6 October 1997

Joint Tactics,

Techniques, and Procedures

for

Health Service Logistics Support

in Joint Operations

Joint Pub 4-02.1
PREFACE

i

1. Scope

This publication provides for the planning

and execution of theater health service

logistics support (HSLS) for all Service

components of a joint or multinational force,

from alert notification to deployment to and

redeployment from a theater. It provides

fundamental principles and doctrine for HSLS

in joint and multinational operations.

2. Purpose

This publication has been prepared under

the direction of the Chairman of the Joint

Chiefs of Staff. It sets forth doctrine and

selected joint tactics, techniques, and

procedures (JTTP) 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 and prescribes doctrine

and selected tactics, techniques, and

procedures 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 joint force

commander (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 selected tactics,

techniques, and procedures 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 (or JTTP)

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.

DENNIS C. BLAIR

Vice Admiral, US Navy

Director, Joint Staff

For the Chairman of the Joint Chiefs of Staff:
ii

Preface

Joint Pub 4-02.1

Intentionally Blank
TABLE OF CONTENTS

iii

PAGE

EXECUTIVE SUMMARY .......................................................................................... vii

CHAPTER I

INTRODUCTION

• Health Service Support Mission ................................................................................ I-1

• Overview of Joint Health Service Support................................................................. I-1

• Joint Health Service Logistics Support Mission ......................................................... I-3

• Principles of Health Service Support ......................................................................... I-4

• Responsibilities for Health Service Logistics............................................................. I-5

CHAPTER II

HEALTH SERVICE LOGISTICS CONSIDERATIONS

• Health Service Logistics Support in Joint Operations ............................................... II-1

• Planning for Joint Health Service Logistics Support ................................................. II-1

• Medical Threat and Medical Intelligence .................................................................. II-2

• Joint Operation Planning and Execution System ...................................................... II-3

• Time-Phased Force and Deployment Data ................................................................ II-3

• Transportation Considerations .................................................................................. II-4

• Communications Support Considerations................................................................. II-4

• Operational Considerations in a Nuclear, Biological, or Chemical Environment ....... II-6

• Overview of Service Component Health Service Logistics Systems ......................... II-6

• Single Integrated Medical Logistics Manager........................................................... II-9

CHAPTER III

STRUCTURING HEALTH SERVICE LOGISTICS SUPPORT

• Transition ............................................................................................................... III-1

• Combat Service Support......................................................................................... III-1

• The Joint Force Surgeon ........................................................................................ III-1

• Planning Considerations Prior to Deployment Notification .................................... III-1

• Deployment ........................................................................................................... III-2

• Captured Medical Materiel .................................................................................... III-2

• Unit-to-Unit Exchange .......................................................................................... III-3

• Aeromedical Evacuation Equipment and/or Patient Movement Items ................... III-3

CHAPTER IV

REDEPLOYMENT OF HEALTH SERVICE LOGISTICS IN

POSTCONFLICT ENVIRONMENTS

• Redeployment Planning ......................................................................................... IV-1

• Joint Force Surgeon Responsibilities ...................................................................... IV-1
iv

Table of Contents

Joint Pub 4-02.1

• Redeployment Phases............................................................................................. IV-1

• Other Redeployment Considerations ...................................................................... IV-3

• Service Responsibility ............................................................................................ IV-3

CHAPTER V

HEALTH SERVICE LOGISTICS SUPPORT IN

MILITARY OPERATIONS OTHER THAN WAR

• Military Operations Other Than War ....................................................................... V-1

• The Role of Joint Health Service Logistics .............................................................. V-3

• Operational Missions .............................................................................................. V-3

• Domestic Support ................................................................................................... V-4

• Funding................................................................................................................... V-5

• Planning Considerations.......................................................................................... V-5

CHAPTER VI

BLOOD MANAGEMENT

SECTION A. THE ARMED SERVICES BLOOD PROGRAM ............................... VI-1

• General .................................................................................................................. VI-1

• Armed Services Blood Program Office .................................................................. VI-1

• Service Blood Programs......................................................................................... VI-3

• Geographic Combatant Commands ........................................................................ VI-3

SECTION B. BLOOD SUPPORT IN THE CONTINUUM OF CARE .................... VI-4

• Blood Distribution System ..................................................................................... VI-4

• Available Blood Products By Echelon .................................................................... VI-7

• Blood Transfusion Practice By Echelon ................................................................. VI-8

SECTION C. PLANNING FOR EFFECTIVE BLOOD MANAGEMENT .............. VI-8

• Coordination .......................................................................................................... VI-8

• Blood Planning .................................................................................................... VI-10

• Host-Nation Support ............................................................................................ VI-12

• Logistical Considerations of Blood Support ......................................................... VI-12

• Maximum Capacities for Blood Product Shipments ............................................. VI-13

CHAPTER VII

HEALTH SERVICE LOGISTICS SUPPORT IN MULTINATIONAL OPERATIONS

• Composition of Multinational Operations.............................................................. VII-1

• Health Service Logistics Support Considerations .................................................. VII-1

• Cultural Diversity and Language ........................................................................... VII-2
v

Table of Contents

APPENDIX

A Aeromedical Support Equipment and Supplies ................................................. A-1

B Blood Management............................................................................................ B-1

C Medical Logistic Systems for Battlefield Interoperability .................................. C-1

D References ........................................................................................................ D-1

E Administrative Instructions............................................................................... E-1

GLOSSARY

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

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

FIGURE

I-1 Health Service Support Echelons.................................................................... I-2

I-2 Health Service Support Principles .................................................................. I-4

I-3 Command Surgeon’s Health Service Logistics Support Responsibilities......... I-7

II-1 Planning for Joint Health Service Logistics Support ...................................... II-2

II-2 Communications Support Considerations ...................................................... II-5

II-3 Single Integrated Medical Logistics Manager (SIMLM).............................. II-10

III-1 Patient Movement Item System ................................................................... III-4

IV-1 Redeployment Issues................................................................................... IV-1

IV-2 Redeployment Phases.................................................................................. IV-2

V-1 Principles of Health Service Logistics Support in Military Operations

Other Than War ........................................................................................ V-1

V-2 Selected Types of MOOTW Operations ....................................................... V-3

V-3 Planning Considerations ............................................................................... V-6

VI-1 The Armed Services Blood Program ........................................................... VI-1

VI-2 The Armed Services Blood Program Office Organization and

Coordination ............................................................................................ VI-2

VI-3 Armed Service Blood Distribution System .................................................. VI-6

VI-4 Blood Products (Class VIIIb) Available to the Theater ................................ VI-8

VI-5 Blood Transfusion Practices by Echelon ...................................................... VI-9

VI-6 Unit Group and Type Distribution ............................................................. VI-11

VI-7 Blood Component Planning Factors .......................................................... VI-12

VI-8 Maximum Capacities for Blood Product Shipments................................... VI-14

VII-1 Multinational Operations Problem Areas.................................................... VII-1

B-1 Master Menu Codes ...................................................................................... B-2

B-2 Example of Message Blood Report ............................................................... B-4

B-3 Example of Voice Blood Report .................................................................... B-5

B-4 Example of Blood Shipment Report .............................................................. B-6
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Table of Contents

Joint Pub 4-02.1

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EXECUTIVE SUMMARY

COMMANDER’S OVERVIEW

•

•

•

•

•

•

vii

The health service

support (HSS) mission to

conserve the fighting

strength and provide the

combatant commander

with a source of trained

manpower is enhanced by

health service logistics

support (HSLS).

Introduction

Health service logistics support (HSLS) provides the required

Class VIII materiel and equipment when and where it is

needed on the battlefield. In joint operations, the combatant

commander may exercise authority over the joint Class VIII

system by designating a single integrated medical logistics

manager (SIMLM) to oversee Class VIII efforts. Health

service support (HSS) in a theater of operations is provided

by echelons. Each echelon reflects an increase in medical

capability while retaining the capabilities found in the

preceding echelon. Within most theater of operations there

are four echelons of care, with Echelon V in the continental

United States (CONUS) support base. HSLS is one of the

functional areas of HSS. As such, it requires comprehensive

planning for inclusion in the HSS estimate and plan which

supports the combatant commander’s operation plan

(OPLAN). The joint HSLS mission is to provide Class VIII

supplies and equipment (medical materiel to include medicalpeculiar repair parts), optical fabrication, medical equipment

maintenance and repair, blood management, and medical

gases.

Introduces Health Service Logistics Support (HSLS)

Concepts

Covers Health Service Logistics Responsibilities and

Considerations

Discusses Structuring HSLS

Explains Health Service Logistics in Postconflict

Environments and Military Operations Other Than War

Outlines Blood Management Programs, Support, and

Planning

Describes HSLS in Multinational Operations
viii

Executive Summary

Joint Pub 4-02.1

The Assistant Secretary of Defense for Health Affairs

(ASD[HA]) establishes health policy and provides oversight

of health policies being implemented by the Services’ Surgeons

General. Within the Department of Defense, two

organizations play a prominent role in management of Class

VIII materiel: the Defense Logistics Agency (DLA) and the

Defense Medical Standardization Board. Upon the

recommendation of the geographic combatant commander, the

Chairman of the Joint Chiefs of Staff advises the Secretary

of Defense on establishing a theater evacuation policy. The

Services’ Surgeons General provide guidance on HSLS

policies to be implemented within their Services. The

combatant commander has authority within his area of

responsibility (AOR) for the execution of the HSLS mission.

The command surgeon is the combatant commander’s principal

HSS advisor in theater and will normally serve as the joint

force surgeon during joint operations. The command surgeon

supervises the planning and execution of the HSS mission.

The Geneva Conventions provide specific safeguards which

apply to health service logistics materiel and personnel.

The health service logistics portion of the HSS estimate and

plan ensures that a thorough and comprehensive analysis of

health service logistics requirements is accomplished and

incorporated into the overall HSS plan. By obtaining medical

intelligence and by studying the medical threat, the health

service logistician can predict, to some extent, the types of

medical materiel that will be required for the mission. The

Joint Operation Planning and Execution System assists

the HSS planner to determine the gross HSS requirements

based upon variables input by the planner, such as forces-atrisk, casualty admissions rates, and the evacuation policy. The

time-phased force and deployment data is the computer

supported portion of the OPLAN; it contains time-phased force

non-unit-related cargo and personnel data as well as

movement data for the OPLAN. The ability to transport

needed medical supplies and equipment to the requesting unit

is an essential part of the HSLS effort. Communications

systems must be able to communicate on a continuous basis,

The health service

logistician needs to

understand the principles

of HSS and apply them to

HSLS operations.

For the HSS mission to

be successfully

accomplished, the

appropriate supplies,

maintenance, and

transportation resources

must be available.

Responsibilities for Health Service Logistics

Health Service Logistics Considerations
ix

Executive Summary

be interoperable, accessible to all users, and able to

communicate the Class VIII requisitions and requirements

from the forward battlefield to the supporting health service

logistics facilities in the theater of operations and the

sustaining base. The threat and possible use of nuclear,

biological, and chemical weapons requires HSS personnel

to protect themselves, their patients, equipment, and supplies

throughout the AOR or joint operations area. The US Army,

US Navy, US Marine Corps, and US Air Force each have

automated systems to assist in medical materiel

management. HSLS of special operations forces is mission

dependent. When two or more Services are operating within

the combatant commander’s AOR, he may designate a Service

as the SIMLM. By exercising his authority over the HSLS

arena, the combatant commander can centralize control,

reduce duplication of services, and provide the support in a

more economical and efficient manner.

The implementation and execution of combat service support

functions are the responsibility of the Services and the Service

component commanders. The commander of a combatant

command (CINC) will designate a joint force surgeon (JFS)

who will be responsible for preparing and coordinating HSS

within the joint force. Units deploying to the operational

area will deploy with their authorized or tailored

requirements in accordance with appropriate Service

doctrine. The Service components are required to resupply

their respective units until the SIMLM is established and

operational. As early as possible (OPLAN-dependent), an

advanced element from the assigned Service HSLS

organization should be deployed into the theater. Within

the combat zone, medical units will normally accomplish a

one-for-one exchange of medical equipment with the

gaining activity at the time of patient transfer. The handling

and return of equipment within the aeromedical evacuation

system requires a reliable supporting logistics infrastructure

to ensure that patient movement items (PMIs) are available

and serviceable. The mission of the PMI system is to support

in-transit medical capability without removing equipment

from patients, to exchange in-kind PMIs without degrading

medical capabilities, and to provide prompt recycling of PMIs.

Transitioning from a

peacetime environment to

mobilization, to

deployment, to

redeployment, and to

demobilization will

require extensive prior

planning by the

combatant commanders,

Military Services, and the

Joint Staff.

Structuring Health Service Logistics Support
x

Executive Summary

Joint Pub 4-02.1

Based on the CINC’s plan, the Service component

commanders issue a redeployment warning order that

conveys the CINC’s redeployment guidance. The command

surgeon and staff must be actively involved in establishing

their redeployment policy as it pertains to medical units.

Redeployment is conducted in six phases: reconstitution for

strategic movement; movement to the redeployment assembly

areas; movement to port of embarkation; strategic lift; reception

at port of debarkation (POD); and onward movement from

POD. Non-unit redeployed equipment and supplies are

redistributed according to plans developed by the appropriate

Service, with input from combatant commanders. The DLA

will play a major role regarding any major redeployment of

medical assets. The logistics officer, in coordination with the

JFS, the DLA, and the Services, determines when the supply

pipeline can be shut down. The Services are responsible for

reconstitution of their Service elements used in the operation.

There are six joint principles which apply to military

operations other than war (MOOTW): objective, unity of

effort, legitimacy, perseverance, restraint, and security. The

medical commander and the health service logistics planner

must use these principles to guide the planning and execution

of the HSS mission. HSLS can provide traditional logistic

support to deployed forces or may be incorporated into

OPLANs for other types of operations. Prior to a deployment

on a noncombatant evacuation operation, the senior medical

person accompanying the force determines if there are any

special medical supply or equipment requirements. In disaster

relief operations, the management of Class VIII materiel is

critical to the successful completion of the mission. In

humanitarian assistance operations, the health service

logistics planner must obtain and coordinate transportation

and receive, sort, store, and distribute Class VIII materiel. In

nation assistance operations, health service logistics

personnel can assist a host nation by conducting an assessment

of the military or civilian medical supply infrastructure and

industry. In peace support operations, the HSLS mission is

more the traditional support to a deployed force. Domestic

support often includes disaster assistance based upon requests

from civil authorities as a result of natural or manmade

disasters.

Redeployment must be

planned and executed in

a manner that facilitates

the use of redeploying

forces and sustainment

equipment and supplies

to meet a new crisis.

HSLS plays a significant

role in the delivery of

health care in military

operations other than war.

Health Service Logistics Support in Military

Operations Other Than War

Redeployment of Health Service Logistics in Postconflict Environments
xi

Executive Summary

A significantly important aspect of conducting MOOTW

missions is the funding mechanism for the operation. The

health service logistics planner must be knowledgeable of

the funding and reimbursement mechanisms of the specific

mission before obligating funds for health service materiel

purposes. Planning for MOOTW uses the same planning

process as that of any military operation.

Established by the ASD(HA), the Armed Services Blood

Program provides transfusion products when required to US

forces worldwide. Tri-Service cooperative efforts between

the US Army, Navy, and Air Force enable blood and blood

products to be collected, tested, processed, and shipped to

military medical treatment facilities (MTFs) throughout the

world. The Armed Services Blood Program Office

(ASBPO) is chartered by the ASD(HA) to coordinate the

collection and provision of blood products throughout the

Services to meet medical requirements during national

emergencies and overseas military operations.

The Chairman of the Joint Chiefs of Staff reviews and

provides guidance on all matters pertaining to blood

support in joint operation planning and execution as well as

activation of the ASBPO in contingency and war. Each

geographic combatant command maintains a separate

integrated system for providing blood products to the various

Service components’ MTFs within the CINC’s AOR. The

theater combatant command Joint Blood Program Office

(JBPO) serves as the overall blood manager within each

command. The command surgeon may recommend the

establishment of an Area Joint Blood Program Office

(AJBPO) to provide regional blood management in the theater.

Blood requires handling by individuals specially trained in

blood movement and storage. To be successful, blood support

must be an organized and cooperative effort on the part of

health service logisticians, laboratory and blood bank

personnel, transportation personnel, and primary health care

providers. Theater blood support during wartime is provided

to US military facilities and potentially, pursuant to proper

authority, allied and coalition military as well as indigenous

civilian medical facilities. Blood services in a theater of

operations containing actual combat operations consist of a

combination of operational capabilities. A JBPO or an

The planning and

execution for the effective

management of blood

and blood products is a

continuing, dynamic

process requiring a

coordinated, highly

responsive system that

extends from the

continental United States

to the battlefield.

Blood support in a

theater of operations

containing actual combat

operations is a dynamic

and ever-evolving

process.

The Armed Services Blood Program

Blood Support in the Continuum of Care
xii

Executive Summary

Joint Pub 4-02.1

AJBPO will be responsible for the Joint Blood Distribution

System within their geographic area.

MTFs will maintain blood products on hand necessary to

meet operational requirements and submit a daily Blood Report

to their supporting blood supply unit (BSU). The mission of

the BSU is to receive, perform limited testing, store, process,

and distribute blood products to its supported MTFs. The BSU

may also collect blood on an emergency basis. The Blood

Product Depots (BPDs) have been built into theater

combatant commands to provide storage for frozen red blood

cells and fresh frozen plasma. Theater combatant commands

are responsible for ensuring that BPDs are maintained,

manned, equipped, and supplied during peacetime operation.

The Blood Transshipment Centers and Transportable

Blood Transshipment Centers are managed by the US Air

Force at primary airfields within the theater of operations.

They receive blood products from the Armed Services Whole

Blood Processing Laboratory, store them, and re-ice and

distribute them to BSUs or MTFs when required.

A coordinated effort between the theater JBPO and the theater

operations officer and plans officer is required for successful

planning. Blood Transshipment Center personnel must have

knowledge of the available Army blood bank platoons, BSUs,

and the types and locations of the MTFs in the combat zone

for proper planning. Blood planning factors are programmed

by the Joint Data Systems Support Center and subsequently

used by the respective combatant command medical planners

to generate daily blood product requirements for the

operational area. Pre-positioned frozen blood products or

blood shipped from CONUS will reduce the requirements to

collect blood in the operational environment. Capabilities to

collect and process blood in the theater are limited.

Once located in the operational area, it is necessary for the

JBPO to maintain current information on the combat

situation and on the anticipated actions of friendly and enemy

forces. Medical intelligence will provide additional

information upon which to base host-nation related decisions.

After the decision has been made on where to locate the blood

banks and the concept of operations for blood support has been

established, plans must be coordinated to effect the timely

distribution of blood and blood products throughout the theater

of operations.

Continuous planning for

mobilization and other

contingencies enables the

Services to rapidly

respond to situations

requiring blood support.

Planning for Effective Blood Management
xiii

Executive Summary

Logistics support in multinational operations present

numerous challenges due to a variety of different policies,

procedures, and practices. Some of the problem areas that

may be confronted include a difference in doctrine, differing

stockage levels, logistics mobility, interoperability concerns,

competition between participants for common support, and

resource limitations. Close coordination and continuous

liaison with all parties to an alliance or coalition is the key to a

successful operation. The North Atlantic Treaty

Organization Standardization Agreements and the

Quadripartite Standardization Agreements have provided

a mechanism for standardizing medical materiel. Based on

these agreements, the HSLS planner can better estimate the

interoperability capabilities of the combined forces. In

multinational operations, significant differences in both

language and customs will exist between the various

participants. Each individual Service member must be

sensitive to these differences and accommodate them when

possible.

