term covering

technologies that relate to the production

of a beam of concentrated electromagnetic

energy or atomic or subatomic particles. (JP

1-02)

disease and nonbattle injury casualty. A

person who is not a battle casualty but who

is lost to the organization by reason of

disease or injury, including persons dying

of disease or injury, by reason of being

missing where the absence does not appear

to be voluntary, or due to enemy action or

to being interned. (JP 1-02)

en route care. The care required to maintain

the phase treatment initiated prior to

evacuation and the sustainment of the

patient’s medical condition during

evacuation. (This term and its definition

are approved for inclusion in the next

edition of JP 1-02.)

essential care. That care received within a

theater that is dependent upon the mission,

enemy, terrain, troops, time available, and

other civilian considerations. It includes

first responder care, forward resuscitative

surgery, and en route care as well as

treatment and hospitalization to return the

patient to duty or to stabilize for movement

to a higher level of care. (This term and

its definition are approved for inclusion in

the next edition of JP 1-02.)

evacuation. 1. The process of moving any

person who is wounded, injured, or ill to

and/or between medical treatment facilities.

(JP 1-02)

evacuation policy. 1. Command decision

establishing the maximum number of days

that patients may be held within the

command for treatment. Patients who, in

the opinion of responsible medical officers,

cannot be returned to a duty status within

the period prescribed are evacuated by the

first available means, provided the travel

involved will not aggravate their

disabilities. (This term and its definition

modify the existing term and its definition

and are approved for inclusion in the next

edition of JP 1-02)

first responder phase. A phase of medical

care in which health care providers’ focus

is to save life and limb and stabilize the

patient sufficiently to withstand evacuation

to the next level of care. This first response

GL-5

Glossary
GL-6

Glossary

JP 4-02

may include first aid (self-aid and buddy

aid, combat lifesavers) or medical

assistance by combat medics, hospital

corpsmen, physician assistants, or

physicians. (This term and its definition

are approved for inclusion in the next

edition of JP 1-02.)

force health protection. All services

performed, provided, or arranged by the

Services to promote, improve, conserve, or

restore the mental or physical well being

of personnel. These services include, but

are not limited to, the management of health

services resources, such as manpower,

monies, and facilities; preventive and

curative health measures; evacuation of the

wounded, injured, or sick; selection of the

medically fit and disposition of the

medically unfit; blood management;

medical supply, equipment, and

maintenance thereof; combat stress control;

and medical, dental, veterinary, laboratory,

optometry, medical food, and medical

intelligence services. (This term and its

definition are approved for inclusion in the

next edition of JP 1-02.)

foreign internal defense. Participation by

civilian and military agencies of a

government in any of the action programs

taken by another government to free and

protect its society from subversion,

lawlessness, and insurgency. (JP 1-02)

forward aeromedical evacuation. That

phase of evacuation that provides airlift for

patients between points within the

battlefield, from the battlefield to the initial

point of treatment, and to subsequent points

of treatment within the combat zone. (JP

1-02)

forward resuscitative surgery. The urgent

initial surgery required to render patients

transportable for further evacuation to

medical treatment facilities staffed and

equipped to provide for their care. Forward

resuscitative surgery is performed on

patients with signs and symptoms of initial

airway compromise, difficult breathing,

and circulatory shock and who do not

respond to initial emergency medical

treatment and advanced trauma

management procedures. (This term and

its definition are approved for inclusion in

the next edition of JP 1-02.)

Global Patient Movement Requirements

Center. A joint activity reporting directly

to the Commander in Chief, US

Transportation Command, the Department

of Defense single manager for the

regulation of movement of uniformed

services patients. The Global Patient

Movement Requirements Center authorizes

transfers to medical treatment facilities of

the Military Departments or the Department

of Veterans Affairs and coordinates

intertheater and inside continental United

States patient movement requirements with

the appropriate transportation component

commands of US Transportation

Command. (JP 1-02)

health service logistic support. A functional

area of logistic support that supports the

joint force surgeon’s health service support

mission. It includes supplying Class VIII

medical supplies (medical material to

include medical peculiar repair parts used

to sustain the health service support

system), optical fabrication, medical

equipment maintenance, blood storage and

distribution, and medical gases. See also

health service support; joint force surgeon.

