Army Filed Manual No. 8-10-14: FM 8-10-14 Employment of the Combat Support Hospital Tactics, Techniques, and Procedures

Army Field Manual FM 8-10-14: Employment of the Combat Support Hospital Tactics, Techniques, and Procedures

Doc_type: 
Other
Doc_date: 
Thursday, December 29, 1994
Doc_rel_date: 
Thursday, December 30, 2004
Doc_text: 

USAPA
ELECTRONIC PUBLISHING SYSTEM OneCol FORMATTER .WIN32 Version 1.22
PIN: 002222-000 DATE: 10-24-00 TIME: 10:57:55 PAGES SET: 101
DATA FILE: C:Iwincompinewdoc.fil DOCUMENT: AR 190-45 DOC STATUS: REVISION
DODDOA-006780

FIELD MANUAL
No. 8-10-14
Page 1 of 7
FM 8-10-14 HEADQUARTERS DEPARTMENT OF THE ARMY Washington, DC, 29 December 1994
FM 8-10-14

EMPLOYMENT OF THE
COMBAT SUPPORT
HOSPITAL TACTICS,
TECHNIQUES, AND
PROCEDURES

Table of Contents
PREFACE
CHAPTER 1 - HOSPITALIZATION SYSTEM IN A THEATER OF OPERATIONS 1-1. Combat Health Support in a Theater of Operations 1-2. Echelons of Combat Health Support 1-3. Theater Hospital System

CHAPTER 2 THE COMBAT SUPPORT HOSPITAL
-
2-1. Mission and Allocation
2-2. Assignment and Capabilities
2-3. Hospital Support Requirements
2-4. Hospital Organization and Functions
2-5. The Hospital Unit,_ Base
2-6. The Hospital Unit, Surgical

DODDOA-006781
http://atiam.train.anny.mil/portaliatia/adlsc/view/public/296784-1/ftn/8... 12/28/2004

CHAPTER 3 - COMMAND, CONTROL, AND COMMUNICATIONS OF THE COMBAT SUPPORT HOSPITAL
3-1. Command and Control
3-2. Communications CHAPTER 4 - DEPLOYMENT AND. EMPLOYMENT OF THE COMBAT SUPPORT HOSPITAL
4-1. Threat
4-2. Planning Combat Health Support Operations
4-3. Mobilization
4-4. Deployment
4-5. Employment
4-6. Hospital Displacement
4-7. Emergency Displacement
4-8. Nuclear, Biological, and Chemical Operations
APPENDIX A - TACTICAL STANDING OPERATING PROCEDURE FOR HOSPITAL OPERATIONS A-1. Tactical Standing Operating Procedure A-2. Purpose of the Tactical StandingOperating Procedure A-3. Format for the Tactical Standing Operating Procedure A-4. Sample Tactical Standing Operating Procedure (Sections) A-5. Sample Tactical Standing Operating Procedure (Annexes) APPENDIX B - HOSPITAL PLANNING FACTORS B-1. General B-2. Personnel and Equipment Deployable Planning Factors B-3. Hospital Operational Space Requirements B-4. Logistics Planning Factors (Class I, II, III, IV, VI, VIII)
DODDOA-006782
http://atiarn.train.army.mil/portallatia/adlsc/view/public/296784-1/frn/... 12/28/2004

APPENDIX C FIELD WASTE
Section I - Overview
C-1. General
C-2. Responsibility for Disposal of Waste
C-3. Categories of Waste

Section II General and Hazardous Waste
-
C-4. General
C-5. Sources of General and Hazardous Waste
C-6. Disposal of General and Hazardous Waste

Section III - Medical Waste
C-7. General
C-8. Responsibility for Disposal of Medical Waste
C-9. Types of Medical Waste
C-10. Source of Medical Waste

11. Handling and Transporting Medical Waste
C-12. Disposal of Medical Waste

Section IV Human Waste
C-13. General
C-14. Responsibility for Disposal of Human Waste
C-15. Patient Facilities

Section V - Wastewater
C-16. General
C-17. Requirement for Disposal
C-18. Responsibility for Disposal
C-19. Wastewater Sources and Collection

DODDOA-006783
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... 12/28/2004
C-20. Disposal of Wastewater APPENDIX D - SAFETY Section I - Introduction D-1. Safety Policy and Program D-2. Responsibility for Accident Prevention D-3. Principles of Accident Prevention D-4. Safety Plan D-5. Accident Investigation and Reporting
Section II - Deployed Medical Unit Safety_Considerations
D-6. X-ray Protective Measures and Standards
D-7. Hearing Conservation
D-8. Compressed Gas Cylinders
D-9. Flammable, Explosive, or Corrosive Materials
D-10. Special Equipment
D-11. Department of Defense Federal Hazard Communication Training Program
D-12. United States Army Environmental Hygiene Agency
D-13. Infection Control APPENDIX E - COMMUNICATIONS, AUTOMATION, AND POSITION/NAVIGATION SYSTEMS E-1. Operational Facility Rules and Equipment E-2. Communications Equipment APPENDIX F - COMMANDER'S CHECKLIST Section I - Personnel Checklist-Mobilization F-1. Personnel and Administration F-2. Finance
DODDOA-006784
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... 12/28/2004
F-3. Medical
F-4. Discipline, Law, and Order
F-5. Religion
F-6. Legal
F-7. Public Affairs

Section II - Operations Checklist-Mobilization
F-8. Operations
F-9. Security_ and. Intelligence
F-10. Training

Section III - Logistics Checklist-Mobilization
F-11. Subsistence
F-12. Supplies and Equipment
F-13. Petroleum, Oils, and Lubricants
F-14. Ammunition
F-15. Major End Items
F-16. Medical Sup_alies and Equipment
F-17. Prescribed Load List
F-18. Maintenance
F-19. Laundry
F-20. Transportation
F-21. Miscellaneous Logistics
F-22. Engineer
F-23. Contracting

Section IV - Personnel Checklist-Deployment
F-24. Personnel and Administration

DODDOA-006785
http://atiam.tain.army.mil/portallatia/adlsc/view/public/296784-1/fm/8-1... s12/28/2004
FM 8-10-14 Table of Contents Page 6 of 7

F-25. Medical
F-26. Discipline, Law, and Order
F-27. Religion
F-28. Legal
F-29. Public Affairs
Section V - Operations Checklist-Deployment
F-30. Operations
F-31. Security and Intelligence
Section VI - Logistics Checklist-Deployment
F-32. Subsistence
F-33. Supplies
F-34. Ammunition
F-35. Major End Items
F-36. Medical Items
F-37. Repair Parts
F-38. Maintenance
F-39. Transportation
F-40. Miscellaneous Logistics
F-41. Engineer
APPENDIX G - THE GENEVA CONVENTIONS
GA. Law of Land Warfare
G-2. Medical Implications of Geneva Conventions
G-3. Compliance with the Geneva Conventions
APPENDIX H - COMBAT SUPPORT HOSPITAL LAYOUT
APPENDIX I - SAMPLE OPERATIONS ORDER WITH ANNEXES
DODDOA-006786
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... 12/28/2004

GLOSSARY REFERENCES AUTHORIZATION LETTER
DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited.

DODDOA-006787
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... 12/28/2004
PREFACE

Throughout history, much has been written on the confrontations and wars between nations. From the beginning, a rnejnr concern of the commander him been the health and fitness orbit; forces. Following all confrontations, an improvement in tactira and techniques has been sought to enhance the force's ability to win the decisive battle. Over the years, advancements in technology have given our commanders weapons with the lethality to destroy or generate casualties once thought to be impossible. These advancements in technology and battlefield strategy have caused support elements to strive to improve the effectiveness of their services. The Army Medical Department fAMEDD) has maintained the pace in the development and employment of battlefield medical techniques to provide responsive, quality combat health support (CHS:ifor the military forces.
The purpose of this publication is to describe the functions and employment of one of the CMS assets, the combat support hospital This publication is designed for the hospital commander, his staff, and assigned personnel. It embodies doctrine based on Medical Force 2000 and the L-edition Table of Organization and Equipment. (TOE'.. 08-70510000. The structural layout. of the hospital is flexible and situatao nay determined (for example, mission requirements, commander's guidance, and terrain features). lt requires intensive prior planning and training of all personnel to establish the Facility. The staffing and organizational structure presented in this publication reflects those established in the I.-edition TOE 08.705L000 ; effective Alb of this publication date. However, such staffing is subject to change to comply with Manpower Requirements Criteria outlined in Army Regulation (AR/ 570-2 and can be subsequently modified by your modification TOE (MTOE).
This publication is in concert with Field Manual (FM) 8-10, FM R-55, and Training Circular (TM 8-13. Other FM 8-Series publications will he referenced in this publication. Lasers should he familiar with FM l0(1-5 and FM 100-10.
Echelon is a North Atlantic Treaty Organization (NATO) term used to describe levels of medical care. For the purposes of this publication, the terms level" and -echelon' an? interchangeable.
The proponent of this publication is the United States sArmy Medical Department Center and School. Send comments and recommendations on Department of the Army MA) Form 2028 directly to the Commander, U.S. Army Medical Department. Center and School, AT HSMC-FCD-L, Fort Sam Houston, Texas 78234-6175.
This publication implements the following NATO International Standardization Agreements (STANAGs);
STANAGsTITLE
2065 Modstmergency War Surgery (Edition 41 (Amendment 3)
2931 Orders for the Camouflage of the Red Cross and Red Crescent on Land in Tactical Operations
Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to men.
Use of trade or brand names in this publication is for illustrative purposes only and does not imply endorsement by the Department of Defense (DOD).
DODDOA-006788
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... 12/28/2004
This chapter implements STANAG 2068 Med. I
CHAPTER 1