This publication provides for the planning and execution of

theater HSLS for all Service components of a joint or combined

force, from alert notification to deployment to and

redeployment from a theater. It provides fundamental

principles and doctrine for HSLS in joint and multinational

operations.

Health Service Logistics Support in Multinational Operations

CONCLUSION
xiv

Executive Summary

Joint Pub 4-02.1

Intentionally Blank
CHAPTER I

INTRODUCTION

I-1

1. Health Service Support

Mission

The health service support (HSS) mission

to conserve the fighting strength and

provide the combatant commander with a

source of trained manpower is enhanced

by health service logistics support (HSLS).

HSLS provides the required Class VIII

materiel and equipment where needed on the

battlefield. It is a Service component

responsibility to provide Class VIII support

to its own forces. In joint operations, the

combatant commander may exercise

directive authority over the joint Class VIII

system by designating a single integrated

medical logistics manager (SIMLM) to

oversee Class VIII efforts.

2. Overview of Joint Health

Service Support

a. HSS in a theater of operations is

provided within echelons of care. Each

echelon reflects an increase in medical

capability while retaining the capabilities

found in the preceding echelon, as shown in

Figure I-1. Within a theater of operations

there are four echelons of care, with Echelon

V in the continental United States (CONUS)

support base.

• Echelon I Care. Care is rendered at

the unit and includes first aid (self-aid,

buddy aid, and combat lifesaver [US

Army] care), examination, and

emergency lifesaving measures such as

“The great thing in all military service is health.”

Admiral Lord Nelson

Health service logistics support ensures that equipment and materiel is

provided where needed on the battlefield.
I-2

Chapter I

Joint Pub 4-02.1

maintenance of an airway, control of

bleeding, prevention and control of

shock, and prevention of further injury.

This echelon of care may include an aid

station that has a physician and/or

medical officer or physician assistant.

The elements of medical care and

management at this echelon prepare

patients for return to duty or evacuation

to a higher echelon of care.

• Echelon II Care. Echelon II care

includes basic resuscitation and

stabilization and may include limited

surgical capability as well as basic

laboratory, pharmacy, and temporary

holding facilities. Surface or air

evacuation to a medical treatment

facility (MTF) is available for patients

who require more comprehensive

treatment.

• Echelon III Care. Care administered

at Echelon III requires clinical

capabilities normally found in an MTF

staffed, equipped, and located in a lower

level threat environment. Echelon III

care may be the first step toward

restoration of functional health, as

compared to procedures to stabilize a

condition or prolong life. Echelon III

care may not have the crisis aspects of

initial resuscitative care. Therefore, care

at this echelon can proceed with greater

deliberation. Limited specialty surgical

capability is also available at this

echelon.

• Echelon IV Care. Care is provided in

an MTF staffed and equipped for

definitive care and includes specialized

surgical capability.

Figure I-1. Health Service Support Echelons

HEALTH SERVICE SUPPORT ECHELONS

ECHELON I

ECHELON II

ECHELON III

ECHELON IV

ECHELON V

!

!

Care rendered at unit

First aid, examination, and

emergency lifesaving measures

!

!

Basic resuscitation and

stabilization

Surface or air evacuation

available

!

!

Clinical capabilities

Restoration of functional health

!

!

Definitive care

Specialized surgical capability

! Convalescent, restorative,

rehabilitative

Support in

the theater

of

operations

Continental

US

support

base
I-3

Introduction

• Echelon V Care. Care is convalescent,

restorative, and rehabilitative and is

normally provided by CONUS-based

military, Department of Veterans Affairs,

and/or National Disaster Medical System

(NDMS) hospitals.

b. Medical units plan and provide

evacuation; hospitalization; health service

logistics; medical laboratory service; blood

management; preventive medicine; dental

support; veterinary support; combat stress

control; and command, control, and

communications.

• Minimally, they should address:

•• Preventative medicine aspects of the

food sanitation and water resources.

•• Command emphasis on hot or cold

weather injury prevention.

•• Field sanitation procedures.

•• An aggressive program to protect US

forces, to include disease surveillance,

diagnosis, and early treatment.

•• Veterinary aspects of food sources.

• The nature of the mission in peace

operations may result in more frequent

and direct contact with the local

population and increase the risk of

acquiring many of the infectious and

contagious endemic diseases of the

country involved. For example, the

malaria risk could be high because of

increased mosquito vector populations

from pools of water and favorable

breeding sites following the monsoon

season in some countries.

• Preventive medicine measures, disease

surveillance and reporting, rapid disease

outbreak investigation, field sanitation,

water and ice quality analysis, veterinary

surveillance of food supplies and sources,

command emphasis, and troop discipline

at all levels significantly limit infectious

disease and environmental health

problems.

3. Joint Health Service Logistics

Support Mission

HSLS is one of the functional areas of

HSS. As such, it requires comprehensive

planning for inclusion in the HSS estimate

and plan which supports the combatant

commander’s operation plan (OPLAN).

a. The joint HSLS mission on the

battlefield is to provide:

• Class VIII supplies and equipment

(medical materiel to include medicalpeculiar repair parts).

• Optical fabrication.

• Medical equipment maintenance and

repair.

• Blood management.

• Medical gases.

• Contract support

b. The Class VIII category is subdivided

into Class VIIIa and Class VIIIb. (For the

purposes of this publication, when the term

Class VIII is used it refers to both Class VIIIa

and Class VIIIb.)

• Class VIIIa consists of all medical

supplies and materiel, optical lens

fabrication, medical equipment

maintenance (to include medicalpeculiar repair parts), and medical

gases. The subclasses which comprise

this category include: controlled

substances; tax-free alcohol; precious

metals; nonexpendable and expendable
I-4

Chapter I

Joint Pub 4-02.1

medical and dental items; all drugs and

related items listed in Federal Class 6505

but not otherwise restricted; designated

controlled items on the advice of the

command surgeon to the geographic

combatant commander; and Service

controlled sensitive items.

• Class VIIIb is comprised of blood and

blood products. The subclasses which

comprise this category include: whole

blood, packed red blood cells (RBCs),

frozen RBCs, fresh frozen plasma (FFP),

and platelet concentrate.

c. The commander of a combatant

command (CINC) may determine that the

joint HSLS mission may be more

effectively accomplished by a SIMLM.

4. Principles of Health Service

Support

There are six principles of HSS shown

in Figure I-2. The health service logistician

needs to understand these principles and apply

them to HSLS operations.

a. Conformity. The HSLS plan must

support and be in consonance with the joint

force commander’s (JFC’s) OPLAN. By

participating in the development of the

commander’s OPLAN, the health service

logistics planner can:

• Determine requirements.

• Plan the support needed to conform to

the tactical operations.

Figure I-2. Health Service Support Principles

HEALTH SERVICE SUPPORT PRINCIPLES

Conformity

Control

Continuity

Mobility

Flexibility

Proximity
I-5

Introduction

b. Proximity. HSS must be provided to

sick, injured, and wounded Service

members at the right place to keep

morbidity and mortality to the minimum.

HSS resources are employed as close to the

combat area as possible. Medical supplies

and blood need to be moved to where they

are accessible by forward treatment elements

yet do not interfere with combat operations.

c. Flexibility. The health service

logistician must remain abreast of the situation

during war or military operations other than

war (MOOTW) in order to reallocate or

cross-level Class VIII items as changes to

the OPLAN occur.

d. Mobility. Medical command and

control headquarters must continually assess

and forecast unit movement and

redeployment. Health service logistics units

must be prepared to move with the flow of

the tactical operation or redeployment of

supported units.

e. Continuity. Optimum care and

treatment of the sick, injured, or wounded are

provided by a progressive, phased echelon of

care system. To ensure that treatment

resources are maximized and morbidity and

mortality reduced, HSLS must provide the

needed Class VIII supplies in the right

quantity at the right time and to the right

place on the battlefield. Continuity of quality

health care is in part dependent upon the

HSLS provided.

f. Control. HSS resources must remain

under the control and supervision of the

command surgeon. The unique

requirements for the handling and storage of

medical materiel is best accomplished by

retaining control of a dedicated HSLS system.

5. Responsibilities for Health

Service Logistics

a. The Assistant Secretary of Defense

for Health Affairs (ASD[HA]). The

ASD(HA) establishes health policy and

provides oversight of health policies being

implemented by the Services’ Surgeons

General. Within the Department of Defense

(DOD), two organizations play a prominent

role in management of Class VIII supplies.

• The Defense Logistics Agency (DLA)

is responsible for wholesale logistic

operations. The DLA, through the

Directorate of Medical Materiel, Defense

Personnel Support Center (DPSC), is the

medical commodity manager. The

agency obtains supplies at the wholesale

level and coordinates transportation of

HEALTH SERVICE SUPPORT IN KOREA

We moved into Koto-ri, nine and one half miles south of Hagaru, on the evening

of November 25. There were no buildings to use and the temperature had

dropped far below zero. The ground was frozen to a depth of 18 inches, making

it impossible to use our regulation wooden tent pegs in anchoring the tents.

We finally found a substitute ... Our original blood supply froze and hemolized;

zepherin chloride solutions froze, plazma units froze....Plazma could be thawed

successfully but when cold water was added, the solution gelatized and refused

to flow into a man’s blood stream. We finally tied hot water bottles around the

solution flask to administer plazma...At times the blood froze on the doctor’s

gloves during an operation.

SOURCE: After Action Report

1st Marine Medical Battalion In North Korea

November 1950
I-6

Chapter I

Joint Pub 4-02.1

those supplies to the port of embarkation

(POE). For certain health service

logistics, it will also coordinate

transportation to the port of debarkation

(POD) upon the redeployment of forces.

• The Defense Medical Standardization

Board (DMSB) coordinates and

standardizes the clinical and technical

aspects of medical materiel for use by

all Services by:

•• Directing the development and

standardization of approved deployable

medical systems (DEPMEDS).

•• Directing the development and

modification of computer simulation

modeling used to determine joint materiel

requirements.

•• Developing medical items substitution

lists.

•• Serving as the point of contact and

maintaining liaison with the DLA and

other government agencies for all clinical

and technical matters pertaining to

medical materiel.

b. Chairman of the Joint Chiefs of Staff

(CJCS). In military operations, the chain of

command emanates from the National

Command Authorities, to the respective

CINC. Upon the recommendation of the

geographic combatant commander, the

Chairman of the Joint Chiefs of Staff advises

the Secretary of Defense on establishing a

theater evacuation policy. This policy

establishes, in a number of days, the

maximum period of noneffectiveness

(hospitalization and convalescence) that

patients may be held within the theater for

treatment. This policy, in turn, is one of the

determining factors governing the

establishment and operation of HSLS

facilities within the area of responsibility

(AOR).

c. The Services’ Surgeons General. The

Services’ Surgeons General provide

guidance on HSLS policies to be

implemented within their Services. The

Services coordinate the clinical, technical,

and logistic aspects of all medical materiel.

Each Service component has organizational

structures for coordinating medical and

dental materiel support for units of the

operating force and to cooperate with other

offices, commands, and agencies in matters

pertaining to health service logistics. The

Services provide this support through the

following agencies:

• Fleet Hospital Program Office (PML500).

• Naval Supply Systems Command

(NAVSUP).

• Naval Medical Logistics Command

(NAVMEDLOGCOM).

• Air Force Medical Logistics Office

(AFMLO).

• US Army Medical Materiel Agency

(USAMMA).

• Marine Corps Systems Command.

d. The Geographic Combatant

Commanders. The CINC has directive

authority within the AOR for the execution

of the HSLS mission, normally with the

advice of the joint force surgeon (JFS). One

way this authority may be exercised is by

designating one of the Services within the

AOR as the SIMLM. This facilitates the

delivery of HSLS by centralizing control,

reducing costs, and reducing redundancy of

services within the theater of operations.
I-7

Introduction

e. Command Surgeon. The command

surgeon is designated to supervise the

planning for the accomplishment of the

HSS mission. The command surgeon’s HSLS

responsibilities are shown in Figure I-3.

f. The Law of Armed Conflict. The four

Geneva Conventions of 1949 are a part of the

law of armed conflict. These conventions

provide specific protections for medical

personnel, facilities, vehicles, and equipment

that will apply, under most circumstances, to

health service logistics materiel and personnel

during an armed conflict.

• Medical personnel considered to be

protected persons at all times and in all

places include: (1) those personnel

exclusively engaged in the search for,

collection, transport, or treatment of the

wounded or sick or in the prevention of

disease; and (2) staff exclusively engaged

in the administration of medical units

and establishments. Under this

protection HSLS personnel are not

subject to attack, but are subject to lawful

capture unless serving on board a

hospital ship. If captured, they are not

prisoners of war and may be retained

only so long as the state of health of allied

prisoners of war require.

• Auxiliary medical personnel are

members of the armed forces specially

trained for employment (should the need

arise) as hospital orderlies, nurses, or

Figure I-3. Command Surgeon’s Health Service Logistics Support Responsibilities

COMMAND SURGEON'S HEALTH SERVICE

LOGISTICS SUPPORT RESPONSIBILITIES

1. Maintain liaison with component surgeons and resolve health

service logistics support (HSLS) conflicts surfaced by the joint task

force (JTF) components

2. Provide detailed HSLS guidance, assign HSLS tasks, and develop

a joint concept of operations. In the interest of maximizing the use of

potentially limited health service support (HSS) resources, the JTF

surgeon recommends to the JTF commander the joint use of HSS

assets

3. Monitor JTF medical readiness to include component status on

patient beds and health service logistics to include blood management

and staffing

4. Coordinate HSLS provided to or received from allies or host nations

during multinational operations

5. Prepare Annex Q for all JTF plans and orders

6. Advise the JTF commander on HSS aspects of the Geneva

Conventions and the Law of Land Warfare

7. Supervise the activities of the Area Joint Blood Program Office, if

established

8. Advise the commander on the disposition of captured enemy

medical materiel
I-8

Chapter I

Joint Pub 4-02.1

auxiliary stretcher-bearers in the search

for, collection, transport, or treatment of

the wounded and sick. If they are

carrying out these duties at the time

when they come into contact with the

enemy, they are also considered

protected persons and not subject to

attack; however, auxiliary medical

personnel who are captured are prisoners

of war and may be retained until the end

of hostilities.

• The status of HSLS personnel as either

medical personnel or auxiliary medical

personnel should be determined by the

commander and appropriate

identification cards should be issued in

accordance with DOD directives. These

personnel may be lightly armed for selfdefense and should wear appropriate

markings identifying their status. They

must also refrain from committing acts

harmful to the enemy to retain their

protected status.

• Fixed medical establishments and mobile

medical units may not be attacked under

any circumstances but must, as far as

possible, be situated in such a manner

that attacks against military objectives

cannot imperil their safety. These

establishments and units should be

properly marked and may not be used

in a manner constituting a hostile act.

Medical material and stores may not be

intentionally destroyed unless done so

in the normal course of medical

procedures, such as destroying

medicines that are past their expiration

date.
CHAPTER II

HEALTH SERVICE LOGISTICS CONSIDERATIONS

II-1

1. Health Service Logistics

Support in Joint Operations

Health service logistics is an integral part

of the HSS system. Timely and efficient

HSLS enhances the quality of medical care

delivered on the modern battlefield. The

execution of military missions in today’s

environment usually entails a joint force.

Normally, each Service component is

responsible for providing HSLS to its own

forces for the duration of an operation

unless a SIMLM is appointed by the CINC.

However, even if a SIMLM has been

established to manage and provide Class VIII

support within the AOR, each Service

component remains responsible for providing

Service unique health service logistics items.

2. Planning for Joint Health

Service Logistics Support

a. For the HSS mission to be successfully

accomplished, the appropriate supplies,

maintenance, and transportation resources

must be available. The health service

logistics portion of the HSS estimate and

plan ensures that a thorough and

comprehensive analysis of health service

logistics requirements is accomplished and

incorporated into the overall HSS plan.

Due to the technical nature of HSLS, coupled

with the rapidly changing battlefield, the

health service logistics planner must develop

flexible plans.

b. The health service logistics estimate

and plan are based on the elements in

Figure II-1.

c. To develop a comprehensive plan, the

joint health service logistics planner must

have a thorough understanding of the

operational and tactical plans. He must be

aware of the potential for contingency

missions beyond those for which a published

plan has been developed. These contingency

missions may arise with little or no prior

notice. The HSLS plan must also be

sufficiently flexible to accommodate changes

in the stated mission and desired end state, as

often occurs in MOOTW.

d. The joint health service logistics

planner determines the requirements for:

• Sizes and locations of health service

logistics organizations and installations

required.

• Types of medical supplies needed.

• Supply procedures to be followed.

• Stock levels to be maintained.

• Medical equipment maintenance

procedures.

• Optical fabrication procedures.

“There are no stores, no surgeons, no drugs, and the hammocks are infected

and loathsome, and the men stink as they go, and the poor rags they have

are rotten and ready to fall off.”

Sir John Pennington

Of conditions in the British Fleet, 1626
II-2

Chapter II

Joint Pub 4-02.1

• Procedures for obtaining medical oxygen

and other medical gases.

• Disposal of unserviceable or outdated US

medical equipment and supplies.

• Disposition of captured medical materiel.

• Preventative medicine support for all

phases of the operation.

3. Medical Threat and Medical

Intelligence

a. A significant planning consideration

when developing the HSS estimate and plan

is the medical threat. The medical threat is

a composite of all ongoing or potential

enemy actions and environmental

conditions that may render a Service

member combat-ineffective. The Service

members’ reduced effectiveness results from

sustained wounds, injuries, stress-induced

performance deterioration, or diseases. The

elements of the medical threat include, but

are not limited to:

• Diseases endemic to the AOR.

• Environmental factors (heat, cold,

humidity, and significant elevations

above sea level).

• Level of compliance with the Law of

Land Warfare and Geneva Convention

requirements regarding respect and

Figure II-1. Planning for Joint Health Service Logistics Support

PLANNING FOR JOINT HEALTH SERVICE

LOGISTICS SUPPORT

Concept of the

operation and

commander's

guidance

Availability of prepositioned war

reserves

Type of operation

Expected duration

of the operation

Medical threat in

the area of

operations

Anticipated

number and types

of casualties

Size of the force

to be supported

Theater

evacuation policy

Health Service Logistics

Estimate and Plan
II-3

Health Service Logistics Considerations

protection of medical personnel,

facilities, transportation, and medical

materiel.

• The potential use of weapons of mass

destruction.

b. In developing the HSLS estimate and

plan, the health service logistician obtains

updated medical intelligence through

standard intelligence sources. Medical

intelligence is the product resulting from the

collection, evaluation, analysis, integration,

and interpretation of all available general

health and bioscientific information. Medical

intelligence is concerned with one or more of

the medical aspects of foreign nations or the

AOR. Until medical information is

appropriately processed (ordinarily on the

national level by the Armed Forces Medical

Intelligence Center), it is not considered to be

intelligence.

c. By obtaining medical intelligence and

by studying the medical threat, the health

service logistician can predict, to some

extent, the types of medical materiel that

will be required for the mission. Further,

when this prediction is considered in light of

the casualty estimate, theater evacuation

policy, and anticipated duration of the

operation, the health service logistician can

also forecast the expected quantities of

materiel items that will be required.

4. Joint Operation Planning

and Execution System

The Joint Operation Planning and

Execution System (JOPES) contains

medical planning tools. These tools assist

the HSS planner to determine the gross HSS

requirements based upon variables input by

the planner such as forces-at-risk, casualty

admissions rates, and the evacuation policy.