(JP 1-02)

health service support. All services

performed, provided, or arranged by the

Services to promote, improve, conserve, or

restore the mental or physical well being

of personnel. These services include but

are not limited to the management of health

services resources, such as manpower,

monies, and facilities; preventive and
GL-7

Glossary

curative health measures; evacuation of the

wounded, sick, or injured; selection of the

medically fit and disposition of the

medically unfit; blood management;

medical supply, equipment, and

maintenance thereof; combat stress control;

and medical, dental, veterinary, laboratory,

optometric, medical food, and medical

intelligence services. Also called HSS. (JP

1-02)

health threat. A composite of ongoing or

potential enemy actions; environmental,

occupational, and geographic and

meteorological conditions; endemic

diseases; and employment of nuclear,

biological, and chemical weapons (to

include weapons of mass destruction) that

can reduce the effectiveness of joint forces

through wounds, injuries, illness, and

psychological stressors. (This term and its

definition modify the term “medical threat”

and its definition and are approved for

inclusion in the next edition of JP 1-02.)

hospital. A medical treatment facility capable

of providing inpatient care. It is

appropriately staffed and equipped to

provide diagnostic and therapeutic services,

as well as the necessary supporting services

required to perform its assigned mission and

functions. A hospital may, in addition,

discharge the functions of a clinic. (JP 1-02)

hostile casualty. A person who is the victim

of a terrorist activity or who becomes a

casualty “in action.” “In action”

characterizes the casualty as having been

the direct result of hostile action, sustained

in combat or relating thereto, or sustained

going to or returning from a combat mission

provided that the occurrence was directly

related to hostile action. Included are

persons killed or wounded mistakenly or

accidentally by friendly fire directed at a

hostile force or what is thought to be a

hostile force. However, not to be

considered as sustained in action and not

to be interpreted as hostile casualties are

injuries or death due to the elements, selfinflicted wounds, combat fatigue, and

except in unusual cases, wounds or death

inflicted by a friendly force while the

individual is in an absent-without-leave,

deserter, or dropped-from-rolls status, or

is voluntarily absent from a place of duty.

(JP 1-02)

host-nation support. Civil and/or military

assistance rendered by a nation to foreign

forces within its territory during peacetime,

crisis or emergencies, or war based upon

agreements mutually concluded between

nations. Also called HNS. (JP 1-02)

INTELINK and INTELINK-S. Secure,

classified intelligence networks that can

provide medical intelligence products.

(This term and its definition are applicable

only in the context of this publication and

cannot be referenced outside this

publication.)

intertheater evacuation. Evacuation of

stabilized patients between the originating

theater and points outside the theater, to

include the continental United States and

other theaters. En route care is provided

by medical attendants qualified for the

specific mode of transportation. (This term

and its definition modify the existing term

and its definition and are approved for

inclusion in the next edition of JP 1-02.)

in-transit visibility. The ability to track the

identity, status, and location of Department

of Defense units, and non-unit cargo

(excluding bulk petroleum, oils, and

lubricants) and passengers; medical

patients; and personal property from origin

to consignee or destination across the range

of military operations. Also called ITV. (JP

1-02)

intratheater evacuation. Evacuation of

stabilized patients between points within the
GL-8

Glossary

JP 4-02

theater. En route care is provided by

medical attendants qualified for the specific

mode of transportation. (This term and

its definition modify the existing term and

its definition and are approved for inclusion

in the next edition of JP 1-02.)

joint force. A general term applied to a force

composed of significant elements, assigned

or attached, of two or more Military

Departments, operating under a single joint

force commander. (JP 1-02)

joint force commander. A general term

applied to a combatant commander,

subunified commander, or joint task force

commander authorized to exercise

combatant command (command authority)

or operational control over a joint force. (JP

1-02)

joint force surgeon. A general term

applied to a medical officer appointed by

the joint force commander to serve as the

joint force special staff officer responsible

for establishing, monitoring, or

evaluating joint force health service

support. (This term and its definition

modify the existing term and its

definition and are approved for inclusion

in the next edition of JP 1-02.)

killed in action. A casualty category

applicable to a hostile casualty, other than

the victim of a terrorist activity, who is killed

outright or who dies as a result of wounds

or other injuries before reaching a medical

treatment facility. See also casualty

category. (JP 1-02)

mass casualty. Any large number of casualties

produced in a relatively short period of time,

usually as the result of a single incident such

as a military aircraft accident, hurricane, flood,

earthquake, or armed attack, that exceeds local

logistical support capabilities. See also

casualty. (JP 1-02)

medical evacuees. Personnel who are

wounded, injured, or ill and must be

moved to or between medical facilities.