HOSPITALIZATION SYSTEM IN A THEATER OF
OPERATIONS

1-1. Combat Health Support in a Theater of Operations
a.
A theater of operations (TO) is that portion of an area of war necessary for military operations and for the administration of such operations. The scenario depicts the size of the TO and the US Forces to be deployed. The theater is normally divided into a combat zone (CZ) and a communications zone (COMMZ). In some instances, the COMMZ may be outside the TO and located in offshore support facilities, Third Country support bases, or in the continental United States (CONUS). The CZ begins at the Army/corps rear boundary and extends forward to the extent of the commander's area of influence. The COMMZ begins at the corps rear boundary and extends rearward to include the area(s) needed to provide support to the forces in the CZ.

b.
The mission of the AMEDD is to conserve the fighting strength. This mission of CHS is a continuous and an integrated function throughout the TO. It extends from the CZ back through the COMMZ and ends in CONUS. Combat health support maximizes the system's ability to maintain presence with the supported soldier, return injured, sick, and wounded soldiers to duty, and to clear the battlefield of soldiers who cannot return to duty (RTD). Patients are examined, treated, and identified as RTD or nonreturn to duty (NRTD) as far forward as is medically possible. Early identification is performed by the treating primary care provider and continues in the evacuation chain with constant reassessment. Patients requiring evacuation out of the division who are expected to RTD within the theater evacuation policy are evacuated to a corps and/or COMMZ hospital. Those patients classified as NRTD follow the evacuation chain for trauma care and stabilization for evacuation out of the theater.

1-2. Echelons of Combat Health Support
The CHS system within a TO is organized into four echelons of support which extend rearward throughout the theater (see Figure 1-1). The system is tailored and phased to enhance patient identification, evacuation, treatment, and RTD as far forward as the tactical situation will permit. Hospital resources will be employed on an area basis to provide the utmost benefit to the maximum number of personnel in the area of operations (AO). Each echelon reflects an increase in capability, with the function of each lower echelon being contained within the capabilities of the higher echelon. Wounded, sick, or injured soldiers will normally be treated, returned to duty, and/or evacuated to CONUS (Echelon V) through these four echelons:
DODDOA-006789
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... 12/28/2004
s
* FELD HOSPITALS MAY NE EMPLOYED IN A CORPS
US ARMY ME (=AL EMPHASIS OF TREATMENT
0
CENTERS
. INWARD SURGICAL TEAM I PET) Ug ARMY DEPLOYED TO DIVISIONS 1Mor.AL
DEPARTMENT ACT MITES GENERAL HOSPITALS OTHER FEDERAL
(ECHELON IV) HOSPITALS HOSPITALS OMAN FIELD 'MASH I Caw) NOSPITAus HOSMTALS • FORWARD SURGICAL TEAM
!ECHELON 111
IFSTI
lEcIELON IV) !ECHELON 1V1
ECHELON 111
SPT SN J REGI
ASPIC ASML MED COM PANMS
MLR STAT fait STA) KEN STAT
cum= AND MSMC 405AI
DISPENSARE5 IECTIELON IU (ECHELON Ik PS ac 4N&A)
ECHELON II (CM ETA)
EaELDN III Ma STATIONS TRAIT STATIONS IN I SOON
AID STATIoros
ECHELON II LECPIELON II (ECHELON Ni (ECHELON II
CST MEDIC
Kamm CST UFESAVER
DEFINITIVE CEFINrTIVE RESUSCITATION EMERGENCY ALL SOLDERS
AND GANS RESUSCITATIVE & smERGENCY MEDICAL CARE
RESTORATIVE SURGERY MEDICAL CARE )AT1UV
CARE 4HOSPITAISI IA101) EMT
FONT AID
LEGEND: SELF . AID
RUDDY AID
AS 1C AREA SUPPORT MEDICAL COMPANY &NT EMERGENCY MEDICAL TREATMENT
ATM ADVANCED TRAUMA MANAGEMENT Paw FORWARD SUPPORT MEDICAL COMPANY
ON BATTALION FET FORWARD SURGICAL TEAM
ESA NUGAZE SUPPORT AREA MASH MOVE ARMY SURGICAL HOSPITAL
CST COMSAT RED MEDICAL
CUT STA CLEARIAG STATION MINE MAIN SUPPORT MEDIrALCOUPANT
CORO4Z COMMuNCAMONS ZONE REGT REGIMENT
CSH COMBAT SUPPORT HOSPITAL SPY ON SUPPORT SATTAU041
DSA DIVISION SUPPORT AREA SOON SQUADRON
EAC ECHELONS ADDVE CORPS TRAIT TREATMENT
Figure H. Echelons of combat health support.

a. Echelon 1. This echelon is also known as unit level. Care is provided by designated individuals or elements organic to combat and combat support (CS) units and elements of the area support medical battalion (ASMB). Major emphasis is placed on those measures necessary to stabilize the patient (maintain airway, stop bleeding, prevent shock) and allow for evacuation to the next echelon of care.
(1) Combat medic. This is the first individual in the CHS chain who makes medically substantiated decisions based on medical military occupational specialty (MOS)-specific training. The combat medic is supported by first-aid providers in the form of self-aid and buddy aid and the combat lifesaver.
DODDOA-006790
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-1 0- 1 4/Chl.htms12/28/2004
(a)
Self-aid and buddy aid. The individual soldier is trained to be proficient in a variety of specific first-aid procedures with particular emphasis on lifesaving tasks. This training enables the soldier, or a buddy, to apply immediate care to alleviate a life-threatening situation.

(b)
Combat lifesaver. Enhanced medical training is provided to selected individuals who are called combat lifesavers. These individuals are nonmedical unit members selected by their commander for additional training to be proficient in a variety of first-aid procedures. A minimum of one individual per squad, crew, team, or equivalent-sized unit is trained. All combat units and some CS and combat service support (CSS) units have combat lifesavers. The primary duty of these individuals does not change. The additional duties of combat lifesavers are performed when the tactical situation permits. These individuals provide enhanced first-aid care for injuries prior to treatment by the combat medic. The training is normally provided by medical nersonnel assigned or attached to the unit. The training program is managed by a senior medical person designated by the commander.