The module uses these variables to calculate

time-phased requirements for HSS. These

requirements include:

a. Medical treatment facilities (beds and

operating rooms).

b. Whole blood and fluids.

c. Class VIII supplies (by weight).

d. Medical evacuation resources.

5. Time-Phased Force and

Deployment Data

a. Units and cargo deploying to a theater

do so in a time-phased manner. The timephased force and deployment data

(TPFDD) is a computer-supported portion

of the OPLAN; it contains time-phased force

data, non-unit-related cargo and personnel

data, and movement data for the OPLAN,

including:

• In-place units.

• Units to be deployed to support the

OPLAN with a priority indicating the

desired sequence for their arrival at the

POD.

• Estimates of non-unit-related cargo and

personnel movements to be conducted

concurrently with the deployment of

forces.

• Estimate of movement requirements that

must be fulfilled by common-user lift

resources as well as those requirements

that can be fulfilled by assigned or

attached transportation assets.

b. Health service logistics units and their

associated cargo are prioritized for

movement on the time-phased force and

deployment list.

c. To ensure continuous HSLS, the health

service logistician must factor in the

priority of health service logistics unit and

non-unit-related cargo for deployment.
II-4

Chapter II

Joint Pub 4-02.1

This can be accomplished by ensuring that

units deploy with an adequate number of

days’ supply to satisfy requirements until the

non-unit-related medical materiel flow is

established. This is accomplished by ensuring

that units maintain their basic unit load in a

combat-ready state.

6. Transportation

Considerations

The ability to transport needed medical

supplies and equipment to the requesting unit

is an essential part of the HSLS effort. Health

service logistics planners at all echelons

must ensure timely transport and delivery

of Class VIII items. The US Transportation

Command provides strategic lift into the

theater of operations. The health service

logistics planner must ensure that Class VIII

materiel is properly prioritized on the

TPFDD to ensure its timely arrival in the

operational area. The health service logistics

planners within the AOR plan for the

transportation of medical materiel from the

POD to supporting supply facilities and then

on to the requesting unit. Health service

logistics organizations use organic or

assigned vehicles to transport the Class

VIII materiel, however they may require

transportation support from supporting

communications zone (COMMZ) or corps

transportation units. Medical evacuation

vehicles returning to forward areas can

backhaul Class VIII materiel to forwarddeployed units. To retain the protections

afforded under the Geneva Conventions,

medical vehicles can only backhaul medical

materiel. To carry other classes of supply

would jeopardize this protected status.

7. Communications Support

Considerations

See Figure II-2.

In joint operations, the Services must be

able to communicate on a continuous basis;

this is especially true in the HSLS arena.

Interoperability issues must be resolved

early on to ensure that timely and effective

HSLS can be provided. Interoperability issues

include not only hardware systems but also

automated information systems (AIS) used by

each Service.

a. Communications systems used can

range from the simplest form such as a

messenger or liaison officer to sophisticated

satellite communications systems. Regardless

Medical supplies are deployed by use of the medical planning

module, which is an element of JOPES.
II-5

Health Service Logistics Considerations

of the method employed, it must be accessible

to all users and must be able to communicate

the Class VIII requisitions and

requirements from the forward battlefield to

the supporting health service logistics facilities

in the theater of operations and the sustaining

base. Requests should be made via the

joint task force (JTF) common-user

communications infrastructure.

b. Class VIII requisitions must be

processed as expeditiously as possible. The

health service logistician will track the status

of each requisition and, when required, stress

the criticality of the item within the command

structure. Access to the Defense Automatic

Addressing System Office (DAASO), which

is the hub for passing supply requisition files

between the retail and wholesale levels, is

essential and is accessible by the Unclassified

but Sensitive Internet Protocol Router

Network, through the JTF communications

architecture, or through available commercial

communications. Additional information is

provided in Appendix C, “Medical Logistic

Systems for Battlefield Interoperability.”

Figure II-2. Communications Support Considerations

COMMUNICATIONS SUPPORT CONSIDERATIONS

interoperable accessible to

all users

able to

communicate on

a continuous

basis

able to

communicate

requisitions

and

requirements

Hardware Systems/

Automated Information

Systems
II-6

Chapter II

Joint Pub 4-02.1

8. Operational Considerations

in a Nuclear, Biological, or

Chemical Environment

a. The threat and possible use of nuclear,

biological, and chemical (NBC) weapons

requires HSS personnel to protect

themselves, their patients, equipment, and

supplies throughout the operational area. The

threat forces may introduce chemical or

biological agents into MTFs, water sources

or supplies, or foodstuffs. Further, supplies

and equipment can become contaminated and

may be damaged by some chemical agents or

destroyed by nuclear weapons.

b. Health service logisticians must plan

to protect themselves and the Class VIII

supplies for which they are responsible.

Health service logistics planners should plan

on:

• Providing protection of medical units

from NBC contaminants in order to

survive and continue their mission.

• Protecting supplies during shipment and

storage.

• Preventing the spread of contamination

into storage and distribution areas.

• Monitoring exposure of Class VIII

supplies to NBC agents during shipment

to forward-deployed forces.

• Maintaining and enhancing survivability

of vehicles and medical equipment.

• Decontaminating medical equipment.

c. After NBC attacks, each affected unit

must establish an inspection and

decontamination point. The inspection and

decontamination process is conducted in

accordance with the unit’s OPLAN.

9. Overview of Service

Component Health Service

Logistics Systems

a. United States Air Force. During

contingency operations, the United States Air

Force (USAF) uses the medical logistics

(MEDLOG) system, mobile medical

logistics (MOMEDLOG), or medical

logistics, junior (MEDLOG JR) to assist

in medical materiel management.

(MEDLOG JR is a smaller, more

transportable computer system that can

interface with laptop computers;

MOMEDLOG is a laptop version of

MEDLOG with similar capabilities, and is

capable of stand-alone operation, complete

with finance and procurement source

interface.) Contingency hospitals (CHs) are

equipped with a full sized MEDLOG AIS.

The air transportable hospitals (ATHs) are

equipped with MOMEDLOG. The

MEDLOG JR is a simple inventory

management tool that runs on a laptop

computer in a disk-operating system

environment, capable of producing

documents for transmission to a supply

source. Its use is normally restricted to

assemblages other than CHs and ATHs.

Contingency HSLS operations mirror

normal support to peacetime MTFs. Both

the ATH and the MTF health service

personnel have the same health service

logistic mission when deployed. Stored

operating supplies are funded through Air

Force Working Capital Fund (AFWCF)

assets. As issues are processed, the AFWCF

is reimbursed with operation and

maintenance (O&M) funds. USAF

assemblages are normally issued up front

using a line of the USAF O&M funds to

reimburse the AFWCF. Each assemblage

deploys with a set number of days of supply

and will require resupply support before the

SIMLM is in place (if designated). The

AFMLO has the capability of developing Air
II-7

Health Service Logistics Considerations

Force Class VIII sustainment requirements

data for specific operation plans.

Contingency hospitals and ATHs can be

equipped to requisition and receive supplies

in a stand-alone mode from their home base,

another support base, or other source of

supply. A CH or ATH may be designated

as a SIMLM for a particular geographic

area and a temporary period of time. The

designation is specified in the combatant

commander’s OPLAN. Transportation and

communications augmentation must be

provided from within theater to fulfill this

mission.

b. United States Navy. The United States

Navy (USN) operational concept is the same

in peacetime as in war. The USN supply

system is integrated with the DLA supply

system.

• The primary contact points of all forces

afloat, including the casualty receiving

and treatment ships and the hospital ships

(T-AHs), are the Fleet and Industrial

Supply Centers (FISC) and the combat

logistics force (CLF) replenishment

ships. Supply is accomplished on a

requisition demand basis via military

standard requisitioning and issue

procedures (MILSTRIPs). If

designated, a SIMLM manager can

provide medical supply support, if

requested, to forces afloat for common

use, recurring demand-supported

medical materiel items. Assistance, if

requested, can be provided to the T-AH

by the N AVMEDLOGCOM to

obtain nonstandard medical materiel.

• The CONUS MTFs are resupplied

through the FISC, DPSC, and

commercial sources using the MicroMedical Inventory Control System

(MICRO-MICS).

• Outside of CONUS, resupply of MTFs

is provided through the FISC systems

such as either Medical Inventory Control

System, MICRO-MICS, or the Uniformed

Automated Data Processing System and

may interface with the Streamlined

Automated Logistics Transfer System

(SALTS) for transmitting requisitions and

supply status.

• Fleet Hospitals use the Management

Information System called Operational

Fleet Hospital Information System

(OFHIS) for medical resupply and use

the Micro-Shipboard Non-Tactical

Automated Data Processing System

(MICRO-SNAP) for nonmedical

resupply and financial management.

Both OFHIS and MICRO-SNAP have

inventory management capabilities and

operate on stand alone personal

computers (PCs). Resupply for Combat

Zone Fleet Hospitals will be normally

through the SIMLM.

• Hospital ship resupply is provided

through the FISC and CLF ships using

the NAVSUP’s MICRO-SNAP Supply

and Financial Management module,

which interfaces with SALTS. During

contingency operations, the SIMLM may

be able to provide common-use,

recurrent-demand medical materiel

items.

c. United States Marine Corps (USMC).

As a general rule, the USMC requisitions

Class VIII materiel through the same channels

as the other classes of supply. The Supported

Activities Supply System (SASSY) is the

USMC supply system. The authorized

medical allowance list (AMAL) and the

authorized dental allowance list (ADAL) are

listed on the tables of equipment of a Marine

expeditionary force (MEF) in an estimated

worst case scenario through a 60-day period

of combat. AMAL and/or ADAL

requirements for medical and dental battalions

can be task-organized to support the Marine

air-ground task force (MAGTF) mission.
II-8

Chapter II

Joint Pub 4-02.1

• Under normal operating conditions, the

medical logistics company (MEDLOGCO),

supply battalion of the force service

support group (FSSG) can interface with

the US Army MEDLOG battalion

within the operational area.

• The AMAL and ADAL held in support

of an MEF are categorized as either

initial or war reserve. The initial issue

quantities, both equipment and

consumable, are employed by the using

unit in support of peacetime deployments

and training exercises. Use of an initial

issue AMAL or ADAL carries with it

an obligation and responsibility to

replenish and maintain them in a

combat-ready state. The war reserve

AMALs or ADALs are maintained with

the medical logistics companies, supply

battalion, FSSGs, and with the maritime

pre-positioned force squadrons.

• All HSS elements of an MAGTF

deploy (mountout) with equipment

and medical materiel sufficient to

support a projected 15 days

(minimum) of combat operations. The

medical and evacuation sections of the

assault echelon are responsible for

bringing ashore an initial 3 to 5 day

supply of medical materiel. This is

accomplished with mobile loading

vehicles. Equipment and supplies

remaining afloat are transferred to shore

either on a demand basis or scheduled

with ensuing waves of the assault

echelon.

• Resupply under all circumstances is a

command responsibility. Medical

department personnel needing resupply

submit their requirements to the SASSY

management unit (SMU) of the supply

battalion, FSSG. The SMU will process

and pass requisitions if unable to fill the

requirement from its Class VIII

inventory. There are MEDLOGCO

representatives attached to all combat

service support detachments and combat

service support elements, and should be

considered during HSS planning.

d. United States Army. The USAMMA,

a subordinate command of the US Army

Medical Research and Materiel Command,

maintains the Class VIIIa portion of the Army

reserve (AR) materiel in accordance with US

Army guidelines. Class VIIIa war reserve

(WR) requirements are identified through

the Army’s WR automated process.

Methods to fulfill the AR requirements are

refined through a series of conferences with

the combatant commands and their

component commands. The USAMMA has

the capability of developing Army Class VIII

sustainment requirements data for a theater

of operations.

• There are four health service logistics

organizations within the Army structure.

These organizations are the Theater

Medical Materiel Management Center

(TMMMC); the MEDLOG battalion,

forward; the MEDLOG battalion, rear;

and MEDLOG support detachments.

• Requests for Class VIII items at

Echelons I, II, and attached forward

surgical teams in the division is initially

provided by preconfigured push

packages until line item requisition

procedures can be established.

Movement of medical materiel to

forward-deployed units will be

accomplished by ambulance backhaul or

supply point distribution methods.

Resupply of Class VIII items in the

division is accomplished by informal

request of the lower element to the

higher element. For example, the

combat medic is resupplied by the

battalion aid station (BAS), and the BAS

is resupplied by the forward support
II-9

Health Service Logistics Considerations

medical company. Resupply of the

medical companies is performed by the

Division Medical Supply Office

(DMSO).

• The MEDLOG battalion provides

supply, maintenance, and optical

fabrication support to the DMSO and

elements located in the corps and, when

situated in the COMMZ, supports all

medical organizations located in echelons

above corps.

• Health service materiel management is

executed through the use of the Theater

Army Medical Management Information

System.

• In a mature theater, a TMMMC may be

established. It is responsible for the

centralized management of theater-level

HSLS activities. Using automated

systems, the TMMMC manages Class

VIII materiel, contracting services,

and end items. The TMMMC maintains

in-transit visibility, redirects shipments

upon CINC approval, and recommends

theater-wide cross-leveling of Class VIII

assets. If a SIMLM is designated for a

theater of operations, the TMMMC may

be designated.

e. Special Operations Forces. The

commander-in-chief, US Special Operations

Command, is a supporting CINC principally

responsible for providing special operations

forces (SOF) to the geographic combatant

commanders.

• Health service logistics support of SOF

is mission-dependent. The HSLS

requirements are determined prior to

deployment and are integrated into the

OPLAN.

• SOF are responsible for deploying with

sufficient health service logistics

materiel to support their operations

until the supporting HSLS system is

established. Once the HSLS system is

established, SOF will receive support on

an area-support basis.

10. Single Integrated Medical

Logistics Manager

See Figure II-3.

a. When two or more Services are

operating within the CINC’s AOR, a

Service may be designated as the SIMLM.

The SIMLM system encompasses the

provision of medical supplies, medical

equipment maintenance and repair, blood

management, and optical fabrication to all

joint forces within the theater of operations

including, on an emergency basis, USN ships

for common-use items. By exercising

directive authority over the HSLS arena for

the accomplishment of assigned missions, the

CINC can centralize control, reduce

duplication of services, and provide the

support in a more economical and efficient

manner. Further, it is the CINC’s

responsibility to ensure coordination

occurs among the Services HSLS systems,

that critical health service logistics resources

are properly allocated, and that medical

materiel requirements are accurately stated.

The SIMLM assumes responsibility for

planning and executing the HSLS mission

for common-use medical items in that AOR.

b. In the European and Korean theaters, the

US Army has been designated as the SIMLM.

Although the US Army may be designated as

the SIMLM in future missions because of a

larger commitment of ground forces, each

Service should devise plans in the event

they are designated the SIMLM.
II-10

Chapter II

Joint Pub 4-02.1

SINGLE INTEGRATED MEDICAL LOGISTICS

MANAGER (SIMLM)

S

I

M

L

M

medical supplies

medical equipment

maintenance and repair

blood

Management

Optical

fabrication

Centralized

control

reduced duplication

of services

economical and

efficient support

Figure II-3. Single Integrated Medical Logistics Manager (SIMLM)
CHAPTER III

STRUCTURING HEALTH SERVICE LOGISTICS SUPPORT

III-1

1. Transition

Defense Planning Guidance tasks the

Military Services to prepare for major theater

wars and MOOTW. In support of these

operations, the CINC may elect to exercise

combatant command (command authority)

through a JTF. Transitioning from a

peacetime environment to mobilization, to

deployment, to redeployment (Chapter IV,

“Redeployment of Health Service Logistics

in Postconflict Environments”) and to

demobilization will require extensive prior

planning by the CINCs, Military Services,

and the Joint Staff.

2. Combat Service Support

Elements of the US forces must be ready

to deploy with supply stock levels

commensurate with the OPLAN. The

implementation and execution of combat

service support (CSS) functions are the

responsibility of the Services and the

Service component commanders. The

CINC exercises authority for logistics as

specified in Joint Pub 0-2, “Unified Action

Armed Forces (UNAAF).” Normally, this

authority is exercised through subordinate

JFCs and Service and/or functional

component commanders. The CINCs’

directive authority over CSS operations

does not release the Services from their

responsibility to staff, equip, train, and

sustain their own forces. A SIMLM may

be designated to provide centralized HSLS

to all participating Services in the CINC’s

AOR.

3. The Joint Force Surgeon

The CINC may designate a JFS who will

be responsible for preparing and

coordinating HSS within the joint force.

Planning must concentrate on the CINC’s CSS

priorities, deploying force structure, and the

mission. The JFS and his staff should consider

and coordinate the use of all WR assets.

Proper planning will provide the CINC with

a tailorable force, deployment flexibility, and

enhance force closure and sustainment of

operations.

4. Planning Considerations

Prior to Deployment

Notification

a. Health Services Logistics Operations

• Medical Supply Support. Units

deploying to the operational area will

deploy with their authorized or

tailored requirements in accordance

with appropriate Service doctrine. The

Service components are required to

resupply their respective units until the

SIMLM is established and operational.

The CINC ensures that statements of the

assigned forces’ requirements are

prepared and submitted in accordance

with existing directives of the Secretary of

Defense, the Secretaries of Military

Departments, and the Chiefs of the

Services. Stock levels will be consistent

with the nature of the contingency mission,

the medical threat, climate, geography, and

other factors related to the AOR.

“For the accommodation, comfort, and health of the Troops, the hair is to be

cropped without exception, and the General will give the example.”

General Order of the Army

Pittsburgh, 30 April 1801
III-2

Chapter III

Joint Pub 4-02.1

• Single Integrated Medical Logistics

Management. The SIMLM must

recognize and support line item

differences which exist between various

Service medical sets and assemblies. A

consolidated recurring item list will be

developed and maintained for medical

line items required for support to the

Services. This list should be used in

conjunction with the D-Day Significant

Item List, maintained by the DMSB, as

the baseline catalog for support by the

SIMLM. The SIMLM will also serve as

the source of supply for obtaining

nonrecurring requirements, including

Service-unique items. This is necessary

to avoid overwhelming the supply system

with requirements not normally part of a

unit’s authorized allowance list. It is

imperative that unit commanders

exercise supply discipline by ordering

non-standard items on an emergency

basis only. Both push package and pull

supply concepts will be employed in the

resupply of deployed units. Maximum

medical standardization should be an

important part of any joint HSLS plan.

b. Support Considerations

• Refrigeration and temperaturecontrolled requirements. Ensure that

refrigeration and temperature-controlled

storage is available.

• Special handling. Ensure that medical

supplies, such as cylinders containing

oxygen and medical gases, code R items,

blood, and other hazardous materials

requiring special handling are identified.

• Facilities. Facilities for forward medical

logistics units must be planned for during

the initial stages of deployment. These

units require facilities with nearby lines

of communications (LOCs) to establish

full operations. Buildings of opportunity

are the first priority. If buildings are not

available, tentage will have to suffice.

5. Deployment

Deployment is the relocation of forces

and material to desired areas of operations.

Deployment encompasses all activities from

origin or home stations through destination,

specifically including intra-continental US,

intertheater, and intratheater movement legs,

staging, and holding areas (Joint Pub 4-0,

“Doctrine for Logistic Support of Joint

Operations”).

a. Advanced Deployment. As early as

possible (OPLAN-dependent) an advanced

element from the assigned Service HSLS

organization should be deployed into the

theater. This advance element provides a

cadre of personnel who can deploy in advance

of follow-on HSLS forces to arrange and

initiate required support such as, but not

limited to, planning, coordinating, and

implementing line item requisitioning and

status, transportation, distribution,

warehousing, and security. These activities

should be under the supervision of the senior

logistics headquarters in the operational area.

b. Mobility. The HSLS advanced element

should be equipped so that it is 100 percent

mobile to enhance its support mission.