(JP 1-02)

medical intelligence. That category of

intelligence resulting from collection,

evaluation, analysis, and interpretation of

foreign medical, bioscientific, and

environmental information which is of

interest to strategic planning and to military

medical planning and operations for the

conservation of the fighting strength of

friendly forces and the formation of

assessments of foreign medical capabilities

in both military and civilian sectors. (JP 1-02)

medical regulating. The actions and

coordination necessary to arrange for the

movement of patients through the levels of

care. This process matches patients with a

medical treatment facility that has the

necessary health service support capabilities

and available bed space. (This term and

its definition modify the existing term and

its definition and are approved for inclusion

in the next edition of JP 1-02.)

medical surveillance. The ongoing,

systematic collection of health data essential

to the evaluation, planning, and

implementation, of public health practice,

closely integrated with timely

dissemination of data as required by higher

authority. (This term and its definition are

approved for inclusion in the next edition

of JP 1-02.)

medical treatment facility. A facility

established for the purpose of furnishing

medical and/or dental care to eligible

individuals. (JP 1-02)

National Command Authorities. The

President and the Secretary of Defense or

their duly deputized alternates or

successors. (JP 1-02)
GL-9

Glossary

nonhostile casualty. A person who becomes

a casualty due to circumstances not directly

attributable to hostile action or terrorist

activity. Casualties due to the elements,

self-inflicted wounds, and combat fatigue

are nonhostile casualties. (JP 1-02)

not seriously injured. The casualty status of

a person whose injury may or may not

require hospitalization; medical authority

does not classify as very seriously injured,

seriously injured, or incapacitating illness

or injury; and the person can communicate

with the next of kin. See also casualty status.

(JP 1-02)

occupational and environmental health

threats. Threats to the health of military

personnel and to military readiness created

by exposure to hazardous agents,

environmental contamination, or toxic

industrial materials. (This term and its

definition are approved for inclusion in the

next edition of JP 1-02.)

originating medical facility. A medical

facility that initially transfers a patient to

another medical facility. (JP 1-02)

patient. A sick, injured, wounded, or other

person requiring medical/dental care or

treatment. (JP 1-02)

patient movement. The act or process of

moving a sick, injured, wounded, or other

person to obtain medical and/or dental care

or treatment. Functions include medical

regulating, patient evacuation, and en route

medical care. (This term and its definition

are approved for inclusion in the next

edition of JP 1-02.)

patient movement requirements center. A

joint activity that coordinates patient

movement. It is the functional merging of

joint medical regulating processes,

Services’ medical regulating processes, and

coordination with movement components

for patient evacuation. This may be joint,

reporting to the joint task force surgeon;

theater, reporting to the theater surgeon;

or global, reporting to the United States

Transportation Command surgeon. (This

term and its definition are approved for

inclusion in the next edition of JP 1-02.)

preventive medicine. The anticipation,

communication, prediction, identification,

prevention, education, risk assessment, and

control of communicable diseases, illnesses

and exposure to endemic, occupational,

and environmental threats. These threats

include nonbattle injuries, combat stress

responses, WMD, and other threats to the

health and readiness of military personnel.

Communicable diseases include

anthropod-, vector-, food-, waste-, and

waterborne diseases. Preventative

medicine measures include field sanitation,

medical surveillance, pest and vector

control, disease risk assessment,

environmental and occupational health

surveillance, waste (human, hazardous,

and medical) disposal, food safety

inspection, and potable water surveillance.

(This term and its definition are approved

for inclusion in the next edition of JP 1-02.)

prisoner of war. A detained person as

defined in Articles 4 and 5 of the Geneva

Convention Relative to the Treatment of

Prisoners of War of August 12, 1949. In

particular, one who, while engaged in

combat under orders of his or her

government, is captured by the armed forces

of the enemy. As such, he or she is entitled

to the combatant’s privilege of immunity

from the municipal law of the capturing

state for warlike acts which do not amount

to breaches of the law of armed conflict.

For example, a prisoner of war may be, but

is not limited to, any person belonging to

one of the following categories who has

fallen into the power of the enemy: a
GL-10

Glossary

JP 4-02

member of the armed forces, organized

militia or volunteer corps; a person who

accompanies the armed forces without

actually being a member thereof; a member

of a merchant marine or civilian aircraft

crew not qualifying for more favorable

treatment; or individuals who, on the

approach of the enemy, spontaneously take

up arms to resist the invading forces. (JP

1-02)

restorative and rehabilitative care. A

period of minimal care and increasing

physical activity necessary to restore

patients to functional health and allow their

return to duty or useful and productive life.

Restorative and rehabilitative treatment

may be available in theater on a limited

basis due to the theater evacuation policy.