(2) Treatment squad. The treatment squad consists of a field surgeon, a physician assistant (PA), two noncommissioned officers (NCOs), and four medical specialists. The personnel are trained and equipped to provide advanced trauma management (ATM) to the battlefield casualty. Advanced trauma management is emergency care designed to resuscitate and stabilize the patient for evacuation to the next echelon of care. Each squad can split into two trauma treatment teams. These squads are organic to medical platoons/sections in maneuver battalions and designated CS units and medical companies of separate brigades, divisions, and echelons above division in the ASMB. Treatment squads (treatment teams) may be employed anywhere on the battlefield. When not engaged in ATM, these elements provide routine sick call services on an area basis. Echelon I care for units not having organic Echelon I capability is provided on an area basis by the organization responsible in the sector.
b.
Echelon II. This echelon may also be known as division level. Care at this echelon is rendered at the clearing station (division or corps). Here the casualty is examined and his wounds and general status are evaluated to determine his treatment and evacuation precedences, as a single casualty among other casualties. Those patients who can RTD within 1 to 3 days are held for treatment. Emergency medical treatment (EMT) (including beginning resuscitation) is continued and, if necessary, additional emergency measures are instituted; but they do not go beyond the measures dictated by the immediate necessities. The division clearing station has blood replacement capability, limited x-ray and ambulatory services, patient holding capability, and emergency dental care. Clearing stations provide Echelon I CHS functions on an area basis to those units without organic medical elements. Echelon II CHS also includes preventive medicine (PVNTMED) activities and combat stress control (CSC). These functions are performed typically by company-sized medical units organic to brigades, divisions, and ASMBs.

c.
Echelon III. The first hospital facilities are located at this echelon. Within the CZ, the mobile army surgical hospital (MASH) and the CSH are staffed and equipped to provide resuscitation, initial wound surgery, and postoperative treatment. Although the MASH is an Echelon III facility, it is designed to be employed within the division area. At the CSH, patients are stabilized for continued evacuation, or returned to duty. Those patients who are expected to RTD within the theater evacuation policy are regulated to a facility that has the capability for reconditioning and rehabilitating.

d.
Echelon IV At this echelon, the patient may be treated at the general hospital (GH) or the field hospital (FH). The GHs are staffed and equipped for general and specialized medical and surgical care. Those patients not expected to RTD within the theater evacuation policy are stabilized and evacuated to CONUS. At the FH, reconditioning and rehabilitating services are provided for those patients who will

DODDOA-006791
http://atiam.tain.army.mil/portal/atia/adlsc/view/public/296784-1/frn/8-... 12/28/2004 be RTD within the theater evacuation policy.
e. Echelon V. This echelon of care is provided in CONUS. Hospitalization is provided by DOD hospitals (military hospitals of the triservices) and Department of Veterans Affairs (DVA) hospitals. Under the National Disaster Medical System, patients overflowing DOD and DVA hospitals will be cared for in designated civilian hospitals.
1-3. Theater Hospital System
a. Medical Force 2000 is the modernization effort to restructure the CHS system including hospitalization in support of a TO. This system consists of four hospitals, a medical company, holding, and six medical/surgical teams. The two corps hospitals are the MASH and the CSH. The two COMMZ hospitals are the FH and the GH. In addition to these hospitals, the medical company, holding, provides a 1,200-cot convalescent capability. For a detailed discussion on the Medical Force 2000 hospital system, refer to FM 8-10.
(1)
Mobile army surgical hospital. This hospital is a 30-bed facility with the primary mission of providing lifesaving surgical and medical care to stabilize patients for further evacuation, either to the CSH or to COMMZ hospitals. Patients are held approximately 24 to 36 hours until considered stable enough to tolerate a bed-to-bed transfer without incurring further risk to their condition. The MASH will be employed in the corps area or forward in the division rear area. This hospital is not Deployable Medical Systems (DEPMEDS)-equipped. It is 100 percent mobile with organic vehicles.

(2)
Forward surgical team. A forward surgical team (FST) will replace the two surgical squads in each of the following: the airborne division; the air assault division; and the 2d Armored Cavalry Regiment (ACR). The FSTs will also replace the medical detachment (surgical) and the 30-bed MASH. This team will be a corps augmentation for divisional and nondivisional medical companies. It will provide emergency/urgent initial surgery and nursing care after surgery for the critically wounded/injured patient until sufficiently stable for evacuation to a theater hospital. The FSTs not organic Lo divisions and the 2d ACR will be assigned to a medical brigade or group and normally attached to a corps hospital when not operationally employed and further attached for support to a divisional/nondivisional medical company.

(3)
Combat support hospital. This hospital is addressed in detail in the following chapters of this publication.

(4)
Field hospital. This hospital is a 504-bed facility with the mission of providing hospitalization for patients and for reconditioning and rehabilitating those patients who can RTD within the theater evacuation policy. The majority of patients within this facility will be in the convalescent care category. The FH is normally located in the COMMZ, but could be used in the corps rear when geographical operational constraints dictate. It is 20 percent mobile with organic vehicles.

(5)
General hospital. This organization is a 476-bed facility with the mission of providing stabilization and hospitalization for patients who require either further evacuation out of the TO, or who can RTD within the theater evacuation policy. The GH will normally be located in the COMMZ. Its mobility is 10 percent with organic vehicles.

(6)
Medical company, holding. This unit provides reconditioning and rehabilitation for up to 1,200 convalescent care patients. This unit may be located in the corps or COMMZ. It is used to

DODDOA-006792
http://atiam.train.anny.mil/portal/atia/adisciview/public/296784-1/fin/8... s12/28/2004
augment the CSH when operational necessity dictates. It may also be used in the 3-week CSC reconditioning program. This unit is staffed and equipped to provide care for minimal category (self-care) patients.
b. The CSH, FH, and GH are designed using the following four modules:
(1)
Hospital unit, base (HUB).

(2)
Hospital unit, surgical (HUS).

(3)
Hospital unit, medical (HUM).

(4)
Hospital unit, holding (HUH).

They are configured using the appropriate combination of these modules. The HUB can operate independently, is clinically similar, and is located in each hospital as the initial building block. The other three mission-adaptive modules (HUS, HUM, and HUH) are dependent upon the HUB (see Figure 1 -2.)
DODDOA-006793
http://atiam.train.anny.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .htm 12/28/2004
FM 8-10-14 Chptr 1 Hospitalization System In A Theater Of Operations Page 6 of 6
550
.525
500
475
450
a5
400
375
360

3:24
BEDS

300
275
250
725
200
175
150
125
100
75
50
2b
0

CSH GH
HOSPITAL TYPES
HUB• HUS HUM HUH 1236 BEDS) 100 BL00 1150 BEDS) C260 BUNN
• ALTHOUGH THE HUB HAS 236 BEDS, WHEN IT IS USED AS THE BASE COM PONENT FOR THE FH, IT IS ONLY STAFFED TO PROVIDE HOSPITALIZATION FOR 224 PATIENTS IN THE FH CON FIGURATION .THE 'it1B HAS TWO INTENSIVE CARE WARDS THAT PROVIDE CARE FOR VP TO 24 PATIENTS. BY CONTRAST, IN THE CSM AND GH CONFIGURATIONS. THE mUB HAS THREE INTENSIVE CARE WARDS THAT PROVIDE CARE FOR UP TO 36 PATIENTS THIS IS THE REASON FOR THE 12 PATIENT DIFFERENCE IN THE FH CO N FlOU RAT ON.
Figure 1-2. enmportent hospital system.

DODDOA-006794
http://atiam.train.army.mil/portallatia/adlsc/view/public/296784-1/fin/8... 12/28/2004
CHAPTER 2

THE COMBAT SUPPORT HOSPITAL
2-1. Mission and Allocation
The mission of this hospital is to provide resuscitation, initial wound surgery, postoperative treatment,
and RTD those soldiers in the CZ who fall within the corps evacuation policy, or to stabilize patients for
further evacuation. This hospital is capable of handling all types of patients. It has a basis of allocation
of 2.4 hospitals per division.

2-2. Assignment and Capabilities
a.
The CSH is assigned to the Headquarters and Headquarters Company (HHC), Medical Brigade, TOE 08-422L100. The hospital may be further attached to the Headquarters and Headquarters Detachment (HHD), Medical Group, TOE 08-432L000.

b.
This unit provides hospitalization for up to 296 patients. The hospital has eight wards providing intensive nursing care for up to 96 patients, seven wards providing intermediate nursing care for up to 140 patients, one ward providing neuropsychiatric (NP) care for up to 20 patients, and two wards providing minimal nursing care for up to 40 patients.

c.
Surgical capacity is based on eight operating room (OR) tables for a surgical capacity of 144 OR table hours per day.

d.
Other capabilities include--


Consultation services for patients referred from other medical treatment facilities (MTFs).


Unit-level CHS for organic personnel only.


Pharmacy, clinical laboratory, blood banking, radiology, physical therapy, and nutrition care
services.


Medical administrative and logistical services to support work loads.


Dental treatment to staff and patients and oral and maxillofacial surgery support for military
personnel in the immediate area plus patients referred by the area CHS units.

2-3. Hospital Support Requirements
In deployment and sustainment of operations, this unit is dependent upon appropriate elements of the
corps for--

Personnel administrative services.


Finance.


Mortuary affairs and legal services.


Transportation services (unit is 35 percent mobile with organic assets).


Laundry services for other than patient-related linen.


Security and enemy prisoner of war (EPW) security during processing and evacuation.


Transportation for discharged patients.