6. Captured Medical Materiel

Captured medical materiel is not to be

used for treatment of US personnel without

specific approval of the command surgeon.

After clearance for safety and potential

military medical intelligence, captured

medical supplies and equipment may be used

to treat enemy prisoners of war (EPWs) and

detainees, and to provide humanitarian

assistance for indigenous populations.

Medical materiel is protected by the Geneva

Conventions from intentional destruction.
III-3

Structuring Health Service Logistics Support

7. Unit-to-Unit Exchange

Within the combat zone, medical units will

normally accomplish a one-for-one

exchange of medical equipment with the

gaining activity at the time of patient transfer.

8. Aeromedical Evacuation

Equipment and/or Patient

Movement Items

See Figure III-1.

The medical equipment and supplies

required to support the patient during

evacuation are referred to as patient movement

items (PMIs). The handling and return of

equipment to the aeromedical evacuation

(AE) system requires a reliable supporting

logistics infrastructure to ensure that PMIs

are available and serviceable. The plan for

a PMI exchange system and the ultimate return

of AE equipment and PMIs to the originating

theater should be addressed in the OPLANs.

a. When a patient requires evacuation, it

is the originating MTF’s responsibility to

provide the PMIs required to support the

patient during evacuation. The PMIs

accompany a patient throughout the chain

of evacuation from the originating medical

unit to the destination MTF, whether it is

an intratheater or intertheater transfer. The

Services will include and maintain initial

quantities of DMSB-standardized PMIs in

the appropriate medical assemblages. They

should not assume or plan for shortfalls of

PMIs being satisfied by PMI centers. The

Services, through the DMSB, will identify

and approve PMI equipment items such as

those currently listed in Appendix A,

“Aeromedical Support Equipment and

Supplies.” Medical equipment for use in

AE must be certified for aircraft use by

the Services’ testing agencies. To reduce

medical equipment shortfalls experienced

within the theater, the JFC must ensure

procedures are established to resupply and

refurbish PMIs.

b. Patient Movement Item System. The

mission of the PMI system is to support intransit medical capability without removing

equipment from patients, to exchange inkind PMIs without degrading medical

capabilities, and to provide prompt

Patient movement items accompany the patient through the

aeromedical evacuation system.
III-4

Chapter III

Joint Pub 4-02.1

recycling of PMIs. The PMI system

comprises the management of PMI

equipment and materiel. The PMI system will

provide seamless in-transit visibility for an

equipment management process from

initial entry to the patient’s final destination,

the patient evacuation system. The Defense

Medical Logistics Standard Support and/or

Transportation Command’s Regulating and

Command and Control Evacuation System

interface will be used ultimately to facilitate

the management of PMIs. The PMI system

will deploy with the AE system, be managed

by the AE system, be supplied through the

normal supply system, and collocated with

the AE theater and/or strategic interfaces in

order to provide initial AE operational

capability, sustainment of AE operations, and

minimize equipment turn around time.

c. PMI Operations. Establishment of

theater PMI centers is the responsibility

of the USAF. Air Force medical units will

be tasked, trained, organized, and equipped

to perform AE missions, including PMI

operations. PMI centers will be established

to support worldwide theater requirements.

PMI centers will be located at POEs and/or

PODs within and outside CONUS to match

AE support plans. PMI centers are

responsible for the overall management, intransit visibility, and tracking of PMIs. PMI

centers will receive, refurbish (includes

technical inspection, calibration, repair, and

provide 3 days of expendable supplies),

redistribute, and return PMIs collected from

MTFs. The USAMMA may be required to

provide the same level of maintenance

support in CONUS if required. PMI centers

can be augmented with personnel and

equipment from the other Services in the

event of surge and sustained requirements.

Service liaison personnel can also be

assigned. At the time an MTF initiates a

patient movement request requiring PMIs,

the PMI center or cell will initiate action for

exchange of in-kind PMIs. The MTFs will

clean the PMI equipment before returning it

to another facility, PMI cell, center, or

transportation point. Intratheater

Figure III-1. Patient Movement Item System

PATIENT MOVEMENT ITEM SYSTEM

supports in-transit

medical capability

provides a

seamless in-transit

patient/equipment

management

process

patient

movement item

centers responsible

for overall

management, intransit visibility, &

tracking

deploys with and is

managed through the

aeromedical evacuation

system and supplied

through the normal

supply system

Patient

Movement Item

System
III-5

Structuring Health Service Logistics Support

movement of PMI equipment is the

responsibility of the CINC, executed by AE

forces.

d. PMI centers incorporate and support

PMI cells. PMI cells are a flexible subset of

the PMI center, capable of establishing a

forward PMI equipment exchange

location. PMI cells will support PMI

exchange as far forward as theater AE patient

movement is approved to operate. PMI cells

will be deployed to forward operating

locations to support one or more forward

medical elements by pushing PMIs to those

locations. These PMI centers and cells will

require base operating support supplied by

local operational support elements. As the

theater matures and a SIMLM is established,

the PMI centers and cells will coordinate

as necessary with the SIMLM to obtain

support in the areas of requisitioning, storage,

maintenance, and battlefield distribution of

PMI-related items. Forward battlefield

distribution and exchange of PMIs will be a

SIMLM or Service responsibility. The plan

for a PMI exchange system and the return of

PMIs to the originating MTF will be

addressed in theater OPLANs.

e. Initial theater PMI requirements will

be supported by deployable modular kits

called patient evacuation contingency kits

(PECKs), to be provided by the PMI centers

and cells. PECKs will augment theater PMI

centers and cells until they are fully

established with their preplanned inventory

levels. A PECK supports the medical

evacuation of 30 patients (see Appendix A,

“Aeromedical Support Equipment and

Supplies,” for contents).
III-6

Chapter III

Joint Pub 4-02.1

Intentionally Blank
CHAPTER IV

REDEPLOYMENT OF HEALTH SERVICE LOGISTICS IN

POSTCONFLICT ENVIRONMENTS

IV-1

1. Redeployment Planning

Redeployment must be planned and

executed in a manner that facilitates the

use of redeploying forces and sustainment

equipment and supplies to meet a new

crisis. In most cases, redeployment is

intertheater or strategic. Redeployment is, in

fact, a new deployment; either back to a unit’s

original home station, or to new duty stations

to meet new crises. (The key to redeployment

is that it should not be considered as a

retrograde movement, but in fact, a new

deployment.) Based on the CINC’s plan, the

Service component commanders issue a

redeployment warning order that conveys

the CINC’s redeployment guidance. This

guidance may include disposition instructions

for Class VIII materiel or for reconstitution

of forces.

2. Joint Force Surgeon

Responsibilities

The JFS must be actively involved in

establishing redeployment policy as it

pertains to medical units. The items shown

in Figure IV-1 are some critical issues that

the HSS planner must consider when

redeploying.

3. Redeployment Phases

During redeployment, contracts for

transportation of materiel and maintenance

can be used extensively to reconstitute the

force. Redeployment is conducted in six

phases shown in Figure IV-2.

“No price is too great to preserve the health of the fleet.”

Lord St. Vincent

Figure IV-1. Redeployment Issues

REDEPLOYMENT

ISSUES

Equipment and supply

disposition 1

Destruction of unserviceable

(non-repairable) or outdated

medical materiel

2

Turn-in and disposition

procedures 3

Role of all Service medical

logistics elements 4

Role of DLA* and Defense

Reutilization Management

Office

5

Transfer of medical items

to foreign military sales

customers

6

Approval for the transfer of

medical items for

humanitarian assistance

7

Disposition of special

equipment items such as

AE** medical equipment

8

Component accountability

procedures 9

* Defense Logistics Agency

** Aeromedical Evacuation
IV-2

Chapter IV

Joint Pub 4-02.1

a. Phase I: Reconstitution for Strategic

Movement. Once the forces move back to

the tactical assembly area, the major focus

should be on rebuilding unit integrity and

accountability to the maximum extent

possible for units, individuals, materiel,

supplies, and equipment. Commander’s

actions include:

• Turn-in of excess Class VIII supplies and

unique medical equipment.

• Reconstitution and/or initial crossleveling of medical materiel.

• Cleaning, repacking, and loading

containers under US Customs and US

Department of Agriculture supervision

(if necessary). Hospital assemblages

should be packed in order to avoid

damage during shipment.

b. Phase II: Movement to the

Redeployment Assembly Areas (RAAs).

Once the medical component is moved into

the RAA, the commander completes the

activities that could not be accomplished

in Phase I, such as washing major end items,

palletizing equipment, and obtaining US

Customs and Department of Agriculture

inspections on all unit equipment.

c. Phase III: Movement to the Port of

Embarkation. Movement to POE may

require a separate, agriculturally sterile

area. Proximity to the loading dock may

reduce and/or eliminate agricultural clearance

compromises.

d. Phase IV: Strategic Lift. The CINC

coordinates the use of land, sea, and air

transportation assets, facilities assigned to the

command, and the use of allocated commonuser resources.

e. Phase V: Reception at the POD.

Commanders should provide advance parties

to coordinate the reception and processing

of redeploying forces and their equipment

at the POD and for the movement to their

follow-on destinations. Onward movement

will heavily involve Military Traffic

Management Command.

f. Phase VI: Onward Movement from

the POD. This phase begins with

reorganization of forces, receipt and repair of

sustainment equipment and supplies, and

Figure IV-2. Redeployment Phases

REDEPLOYMENT

PHASES

Reconstitution for Strategic

Movement

Movement to the

Redeployment Assembly

Areas

Movement to the Port of

Embarkation

Strategic Lift

Reception at the Port of

Debarkation

Onward Movement from the

Port of Debarkation

Phase I

Phase II

Phase III

Phase IV

Phase V

Phase VI
IV-3

Redeployment of Health Service Logistics in Postconflict Environments

movement to designated marshalling areas

outside the processing area, and concludes

with arrival at their destination.

4. Other Redeployment

Considerations

a. Non-unit redeployed equipment and

supplies are redistributed according to plans

developed by the appropriate Service, with

input from CINCs. Priority of effort is

generally given to Service forces

committed to CJCS-approved OPLANs.

Other recipients may include US Army

Materiel Command, DLA, and General

Services Administration distribution centers.

In the redistribution process equipment may

be available for foreign military sales, or a

grant program such as excess defense articles,

to support national interests and policies.

b. The DLA will play a major role

regarding any major redeployment of

medical assets. Unified and component

MEDLOG organizations must coordinate with

DLA representatives in the following ways:

• The Defense Reutilization Marketing

Service. Medical logistics planners

must coordinate with DLA as they

develop redeployment plans and

incorporate disposal support into these

plans.

• The Defense Logistics Agency Depots.

As HSS planners develop plans for

redeployment of medical units, they must

also take into consideration possible

turn-in of excess equipment and return

of medical assemblages to DLA depots.

Procedures for these actions must be

coordinated with the DLA liaison

personnel in the theater or referred for

action to the DLA.

5. Service Responsibility

As an operation nears completion,

medical materiel is often both onrequisition and en route in the distribution

system. The Services will continue to require

supplies, but some categories will not be

required in the quantity that was

requisitioned. The logistics officer, in

coordination with the JFS, the DLA, and the

Services, determines when the supply

pipeline can be shut down. The Services

are responsible for reconstitution of their

In postconflict environments, logistics plans must accommodate

redeployment of medical equipment.
IV-4

Chapter IV

Joint Pub 4-02.1

Service elements used in the operation. The

procedures for redeployment from the

SIMLM are as follows:

a. US Army Redeployment.

Commanders and planners must plan and

execute redeployment in an efficient

manner that facilitates the use of redeploying

units, individuals, and materiel to meet new

crises. Unit integrity should be maintained

to the maximum extent possible. By doing

so, units can be diverted anywhere, ready to

continue the HSS mission. The focus of

individual manpower and materiel

redeployment is total accountability and

efficient handling of all HSS equipment

and medical materiel. The desired end state

after redeployment is the restoration of the

Army’s capability to conduct future

operations.

• In order to conduct an effective and

efficient redeployment operation,

specific units, individuals, and

equipment and supplies must be

identified and allocated to the

operation. The CINC must identify a

structure to support the redeployment

operation.

• Medical care, life support, and other

services, as well as supplies and materiel,

must be provided.

• The redeploying command uses ad hoc

port support teams provided by the

moving units to finalize the preparation

HEALTH SERVICE SUPPORT IN KOREA

At Hagaru-ri, when the casualties started to flow from north and south, C and

E Medical Companies (with a listed bed capacity of 60 each) expanded their

facilities over and over again. C Company, for instance . . . treated 400 patients

simultaneously; E Company handled 600 patients at one time.

SOURCE: After Action Report

1st Marine Medical Battalion In North Korea

November 1950

and loading of vehicles and equipment

for shipment.

• Maintaining unit integrity during

redeployment is as critical to readiness

as it is during deployment. When

possible, containerized unit equipment

will be shipped with the unit’s noncontainerized cargo. This requires intransit visibility of the cargo to facilitate

diversion en route, if required.

b. USAF Redeployment

• Pre-positioned assets (CHs, mobile

aeromedical staging facility, aeromedical

staging facilities, blood donor centers

[BDCs], and blood transshipment

centers [BTCs]) are normally

reconstituted “in-place” unless they

are being deactivated. A complete

inventory is conducted, table of

allowances are validated, and

appropriate records adjusted. Quality

assurance data is collected and recorded.

Requirements are identified “upchannel” for funding if necessary. Items

not in an applicable table of allowance

are segregated and reported as excess.

This work is normally accomplished

prior to redeployment of personnel to

their home stations.

• Mobility assets (ATHs, air transportable

clinics, and transportable blood

transshipment centers [TBTCs]) are

normally redeployed to their home
IV-5

Redeployment of Health Service Logistics in Postconflict Environments

base after a complete inventory and

collection of quality assurance data.

Assets could also be shipped to AFMLO

and/or operating location-2 for

refurbishment. If deployed with

MOMEDLOG and a stock record

account number, all appropriate

transactions (including table of

allowance validation) can be processed

on site. Excess materiel may be

transported to the home station for

final disposition or transferred to the

SIMLM or other authorized activities in

the AOR, as directed by higher

headquarters. The mode of shipment for

redeployment determines packing

methods. Normally, 463L pallets are

used for airlift, and seavans for sealift.

Coordination with the supporting

transportation activity is required. After

the ATH is received at the home base,

requirements are identified for funding

to support reconstitution.

c. USN Redeployment. Upon receipt of

deactivation orders, Navy MTFs discontinue

accepting patients and begin to arrange for

evacuation of patients to an appropriate

facility that can best treat their injuries. Fleet

hospitals will normally be redeployed to a

CONUS location for reconstitution after a

conflict. A thorough identification together

with appropriate packing, labeling,

blocking, and bracing of all appropriate

materiel into International Organization for

Standardization containers is required. All

materiel will not be returned to CONUS. In

making decisions as to what items to retain,

it is imperative to consider the total cost of

an item that must be shipped, refurbished,

repackaged, and redeployed. Assistance

teams will be deployed in theater to

facilitate the deactivation of the hospital and

to work with the hospital staff in providing

for an orderly redeployment of hospital assets.

d. USMC Redeployment. Upon

conclusion of the operation, the

MEDLOGCO commanding officer,

through the chain of command, will request

cancellation of outstanding and/or open

requisitions through the SIMLM. Excess

medical materiel which is on hand or intransit will be evaluated to ensure the most

efficient and effective redistribution plan is

enacted. Existing excesses should be

reported to the in-theater Defense

Reutilization Marketing Office;

consideration should be given to crossleveling medical materiel items with other

medical elements experiencing shortfalls.

Medical materiel which was deployed into

the theater of operations by a MEDLOGCO

and medical and dental battalions will be

retrograded using the same procedures.

Maritime pre-positioning ships’ assets

which were off-loaded and used will be

returned to the maritime pre-positioning force

program. All remaining expired and

nonfunctional medical materiel will be

disposed of in accordance with local laws and

DOD directives.
IV-6

Chapter IV

Joint Pub 4-02.1

Intentionally Blank
CHAPTER V

HEALTH SERVICE LOGISTICS SUPPORT IN MILITARY

OPERATIONS OTHER THAN WAR

V-1

1. Military Operations Other

Than War

MOOTW encompass a wide range of

activities where the military instrument of

national power is used for purposes other than

the large scale combat operations normally

“Generally, management of the many is the same as management of the

few. It is a matter of organization.”

Sun Tzu, The Art of War

400-320 BC

associated with war. There are six joint

principles which apply to MOOTW, and the

medical commander and the health service

logistics planner must use these principles to

guide the planning and execution of the HSS

mission. These principles are shown in Figure

V-1 and discussed below.

Figure V-1. Principles of Health Service Logistics Support in

Military Operations Other Than War

PRINCIPLES OF HEALTH SERVICE

LOGISTICS SUPPORT IN MILITARY

OPERATIONS OTHER THAN WAR

Principles of Health

Service Logistics

Unity of

Effort

Restraint

Objective

Security

Legitimacy

Perseverance
V-2

Chapter V

Joint Pub 4-02.1

a. Objective. The HSS commander

directs every HSS mission toward a clearly

defined, decisive, and attainable objective.

The military effort must be integrated into

the total effort in achieving strategic aims and

culminating in the desired end state. The

joint health service logistics planner must

understand the strategic, operational, and

tactical aims, set appropriate objectives, and

execute the HSLS mission in consonance with

the HSS portion of the OPLAN.

b. Unity of Effort. The joint health service

logistics planner must seek unity of effort

toward every objective. This entails

ensuring that close coordination is maintained

with all Service participants in the HSLS

arena, as well as other US agencies, allied and

coalition forces, host nation (HN),

nongovernmental organizations (NGOs), and

religious groups. Health service logistics

planning must address the military

contribution to MOOTW initiatives that are

political, economic, psychological, and

military in nature.

c. Legitimacy. Legitimacy involves

sustaining the people’s willingness to accept

the right of the government to govern or of

a group or agency to make and carry out

decisions. For example, in nation assistance

programs, HSS operations should not

undermine the confidence people have in their

nation’s government. HSS operations

should complement, not detract from, the

legitimate authority of the HN government.

US forces are also concerned with the

legitimacy issue when involved with foreign

interventions. Due to its acceptance by the

civilian population, HSS can assist in

mitigating the adverse impacts that other US

military interventions may cause in a region.

d. Perseverance. In MOOTW, strategic

goals may be accomplished by long-term

involvement, plans, and programs. Short

duration operations will occur, but these

operations must also be viewed as to their

impact on the long-term strategic goals.

Therefore, HSS planners must prepare for the

measured, protracted application of

military HSS to support the desired end state.

e. Restraint. MOOTW place constraints

on the potential actions that can be

undertaken to achieve military objectives.

The rules of engagement (ROE) governing

these actions reflect those constraints.

The health services logistics planner must ensure that adequate personnel

and materiel are available to provide necessary health services.
V-3

Health Service Logistics Support in Military Operations Other Than War

Imprudent action outside of the ROE may,

in fact, have a detrimental effect on the

attainment of strategic goals and objectives.

All forces participating in these types of

operations must incorporate restraint and

adherence to established ROE, laws,

regulations, policies, and norms to ensure the

furtherance of the mission accomplishment.

f. Security. The security of US forces

abroad is paramount. Commanders and

planners at all echelons must be aware of the

ever present danger that can exist from various

groups, factions, or other governments. Even

in a peacetime environment, US forces can

be targeted for terrorist activities. Health

service logistics planners must ensure they

include force security measures as well as

security measures for safeguarding health

service logistics materiel from contamination,

destruction, or theft.

