SUSTAINMENT: Health Service Support

Doc! The Army Health System is everywhere in Army life. From platoon-level medics, to MEDEVAC training to the lowest levels, to on-post medical centers that treat Soldiers and dependents alike.

Health Support Service is the fourth element of Army Sustainment – and it actually crosses warfighting function lines.

As always, italics added for our emphasis, and […] indicates we cut out stuff we thought was fluff. And, as always: you’re smarter reading the pub yourself to be exactly sure

The Big Ideas:

The Army Health System is composed of both health service support and force health protection

Principles of Army Health System

Functions of Army Medical Department

The major takeaways:

The principles of the Army Health System are conformity, proximity, flexibility, mobility, continuity, and control.

Part of two Warfighting Functions

Health service support is part of the sustainment warfighting function, and force health protection is part of the protection warfighting

Health service support includes—

• Casualty care which encompasses a number of Army Medical Department functions, including—

  • Medical treatment (organic and area medical support).

  • Hospitalization.

  • Dental care (treatment aspects).

  • Behavioral health/ neuropsychiatric treatment.

  • Clinical laboratory services.

  • Treatment of chemical, biological, radiological, and nuclear patients.

• Medical evacuation (including medical regulating).

• Medical logistics (including blood management).

Diving deep in the doctrinal details:

HEALTH SERVICE SUPPORT

1-100. The Army Health System is composed of both health service support and force health protection. Health service support is part of the sustainment warfighting function, and force health protection is part of the protection warfighting function. The principles of the Army Health System are conformity, proximity, flexibility, mobility, continuity, and control. These principles are defined in appendix A of FM 4-0. Health service support encompasses all support and services performed, provided, and arranged by the AHS to promote, improve, conserve, or restore the behavioral and physical well-being of Army personnel and as directed, UAPs. Health service support includes—

• Casualty care which encompasses a number of Army Medical Department functions, including—

  • Medical treatment (organic and area medical support).

  • Hospitalization.

  • Dental care (treatment aspects).

  • Behavioral health/ neuropsychiatric treatment.

  • Clinical laboratory services.

  • Treatment of chemical, biological, radiological, and nuclear patients.

• Medical evacuation (including medical regulating).

• Medical logistics (including blood management).

Diving deep in the doctrinal details

CASUALTY CARE

1-101. Casualty care encompasses all issues pertaining to the provision of clinical services for the treatment of Soldiers from the point of injury to successive roles of care. Casualty care includes the following sub[1]functions: medical treatment (organic and area medical support), hospitaliz

ation, the treatment aspects of dental care and behavioral health/neuropsychiatric treatment, clinical laboratory services, treatment of chemical, biological, radiological and nuclear patients. Fundamentals of Sustainment 31 July 2019 ADP 4-0

Medical Treatment (Organic and Area Medical Support)

1-102. The medical treatment function encompasses Roles 1 and 2 medical treatment support. Role 1 medical treatment is provided by the combat medic or by the physician, the physician assistant, or the health care specialist in the battalion aid station/Role 1 medical treatment facility. Role 2

medical care provides greater resuscitative capability than is available at Role 1 and is rendered by the medical company in the BSB or by the medical company (area support), which is an echelon above brigade asset. These roles of care are provided by organic assets or on an area support basis from supporting medical companies or detachments. The area support function encompasses emergency medical treatment, advanced trauma management, routine sick call, emergency dental care, preventive medicine, and combat and operational stress control support.

Hospitalization

1-103. The Army’s hospitalization capability consists of Role 3 combat support hospitals and hospital centers purposely positioned to provide support in the AO. At Role 3, the combat support hospital and hospital centers expand the support provided at Role 2 and are staffed and equipped to provide care for all categories of patients, to include resuscitation, initial wound surgery, damage control surgery, and postoperative treatment. Hospitalization capabilities deploy as modules or multiple individual capabilities that provide incrementally increased medical services in a progressively more robust AO. The hospitalization capability in the AO offers essential care to either return the patient to duty (within the theater patient movement policy) and/or stabilization to ensure the patient can tolerate evacuation to a definitive care facility outside the area of operations (this support is key to early identification and

treatment of mild traumatic brain injuries).

Dental Care

1-104. Dental care provided as part of health service support includes far forward dental treatment, treatment of oral and dental disease, and early treatment of severe oral and maxillofacial injuries. Dental personnel may also be used to augment medical personnel (as necessary) during mass casualty operations.

Behavioral Health

1-105. The primary focus of behavioral health/neuropsychiatric treatment is to screen and evaluate Soldiers with maladaptive behaviors. The purpose of this function is to provide diagnosis, treatment, and disposition for Soldiers with neuropsychiatric/behavioral health-related issues.

Clinical Laboratory Services

1-106. Clinical laboratory services provide basic support within the theater, to include procedures in hematology, urinalysis, microbiology, and serology. Role 2 medical company (area support) and brigade support medical companies, when operating with or collocated with a forward resuscitative and surgical team or other resuscitative and surgical team, may augment the clinical laboratory and blood storage capabilities of that element. The combat support hospital and hospital center perform procedures in biochemistry, hematology, urinalysis, microbiology, and serology in support of clinical activities. The hospital also provides blood-banking services.

Treatment of Chemical, Biological, Radiological, and Nuclear Patients

1-107. Health service support operations in a chemical, biological, radiological and nuclear environment are complex. Medical personnel may be required to treat chemical, biological, radiological and nuclear injured and contaminated casualties in large numbers. Medical treatment is provided in protected environments and protective clothing must be worn. Movement of chemical, biological, radiological and nuclear casualties can spread contamination to clean areas. All casualties are decontaminated as far forward as the situation permits and are decontaminated before they are admitted into a clean medical treatment facility. The admission of one contaminated casualty into a clean medical treatmen

t facility may contaminate the facility, thereby reducing treatment capabilities in the facility. ATP 4-02.7 has additional information.

Medical Evacuation (Including Medical Regulating)

1-108. Medical evacuation is the timely and effective, movement of the wounded, injured, or ill to and between medical treatment facilities on dedicated and properly marked medical platforms with en route care provided by medical personnel. The provision of en route care on medically equipped vehicles or aircraft enhances the patient’s potential for survival and recovery and may reduce long-term disability. Medical regulating is the coordination and control of moving patients to medical treatment facilities that are best able to provide the required specialty care. See ATP 4-02.2 for addition

al information.

MEDICAL LOGISTICS

1-109. Medical logistics encompasses planning and executing all class VIII supply support to include management of the following functions: medical materiel, medical equipment maintenance and repair, optical fabrication and repair, patient-movement items, medical gases, blood storage and distribution, regulated medical waste (including hazardous material), medical facilities and infrastructure, and medical contracting. The system is anticipatory with select units capable of operating in a split-based mode. ATP 4-02.1 has details.

An extra dose of healthcare doctrine will do you good!

Take A Doctrine Deep Dive with a read of ADP 4-0 here.