This treatment is normally provided in the

continental United States. (This term and

its definition are approved for inclusion in

the next edition of JP 1-02.)

resuscitative care. The aggressive

management of life- and limb-threatening

injuries. Interventions include emergency

medical treatment, advanced trauma

management, and lifesaving surgery to

enable the patient to tolerate evacuation to

the next level of care. (This term and its

definition are approved for inclusion in the

next edition of JP 1-02.)

safe haven. 1. Designated area(s) to which

noncombatants of the United States

Government's responsibility and

commercial vehicles and materiel may be

evacuated during a domestic or other valid

emergency. (JP 1-02)

seriously ill or injured. The casualty status

of a person whose illness or injury is

classified by medical authority to be of such

severity that there is cause for immediate

concern, but there is not imminent danger

to life. See also casualty status. (JP 1-02)

seriously wounded. A casualty whose

injuries or illness are of such severity that

the patient is rendered unable to walk or

sit, thereby requiring a litter for movement

and evacuation. (This term and its

definition modify the existing term and its

definition and are approved for inclusion

in the next edition of JP 1-02.)

slightly wounded. A casualty whose injuries

or illness are relatively minor, permitting

the patient to walk and/or sit. (This term

and its definition modify the existing term

and its definition and are approved for

inclusion in the next edition of JP 1-02.)

unaccounted for. An inclusive term (not a

casualty status) applicable to personnel

whose person or remains are not recovered

or otherwise accounted for following

hostile action. Commonly used when

referring to personnel who are killed in

action and whose bodies are not recovered.

See also casualty; casualty category;

casualty status; casualty type. (JP 1-02)

very seriously ill or injured. The casualty

status of a person whose illness or injury is

classified by medical authority to be of such

severity that life is imminently endangered.

See also casualty status. (JP 1-02)

walking patient. A patient whose injuries

and/or illness are relatively minor,

permitting the patient to walk and not

require a litter. (This term and its definition

modify the existing term and its definition

and are approved for inclusion in the next

edition of JP 1-02.)

wellness. Force health protection program

that consolidates and incorporates

physical and mental fitness, health

promotion, and environmental and

occupational health. (This term and its

definition are approved for inclusion in

the next edition of JP 1-02.)
GL-11

Glossary

wounded. See seriously wounded; slightly

wounded. (JP 1-02)

wounded in action. A casualty category

applicable to a hostile casualty, other than

the victim of a terrorist activity, who has

incurred an injury due to an external agent

or cause. The term encompasses all kinds

of wounds and other injuries incurred in

action, whether there is a piercing of the

body, as in a penetration or perforated

wound, or none, as in the contused wound.

These include fractures, burns, blast

concussions, all effects of biological and

chemical warfare agents, and the effects

of an exposure to ionizing radiation or any

other destructive weapon or agent. The

hostile casualty’s status may be very

seriously ill or injured, seriously ill or

injured, incapacitating illness or injury, or

not seriously injured. See also casualty

category. (JP 1-02)
GL-12

Glossary

JP 4-02

Intentionally Blank
Assessments/

Revision

CJCS

Approval

Two

Drafts

Program

Directive

Project

Proposal

J-7 formally staffs with

Services and CINCs

Includes scope of

project, references,

milestones, and who will

develop drafts

J-7 releases Program

Directive to Lead Agent.

Lead Agent can be

Service, CINC, or Joint

Staff (JS) Directorate

STEP #2

Program Directive

The CINCs receive the JP and

begin to assess it during use

18 to 24 months following

publication, the Director J-7,

will solicit a written report from

the combatant commands and

Services on the utility and

quality of each JP and the

need for any urgent changes or

earlier-than-scheduled

revisions

No later than 5 years after

development, each JP is

revised

STEP #5

Assessments/Revision



ENHANCED

JOINT

WARFIGHTING

CAPABILITY

Submitted by Services, CINCs, or Joint

Staff to fill extant operational void

J-7 validates requirement with Services and

CINCs

J-7 initiates Program Directive



STEP #1

Project Proposal

All joint doctrine and tactics, techniques, and procedures are organized into a comprehensive hierarchy as

shown in the chart above. is in the series of joint doctrine

publications. The diagram below illustrates an overview of the development process:

Joint Publication (JP) 4-02 Logistics

JOINT DOCTRINE PUBLICATIONS HIERARCHY JOINT DOCTRINE PUBLICATIONS HIERARCHY

JP 1-0 JP 2-0 JP 3-0

PERSONNEL

JP 4-0 JP 5-0 JP 6-0

INTELLIGENCE OPERATIONS C4 SYSTEMS LOGISTICS PLANS

JOINT

DOCTRINE

PUBLICATION

Lead Agent forwards proposed pub to Joint

Staff

Joint Staff takes responsibility for pub,

makes required changes and prepares pub

for coordination with Services and CINCs

Joint Staff conducts formal staffing for

approval as a JP

STEP #4

CJCS Approval

Lead Agent selects Primary Review

Authority (PRA) to develop the pub

PRA develops two draft pubs

PRA staffs each draft with CINCs,

Services, and Joint Staff

STEP #3

Two Drafts

JP 1

JOINT

WARFARE

JP 0-2

UNAAF