Class I supplies (rations) to include the Medical B Rations required for patient feeding.


Engineer support for site preparation waste disposal, and minor construction. ,

DODDOA-006795
http://atiam.train.army.mil/portal/atia/adlsc/view/public./296784-1/fin/... 12/28/2004

Veterinary support for zoonotic disease control and investigation; inspection of medical and nonmedical rations, to include suspected contaminated rations and disposition recommendations; and animal bites.


PVNTMED support for food facility inspection, vector control, and control of medical and
nonmedical waste.

2 4. Hospital Organization and Functions
-
The CSH is a modular-designed facility which consists of a HUB and HUS. It can be further augmented with specialty surgical/medical teams to increase its capabilities. It may become a designated specialty center as the work load or mission dictates (Figure 2-1).
COMBAT SUPPORT HOSPITAL HOSPITAL
HOSPITAL UNIT
UNIT BASE
SURGICAL
r— T —1 T
MEDICAL TEAM MEDICAL TEAM MEDICAL TEAM MEDICAL TEAM MEDICAL TEAM MEDICAL TEAM RENAL INFEcTIOuS PATHOLOGY HEAD & NECK NEUROSURGERY EYE SURGERY HEMODIALYSIS DISEASE S URGERY
NOTE: DEPENDING UPON OPERATIONAL RECUIREMENTS. THE MEDICAL AND SURGICAL TEAMS MAY OR MAY NOT GE ATTACHED TO THE INDIVIDUAL CLINICAL ELEMENT OF THE CSH.
Figure 2.2. Combat support hospital organtratton.
a. The HUB is a 236-bed facility which has 36 intensive, 140 intermediate, 40 minimal, and 20 NP care beds. It has two OR modules, one surgical and the other orthopedic, which are staffed to provide a total of 72 OR table hours per day. It also allows for attachment of specialty surgical teams. The HUB is an independent organization which includes all hospital services (Figure 2-2).

DODDOA-006796
http://atiam.train.army.mil/portallatia/adIsc/view/public/296784-1/fm/8-... 12/28/2004
HOSPITAL
UNIT BASE

HOSPITALPROFESSIONALHOSPITAL MCI ADMIN SVC MINISTRYSVC TEAM
OPERATIONS EMERGENCY INPATIENT SEC MED SVC MED A
UTTER NP WARD &COMPANY TRIAGE/ BEARER CONSULTATIONHQ EMT/PREOP SVC SVC
DENTAL NURSING
ADMIN NV SVC SVC
1
NURSING
SURGICAL
PAD SVC CONT ICW
SVC
TEAM
OR1110
11••¦¦I
NUTRITION MCW
ICU
CMS CAST
CARE DIV
2
CLINIC
2
OR/CMS
OR ANCILLARYSUPPLY ao CONTROL ROOM A Svc
SVC ON
TEAM
OR PHARMACY RADIOLOGY ROOM B SVC SVC
PHYSICAl.
LAB THERAPY
SVC SVC
BLOOD BANK
Figure 2-2. Ifuspetal, unit, haw.
b. The HUS is comprised of 60 intensive care beds, two OR modules, one x-ray module, one triage/preoperative/EMT module, and the appropriate staffs (Figure 2-3). The HUS is dependent on the HUB for food service, maintenance, and administration.
DODDOA-006797
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... 12/28/2004
HOSPITAL
UNTT
SURGICAL

HOSPITAL PROFESSIONAL SUPPLY & UNF HO SVC
SVC DIV
OR/CMS
TRIAGE/CONTROL
EMT/PRE-OP TEAM
••¦¦•••1
CMS ICU
2
OR RADIOLOGY ROOM C SERVICE
OR ORTHO CAST ROOM CI CLINIC
Figurc 2-3. Hospital, unit, surgical.
c. When the HUB and HUS are employed to form a single hospital, half of the OR tables are staffed for two 12-hour shifts with the other half only staffed for one 12-hour shift per day.
2-5. The Hospital Unit, Base
The HUB provides a solid infrastructure for the CSH operations. The HUB contains the following sections:
a. Hospital Headquarters Section. This section provides internal command and control (C2) and management of all hospital services. Personnel of this section supervise and coordinate the surgical, nursing, medical, pastoral,, and administrative services. Staffing includes the HUB commander, the chiefs of surgery, nursing, and medicine, an executive officer (XO), a chaplain, a command sergeant major (CSM), and an administrative specialist (Table 2-1). When the HUB and the HUS join to function as a CSH, the HUB commander is the CSH commander unless otherwise designated.
DODDOA-006798
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... 12/28/2004
Table 2-1. Hospital Headquarters Organizatim
HOSPITAL HEADQUARTERS
HOSPITAL COMMANDER CDL 60A00 MC
CHIEF, SURGICAL SERVICE COL 61-100 MC
CHIEF, NURSING SERVICE COL 66A00 AN
CHIEF, MEDICAL SERVICE LTC 61F00 MC
EXECUTIVE OFFICER LTC 67A00 MS
H0SP!TAL CHAPLAIN MX.) 56A00 CH
COMMAND SERGEANT MAJOR CSM 01750 NC
ADMINISTRATIVE SPECIALIST SGT 71_20 NC

(1)
Hospital commander (60A00). Command and control is the process through which the activities of the hospital are directed, coordinated, and controlled to accomplish the mission. This process begins and ends with the commander. An effective commander must have a thorough knowledge and understanding of planning and implementing CHS (FM 8-55). He is decisive and provides specific guidance to his staff in the execution of the mission. The successful commander delegates authority and fosters an organizational climate of mutual trust, cooperation, and teamwork. He has the overall responsibility for coordination of CHS within the hospital's AO. Additionally, he is responsible for the structural layout of the hospital.

(2)
Chief surgical service (61J00). The chief surgeon is the principal advisor to the hospital commander for surgical activities. He provides supervision and control over the surgical services to include the ORs. He prescribes courses of treatment and surgery for patients having injuries or disorders with surgical conditions and participates in surgical procedures as required. He coordinates and is responsible for all matters pertaining to the evaluation, management, and disposition of patients received by the section. He is responsible for the evaluation and training programs for his professional staff. He also functions as the Deputy Commander for Professional Services.

(3)
Chief nurse (66A00). The chief nurse is the principal advisor to the hospital commander for nursing activities. This officer plans, organizes, supervises, and directs nursing care practices and activities of the hospital. This officer is also responsible for the orientation and professional development programs for the nursing staff.

(4)
Chief medicine services (61F00). This officer is responsible for the examination, diagnoses, and treatment, or recommended course of management for patients with medical illnesses. He controls the length of patient stay through continuous patient evaluation, early determination of disposition, or evacuation to the next echelon of care.

(5)
Executive officer (67A00). The hospital XO advises the commander on matters pertaining to health care delivery. He plans, directs, and coordinates administrative activities for the hospital. He provides guidance to the tactical operations center (TOC) staff in planning for future operations. He also functions as the Chief, Administrative Service.

(6)
Hospital chaplain (56A00). The chaplain functions as the staff officer for all matters in which religion impacts on command programs, personnel, policy, and procedures. He provides for the spiritual well-being and morale of patients and hospital personnel. He also provides religious services and pastoral counseling to soldiers in the AO.

00000A-006799
http://atiam.train.army.mil/portal/atia/adlsc/view/public./296784-1/fin/... 12/28/2004
(7)
Command sergeant major (00Z50). The CSM is the principal enlisted representative to the commander. He advises the commander and staff on all matters pertaining to welfare and morale of enlisted personnel in terms of assignment, reassignment, promotion, and discipline. He provides counsel and guidance to NCOs and other enlisted personnel of the hospital. He is also responsible for the reception of newly assigned enlisted personnel into the unit. The CSM evaluates the implementation of individual soldier training on common soldier tasks and supervises the hospital's NCO professional development.