2. The Role of Joint Health

Service Logistics

a. Health service logistics plays a

significant role in the delivery of health care

in MOOTW. As most MOOTW missions

are conducted within an immature theater or

under disaster conditions, the full complement

of logistics capabilities and services may not

be in place or may have been destroyed. The

health service logistics planner must be

flexible and innovative to be able to bridge

the gap between the requirements generated

by the operation and the capability to provide

the necessary Class VIII materiel.

b. Each Service should deploy with an

adequate number of days’ supply of health

service materiel to accomplish the mission

until push package resupply or a line item

requisition support is established.

c. To ensure that the correct mix of

pharmaceuticals and equipment are available

for the mission, the health service logistics

planner must maintain close coordination

with the clinicians.

3. Operational Missions

HSLS can provide traditional logistic

support to deployed forces or may be

incorporated into OPLANs for other types

of operations shown in Figure V-2.

a. Prior to a deployment on a

noncombatant evacuation operation

(NEO), the senior medical person

accompanying the force should be provided

information by regional CINC or major Army

command level personnel (such as a Country

Team) to determine if there are any special

medical supply or equipment requirements.

These items could include pediatric or

geriatric medicines and medical equipment,

depending on the composition of the

evacuees. Under most circumstances, the

Class VIII supplies and equipment the

force brings with them is all that they will

have to sustain themselves and the evacuees.

In a permissive NEO, it may be possible to

obtain more medical supplies or equipment

Figure V-2. Selected Types of

MOOTW Operations

SELECTED TYPES

OF MOOTW

OPERATIONS

!

!

!

!

Noncombatant evacuation

Humanitarian assistance

Nation assistance

Peace operations
V-4

Chapter V

Joint Pub 4-02.1

locally; however, these supplies and

equipment must meet stringent US

requirements. Further, caution must be used

when acquiring medical equipment locally,

as the equipment may not be approved for

use on USAF aircraft.

b. In disaster relief operations, the

management of Class VIII materiel is

critical to the successful completion of the

mission.

• An assessment of the disaster area (to

include coordination with other agencies

or countries providing assistance) must

be accomplished to determine how

many victims requiring assistance there

are and what types and quantities of

supplies and equipment are required and

whether the materiel is currently

available or anticipated to be donated.

• The JTF commander may taskorganize an HSLS element to provide

for the management, receipt, sorting,

storage, repackaging, distribution, and

accounting for donated medical supplies

and equipment. This task-organized

element would further be responsible

for the requisition, receipt, and

accountability of Class VIII resources

which are required but cannot be met

through donated materiel.

c. In humanitarian assistance operations,

the health service logistics planner must

obtain and coordinate transportation and

receive, sort, store, and distribute Class

VIII materiel. Depending upon the scope

of the operation, there may also be donated

medical supplies which must be handled,

stored, repackaged, and distributed. Due

to the remote locations of many

humanitarian assistance missions,

transportation of medical personnel and

medical materiel is critical to the successful

completion of the missions.

d. In nation assistance operations, health

service logistics personnel can assist an HN

by conducting an assessment of the military

or civilian medical supply infrastructure

and industry. In many countries, a formal

health service logistics system does not exist

or is rudimentary in nature. Health service

logistics personnel can provide an analysis,

assist in establishing a system, and provide

training in materiel handling, storage, and

distribution techniques.

e. In peace operations, the HSLS mission

is more the traditional support to a

deployed force. Due to the austere staffing

and troop ceilings placed on many of these

missions, the health service logistics element

may be restricted in size. Other than the

strategic delivery of materiel, the functions

of receiving, storing, accounting for,

requisitioning, repackaging, optical

fabrication, and managing blood and blood

products may be accomplished in another

country or safe haven.

4. Domestic Support

Throughout the history of the United

States, military personnel have been called

upon to provide assistance to federal, state,

and local governments during times of need.

This assistance can take the form of disaster

relief as occurred following Hurricane

Andrew in 1992, community assistance,

environmental assistance, and law

enforcement support. Because the laws

governing military assistance to state and

local governments and agencies are complex,

the commander receiving the request for

assistance should review it cautiously and

obtain an opinion from the support staff judge

advocate.

a. Humanitarian assistance includes

those disaster and civil defense activities,

functions, and missions in which the

Department of Defense has legal authority
V-5

Health Service Logistics Support in Military Operations Other Than War

to act. The Department of Defense provides

disaster assistance to states, the District of

Columbia, and US territories and possessions.

Assistance is based upon requests from civil

authorities and usually as a result of natural

or manmade disasters, such as hurricanes,

earthquakes, or massive explosions. Public

Law 93-288 (as amended) is the authority

for the Federal Response Plan. The

emergency support function (ESF) #8 is the

Health and Medical Services Annex of the

Federal Response Plan. The purpose of this

function is to provide US Government

assistance to supplement state and local

resources in response to public health and

medical care needs following a significant

natural disaster or manmade event. The

assistance provided under ESF #8 is directed

by the Department of Health and Human

Services (DHHS) through its executive agent,

the Assistant Secretary for Health.

• In civil emergencies, the principal

interface for the Department of Defense

will be with the Federal Emergency

Management Agency, the DHHS

regional coordinators, and the state’s

medical and health coordinators.

• At the onset of the operation, criteria for

eligibility for care must be established,

an assessment of the assistance needed

must be conducted, the duration of the

operation must be estimated, and the end

state of transitioning control back to the

civil authority planned. In the HSLS

arena, a determination must be made of

what supplies and services are

reimbursable and what governmental

agency or organization is responsible for

this reimbursement.

• Depending on the magnitude of the

disaster, the local civilian hospitals and

other medical resources may be

overwhelmed. In the event the

community’s medical infrastructure is

not sufficient to handle the emergency,

the NDMS may be activated. The

NDMS is a nationwide network of over

100,000 nonfederal acute care hospital

beds. Other in-place resources to execute

relief operations include communications

networks, transportation systems, and

medical regulating systems. The

national medical mutual aid response

network provides disaster medical

assistance teams, available military

medical units, and supplementary

medical supplies and equipment.

b. HSLS to the other categories of

domestic support are limited. Support

would normally be only that which is required

for the deployed military personnel

participating in the operation.

c. Refer to Joint Pub 3-07.7, “Joint Tactics,

Techniques, and Procedures for Domestic

Support Operations,” for an in-depth

discussion of domestic support operations.

5. Funding

A significantly important aspect of

conducting MOOTW missions is the funding

mechanism for the operation. Funding can

come from a variety of sources, such as

internal DOD sources, funds approved by

Congress for a specific operation, other US

governmental agencies, international

governments or organizations, and NGOs (to

include charitable and religious groups). The

health service logistics planner must ensure

that he is knowledgeable of the funding and

reimbursement mechanisms of the specific

mission before obligating funds for health

service materiel purposes.

6. Planning Considerations

See Figure V-3.

Planning for MOOTW uses the same

planning process as that of any military

operation. The health service logistics
V-6

Chapter V

Joint Pub 4-02.1

planner, however, must use innovative

thinking and incorporate flexibility into the

HSLS plan to ensure responsive support in a

challenging and possibly novel environment.

a. The type and duration of the

operation will influence the composition of

the health service logistics element, the types

and quantities of medical materiel required,

and the level of development of the HSLS

system facilities. Further, troop ceiling

limitations may also restrict the number of

HSLS personnel in the operational area.

b. In many developing countries,

obstacles to rapid and efficient

transportation may present unrecognized

challenges. The HSLS planner must consider

existence and capabilities of port facilities

(such as depth of the harbor, availability of

materials handling equipment, or refrigerated

storage capabilities) and the state of

development of the country’s road network.

Many developing countries do not have

extensive improved roadways and, as the

operation moves away from populated areas,

the road networks deteriorate or cease to

exist. In humanitarian assistance and disaster

relief operations, it often requires

nontraditional approaches to maintain a

continuous flow of medical materiel into

isolated areas.

Figure V-3. Planning Considerations

PLANNING CONSIDERATIONS

Type and

duration of

operation

Obstacles to

rapid and

efficient

transportation

Diverse

ethnic,

cultural, and

religious

practices

Sources of

support

Endemic

diseases, poor

sanitary

conditions

PLANNING

CONSIDERATIONS

Increased

exposure to

disease in

developing

countries
V-7

Health Service Logistics Support in Military Operations Other Than War

c. Due to the prevalence of endemic

diseases, poor sanitary conditions, and

increased exposure to disease in developing

countries, HSLS must closely coordinate

with medical treatment elements to ensure

that appropriate quantities and types of

medicines needed to counter the threat are

available.

d. Diverse ethnic, cultural, and religious

practices challenge the HSLS planner to

be cognizant of the sensibilities of the

population supported in the health service

logistics area.

e. Other sources of support should be

considered by the HSLS planner. This

support may come from the other federal

agencies, allied or coalition forces, or the

HN. Due to stringent federal regulations

concerning drug standards and the highly

sophisticated technology of medical

equipment, the availability of this type of

support may be limited.
V-8

Chapter V

Joint Pub 4-02.1

Intentionally Blank
CHAPTER VI

BLOOD MANAGEMENT

VI-1

SECTION A. THE ARMED

SERVICES BLOOD

PROGRAM

1. General

Established by the ASD (HA), the Armed

Services Blood Program (ASBP) provides

transfusion products when required to US

forces worldwide. Tri-Service cooperative

efforts between the US Army, Navy, and Air

Force enable blood and blood products to be

collected, tested, processed, and shipped to

“Blood is the price of victory.”

Clausewitz

On War, 1832

military MTFs throughout the world. The

planning and execution for the effective

management of blood and blood products

is a continuing, dynamic process requiring

a coordinated, highly responsive system that

extends from CONUS to the battlefield. The

various aspects of this coordination are

depicted in Figure VI-1.

2. Armed Services Blood

Program Office

The Armed Services Blood Program Office

(ASBPO) (Figure VI-2) is chartered by the

Figure VI-1. The Armed Services Blood Program

THE ARMED SERVICES BLOOD PROGRAM

Military

Departments

DOD Health Affairs

OASD (HA) Policy

Civilian

Blood Agencies

Military Blood

Research

Laboratories

Federal

Agencies

Armed Services Whole

Blood Processing

Laboratories

Allied Blood

Programs

Defense Medical

Standardization

Board

ASBPO

The Joint Staff J-4

(MRD) Operations

Unified Command

JBPOs

Armed Services Blood Program Office

Department of Defense

Director for Logistics, Joint Staff

Joint Blood Program Office

Medical Regulating Division

Office of the Assistant Secretary of Defense (Humanitarian Assistance)

ASBPO

DOD

J-4

JBPO

MRD

OASD (HA)
VI-2

Chapter VI

Joint Pub 4-02.1

Department of Defense to coordinate the

provision of blood products throughout the

Services to meet medical requirements

during national emergencies and overseas

military operations. The ASD (HA) will

provide overall policy guidance in blood

program matters.

These programs shall adhere to ASD (HA)

policies, and meet the Food and Drug

Administration (FDA) regulations published

in the Code of Federal Regulations and Army

Field Manual 8-70, NAVMED P-5120, AFI

160-11, and follow the procedures of the

American Association of Blood Banks

(AABB) as established in Army Technical

Manual 8-227-3, NAVMED P-5101, AFM

160-50. The Chairman of the Joint Chiefs

of Staff reviews and provides guidance on

all matters pertaining to blood support in

joint operation planning and execution as

well as activation of the ASBPO in

contingency and war. The ASBPO

coordinates implementation of the ASD (HA)

policies and DOD procedures for the ASBP.

The ASBPO is under the policy guidance of

the ASD (HA). The ASBPO:

a. Coordinates and monitors the blood

programs of the US Army, Navy, and Air

Force and that of each geographic combatant

command.

b. Coordinates standardization of policies

through the ASD (HA) for the collection of

blood and the operation of the Services’ blood

programs.

c. Coordinates the development and

submission of specifications on the essential

characteristics of required blood program

equipment to the DMSB.

d. Performs liaison with other federal,

civilian, and allied and coalition agencies

concerning blood-related matters. The

Secretary of the Army shall provide

appropriate support personnel, facility, and

budgetary resources as required to ensure that

the responsibilities of the ASBPO can be

properly discharged.

e. Directs the Services, upon mobilization

or during periods of increased blood needs

for contingency operations, to meet required

Figure VI-2. The Armed Services Blood Program Office Organization and Coordination

THE ARMED SERVICES BLOOD PROGRAM

OFFICE ORGANIZATION AND COORDINATION

Deputy Director

(Modernization)

Armed Services

Blood Program

Office Director

Deputy Director

(Operations)
VI-3

Blood Management

quotas of blood or blood products to be

shipped to designated Armed Services Whole

Blood Processing Laboratories (ASWBPLs).

3. Service Blood Programs

The US Army, USN, and USAF maintain

separate blood programs to meet normal

peacetime requirements. To meet ASBP

contingency requirements, the Services direct

expansion of their BDCs to rapidly expand

their blood collecting capabilities. Additional

responsibilities of the Services with regard to

the ASBP are described in DOD Directive

6000.12, “Health Services Operations and

Readiness,” and DODI 6480.4, “Armed

Services Blood Program (ASBP) Operational

Procedures.”

4. Geographic Combatant

Commands

Each geographic combatant command

maintains a separate integrated system for

providing blood products to the various

Service components’ MTFs within the

CINC’s AOR. The geographic combatant

command Joint Blood Program Office

(JBPO) serves as the overall blood manager

within each command. In support of

geographic command OPLANs, the ASBPO

establishes shipment requirements for

liquid and frozen blood products from

CONUS ASWBPLs to the respective

geographic commands. Frozen blood

products can be pre-positioned in designated

geographic combatant commands to augment

blood requirements during the initial days of

an armed conflict.

a. Joint Blood Program Office. The

JBPO is under the staff supervision of the

combatant command surgeon. This office is

responsible for the joint blood program

management in the theater of operations.

The organization of the JBPO depends on the

overall command mission. Personnel are

assigned from all Service components as

necessary to meet the blood operational

requirements. The JBPO:

• Advises the geographic combatant

commander on all matters pertaining to

theater blood management activities.

This shall include the development of the

concept of operations for the blood

program and the writing of the supporting

OPLANs using command mobilization

planning factors. Mobilization planning

factors will include the establishment and

coordination of Area Joint Blood

Program Office (AJBPOs) as necessary.

• Ensures ASBP policies are followed by

evaluating BDCs and Blood Product

Depots (BPDs) to ensure compliance

with policies, standards, and regulations

Efficient blood management and distribution often

is the difference between life and death in the field.
VI-4

Chapter VI

Joint Pub 4-02.1

of the ASBPO, the FDA, and the AABB.

• Provides managerial and technical

oversight of all DOD military blood

activities within the AOR, to include the

coordination of Service component blood

programs, blood product requirements,

and capabilities within the theater of

operations.

• Maintains direct liaison with the

ASBPO.

• Plans and executes Joint Blood

Program exercises.

• Evaluates the AJBPO, BDC, BPD,

BTC, and blood supply units (BSUs)

to ensure that personnel, equipment, and

resource requirements are addressed in

the geographic combatant command

OPLANs.

b. Area Joint Blood Program Office.

The combatant command surgeon may direct

the establishment of AJBPO to provide

regional blood management in the theater.

The AJBPO may be established upon

activation of a JTF as outlined in the

respective OPLAN or operation order. The

functions of an AJBPO are similar to a

JBPO, but in a limited geographical area.

The AJBPO:

• Coordinates blood requirements and

distribution of blood and blood

products to support all the BSUs and

MTFs in the AJBPO area regardless of

Service component. This includes

defining the distribution system for blood

and blood products at all echelons, from

the supporting BTC or BSU down to the

MTF.

• Evaluates BDC, BPD, BTCs, BSU, and

MTF transfusion services within the

operational area to ensure the

requirements of the JBPO are supported or

addressed in the geographic combatant

command and/or JTF OPLAN.

SECTION B. BLOOD

SUPPORT IN THE

CONTINUUM OF CARE

5. Blood Distribution System

Blood and blood products are more than

just another commodity of medical supply.

Blood is a live tissue and, as such, requires

handling by individuals specially trained

in blood movement and storage.

a. Blood support in a theater of operations

containing actual combat operations is a

dynamic and ever-evolving process, heavily

influenced by:

• Stringent storage and handling

requirements.

• Inventory management constraints.

• Limited potency periods.

• Available technology.

b. To be successful, blood support must

be an organized and cooperative effort on

the part of health service logisticians,

laboratory and blood bank personnel,

transportation personnel, and primary health

care providers.

c. Theater blood support during

wartime is provided to US military facilities

and, as directed, allied and coalition military

and indigenous civilian medical facilities.

Service components under the geographic

combatant commands maintain individual

peacetime blood programs to meet their

individual needs. These programs interface

with CONUS blood bank services and receive

blood components directly from established

DOD joint programs.
VI-5

Blood Management

d. Theater blood support may consist of

a combination of liquid and frozen blood

components. The actual ratio of liquid to

frozen blood components is determined by the

urgency of need and availability of resources

within the theater of operations to handle

frozen blood.

e. Blood services in a theater of

operations containing actual combat

operations consist of a combination of

operational capabilities. Of importance are

the following:

• Receiving blood components from the

supporting base.

• Moving, storing, and distributing blood

components to primary users.

• Storing, processing, and distributing

previously frozen blood components prepositioned within the theater.

• Collecting and processing blood in the

theater of operations. (This may be

accomplished on a routine or an

emergency basis depending on the

combat intensity.)

f. T h e Armed Services Blood

Distribution System from the supporting

base to the MTF is depicted in Figure VI-3.

A JBPO or an AJBPO will be responsible

for the Joint Blood Distribution System

within their geographic area. The JBPO

works for the geographic combatant command

surgeon. The AJBPO, when formed, may

work for the JTF surgeon of a subordinate JTF

or for a component command surgeon. The

AJBPO mission is based on a geographic area

as well as a specific command. Therefore,

AJBPO shall plan and train for joint

operations and shall coordinate with the

JBPO for all blood operations. Geographic

combatant command, subunified command

and JTF OPLANs will include projected

blood requirements developed by JOPES.

These requirements are documented in

Appendix 2 of Annex Q, “Medical Services

to the Unified Command” OPLAN as

prescribed in CJCSM 3122.03, “Joint

Operation Planning and Execution System,

Vol II: (Planning Formats and Guidance).”

g. MTFs will:

• Maintain an amount of blood products

on hand necessary to meet operational

requirements, yet minimize waste due

to out-dating. MTFs have the capability

to collect blood in emergencies. This

practice is not encouraged, however,

since the MTF does not have the

capability to perform serological testing

of these units for infectious diseases. A

sample of serum must be kept of all

emergency donations for retrospective

testing purposes. In addition, the

attending physician must certify in

writing that the use of blood not fully

tested is required to sustain the life of the

patient.