(8)
Administrative specialist (71L20). The administrative specialist performs typing, clerical, and administrative duties for the hospital headquarters. He proofreads correspondence for proper spelling, grammar, punctuation, format, and content accuracy. He establishes and maintains files, logs, and other statistical information for the command. He is the light-vehicle driver and radio operator for the command section.

b. Hospital Operations Section. This section is responsible for communications (internal and external), security, plans and operations, deployment, and relocation of the hospital. The staff is composed of a medical operations officer, a field medical assistant, an operations NCO, a nuclear, biological, and chemical (NBC) NCO, an administrative specialist, and appropriate communications personnel (Table 2-2). The authorization for the field medical assistant is counted in the HUS.
Table 2-2. Hospital Operations Section Organization
HOSPITAL OPERATIONS SECTION
MEDICAL OPERATIONS OFFICER MAJ 70H87 MS
FIELD MEDICAL ASSISTANT CPT 70687 MS
OPERATIONS SERGEANT SFC 91340 NC
SECTION CHIEF SFC 31U40 NC
NUCLEAR, BIOLOGICAL, AND
CHEMICAL NCC SFC 54640 NC
ELECTRONIC SWITCH SYSTEMS
OPERATOR SGT 31F20 NC
ELECTRONIC SWITCH SYSTEMS
OPERATOR SPC 31F10
SIGNAL INFORMATION SERVICE
SPECIALIST SPC 31U10
ADMINIS-RATIVE SPECIALIST SPC 71110
ELECTRONIC SWITCH SYSTEMS
OPERATOR PFC 31F10
SIGNAL SUPPORT SYSTEMS
SPECIALIST PFC 31U10
DODDOA-006800

(1)
Medical operations officer (70H67). This officer is responsible to the XO for the Intelligence Officer/Operations and Training Officer (S2/S3) functions of the hospital. He supervises all tactical operations conducted by the hospital to include planning and relocation. He is responsible for the formulation of the tactical standing operating procedures (TSOP) and hospital planning factors (refer to Appendix A for an example of a TSOP format and Appendix B for an estimate of hospital planning factors).

(2)
Field Medical Assistant (70B67). This officer is responsible to the medical operations officer for planning and coordinating site selection and convoy operations during hospital deployment

http://atiam.train ..army.mil/portal/atia/adlsc/view/public./296784-1/fm/8-10-14/Ch2.htm 12/28/2004
and relocation. He also functions as the operations security (OPSEC) and communications
security (COMSEC) officer for the hospital. The requirement for this position is counted in the
unit headquarters section (HUS). When the HUB and HUS form a CSH, the field medical
assistant, HUS becomes the field medical assistant in this section.
(3)
Operations sergeant (91B40). The operations sergeant is responsible to the medical operations officer for physical security, to include the hospital defense plan; preparation of unit plans, operation orders (OPORDs) and map overlays; and intelligence information and records. He also supervises subordinate staff.

(4)
Section chief (31 U40). This NCO serves as the principal signal advisor to the hospital • commander and medical operations officer on all communications matters. He is responsible to the medical operation and plans officers for the planning, supervising, coordinating, and technical assistance in the installation, operation, management, and operator-level maintenance of radio, field wire, and switchboard communications systems. He supervises all subordinate communications personnel.

(5)
Nuclear, biological, and chemical noncommissioned officer (54B40). This NCO is the technical advisor to the hospital commander and medical operations officer on matters pertaining to NBC operations. He is responsible to the medical operations officer for the planning, training, NBC decontamination (less patient), and other aspects of hospital NBC defensive operations.

(6)
Electronic switch systems operator (31F20). This operator is responsible to the section chief for the installation, operation, and operator-level maintenance of switchboards and switching systems.

(7)
Electronic switch systems operator (31F10). These operators are responsible to the section chief for the installation, operation, and unit-level maintenance on switchboards, switching assemblages, and associated communications equipment.

(8)
Signal information service specialist (31UI0). This individual is responsible to the section chief for installation and operation of unit wire systems, associated equipment, and frequency modulated (FM) radios.

(9)
Administrative specialist (7L10). This individual is responsible to the operations sergeant for general typing and administrative functions for the section.

(10)
Signal support systems specialist (31U10). This individual is responsible to the section chief for installing wire for field telephones and assisting in the operation of the hospital FM radios.

c. Company Headquarters. This section is responsible for company-level command, duty rosters, weapons control, and mandatory training. Staffing includes the company headquarters commander, the first sergeant, a decontamination specialist, an administrative clerk, and an armorer (Table 2-3).
DODDOA-006801
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... 12/28/2004
Table 2.3. Company Headquarters Organization
COMPANY HEADQUARTERS
COMPANY COMMANDER CPT 701357 MS
FIRST SERGEANT MSG 91B5M NC
DECONTAMINATION SPECIALIST SPC 54810
ADMINISTRATIVE CLERK SPC 71L10
ARMORER SPC 92Y10

(1)
Company commander (70B67). The company commander is responsible to the XO for all activities in the company headquarters. He administers Uniform Code of Military Justice (UCMJ) actions for enlisted personnel; plans and conducts common task training; and functions as the commander of the medical holding detachment, when assigned. When the HUB and HUS are employed to form the CSH, the medical holding detachment is assigned as dictated by the medical mission.

(2)
First sergeant (91B5M). The first sergeant is responsible to the company commander for enlisted matters. He also assists in supervising company administration and training activities. He provides guidance to the enlisted members of the company and represents them to the company commander. He also functions as the reenlistment NCO.

(3)
Decontamination specialist (54B10). This specialist is responsible to the first sergeant for training the company's NBC teams on the operation of NBC detection and decontamination equipment and for the operator maintenance on this equipment. He assists the NBC NCO in the establishment, administration, training, and application of NBC defense measures. He also performs NBC reconnaissance and is designated as a light-vehicle operator.

(4)
Administrative clerk (71110). The clerk-typist is responsible to the first sergeant for providing the personnel and unit administration support for the company headquarters. His duties consist of general administration and personnel actions.

(5)
Armorer (92YI0). The armorer's primary duty is that of maintaining the weapons storage area, small arms, and ammunition and performing small arms unit maintenance. He is designated as the light-vehicle operator for the section.

d. Administrative Division. This division provides overall administrative services for the hospital to include personnel administration, mail distribution, awards and decorations, leaves, and typing support. The staff is composed of the hospital adjutant, personnel sergeant, personnel administrative sergeant, an administrative specialist, mail delivery clerks, and an administrative clerk (Table 2-4). This section coordinates with elements of corps support command (COSCOM) for finance, personnel, and administrative services.

DODDOA-006802
http://atiam.train.army.mil/portallatia/adlsc/view/public/296784-1/ftn/8... 12/28/2004
Table 2.4. Administrative Division
Organization

ADMINISTRATIVE DIVISION
HOSPITAL ADJUTANT CPT 70F67 MS
PERSONNEL SERGEANT SFC 75Z40
PERSONNEL ADMINISTRATIVE SGT 76820 NC
SERGEANT
ADMINISTRATIVE SPECIALIST SPC 71L10
MAIL DELIVERY CLERK PFC. 711_'.0 (3)
ADMINISTRATIVE CLE RK PFC 711;0

(1)
Hospital adjutant (70F67). This officer is responsible to the hospital XO for the adjutant functions within the hospital. He also advises the commander and staff in the area of personnel management for patients and staff.

(2)
Personnel sergeant (75240). The personnel sergeant is responsible to the adjutant for specific personnel functions which include personnel management, records, actions, and preparation of Standard Installation/Division Personnel System (SIDPERS) changes. He ensures coordination between the medical brigade and/or medical group Personnel and Administration Center (PAC) and the hospital. He advises the hospital commander, adjutant, and other staff members on personnel administrative matters. He also supervises the activities of subordinate personnel.

(3)
Personnel administrative sergeant (75B20). This individual is responsible to the personnel sergeant for personnel and administrative functions for the hospital.

(4)
Administrative specialists (71L10). These specialists are responsible to the personnel sergeant for general typing and administrative functions for the division.

(5)
Mail delivery clerks (71L10). These administrative specialists are responsible to the personnel staff NCO for establishing and operating the unit mail room. They also assist the personnel staff NCO with personnel and clerical duties. They are the designated light-vehicle operators for the division.

e. Patient Administration Division (PAD). This division is responsible for the admission and disposition of patients, maintenance of patient records, security of patient valuables, and preparation of patient statistical reports for the hospital. The staff is composed of the patient administration officers, NCOs, and specialists (Table 2-5).
DODDOA-006803
http://atiamirain.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8-... 12/28/2004
Table 2-5, Patient Administration Division Organization
PATENT ADMINISTRATION DIVISION PATIENT ADMINISTRATION
OFFICER N'.AJ 70E67 MS
OFFICER CPT 70E67 MS
NCO SSG 71G30 NC
NCO S3T 71G20 NC (3)
SPECIALIST SPC 71G10 (4)
SPECIALIST PFC 71G10 (4)

(1)
Patient administration officer (70E67). As chief of the PAD, this officer is responsible to the hospital XO for planning, organizing, directing, and controlling the patient administration aspects of the hospital. He advises the commander on patient administration matters. He maintains close liaison with the chiefs of services, attending physicians, and chiefs of administrative sections and offices to ensure timely decisions on patient administration matters.

(2)
Patient administration officer (70E67). This officer assists the chief, PAD in developing plans and procedures for patient administration support, to include patient statistical reports and medical regulation of patient dispositions (refer to FM 8-10-6).

(3)
Patient administration non-commissioned officer (71G30). This NCO is responsible to the patient administration officer for patient administration and disposition procedures, inpatient records, and security of patients' personal effects. He works in concert with the supply sergeant (company headquarters) on reequipping the RTD soldier. He also supervises the application of the Theater Army Medical Management Information System (TAMMIS) for the Medical Patient Accounting and Reporting (MEDPAR) System and for the Medical Regulating (MEDREG) System.

(4)
Patient administration noncommissioned officers (71G20). These NCOs are responsible to the principal patient administration NCO for implementing the TAMMIS for the hospital. They process correspondence received for medical information. They also assist in supervising subordinate specialists.

(5)
Patient administration specialists (71G10). These specialists are responsible to the patient administration NCOs for preparing, consolidating, and maintaining medical records and statistics pertaining to patient data. They also implement the TAMMIS for the division.

f Nutrition Care Division. This division is responsible for providing hospital nutrition services, meal
preparation and distribution to patients and staff; dietetic planning; and supervision and control of
overall operations. Hospital staff will be fed in accordance with the theater ration policy. The field
medical feeding standard for hospitals is to prepare three hot meals per day plus nourishments and
forced fluids using Medical B (or A) Rations. Meals, ready to eat (MRE) are not authorized for patient
use. Rations will be obtained from the supporting COSCOM. Patient meals, nourishments, and forced
fluids will be distributed to the wards three times per day; tube feedings are provided intermittently as patient's nutritional needs require. (Refer to FM 8-505, Technical Manual [TM] 8-500, and Appendix B of this manual.) The staff is composed of dietitians, hospital food service NCO, and hospital food service specialists (Table 2-6).
DODDOA-006804
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... 12/28/2004
Table 2.6, Nutrition Care Division Organization
NUTRITION CARE DIVISION
CHIEF, NUTRITION CARE DIVISION MAJ 65C00 SP
DIETITIAN CPT 65C00 SP
HOSPITAL FOOD SERVICE
NCO SFC 91M4: NC
NCO SSG 9:M30 NC
NCO SOT g1M20 NC IS)
SPECIALIST SPC 91M10 1101
SPECIALIST PFC 81M10

(1)
Chief nutrition care division (65C00). This officer is responsible to the Chief, Administrative Services for the operation of this division. He directs and supervises the operation of nutrition care services.

(2)
Dietitian (65C00). This officer is responsible to the Chief, Nutrition Care for formulating policies, developing procedures, and assisting in supervising the operation of nutrition care. This officer also assists physicians in dietary management of patients.

(3)
Hospital food service noncommissioned officer (91M40). This NCO serves as the principal NCO for the nutrition care division. He is responsible to the Chief, Nutrition Care for the implementation of policies and procedures and for supervision of subordinate personnel.

(4)
Hospital food service noncommissioned officer (91M30). This NCO is responsible to and serves as an assistant to the principal NCO in nutrition care operations. He implements and directs contingency and combat feeding plans.

(5)
Hospital food service sergeants (91M20). These sergeants are responsible to the principal NCO and assist with the clinical and administrative management of nutritional care programs.

(6)
Hospital food service specialists (91M10). These hospital food service specialists are responsible to the hospital food service sergeants for performing basic clinical dietetic functions in the dietary management and treatment of patients. They prepare, cook, and serve regular and modified food. They also perform light-vehicle operator/driver duties for the division, to include operator maintenance.

g. Supply and Service Division. This division provides logistics functions throughout the hospital, to include laundry, general and medical supplies, and maintenance; blood management (see Appendix B [paragraph B-4k]); utilities such as water distribution, waste disposal, and environmental control of patient treatment areas; power and vehicle maintenance; equipment records and repair parts; fuel distribution; and transportation to include ground/air movement operations. The logistics division requests resupply from the supporting medical logistics (MEDLOG) battalion (forward) and COSCOM elements using whatever communication links are available and compatible with the Theater Army Medical Management Information System-Medical Logistics (TAMMIS-MEDLOG). Medical logistics and medical maintenance (MEDMNT) will be managed utilizing TAMMISMEDLOG and TAMMIS-MEDMNT. This division coordinates with COSCOM elements for materiels handling equipment (MHE) capable of moving DEPMEDS equipment, environmental control units, and power distribution equipment for the hospital. This division is also responsible for maintaining the unit property book and
DODDOA-006805
http://atiam.train.army.mil/portal/atia/adIsc/view/public/296784-1/fm/8-... 112/28/2004 for establishing a temporary morgue for handling remains until transported to supporting mortuary affairs organization. This section coordinates with elements of the corps and COSCOMs for movement control, nonmedical supplies and equipment, and field services. This section will provide one basic uniform to RTD soldiers and will also coordinate with the COSCOM for the transportation of these soldiers to the replacement companies. Table 2-7 lists the staffing for this division.
Table 2.7. Supply and Service DiviRtan Organtzation
SUPPLY AND SERVICE DIVISION
HEALTH SERVICE MATERIEL OFFICER MAJ 70K67 MS
HEA%11.1 SERVICE MATERIEL OFFICER cPT ms
POWER SYSTEMS TEC-iNIC AN W2 2'0AS WO
H EA .TII SERVICE MA iN-ENAN CE TECHNICIAN Wz 677:: WO
MEDICAL SUPPLY NCO SFC 16J49 NC

MOTOR SERGEANT SFC &lam) ND
MEDICAL EQUIPMENT REPAIR ER:SL PEF,V1SOR SSG siA3:: NC
SENIOR LT LITIES EQUIPMENT REPA RER SSG 52030 NC
SHOWER NCO SSG 57E30 NC
SENIOR MECHANIC SSG 53820 NC
MEC CAL STORAGE SU PIRVIsoft SSG ?SAG NC
SUPPLY SERGEANT SSG 92Y30 NC
NI ED .C.AL i(luIPMENT REPAIRER JTILITIES EOUIPMENT REPAIRER SGT SOT 91A20 52C2C NC NC 121
PowER-O ENE RATOR EOUIPMENT REPAIRER SGT 52020 NC
TEA M C.}IIE: I iGHT.WP EEL ED VEHICLE MECHANIC SOT SOT 61E20 631323 NC (41 NC
auARTERmASTER AND CHEm ICA _ EQUIPMENT REPAIRER SOT 63JZ0 NC
MEOICA. SUPPLY SERGEANT SGT 76.120 NC ',2)
EQUIPMENT IECEIVERRARTS SPECIALIST SiGNAL SUPPORT SYSTEMS MAINTAINER SOT SPC 92A20 311)10 NC
MEDICAL EQUIPMENT REPAIRER u Ti unEs EQUIP MENT REPAIRER SPC SPC 91A19 52C10 (2I U)
POWER-GENERATOR EDUIPRIEN1 REPAIRER SPC 52DIO
LAUNDRY SPEC ALsT SPC STE10 14)
LIGHT-WHEELED rEHiCIE MECHAN:C SPC 63510
AEC own VE•liCLE OPERATOR SPC 636.0
MEC CAL SUPPLY SPECIAUST SPC 76J19 1 4)
PETRO _EU M 1.1G H T-VE HIcLE OPERATOR SPC 77F10
SJPPLY SPECIALIST SPC 92Y19
UTILITIES EQJIPM ENT REPAIRER PFC 52C10 (2;
POWER-GENERATOR EQULPMENT REPAIRER PFC S2DIC
LAUNDRY SPECIALIST PfC 5700 (4)

LIGHT WHEELED VEHICLE MECHANIC PFC 631310 (2)
QUARTERMASTER ANC CHEMICAL EQUIPMENT REPAIRER PFC 63.110
MEDICAL SUPPLY SPECIAUST PETROLEUM LIGHT VEHiCi.L OPERATOR PIC Fft 16.110 77ric :4) :2•1
EOU:PMENT RECEIVEIVPARTS SPECIALIST PFC 92A10
SUPPLY SPECIALIST PFC 92Y16

(I)
Health service materiel officer (70K67). This officer irresponsible to the Chief, Administrative Services. He plans, coordinates, and manages the entire logistics system for the hospital. Additionally, he controls and manages the budget for the hospital commander. He is also responsible for hospital field waste and safety procedures (refer to Appendixes C and D for examples of these programs).