• Submit a daily blood report

(BLDREP) (Appendix B, “Blood

Management”) to their supporting

BSU, as designated by the JBPO or

AJBPO. This BSU may be from any

Service component. In certain joint

operations, such as small contingency

operations or in MOOTW, MTFs may

deploy with blood if a requirement to use

blood prior to establishment of the

resupply chain is anticipated. In this case,

the ASBPO should be notified to

coordinate the provision of the necessary

blood products.

h. A BSU can usually support a

maximum of 12 MTFs depending on the

situation, and may include forces afloat. The

mission of the BSU is to collect blood on an

emergency basis and receive, perform limited

testing, store, process, and distribute blood

products to its supported MTFs. A BSU:
VI-6

Joint Pub 4-02.1Figure VI-3. Armed Services Blood Distribution System

ARMED SERVICE BLOOD DISTRIBUTION 

US Army

Blood Donor Center

US Air Force

Blood Donor Center

US Navy

Blood Donor Center

Civilian

Blood Donor Center

Joint

Staff

Armed Service Blood

Program Office

Armed Services Whole

Blood Processing

Laboratory

Unified Command

Joint Blood

Program

Office

Area Joint Blood

Program Office

Blood Transshipment

Center

Transportable Blood

Transshipment Center

B

C

Blood

Produc

Depot

US Army, Air Force,

and Navy Blood

Program Offices

COORDINATION

BLOOD FLOW

REPORTS

Supporting Base Theater of

Operations
VI-7

Blood Management

• Is responsible for maintaining a

minimum of a 5-day supply of blood

products based on MTF BLDREP

requirements.

• Is deployable with blood products when

the operation involves immediate

conflict.

• Is tailored to force packages for

contingency operations.

• Can be tasked by the geographic

combatant commander to manage a BPD.

• Can be tasked by the senior medical

authority to collect, process, store, and

distribute platelets within a theater.

• Can provide a consolidated BLDREP

(from its MTFs) to the AJBPO.

i. The BPDs have been built into

geographic combatant commands to

provide storage for frozen RBCs and FFP.

(Frozen platelets have not been licensed by

the FDA. Once this product is licensed, it

may also be stored in BPDs.)

• Blood product depots:

•• Are needed to offset strategic

shortages of blood products during the

initial stages of an operation until the

liquid RBC units can be shipped into the

theater.

•• Provide frozen blood products to ships

offshore.

•• Have the capabilities to distribute

frozen products as well as to

deglycerolize frozen RBCs.

•• Issue blood and blood products to

BSUs, as required.

•• Act as a BSU and distribute blood and

blood products to MTFs.

•• Provides daily BLDREP to their

respective AJBPO or JBPO, when

operational.

• Geographic combatant commands are

responsible for ensuring that BPDs are

maintained, manned, equipped, and

supplied during peacetime operation.

j. The BTCs and TBTCs are managed

by the USAF at primary airfields within

the operational area. They receive blood

products from the ASWBPL, store them, and

re-ice and distribute them to BSUs or MTFs

when required. They provide daily

BLDREPs to their respective AJBPO or

JBPO. The TBTCs may be airlifted to

designated airports or landing zones to

maximize blood distribution and to provide

for BTC operations not otherwise available

in the theater.

NOTE: Assets to meet anticipated EPW,

civilian, and valid allied or coalition personnel

workload must be included in the TPFDD as

documented in accordance with CJCSM

3122.03, “Joint Operation Planning and

Execution System, Vol II: (Planning Formats

and Guidance).” Additionally, a 5-day safety

factor will normally be added to the blood

requirements in combat zone, operations zone

I to take into account LOCs disruption,

damage, and in-transit spoilage.

6. Available Blood Products By

Echelon

Figure VI-4 provides a summary of the

blood products now available to the theater,

as well as the echelon at which they are

provided.

a. The storage temperature for liquid

RBCs is 1 to 6° Centigrade (C).
VI-8

Chapter VI

Joint Pub 4-02.1

b. The storage temperature for frozen

RBCs is -65°C or colder. Once frozen blood

has been deglycerolized, it can be stored up

to 3 days at 1-6°C prior to transfusion.

c. Fresh frozen plasma is stored at -18°C

or colder. Once FFP is thawed, it must be

transfused within 24 hours.

d. Platelet concentrates are normally kept

at room temperature, 20-24°C.

e. Frozen blood shelf life has been

licensed by the FDA for 10 years and 24 hours

post thaw. However, the DMSB allows for

21 years/3 days post thaw for wartime

requirements.

7. Blood Transfusion Practice

By Echelon

Figure VI-5 provides the blood products

available by echelon as well as the blood

typing system (ABO) and Rhesus (Rh) factor

group for each echelon.

SECTION C. PLANNING FOR

EFFECTIVE BLOOD

MANAGEMENT

8. Coordination

Continuous planning for mobilization

and other contingencies enables the Services

to rapidly respond to situations requiring

blood support.

Figure VI-4. Blood Products (Class VIIIb) Available to the Theater

BLOOD PRODUCTS (CLASS VIIIb) AVAILABLE TO THE THEATER

PRODUCT UNIT

OF

ISSUE

SHELF

LIFE FOR

STORAGE

ECHELON

AVAILABILITY

DISTRIBUTION

O A B AB

RBCs APPROX

250ml

35 DAYS

(42 DAYS

WITH ADSOL)

II

III & IV

100%

50%

---

40%

---

10%

---

---

FROZEN

DEGLYCEROLIZED

RBCs

APPROX

250ml

21 YEARS III & IV 100% --- --- ---

FFP APPROX

250ml

1 YEAR III & IV --- 50% 25% 25%

PLATELET

CONCENTRATE

APPROX

300ml

5 DAYS III & IV 50% 50% --- ---

LEGEND: APPROX-APPROXIMATELY

 ml-MILLILITERS
VI-9

Blood Management

Figure VI-5. Blood Transfusion Practices by Echelon

BLOOD TRANSFUSION PRACTICES BY ECHELON

ECHELON BLOOD

PRODUCT

ABO & Rh

GROUP

TRANSFUSION

SERVICE

STORAGE

CAPACITY

BLOOD

RESUPPLY

I NONE --- --- --- ---

II RBCs

Rh+-

O ABO GROUP

DONOR

RBCs**

50 UNITS PER

MED FLD

REFRIGERATION

III

BLOOD

SUPPLY

UNITS (BSU)

III

D304(1)*

RBCs

Rh+-

O,A,B ABO & Rh 480 UNITS

LIQUID

III

BSU

MAJOR SIDE

CROSSMATCH

(IS)

III

D304(2)*

RBCs O,A,B

Rh+-

SAME AS

D304

475 UNITS

FZ

480 UNITS

LQ

III

BSU

FRESH

FROZEN

PLASMA (FFP)

A,B,AB

Rh+-

NONE 20 UNITS III

BSU

PLATELET

CONCENTRATE (AS

NEEDED)

O,A

Rh+-

NONE 5 UNITS III

BSU

UNITS

IV SAME AS

D404

SAME AS

D404

SAME AS

D404

SAME AS

D404

IV

BSU

*CAPABILITY TO COLLECT AND PERFORM THE ABO AND Rh GROUP DETERMINATION ON 180

UNITS OF WHOLE BLOOD FOR EXTREME EMERGENCIES.

**NOT NECESSARY IF ASWBPL HAS VERIFIED THE ABO GROUP.

NOTE: (1 )D304 IS A LIQUID-ONLY DEPMEDS MODULE.

 (2) D404 IS A HYBRID LIQUID-FROZEN DEPMEDS MODULE.
VI-10

Chapter VI

Joint Pub 4-02.1

a. A coordinated effort between the theater

JBPO and the theater operations officer and

plans officer is required for successful planning.

Operation plans dictate blood management

strategy. Some issues include:

• Will blood be required immediately upon

arrival of the combat units?

• Should blood be brought into the AOR

with the initial medical units?

• Will there be multinational operations

and will the JBPO be responsible for

blood requirements of multinational

forces?

• Do the storage capabilities of the BTCs

and/or TBTCs, BSUs, and BPDs support

the blood product requirements?

• Will BPD and/or MTF capabilities to

deglycerolize frozen RBCs meet blood

requirements prior to shipments of liquid

RBCs from the supporting base?

• Are transportation assets readily available

for emergency blood product

distribution?

• Where will the air terminals be located?

b. Location of BTCs is dependent upon

the location of air terminals and

operational necessity. Blood storage

capability at a BTC is usually 3,600 to 7,200

units. With additional personnel and

equipment, this may be expanded to meet

overall command requirements. BTC

personnel must have knowledge of the

available Army blood bank platoons, BSUs,

and the types and locations of the MTFs in

the combat zone for proper planning.

c. Timely communication with the next

higher echelon of support usually ensures that

adequate supplies of blood and blood products

are available.

9. Blood Planning

a. Product Availability. Liquid RBCs and

FFP are available for use. Frozen platelet

concentrates are not yet available, and it is

difficult to provide liquid platelet concentrates

to the AOR within the current 5 day dating

period.

b. Shipping Red Blood Cells. Subject to

availability, RBCs shipped from CONUS are

packed with the unit group and type

distributions as depicted in Figure VI-6.

c. Blood Planning Factors. Blood planning

factors are programmed in the medical

planning module by the Joint Data Systems

Support Center and subsequently used by the

respective combatant command medical

planners to generate daily blood product

requirements (Class VIIIb) for the theater of

operations. Generally, 20 percent of all RBCs

will be given at Echelon II, 60 percent at Echelon

III, and 20 percent at Echelon IV.

d. Blood Support to Rh Patients

• Females. Transfusing Rh positive

RBCs to Rh negative females at

Echelon II facilities, where blood

grouping and typing capabilities are not

available, may result in future

complications if the female is of childbearing age.

• Males. Although the impact of

sensitization on males and the health care

system is not as great, the procedural

changes for transfusions at Echelon II

will also help to reduce sensitization to

Rh negative males.

e. Total Blood Product Requirements.

Initial blood planning factors to determine the

estimated total blood product requirements

for the theater of operations as established in

the geographic combatant commander’s

OPLAN are listed in Figure VI-7.
VI-11

Blood Management

f. Pre-positioned Frozen Blood

Products. Pre-positioned frozen blood

products or blood shipped from CONUS will

reduce the requirements to collect blood in

the operational environment. Capabilities

to collect and process blood in the theater

are limited, but when required, may provide

platelets. Theater collection capabilities exist

at DEPMEDS-equipped Echelon III MTFs

(180 units) and at certain BSUs, BPDs, and

USN vessels. This capability is not meant to

supply local needs. The health service

logistics planner must realize that Echelon II

and III facilities generally do not have the

personnel, supplies, or equipment for

extended donor operations or for serological

testing for diseases such as human

immunodeficiency virus, hepatitis, and

syphilis.

g. Armed Services Blood Program

Office Reaction Time. The reaction time

of the ASBPO or other supporting JBPO must

be considered. Optimally, receipt by the

requesting command of blood or blood

products for sustainment of operations

should take no longer than 72 hours. Within

some Unified Commands, BPDs with prepositioned frozen blood products have been

constructed to provide blood products prior

to the delay in receiving liquid blood products

from CONUS. This is especially important

in theaters where the command anticipates

short notice or no notice of impending combat

operations where large numbers of casualties

can be expected. Most MTFs should plan

to keep a 3-day supply of blood and blood

products on hand. Most BSUs should have

a 5-day inventory goal. Realistically, a

planner may expect a 4- to 5-day resupply

response time from outside the theater

dependent upon at least two factors:

• Availability of air transportation.

• Location of the operational needs.

h. Red Blood Cells Shelf Life. Currently,

the health service logistics planner can

expect RBCs to be at least 8- to 10-days old

upon receipt. Blood collected in CPDA-1

(an anticoagulant preservative solution) and

stored at 1° to 6°C expires 35 days after

collection. This leaves a maximum shelf life

of 25 to 27 days for use within the theater.

However, with use of an additive solution, the

shelf life of the RBCs is extended 7 more

days (or for a maximum shelf life of 42 days

after collection).

i. Needs for Intelligence. Once located

in the AOR, it is necessary for the JBPO to

maintain current information on the

combat situation and on the anticipated

actions of friendly and enemy forces. The

best sources of this information are the joint

force intelligence officer and the operations

officer. As required, the health service

logistics planner can anticipate increasing

requirements for the AOR as a whole, or he

may reallocate resources within the AOR to

Figure VI-6. Unit Group and Type

Distribution

UNIT GROUP AND TYPE

DISTRIBUTION

BLOOD

GROUP/TYPE DISTRIBUTION

O Rh POSITIVE 40%

O Rh NEGATIVE 10%

A Rh POSITIVE 35%

A Rh NEGATIVE 5%

B Rh POSITIVE 8%

B Rh NEGATIVE 2%
VI-12

Chapter VI

Joint Pub 4-02.1

support specific operations. A good

reporting and inventory control system is

crucial:

• How much blood is in the command?

• Where is it concentrated?

• Is it where the “action” is?

• Should blood or blood components be

relocated?

10. Host-Nation Support

a. Host-Nation Blood Bank Support.

The health service logistics officer will contact

the CINC’s staff to determine if there are

existing bilateral agreements in place, and

to evaluate if health service issues and/or

requirements have been determined. Medical

intelligence will provide additional

information upon which to base a decision

on the comparability of HN blood with

reference to required FDA level of blood

testing and the willingness and ability of

the HN to provide blood bank support.

This support could take the form of additional

units of blood or RBCs, additional

refrigerators in local hospitals or hotels, icemaking capability, or sources for dry ice to

store FFP or frozen RBCs.

b. Obtaining Alternative Ice Sources.

Blood bank units and MTFs, along with

units involved primarily with the storage and

shipment of blood and blood components,

must develop alternative sources for ice

and refrigeration in case of equipment

failure. These alternative sources can include

other military units in the area or HN sources.

11. Logistical Considerations of

Blood Support

a. After the decision has been made on

where to locate the blood banks and the

concept of operations for blood support has

been established, plans must be coordinated

to effect the timely distribution of blood and

blood products throughout the theater of

operations. Prior planning must be

accomplished with the joint movement center

to establish procedures for the emergency

movement of blood. Specific information

required when shipping blood by air includes

weight, number of units, and number of

boxes.

b. After transportation requirements and

priorities have been established, planning

consideration must be given to maintaining

adequate levels of required supplies for the

planned operational scenario. If the Army is

the dominant user, a MEDLOG battalion will

Figure VI-7. Blood Component Planning Factors

BLOOD COMPONENT PLANNING FACTORS

RBC 4 UNITS FOR EACH WOUNDED IN ACTION

(WIA) AND EACH NONBATTLE INJURY (NBI)

CASUALTY INITIALLY ADMITTED TO A

HOSPITAL

FFP 0.08 UNITS FOR EACH HOSPITALIZED WIA OR

NBI

PLATELET

CONCENTRATE

0.04 UNITS FOR EACH HOSPITALIZED WIA OR

NBI
VI-13

Blood Management

usually be augmented to perform Class VIII

management functions and assume the role

of the SIMLM for the AOR. The SIMLM

will have liaison officers from supported

Services to assist in coordinating logistics

support requirements during joint or

combined operations. Examples of required

supplies include:

• Blood bags with the appropriate anticoagulant preservative solutions.

• ABO grouping and Rh typing antiserum.

• Test tubes.

• Blood shipping boxes.

• Plastic bags.

• Adequate supply of ice for maintenance

of required blood temperature during

transit.

12. Maximum Capacities for

Blood Product Shipments

Figure VI-8 depicts the maximum

capacities for blood product shipments.
VI-14

Chapter VI

Joint Pub 4-02.1

MAXIMUM CAPACITIES FOR BLOOD PRODUCT SHIPMENTS

1. PALLET, 463L.

A. MISSION/CAPABILITIES.

(1) PROVIDES ONE STANDARD SIZE PALLET CAPABLE OF

TRANSPORTING 54 BOXES CONTAINING A MAXIMUM OF 972 UNITS OF

FROZEN RBCs.

(2) THE 463L STANDARD PALLET MEASURES 108 X 88 X 4 INCHES.

THE MAXIMUM LOADED HEIGHT IS 96 INCHES AND MAXIMUM

ALLOWABLE WEIGHT IS 8,000 POUNDS. A PALLET WITH CARGO NET

WEIGHS 354 POUNDS.

B. CHARACTERISTICS OF LOADED PALLETS.

(1) A LOADED PALLET WITH 54 BOXES OF 18 UNITS EACH

WEIGHS 4,350 POUNDS AND HAS A VOLUME OF 432 CUBIC FEET. BOXES

ARE STACKED 3 WIDE X 6 LONG X 3 HIGH. TOTAL CAPACITY IS 3,600

UNITS OF RBCs.

(2) A LOADED PALLET WITH 120 BOXES OF FROZEN PLASMA

WEIGHS 6,000 POUNDS AND HAS A VOLUME OF 360 CUBIC FEET. TOTAL

CAPACITY IS 2,160 UNITS (IF FFP UNITS ARE PACKAGED INDIVIDUALLY)

OR 4,320 UNITS (IF FFP UNITS ARE PACKAGED IN PAIRS).

(3) A LOADED PALLET WITH 120 BOXES OF FROZEN BLOOD

WEIGHS 6,000 POUNDS AND HAS A VOLUME OF 360 CUBIC FEET. TOTAL

CAPACITY IS 1,560 UNITS OF FROZEN BLOOD (13 UNITS PER BOX WITH

DRY ICE). A NEW FROZEN BLOOD SHIPPING CONTAINER USING AN

EUTECTIC LIQUID FOR FREEZING INSTEAD OF DRY ICE IS CURRENTLY

UNDER DEVELOPMENT AND TESTING. ONCE IT IS STANDARDIZED,

PALLET CHARACTERISTICS WILL BE PROVIDED.

2. INSULATED BLOOD SHIPPING CONTAINERS.

A. SPECIFICATIONS.

(1) NSN 8145-01-357-1551.

(2) EMPTY WEIGHT IS 56 POUNDS WITH 5 EUTECTICS.

(3) CUBIC FEET IS 8.0

(4) EXTERIOR DIMENSIONS—26 INCHES LONG X 17 INCHES

WIDE X 32 INCHES HIGH.

B. CAPACITY: FROZEN RBC OR FFP; 18 UNITS, WEIGHT 18 POUNDS.

Figure VI-8. Maximum Capacities for Blood Product Shipments
CHAPTER VII

HEALTH SERVICE LOGISTICS SUPPORT IN

MULTINATIONAL OPERATIONS

VII-1

1. Composition of Multinational

Operations

a. Multinational operations occur when

two or more nations join their armed forces

to accomplish a common objective. These

operations can occur in war and in MOOTW.

• Alliances are the result of formal

agreements between two or more

nations to accomplish broad, long-term

objectives. The alliances normally adopt

interoperability standards and procedures

which are codified in standardization

agreements. The North Atlantic Treaty

Organization (NATO) is an example of

an alliance.

• Coalitions are ad hoc arrangements

between two or more nations for the

accomplishment of a specific objective.

Once the objective is accomplished, the

coalition is disbanded.

b. Multinational operations must maintain

a unified effort toward the common objective.

2. Health Service Logistics

Support Considerations

a. Logistics support in multinational

operations presents numerous challenges

due to a variety of different policies,

procedures, and practices. Some of the

problem areas that may be confronted are

shown in Figure VII-1.

b. Close coordination and continuous

liaison with all parties to an alliance or

“Even the bravest cannot fight beyond his strength.”

Homer, The Iliad

coalition is the key to a successful operation.

This is especially true in the health service

logistics arena. Each nation is responsible for

providing HSS to its own forces unless an

agreement defining a different arrangement

has been reached. Usually, allied patients

received at US MTFs are stabilized and

evacuated to their own nations’ facilities once

their medical condition permits. In the

functional area of health service logistics,

common medical items which meet the

specifications of all involved nations enhances

the ability of the HSLS planner to cross-level

medical materiel, alleviate shortages, and

ensure continuous HSLS.