(2)
Health service materiel officer (70K67). This officer is responsible to the Chief, Supply and Services Division. He has primary responsibility for the medical supply area and functions as the supply officer for the hospital. This officer is also responsible for managing the controlled substances stored by the medical supply section.

(3)
Power systems technician (210A5). This warrant officer is responsible to the Chief, Supply and Services Division. He advises the command on the status, maintenance, and repairs of general support (GS) equipment. He supervises organizational maintenance of wheeled vehicles,

DODDOA-006806
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... 112/28/2004 associated support equipment, and power support equipment. He is responsible for the preparation
of log books, maintenance records, and associated reports.
(4)
Health service maintenance technician (670A0). This warrant officer is responsible to the Chief, Supply and Services Division. He supervises and assists in the installation and maintenance of hospital equipment. He serves as the technical consultant to all members of the hospital staff on medical maintenance matters. He also supervises scheduled (preventive maintenance) and unscheduled (repair) services on medical and related equipment within his scope of responsibility.

(5)
Medical supply noncommissioned officer (76J40). This NCO assists the division chief in the supervision of the logistics division, to include medical supply operations, stock control, and medical assemblage management. He is responsible for the development and preparation of plans, maps, overlays, sketches, arid other administrative procedures related to employment of the supply and service division.

(6)
Motor sergeant (63B40). This NCO is responsible to the power systems technician for unit maintenance on wheeled vehicles and MHE and the upkeep of hand and power tools. He supervises, trains, advises, and inspects subordinate personnel in the use of the Army Maintenance Management System (TAMMS), prescribed load list (PLL), and automated systems output. He is also responsible for supervising the training and licensing of vehicle and equipment operators and ensuring their skills qualification.

(7)
Medical equipment repairer/supervisor (91A30). This NCO is responsible to the health service maintenance technician for performing and supervising hospital medical maintenance operations. He is responsible for interpreting technical publications that apply to inspection, troubleshooting, maintenance, repair, calibration, and testing of medical equipment. He also supervises the operation of TAMMIS-MEDMNT.

(8)
Senior utilities equipment repairer (52C30). This NCO is responsible to the power systems technician for supervising and performing unit maintenance of utilities quartermaster equipment. He inspects the installation and condition of power generation and distribution equipment systems.

(9)
Shower noncommissioned officer (57E30). This NCO is responsible to the medical supply sergeant for the supervision of laundry and bath operations for the hospital. He supervises the subordinate laundry specialists. He coordinates with the supporting engineer unit and quartermaster unit for water support and wastewater disposal.

(10)
Senior mechanic (63B30). This NCO assists the motor sergeant in the performance of his duties. He instructs and supervises subordinate personnel in proper unit maintenance practices and procedures.

(11)
Medical storage supervisor (76J30). This NCO is responsible to the medical supply sergeant for supervising and planning hospital storage activities. He operates the TAMMIS-MEDLOG for the hospital.

(12)
Supply sergeant (92Y30). The supply sergeant is responsible to the medical supply NCO for the requisitioning, accountability, and issuing of general supplies and equipment for the hospital. He keeps the property book for the hospital on the Tactical Army Combat Service Support (CSS) Computer System. (TACCS), using the standard property book supply revised (SPBSR) system.

DODDOA-006807
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
He works in concert with the PAD and requests, from the supporting direct support (DS) supply company, those minimum Class II supply items authorized for issue to RTD soldiers (to include mission-oriented protective posture [MOPP] gear, if required). He ensures that RTD soldiers are provided transportation to the replacement company. The supply sergeant supervises the activities of the supply specialists.
(13)
Medical equipment repairer (91A20). This NCO assists the medical equipment repairer/supervisor in the performance of his duties. He advises and assists equipment operators in the assembly and disassembly of field medical equipment.

(14)
Utilities equipment repairers (52C20). These NCOs are responsible to the senior utilities equipment repairer for repair and maintenance of utilities-type equipment. They install heating, refrigeration, and air-conditioning equipment. They are also light-vehicle operators for the section.

(15)
Power-generator equipment repairer (52D20). This NCO is responsible to the power systems technician for performing unit-level maintenance functions on power generation equipment and associated items. He also supervises the subordinate power-generator equipment repairer.

(16)
Team chiefs (57E20). These NCOs assist the shower NCO in performing his duties. They also conduct laundry site reconnaissance to determine the best site based on drainage, water supply, hospital layout, cover, and concealment.

(17)
Light-wheeled vehicle mechanic (63B20). This mechanic is responsible to the motor sergeant for those mechanical duties within his scope of responsibility. He also performs driver operator duties.

(18)
Quartermaster and chemical equipment repairer (63J20). This NCO is responsible to the senior utilities equipment repairer for troubleshooting and repairing quartermaster and chemical equipment malfunctions.

(19)
Medical supply sergeants (76J20). These NCOs are responsible to the medical supply NCO in performing medical supply duties. They supervise the medical supply specialists.

(20)
Equipment receiver/parts specialist (92A20). This soldier is responsible to the motor sergeant for maintaining equipment records and repair parts list and performing maintenance control duties. He also performs driver operator duties.

(21)
Signal support systems maintainer (31U10). This individual is responsible to the medical supply sergeant for removing, installing, and providing unit-level maintenance of tactical radio communications systems, field wire equipment, and other electronic items of equipment. He works in coordination with the Chief, Hospital Operations Section.

(22)
Medical equipment repairers (91A10). These repairers are responsible to the medical equipment repairer/supervisor for performing unit-level maintenance on assigned medical equipment. They also assist in training equipment operators in the performance of operator-level preventive maintenance checks and services (PMCS).

(23)
Utilities equipment repairers (52C10). These repairers are responsible to the senior equipment repairer for unit maintenance of refrigeration equipment, air-conditioning units, and gasoline engines used as prime movers of refrigeration units. They are also vehicle operators for

DODDOA-006808
http://atiam.train.anny.mil/portal/atia/adlseview/public/296784-1/fin/8-... 112/28/2004
their section.
(24)
Power generator equipment repairers (52D10). These equipment repairers are responsible to the power generator equipment repairer NCO for operator and unit maintenance of tactical utility and power generation equipment and associated items.

(25)
Laundry specialists (57E10). These specialists are responsible to the shower NCO for performing their designated duties.

(26)
Light-wheeled vehicle mechanics (63B10). These specialists are responsible to the light­wheeled vehicle mechanic NCO for performing their designated duties. They are vehicle operators for the division.

(27)
Recovery vehicle operator (63B10). This specialist is responsible to the senior mechanic for unit-level maintenance and recovery operations on light-and heavy-wheeled vehicles, MHE, and associated items.

(28)
Medical supply specialists (76J10). These specialists are responsible to the medical supply sergeants for performing designated medical supply and equipment functions. They are designated light-vehicle operators for their section.

(29)
Petroleum light-vehicle operators (77F10). These petroleum light-vehicle operators are responsible to the motor sergeant. They receive, store, account and care for, dispense, issue, and ship bulk and packaged petroleum, oil, and lubricant (POL) supplies. They also operate and maintain the petroleum vehicles.

(30)
Supply specialists (92Y10). These supply specialists assist the supply sergeant in the accomplishment of his duties.

(31)
Quartermaster and chemical equipment repairer (63J10). This equipment repairer is responsible to the quartermaster and chemical equipment repairer NCO for unit maintenance on quartermaster and chemical equipment.

(32)
Equipment receiver/parts specialist (92A10). This specialist is responsible to the motor sergeant for maintaining equipment records and repair parts lists and performing maintenance control duties.

h. Nursing Service Control Team. This team is responsible to the Chief, Nursing Service for supervision of all nursing service personnel regardless of organizational placement. This team also provides daily patient reports to the chief nurse and PAD and is responsible for the standards of nursing practice and nursing care throughout the facility. The staff to provide this control are the assistant chief nurse, chief and assistant chief wardmasters, and a respiratory NCO (Table 2-8).

DODDOA-006809
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
Table 2-8_ Nursing Service Control Team.
Organization

NURSING SERVICE CONTROL TEAM
ASSISTANT CHIEF NURSE LTC 66A00 AN
CHIEF WAROMASTER MSG 91050 NC
ASSISTANT CHIEF
WARDMASTER SFC 91C40 NC
RESPIRATORY NCO SFC 91V4O NC

(1)
Assistant chief nurse (66A00). The assistant chief nurse works in concert with the Chief, Nursing Service. This nurse plans, organizes, executes, and directs nursing care practices for the hospital. This officer holds the additional skill identifier (ASI) 8J as an infection control officer.