Figure VII-1. Multinational Operations

Problem Areas

Difference in doctrine

Differing stockage levels

Logistics mobility

Interoperability concerns

Competition between

participants for common

support

Resource limitations

MULTINATIONAL

OPERATIONS

PROBLEM AREAS
VII-2

Chapter VII

Joint Pub 4-02.1

c. The NATO Standardization Agreements

and the Quadripartite Standardization

Agreements have provided a mechanism for

standardizing medical materiel. These

agreements describe the specifications for a

number of medical items as well as describing

echelons of care, markings on medical

vehicles, patient classifications, and

evacuation priorities. Based on these

agreements, the HSLS planner can better

estimate the interoperability capabilities of

the combined forces. An example of this

standardization is ensuring that all nations are

using the same size litter so that it will fit into

an evacuation vehicle from any party to the

alliance.

d. HSLS faces greater challenges in

coalition operations because standardization

of medical materiel has not been

accomplished over time. As with allied

operations, each member nation is

responsible for the provision of HSS to its

own forces unless other arrangements have

been formalized. In coalition operations,

however, it may not be possible to cross-level

medical materiel due to different

specifications and quality of medical items.

3. Cultural Diversity and

Language

In multinational operations, significant

differences in both language and customs

will exist between the various participants.

Each individual Service member must be

sensitive to these differences and to

accommodate them when possible.

Misunderstandings due to differences in

languages can be mitigated by using

translators. In the HSS arena, however, it is

critical for the health care provider to be

able to understand what a patient is telling

him. To facilitate this process the multiService publication, “Medical Service

Multilingual Phrase Book” (DA Pamphlet

40-3, Department of the Navy Medical

Publication 5104, and Department of the Air

Force Manual AFMAN 48-142) was

developed for NATO operations. If the

languages present in the AOR are not included

in this publication, the JFS should develop a

command publication for use by JTF health

service personnel. This measure would

enhance the ability of US health service

personnel providing medical treatment and

medical administration (to include HSLS) to

allied or coalition forces.

HEALTH SERVICE SUPPORT IN KOREA

I drove on the ice and headed north catching inaccurate enemy rifle and

machine gun fire as I went. Finally, after driving about three and a half miles,

I spotted some men lying and crawling around on the frozen reservoir, and

some crawling down the slope leading to the ice. These men had come from

the convoy of wounded soldiers (31st and 32d Infantry and 57th Field Artillery)

trying, as one said, ‘to get to Hagaru the best way we could.’... So I began

bringing them down and sending them to the rear by jeep and sled. Later in

the day Lieutenant Fred Van Brunt and a hospital corpsman joined my jeep

driver, Private Ralph Milton, and me. Altogether we rescued over 300 soldiers

from the 26 truck convoy. As long as we carried no weapons the Chinese held

their fire...I noticed, however, that they had killed all the truck drivers. Their

bodies were still slumped over their wheels.

SOURCE: Lieutenant Colonel Olin L. Beall

Commander, Marine Motor Transport Battalion In North Korea

1 December 1950
APPENDIX A

AEROMEDICAL SUPPORT EQUIPMENT AND SUPPLIES

A-1

1. Aeromedical Evacuation

Patient Support Equipment

and Supplies

Patient support equipment and supplies for

use aboard AE aircraft are contained in 3

general subcategories or kits as listed below:

a. Standardized AE In-flight Kits (Air

Force TA 887) will remain with the assigned

AE crews and will be managed separately

within the AE system:

• Cardiac monitor and defibrillator

• 1 pulse oximeter

• 1 oxygen analyzer

• 3-4 continuous intermittent suction units

• Emergency supplies to include:

•• Tracheostomy tubes

•• Chest tube insertion kit

•• Laryngoscope and endotracheal tubes

•• Oral airways

•• AMBU bags

•• First line cardiac drugs (bicarbonate,

epinephrine, lidocaine and bretylium)

•• Routine medical supplies (intravenous

supplies, Foley Catheters, nasogastric

tubes, reinforcement dressings)

•• Limited amounts of morphine and

meperidine for emergency use only

•• Heimlich valves

b. The following is the DMSB-approved

list of AE PMIs. The quantities listed equal

the initial PMI requirements contained in

deployable modular kits called patient

evacuation contingency kits (Air Force TA

887D)

NOMENCLATURE QUANTITY

Ventilator 4

Pulse Oximeter 4

Oxygen Analyzer 4

Cardiac Monitor and Defibrillator 4

Vital Signs Monitor 4

Suction (Continuous or

 Intermittent) 8

Infusion Pump 4

Turning Frame 1

Locking Restraints 1

Spinal Board 10

Litter 30

IV Pole 30

Blankets 30

Litter Pads 30

Litter Straps 60

Traction Appliance 1

Note: Items not listed above will not be

managed by the PMI return system and are

the responsibility of the originating MTF.

2. The PMIs used in support of the AE

mission must be AE-certified by Armstrong

Laboratories, Brooks AFB, Texas, and the

Aeromedical Evacuation Proponency, Ft.

Rucker, Alabama, to ensure proper form, fit,

and functionality for fixed- and rotary-wing

military aircraft. Refer to USAFSAM-90-26,

“Status Report on Medical Material Items

Tested and Evaluated for Use in the USAF
A-2

Appendix A

Joint Pub 4-02.1

Aeromedical Evacuation System” and J/AFI

41-30 (draft) for detailed lists of certified

equipment. An aeromedical certification label

is required to designate AE certification for

all PMI equipment. The DOD standard label

must be affixed to each piece of AE certified

equipment.
APPENDIX B

BLOOD MANAGEMENT

B-1

1. Purpose of the Standardized

Blood Reporting System

The purpose of the standardized blood

reporting system is to effectively manage

blood and blood products, project blood

requirements, request blood, report blood

inventories, and provide information on the

overall blood element operations of all Service

components in the theater of operations. The

ASBPO has developed the contingency

BLDREPs. Use of the Joint Message Text

BLDREPs are mandated by CJCSM 6120.05,

“Tactical Command and Control Planning

Guidance and Procedures for Joint Operations

- Joint Interface Operational Procedures

(JIOP) Message Text Formats,” CJCS

5725.04, “US Message Text Formatting

Program,” and CJCSM 6120.01, “Tactical

Command and Control Planning Guidance

and Procedures for Joint Operations - Joint

Interface Operational Procedures (JIOP)

Planning Guidance.” The two standard joint

message text format reports used to report

contingency blood program operations are the

BLDREP and the blood shipment report

(BLDSHIPREP).

2. Use of the Blood Report

The BLDREP provides a standardized

message format that is used to report blood

inventories, request blood, and project

requirements. The BLDREP in its full or

abbreviated form is used throughout all echelons

of the blood management system. All MTF or

medical treatment elements, including Echelon

II, will use the standard BLDREP format. The

Joint Interoperability Tactical Command and

Control Systems’ Automated Message

Preparation System and the Message Text

Format Editor are two software programs that

may be available to automate the BLDREP

formatting. Telephonic BLDREPs may be used

in theater. To help reduce the length of the

messages, a master menu of BLDREP codes

has been standardized as shown in Figure B-1.

a. The theater blood program manager may

assign brevity codes and designate those lines

to be utilized in daily reporting. Locations of

activities will be reported only on the first

report or upon relocation.

b. Requests for RBCs should normally be

based on a random distribution of blood groups

and types (that is, 40 percent O positive; 10

percent O negative; 35 percent A positive; 5

percent A negative; 8 percent B positive; and 2

percent B negative). At Echelons III and IV,

group and type-specific RBCs should be

transfused whenever possible. Certain

designated MTFs will require Group O RBCs

only. Upon activation, each MTF should request

a base load of blood components.

c. Medical treatment facilities should

submit a daily BLDREP to their blood

supplier. A complete BLDREP should

include the following:

• Heading of message: from and to

addressees, information copy addressee(s),

message classification, operation name,

report identification, date and time of

message, reference to other messages and

the following lines:

•• Line 1, as of date/time group

(ASOFDTG): date and time zone of the

BLDREP.

•• Line 2, reporting unit (REPUNIT):

name, designator code, and activity

brevity code of the REPUNIT.

•• Line 3, blood inventory: Used to

report the total number of each blood
B-2

Appendix B

Joint Pub 4-02.1

product on hand at the end of the report

period. Provide the REPUNIT code or

name and activity code when reporting

another blood program activity and/or

unit. Total the blood products at the end

of the reporting period.

•• Line 4, blood request: Used to report

the total number of each blood product

requested and time frame needed.

Provide the REPUNIT code or name and

activity code when reporting another

blood program activity and/or unit.

•• Line 5, blood expiration: Used to

report the estimate of the number of each

blood product which will expire within

the next 7 days.

Figure B-1. Master Menu Codes

MASTER MENU CODES

MANAGEMENT A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

P

Q

R

S

T

U

V

W

X

Y

Z

Joint Blood Program Office

Area Joint Blood Program Office

Armed Services Whole Blood Processing

Laboratory

Blood donor center

Blood products depot

Blood transshipment center

Blood supply unit

Medical treatment facility

Naval vessel

Red blood cells

Whole blood

Frozen red blood cells

Frozen plasma

Platelets

Cryoprecipitate

To be determined

Random Group and Type O, A, B

Random Group and Type O, A

Random Type O

Random Type A

Random Type B

Random Type AB

Required within 12 hours

Required within 24 hours

Required within 48 hours

Not applicable or see remarks

BLOOD PRODUCTS

TIME FRAME

CATEGORY CODE DEFINITION

BLOOD GROUPS

1. There currently are no frozen platelets. However, this code is used when dealing with platelet

concentrates when they are pooled random donor platelets or platelet pheresis concentrates.

MISCELLANEOUS
B-3

Blood Management

•• Line 6, blood estimate: Used to report

the estimate of the total number of each

blood product required for resupply

within the next 7 days. Provide the

reporting code or name and activity code

when reporting another blood program

activity and/or unit (See Figure B-1).

•• Line 7, CLOSTEXT or RMKS: Used

to provide additional amplifying

information if required.

•• Line 8, DECL: Mandatory if the

message is classified.

3. Transmission of the Blood

Report

a. Method. Message is the primary method,

with voice as alternate. Communications

capabilities of originator and addressee, as well

as urgency of the message subject and/or text

material, will determine the method. Messages

should be sent in immediate precedence because

of short blood expiration dates. Correct plain

language addresses from a current directory must

be used. The BLDREPs may be transported by

courier if that is more practical and expedient.

b. Frequency. Required as follows unless

otherwise directed:

• MTF (including Echelon II) to blood

donor unit: daily as of 2359Z; report

required not later than 0400Z.

• BSU to an AJBPO: daily as of 2359Z;

report required not later than 0400Z.

• BPD to an AJBPO: daily as of 2359Z;

report required not later than 0400Z.

• BTC to an AJBPO: daily as of 2359Z;

report required not later than 0400Z.

• AJBPO to JBPO: daily as of 0400Z;

report required not later than 0800Z.

• JBPO to ASBPO: daily as of 0800Z;

report required not later than 1200Z.

4. Blood Report Policies

a. Information copies should be kept to a

minimum and be specifically required by the

respective OPLAN. Increased quantities of

information copies overload the message

channels.

b. If an AJBPO is not established, the BSU

and BTC will report directly to the JBPO.

c. The addressee will normally be the next

higher organization level with whom the

reporting unit (originator) is authorized direct

communication: MTF to blood supplier;

blood supplier to AJBPO (if established);

blood supplier to JBPO (if AJBPO not

established); BTC to JBPO (if AJBPO not

established); AJBPO to JBPO (if AJBPO is

established); JBPO to ASBPO.

d. A BSU of one Service component may

receive blood reports from an MTF of another

Service component when the BSU is in an

area support role.

e. All BLDREPs should be classified at the

lowest level required to meet operational

constraints.

f. Each MTF, including those at Echelon

II, will submit a BLDREP to the supporting

BSU as required.

g. The BSU will submit a BLDREP to

AJBPO on the status of blood components

in the BSU, as required. Report will reflect

BSU inventory and anticipated blood

requirements.

h. The BTC blood manager will submit a

BLDREP to the AJBPO on the status of blood

components in the BTC.
B-4

Appendix B

Joint Pub 4-02.1

i. The BPD blood manager will submit a

BLDREP to the AJBPO on the status of the

blood components in the BPD.

j. The AJBPO will submit a BLDREP to

the JBPO on the status of blood components

in the BTCs and BSU, as required.

k. The JBPO will submit a consolidated

BLDREP to the ASBPO on the status of blood

components in each geographic combatant

command Joint Blood Program area.

l. Examples of completed BLDREPs

(message and voice) are shown in Figure B2 and Figure B-3.

5. Blood Shipment Report

a. The BLDSHIPREP provides a

standardized message format that is used

worldwide in the ASBPOs to report blood

shipments (See Figure B-4).

b. In lieu of standard nomenclature the

respective JBPO may assign brevity codes for

individual component blood program

elements. The Joint Interoperability Tactical

Command Automated Message Preparation

and the MTF may be available to automate

the BLDSHIPREP formatting. To reduce the

length of the messages, a master menu of

BLDSHIPREP codes has been standardized.

Figure B-2. Example of Message Blood Report

EXAMPLE OF MESSAGE BLOOD REPORT

FM:CDR 51ST MEDGP OSAN KOR/BTC//

TO: USFKSURGEON SEOUL KOR/KAJBPO//

UNCLAS

OPER/SMITH//

MSGID/BLDREP/OSAN BTC/1012221//

REF/A/CDRUSFK/090300ZJAN96/-/NOTAL//

ASOFDTG/100001ZJAN96

REPUNIT/BLUE1/F/OSAN KOR//

BLDINVT/-/900JQ/60LS/60MV//

RMKS/ONE WALK-IN REFRIGERATOR NEEDS REPAIR//

FM:CDR 32ND MEDLOGBN/BSU//

TO:CDR JTF CHARLIE SURGEON/AJBOP//

INFO:CDR 16MEDGRP/LOG//

CONFIDENTIAL

OPER/VALIANT ENTERPRIZE//

MDGID/BLDREP/BSU/1012221//

REF/A/CDRUSACOM/090300ZJAN96/-/NOTAL//

ASOFDTG/100001ZJAN96//

REPUNIT/32ND MEDLOGBN/G/BZ44327432//

BLDINVT/-/-/300JQ/60MV//

BLDEZP/-/-/15JQ//

BLDEST/-/-/3--JQ/30MV//

RMKS/COLLECTED 12 UNITS KQ BLOOD FOR EMERGENCY PLATELET

REQUEST FOR 5TH EVAN HOSP.SHIPD 12 UNITS WHOLE BLOOD PLUS

30 UNITS JQ TO 5TH EVAC THIS REPORTING PERIOD.
B-5

Blood Management

These codes are the same as used for the

BLDREP (See Figure B-2).

c. The heading of the BLDSHIPREP

message includes: from and to addresses,

information copy addressee(s), message

classification, operation name, report

identification, date and time of message,

references to other messages, and the

following lines:

• Line 1, ASOFDTG: date and time zone

of the blood shipment.

• Line 2, REPUNIT: name, designator

code, activity brevity code of the

REPUNIT, location of unit.

• Line 3, 1SHIPD: blood products, codes,

and/or number of units shipped and/or

total number of units shipped.

• Line 4, BLDSHIP: blood shipment or

air bill control number, aircraft flight

number, and/or estimated time of arrival.

• Line 5, POC: point of contact at shipping

location (names, rank, phone number,

location).

• Line 6, CLOSTEXT: additional

comments, such as when the blood will

need re-icing.

• Line 7, DECL: message downgrading

instructions. Required if classified.

d. Example of a completed BLDSHIPREP

is shown in Figure B-4.

Figure B-3. Example of Voice Blood Report

EXAMPLE OF VOICE

BLOOD REPORT

BLUE THIS IS RED; BLOOD

REPORT OVER

THIS IS RED; IMMEDIATE,

UNCLASSIFIED

LINE 1: 102359Z

LINE 2: 32CSH-H

LINE 3: 100JS, 80JT, 20JR,

50MV

LINE 4: 100JQX

LINE 5: 25JS, 5JT

LINE 6: 700JQ

LINE 7: RECEIVED 100JQ,

TRANSFUSED 100JQ

EXPIRED 10JS;

REFRIGERATOR NEEDS

REPAIR K
B-6

Appendix B

Joint Pub 4-02.1

Figure B-4. Example of Blood Shipment Report

EXAMPLE OF BLOOD SHIPMENT REPORT

FR: CDR USAMEDDAC FT KNOX KY//HSLBB//

TO; ASWBPL MDGUIRE AFB NJ

INFO: CDRUSAHSC FT SAM HOUSTON TX/MCHO-CL-R//

UNCLAS

OPER/DULL BRASS//

MSGID/BLDSHIPREP/FT KNOX BDC/10122ZJAN96

REF/A/CDRUSAMEDCOM/090300ZJAN96/-/NOTAL//

ASOFDTG/100001ZJAN96//

REPUNIT/CMBC/D/FT KNOX KY//

ISHIPD

/DP/OPOS/ONEG/APOS/ANEG/BPOS/BNEG/ABPOS/ABNEG/TOTAL//

/J160/ 140/ 32/ 40/ 20/ 8/ 0/ 0/ 400//

/M/ 0/ 0/ 0/ 0/ 0/ 24/ 0/ 24//

BLDSHIP/AB12134/DELTA32/101500ZJAN96/14//

POX/NEVAREZZ/SSG/PRIPHN:DSN555-1212/-FT LMPX LUSE[JM"555-

1213//

CLOSTEXT/BLOOD NEEDS RE-ICED BY 130001AJAN96/CMBC SHIPMENT

NO1//
APPENDIX C

MEDICAL LOGISTICAL SYSTEMS FOR

BATTLEFIELD INTEROPERABILITY

C-1

1. Interoperability among the Services is of

paramount importance to the successful

completion of a joint mission. The often

mentioned interoperability problem on afteraction reports is a shortcoming of the

MEDLOG communications system. The

MEDLOG problems encountered by all joint

US forces, especially when supported by the

SIMLM concept during the Gulf War, once

again highlighted the same communications

and interoperability issues that have always

plagued HSLS. These HSLS issues have

proven to be most difficult in finding a

permanent fix that meets all needs, gains the

approval of all of the Services, and is

affordable to implement. Communication

issues have received much attention at all

levels of command. All four Services have

conducted extensive interoperability testing

since the Gulf War.

2. The intent of this appendix is to acquaint

HSLS personnel with what works today in

the critical area of MEDLOG interoperability.

The most current information on

communications is presented in this

publication. These procedures will work in

time of war or MOOTW and during a national

emergency within CONUS or US territories.

Emerging technology will keep this topic in a

constant state of change for the foreseeable

future; it will not stay static. Service

components are now able to transmit and

receive medical requisition files and/or

statuses that are in a compatible and

interoperable format within the respective

Service MEDLOG AIS.

3. Prototype systems have been tested and

refined for battlefield MEDLOG systems

interoperability and use the DAASO as the

MEDLOG AIS communications focal point.

Each of the Services sends and receives

requisitions and supply statuses using

Defense Data Network, land lines, or satellite

communications to the Defense Automatic

Addressing System (DAAS) located in

Dayton, Ohio. DAAS routes all the

transactions according to DOD rules.

4. Each of the Services incorporates either

of two software communication packages for

communicating with the DAASO, which has

a mailbox service within the DAASO DAAS

Automated Message Exchange System

(DAMES). The DAMES and the SALTS,

which supports standard USN logistics and

administrative systems provide the

communications software necessary to

provide MEDLOG interoperability via the

DAASO.

a. The DAASO routinely provides the

following services: receives, processes,

routes, and transmits supply requisitions and

related information; determines sources of

both depot and commercial supplies;

provides an on-line redistribution network for

materials; provides users with up-to-date

status of requirements; analyzes databases

and prepares logistics reports; customizes

reporting as requested; and maintains official

repository for logistics-related databases and

publications.

b. DAMES and SALTS software on a unit

PC provides the capability to communicate

with DAAS, sending and receiving logistics

transactions and narrative text through a

modem using standard telephone lines and/

or via military or civilian satellite systems.

• Each Service requisitioning element is

assigned a separate mailbox at DAASO.

Their Department of Defense activity

address code (DODAAC) is then
C-2

Appendix C

Joint Pub 4-02.1

matched to the mailbox and their

messages are stored. A group of

DODAACs may be assigned to a single

mailbox, if necessary.

• Messages and/or files received and

transmitted by DAAS follow the Joint

Army, Navy, Air Force Publication

(JANAP) 128 procedures. DAMES

transaction files, produced by user

programs, are built into standard

JANAP-data pattern, formatted

communications messages for

transmission. Messages containing

narrative text, messages containing

MILSTRIP logistics transactions,

and messages containing nonstandard

part number requisitions may also be

built interactively at the keyboard.

c. Protocols for use of SALTS software can

be found in USN procedural guides.

d. DAASO supplies the DAMES software

after units register and are assigned DAMES

mailboxes. The DAMES user can

communicate with DAAS using either

asynchronous protocol at 1200 baud to 9600

baud or bisynchronous 2780 or 3780 protocol

at 2400 or 4800 baud. The software used to

create messages for transmission and the

software used to process received messages

is the same in both the DAMES asynchronous

package and the DAMES bisynchronous

package. The main difference in the two

packages is the actual communications

software.

e. The DAMES general system

requirements are a PC system capable of

running MS-DOS and a minimum of 256 K

RAM; hard disk drive; printer (configure as

LPT1); modem; and access to a telephone line.

f. The transactions to be sent through

DAAS can be loaded on to the DAMES PC

using a floppy from the respective Service

MEDLOG AIS. The transactions will be an

American Standard Code for Information

Exchange (ASCII) formatted file on a disk.

If the PC is on a local area network, the

transactions can be transferred to the DAMES

PC using a file transfer utility. The ASCII

file in both approaches has one transaction

per line separated by hard returns. DAMES

can accept the transaction file with or without

the JANAP headers and trailers included in

the file. The DAMES software first sends

transactions that are waiting on the PC. After

sending the transactions through DAMES to

DAAS, DAMES then checks for transactions

in the mailbox at DAAS to pull back to the

PC. A DAMES user may also dial in to check

and/or download their mailbox without having

any transactions to send.

5. Communications software packages can

reside on the Services’ MEDLOG system or

on a separate DOD-based PC. A modem

provides communications across land lines or

satellite connections.

6. Several issues are raised concerning the

use of commercial satellite for transmitting

medical information in support of military

operations. The medical information passed

is by commercial satellites because military

satellites systems become saturated with

traffic of higher priority than medical

information. The primary commercial

satellite system used by the military is through

Communications Satellite Corporation,

which is the US signatory to the Convention

on the International Maritime Satellite

Organization Treaty. The international

satellite system:

a. Offers analog voice and data service on

a global basis. Has digital voice capability

on a soon-to-be global basis.

b. Is used extensively by the USN, though

it is not limited to maritime purposes.

c. Is intended to support peaceful

operations, though its use was approved when
C-3

Medical Logistical Systems for Battlefield Interoperability

under the auspices of the United Nations

Council Organization.

d. Article 34 of the 1949 Geneva

Convention for the Amelioration of the

Condition of Wounded, Sick, and

Shipwrecked Members of the Armed Forces

at Sea provides that “hospital ships may not

possess or use encryption for their wireless

or other means of communications.” All

communication security hardware would be

removed from the hospital ships and stored

in order to comply with this regulation.

Hospital ships may continue to utilize satellite

systems in a nonencrypted mode.

7. Processing rules for DOD users to

interface through the DAAS are found in

DOD Directive 4000.25-1-M, “Military

Standard Requisitioning and Issuing

Procedures (MILSTRIP).”
C-4

Appendix C

Joint Pub 4-02.1

Intentionally Blank
APPENDIX D

REFERENCES

D-1

The development of Joint Pub 4-02.1 is based upon the following primary references:

1. US Code (Armed Forces).

Title 10, United States Code — Armed Forces. (As amended by DOD Reorganization Act

of 1986)

2. Multinational Documents.

NATO

STANAG TITLE

288 Intravenous Replacement Fluids

289 Minimum Essential Characteristics of Blood Products Shipping Containers

2061 Procedures for Disposition of Allied Patients By Medical Installations

2068 Emergency War Surgery

2105 NATO Table of Medical Equivalents AMEDP1-(D)

2122 Medical Training in First-Aid, Basic Hygiene, and Emergency Care

2126 First-Aid Kits and Emergency Medical Care Kits

2127 Medical, Surgical, and Dental Instruments, Equipment, and Supplies

2135 Procedures for Emergency Logistic Assistance

2342 Minimum Essential Medical Equipment and Supplies for Motor

Ambulances at All Levels

2367 Minimum Essential Medical Supply Items in Theaters of Operations

2907 Procedures for Reporting and for Initial Disposition of Unsatisfactory

Medical Materiel and Drugs

2939 Medical Requirements for Blood, Blood Donors, and Associated Equipment

3204 Aeromedical Evacuation

ABCA

QSTAG TITLE

815 Blood Supply in the Area of Operations (AO)

850 Blood Donor and Transfusion Equipment Requirements-Amendment No. 2

3. Department of Defense Directives.

a. DOD 4000.25-1-M, “Military Standard Requisitioning and Issue Procedures

(MILSTRIP).”

b. DOD 6000.12, “Health Services Operations and Readiness.”

c. DOD 6420.1, “Organization and Functions of the Armed Forces Medical Intelligence

Center (AFMIC).”
D-2

Appendix D

Joint Pub 4-02.1

d. DODI 6480.4, “Armed Services Blood Program (ASBP) Operational Procedures.”

4. Joint Publications.

a. Joint Pub 0-2, “Unified Action Armed Forces (UNAAF).”

b. Joint Pub 3-0, “Doctrine for Joint Operations.”

c. Joint Pub 3-05.3, “Joint Special Operations Operational Procedures.”

d. Joint Pub 3-07, “Joint Doctrine for Military Operations Other Than War.”

e. Joint Pub 3-07.3, “Joint Tactics, Techniques, and Procedures for Peacekeeping

Operations.”

f. Joint Pub 3-07.7, “Joint Tactics, Techniques, and Procedures for Domestic Support

Operations.”

g. Joint Pub 4-0, “Doctrine for Logistic Support of Joint Operations.”

h. Joint Pub 4-01, “Joint Doctrine for the Defense Transportation System.”

i. Joint Pub 4-02, “Doctrine for Health Service Support in Joint Operations.”

j. Joint Pub 4-02.2, “Joint Tactics, Techniques, and Procedures for Patient Movement in

Joint Operations.”

k. Joint Pub 5-03.1, “Joint Operation Planning and Execution System, Vol. I: (Planning

Policies and Procedures).”

l. CJCSM 3122.03, “Joint Operation Planning and Execution System, Vol. II: (Planning

Formats and Guidance).”

5. Air Force Regulations.

a. AFMAN 23-110, Vol. 5, “USAF Supply Manual.”

b. AFI 41-106, “Medical Readiness Planning and Training.”

c. DTIC REF A 186 280, “Logistical Support for LIC, An Air Force Perspective.”

d. AFM 167-230, “Medical Logistics System (MEDLOG) — Air Force Medical Logistics

Office.”

6. Army Regulations.

Army Regulation 40-61, “Medical Logistics Policies and Procedures,” 1 August 1989.
D-3

References

7. Multi-Service Publications.

TM 8-227-11, NAVMED P-5123/AFI 44-118, “Operational Procedures for the Armed Services

Blood Program Elements,” 1 September 1995.

8. US Army Field Manuals.

a. FM 8-10, “Health Service Support in a Theater of Operations,” 1 March 1991.

b. FM 8-42, “Medical Operations in Low Intensity Conflict,” 4 December 1990.

c. FM 8-55, “Planning For Health Service Support,” 15 January 1994.

d. FM 55-12, “Movement of Units in Air Force Aircraft,” 22 July 1986.

e. FM 100-5, “Operations,” 14 June 1993.

f. FM 100-10, “Combat Service Support,” 18 February 1988.

g. FM 100-17, “Mobilization, Deployment, Redeployment, Demobilization,” 28 October

1992.

h. FM 100-20, “Military Operation in Low Intensity Conflict,” 5 December 1990.

i. FM 101-5, “Staff Organization and Operations.”

j. FM 101-10-1, “Organizational, Technical, and Logistical Data, Planning Factors,” 7

October 1987.

9. US Navy and Marine Corps Publications.

a. FMFM 4, “Combat Service Support.”

b. FMFM 4-50, “Health Service Support,” 19 September 1990.

c. FMFM 4-51/NAVMED P-5133, “Task Force Medical Regulating Manual.”

d. CGSC 100-1, “Navy and Marine Corps.”

e. MCBUL 4790, “Maintenance Management of Marine Corps Class VIII (Medical/Dental)

Equipment.”
D-4

Appendix D

Joint Pub 4-02.1

Intentionally Blank
APPENDIX E

ADMINISTRATIVE INSTRUCTIONS

E-1

1. User Comments

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

Joint Warfighting Center, Attn: Doctrine Division, Fenwick Road, Bldg 96, Fort Monroe,

VA 23651-5000. These comments should address content (accuracy, usefulness,

consistency, and organization), writing, and appearance.

2. Authorship

The lead agent for this publication is the United States Army. The Joint Staff doctrine

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

3. 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-JDD//

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

Interoperability (J-7), JDD, 7000 Joint Staff Pentagon, Washington, DC 20318-7000.

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

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________
E-2

Appendix E

Joint Pub 4-02.1

4. Distribution

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

centers.

b. Only approved pubs and test pubs 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

Attache Office) to DIA Foreign Liaison Office, PSS, 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.”

By Military Services:

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

2800 Eastern Boulevard

Baltimore, MD 21220-2896

Navy: CO, Naval Inventory Control Point

700 Robbins Avenue

Bldg 1, Customer Service

Philadelphia, PA 19111-5099

Marine Corps: Marine Corps Logistics Base

Albany, GA 31704-5000

Coast Guard: Coast Guard Headquarters, COMDT (G-OPD)

2100 2nd Street, SW

Washington, DC 20593-0001

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.
GLOSSARY

PART I—ABBREVIATIONS AND ACRONYMS

GL-1

AABB American Association of Blood Banks

ABO blood typing system

ADAL authorized dental allowance list

AE aeromedical evacuation

AFMLO Air Force Medical Logistics Office

AFWCF Air Force Working Capital Fund

AIS automated information systems

AJBPO Area Joint Blood Program Office

AMAL authorized medical allowance list

AOR area of responsibility

AR Army reserve

ASBP Armed Services Blood Program

ASBPO Armed Service Blood Program Office

ASCII American Standard Code for Information Exchange

ASD(HA) Assistant Secretary of Defense for Health Affairs

ASOFDTG as of date/time group

ASWBPL Armed Services Whole Blood Processing Laboratory

ATH air transportable hospital

BAS battalion aid station

BDC blood donor center

BLDREP blood report

BLDSHIPREP blood shipment report

BPD Blood Product Depot

BSU blood supply unit

BTC blood transshipment center

C Centigrade

CH contingency hospital

CINC commander of a combatant command

CJCS Chairman of the Joint Chiefs of Staff

CLF combat logistics force

COMMZ communications zone

CONUS continental United States

CSS combat service support

DAAS Defense Automatic Addressing System

DAASO Defense Automatic Addressing System Office

DAMES DAAS Automated Message Exchange System

DEPMEDS Deployable Medical Systems

DHHS Department of Health and Human Services

DLA Defense Logistics Agency

DMSB Defense Medical Standardization Board

DMSO Division Medical Supply Office
GL-2

Glossary

Joint Pub 4-02.1

DOD Department of Defense

DODAAC Department of Defense activity address code

DPSC Defense Personnel Support Center

EPW enemy prisoner of war

ESF emergency support function

FDA Food and Drug Administration

FFP fresh frozen plasma

FISC Fleet and Industrial Supply Centers

FSSG force service support group

HN host nation

HSLS health service logistics support

HSS health service support

JANAP Joint Army, Navy, Air Force Publication

JBPO Joint Blood Program Office

JFC joint force commander

JFS joint force surgeon

JOPES Joint Operation Planning and Execution System

JTF joint task force

LOC line of communications

MAGTF Marine air-ground task force

MEDLOG medical logistics (USAF AIS)

MEDLOGCO medical logistics company

MEDLOG JR medical logistics, junior (USAF AIS)

MEF Marine expeditionary force

MICRO-MICS Micro-Medical Inventory Control System

MICRO-SNAP Micro-Shipboard Non-Tactical Automated

 Data Processing System

MILSTRIP military standard requisitioning and issue procedures

MOMEDLOG mobile medical logistics (USAF AIS)

MOOTW military operations other than war

MTF medical treatment facility

NATO North Atlantic Treaty Organization

NAVMEDLOGCOM Naval Medical Logistics Command

NAVSUP Naval Supply Systems Command

NBC nuclear, biological, and chemical

NDMS National Disaster Medical System

NEO noncombatant evacuation operation

NGO nongovernmental organization

O&M operation and maintenance

OFHIS Operational Fleet Hospital Information System
GL-3

Glossary

OPLAN operation plan

PC personal computer

PECK patient evacuation contingency kit

PMI patient movement item

POD port of debarkation

POE port of embarkation

RAA redeployment assembly area

RBC red blood cell

REPUNIT reporting unit

Rh Rhesus

ROE rules of engagement

SALTS Streamlined Automated Logistics Transfer System

SASSY Supported Activities Supply System

SIMLM single integrated medical logistics manager

SMU SASSY management unit

SOF special operations forces

T-AH hospital ship

TBTC transportable blood transshipment center

TMMMC Theater Medical Materiel Management Center

TPFDD time-phased force and deployment data

USAF United States Air Force

USAMMA United States Army Medical Materiel Agency

USMC United States Marine Corps

USN United States Navy

WR war reserve
aeromedical evacuation. The movement of

patients under medical supervision to and

between medical treatment facilities by air

transportation. Also called AE. (Joint Pub

1-02)

aeromedical evacuation system. A system

which provides: a. control of patient

movement by air transport; b. specialized

medical attendants and equipment for inflight medical care; c. facilities on or in the

vicinity of air strips and air bases, for the

limited medical care of intransit patients

entering, en route via, or leaving the system;

and d. communication with originating,

destination, and en route medical facilities

concerning patient transportation. (Joint

Pub 1-02)

clinic. A medical treatment facility primarily

intended and appropriately staffed and

equipped to provide outpatient medical

service for nonhospital type patients.

Examination and treatment for emergency

cases are types of the services rendered. A

clinic is also intended to perform certain

nontherapeutic activities related to the

health of the personnel served, such as

physical examinations, immunizations,

medical administration, and other

preventive medical and sanitary measures

necessary to support a primary military

mission. A clinic will be equipped with

the necessary supporting services to

perform the assigned mission. A clinic may

be equipped with beds (normally fewer than

25) for observation of patients awaiting

transfer to a hospital and for care of cases

which cannot be cared for on an outpatient

status, but which do not require

hospitalization. Patients whose expected

duration of illness exceeds 72 hours will

not normally occupy clinic beds for periods

longer than necessary to arrange transfer to

a hospital. (Joint Pub 1-02)

evacuation. 1. The process of moving any

person who is wounded, injured, or ill to

and/or between medical treatment

facilities. 2. The clearance of personnel,

animals, or materiel from a given locality.

3. The controlled process of collecting,

classifying, and shipping unserviceable or

abandoned materiel, United States and

foreign, to appropriate reclamation,

maintenance, technical intelligence, or

disposal facilities. (Joint Pub 1-02)

evacuation policy. 1. Command decision

indicating the length in days of the

maximum period of noneffectiveness that

patients may be held within the command

for treatment. Patients who, in the opinion

of responsible medical officers, cannot be

returned to duty status within the period

prescribed are evacuated by the first

available means, provided the travel

involved will not aggravate their

disabilities. 2. A command decision

concerning the movement of civilians from

the proximity of military operations for

security and safety reasons and involving

the need to arrange for movement,

reception, care, and control of such

individuals. 3. Command policy

concerning the evacuation of unserviceable

or abandoned materiel and including

designation of channels and destinations for

evacuated materiel, the establishment of

controls and procedures, and the

dissemination of condition standards and

disposition instructions. (Joint Pub 1-02)

health service logistics support. A

functional area of logistics support that

supports the joint force surgeon’s health

service support mission. It includes

supplying Class VIII medical supplies

(medical materiel to include medical

peculiar repair parts used to sustain the

health service support system), optical

PART II—TERMS AND DEFINITIONS

GL-4 Joint Pub 4-02.1
fabrication, medical equipment

maintenance, blood storage and

distribution, and medical gases. Also

called HSLS. (This term and its definition

is approved for inclusion in the next edition

of Joint Pub 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

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,

optometric, medical food, and medical

intelligence services. (Joint Pub 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. (Joint

Pub 1-02)

humanitarian assistance. Programs

conducted to relieve or reduce the results

of natural, or manmade disasters or other

endemic conditions such as human pain,

disease, hunger, or privation that might

present a serious threat to life or that can

result in great damage to or loss of property.

Humanitarian assistance provided by US

Forces is limited in scope and duration. The

assistance provided is designed to

supplement or complement the efforts of

the host nation civil authorities or agencies

GL-5

Glossary

that may have the primary responsibility

for providing humanitarian assistance.

(Joint Pub 1-02)

intertheater evacuation. Evacuation of

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 trained medical

personnel. (Joint Pub 1-02)

intratheater evacuation. Evacuation of

patients between points within the theater.

En route care is provided by trained medical

personnel. (Joint Pub 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. (Joint Pub 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.

Also called JFC. (Joint Pub 1-02)

joint force surgeon. A general term applied

to an individual appointed by the joint force

commander to serve as the theater or joint

task force special staff officer responsible

for establishing, monitoring, or evaluating

joint force health service support. (Joint

Pub 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
GL-6

Glossary

Joint Pub 4-02.1

assessments of foreign medical capabilities

in both military and civilian sectors. (Joint

Pub 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 which has the

necessary health service support

capabilities, and it also ensures that bed

space is available. (Joint Pub 1-02)

medical treatment facility. A facility

established for the purpose of furnishing

medical and/or dental care to eligible

individuals. (Joint Pub 1-02)

patient. A sick, injured, wounded, or other

person requiring medical/dental care or

treatment. (Joint Pub 1-02)

triage. The evaluation and classification of

casualties for purposes of treatment and

evacuation. It consists of the immediate

sorting of patients according to type and

seriousness of injury, and likelihood of

survival, and the establishment of priority

for treatment and evacuation to assure

medical care of the greatest benefit to the

largest number. (Joint Pub 1-02)
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 pub

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 pub and the

need for any urgent changes or

earlier-than-scheduled

revisions

No later than 5 years after

development, each pub 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 Pub 4-02.1 Logistics

JOINT DOCTRINE PUBLICATIONS HIERARCHY JOINT DOCTRINE PUBLICATIONS HIERARCHY

JOINT PUB 1-0 JOINT PUB 2-0 JOINT PUB 3-0

PERSONNEL

JOINT PUB 4-0 JOINT PUB 5-0 JOINT PUB 6-0

INTELLIGENCE OPERATIONS LOGISTICS PLANS C4 SYSTEMS

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 Joint Publication

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

JOINT PUB 1

JOINT

WARFARE

JOINT PUB 0-2

UNAAF