(2)
Chief wardmaster (91050). This master sergeant manages and supervises enlisted personnel and assists in the planning and operation of nursing service. He coordinates with the operations section in planning the hospital layout. He is responsible to the chief nurse for the erection of the hospital clinical facilities.

(3)
Assistant chief wardmaster (91C40). This NCO assists the chief wardmaster in supervision of enlisted personnel and operation of nursing service.

(4)
Respiratory noncommissioned officer (91 V40). Under the technical guidance of a physician or nurse anesthetist, this NCO supervises the respiratory activities within nursing service.

i. Triage/Preoperative/Emergency Medical Treatment. This section provides for the receiving, triaging, and stabilizing of incoming patients. The staff will receive patients, assess their medical condition, provide EMT, and transfer them to the appropriate areas of the hospital The staff will be trained in both advanced cardiac life support (ACLS) and ATM. The staff monitors patient conditions and prepares those requiring immediate surgery for the OR. Sick call for organic staff is conducted by this section. Table 2-9 lists the staffing for this section.
(
DODDOA-006810
http://atiam.train.anny.mil/portallatia/adlsc./view/public/296784-1/fm/8... 112/28/2004
Table 2-9. Triage.PreaperativelEmergency
Medical Treatment Section Organization
TRIAGE /PRE OPE RATIVE/ EME RG ENCY
MEDICAL TREATMENT

EMERGENCY PHYSICIAN MAJ 62A00 MC
HEAD NURSE MAJ 66H00 AN
PRIMARY CARE PHYSICIAN CP- 61H00 MC
EMERGENCY PHYSICIAN CR" 432A00 MC
MEDICAL-SURGICAL NURSE CP' 66H00 AN 12)
MEDICAL SURGICAL NURSE LT 66H00 AN
EMERGENCY TREATMENT
NCO SEC 91B40 NC
NCO SSG 91B30 NC 12)
NCO SGT 91B20 NC (3)
MEDICAL
SPECIALIST SGT 91820 NC
SPECIALIST SPC 9 1 El 10 {2)
SPECIALIST PEC 911310 (3)

(1)
Emergency physician (62A00). This physician is responsible to the Chief, Professional Services (or the designated chief of emergency medical services) for management and operations of this section. He examines, diagnoses, and treats or prescribes courses of treatment for the initial phase of diseases and injuries. This officer is the physician primarily responsible for triage.

(2)
Head nurse (66H00). This nurse manages the operations of the EMT section, to include staffing and supervising nursing personnel and developing nursing policies and procedures. He is also responsible for the standard of nursing care provided and assists in providing patient care.

(3)
Primary care physician (61H00). This physician provides care to patients in the areas of general medicine, obstetrics/gynecology (OB/GYN), psychiatry, PVNTMED, pediatrics, and orthopedics. When the EMT/surgical patient load is heavy, this officer can assume the duties of triage and preoperative evaluation/care.

(4)
Emergency physician (62A00). This physician examines, diagnoses, and treats or prescribes course of treatment for the initial phase of disease and injuries.

(5)
Medical-surgical nurses (66H00). These nurses plan and implement nursing care under the supervision of the head nurse. They provide direct supervision to subordinate nursing service personnel.

(6)
Emergency treatment noncommissioned officer (91B40). This NCO is responsible to the senior nurse. He manages and supervises the enlisted nursing staff. He is also responsible for supplies and equipment.

(7)
Emergency treatment noncommissioned officers (91B30/91B20). These NCOs are supervised by the principal NCO. They perform direct patient care within their scope of practice and under professional supervision. They supervise subordinate nursing staff.

(8)
Medical specialists (91B10). Under professional supervision, these specialists are responsible for providing nursing care within their scope of practice.

DODDOA-006811
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... 112/28/2004 j. Litter Bearer Section. This section is responsible to the triage/preoperative/EMT section for the transportation of patients within the hospital on a 24-hour basis. The staffing is identified in Table 2 -10.
Table 2-10. Litter Bearer Section Organization
LITTER BEARER SECTION
SENIOR UTTER BEARER SGT 91B20 (2)
LITTER BEARER SPC 911310 (2)
LITTER BEARER PFC 91810 (8)

(1)
Senior litter bearers (91B20). These NCOs are responsible to the emergency treatment NCO (triage/preoperative/EMT section). They supervise and coordinate the activities of the subordinate litter bearers.

(2)
Litter bearers (91B10). These litter bearers are responsible for transporting patients internally in the hospital. They are also responsible for loading and off-loading air and ground ambulances.

k. Operating Room/Central Materiel Service (CMS) Control Team. This team provides supervision of the OR and CMS. It is responsible for the scheduling of nursing staff, preparing and maintaining the OR and CMS, and the maintaining of surgical, anesthetic, and nursing standards within these areas. The OR/CMS control team is composed of an anesthesiologist, a clinical head nurse, an OR NCO, and a • CMS NCO (Table 2-11).
Table 2-11. Operating RoomICentral Materiel Service control Team Organizatim
OPERATING ROOM/CENTRAL MATERIEL SERVICE CONTROL TEAM
ANESTHESIOLOGIST LTC 60N00 MC OPERATING ROOM CLINICAL HEAD NURSE, LTC 68E00 AN CENTRAL MATERIEL SERVICE NCO SFC 91D40 OPERATING ROOM NCO SFC 91D40
(1)
Anesthesiologist (60N00). This physician supervises team members and is responsible to the Chief, Surgical Services. He establishes the hospital's anesthesiology program. He administers or supervises administration of anesthetics to patients in the ORs.

(2)
Operating room clinical head nurse (66E00). This officer is responsible to the chief nurse for the management of daily operations of the OR and CMS to include scheduling and supervision of nursing staff. He coordinates with the Chief, Surgical Services in the scheduling of patient cases. He is responsible for the quality of nursing care provided.

(3)
Central materiel service noncommissioned officer (91D40). This NCO is responsible to the clinical head nurse for supplies, equipment maintenance, and supervision of enlisted CMS nursing staff.

DODDOA-006812
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... 112/28/2004 (4) Operating room noncommissioned officer (91D40). This NCO is responsible to the clinical head nurse for the supervision and management of the enlisted OR nursing staff. He also manages supplies and equipment.
1. Operating Room A. This section provides general surgical services with two OR tables for a total of 36 hours of table time per day. The staff is composed of general surgeons, OR nurses, nurse anesthetists, and OR specialists (Table 2-12).
Table 2-12. Operating Room A Organization
OPERATING ROOM A
GENERAL SURGEON MAJ 61J00 MC (2}
OPERATING ROOM NURSE MAJ 88E00 AN
OPERATING ROOM NURSE CPT WOO AN
CLINICAL NURSE,
ANESTHETIST CPT eafoo AN C2)
OPERATING ROOM
NCO SSG 91030 NC
SPECIALIST SGT 91020 NC
SPECIALIST SPC 91D10
SPECIALIST PFC 91010

(1)
General surgeon (61J00). The senior physician is responsible to the Chief, Surgical Service for the operations of the surgery team. These physicians examine, diagnose, and treat or prescribe courses of treatment and surgery for patients having injuries or disorders with surgical conditions.

(2)
Operating room nurse (66E00). This nurse is responsible to the OR clinical head nurse for all nursing activities of this section. He supervises the OR enlisted staff. This officer performs nursing duties in any phase of the operative process for patients undergoing surgery; he ensures that safe supplies and equipment are available for operative services.

(3)
Operating room nurse (66E00). This nurse performs nursing duties in any phase of the operative process for patients undergoing surgery; he also ensures that safe supplies and equipment are available for operative services. He supervises the OR enlisted nursing staff. He is responsible to the chief OR nurse.

(4)
Clinical nurse, anesthetists (66F00). These two anesthetists perform nursing duties of a specialized nature in the care of patients requiring general or regional anesthesia, respiratory care, cardiopulmonary resuscitation, and/or fluid therapy. Under the supervision of the anesthesiologist (OR/CMS control team), they administer general and regional anesthesia for surgical patients.

(5)
Operating room noncommissioned officer (91D30). This NCO is responsible to the chief OR nurse for supplies, equipment maintenance, and supervision of enlisted nursing staff.

(6)
Operating room specialists (91D20/91D10). Under professional supervision, these specialists provide patient care within their scope of practice.

m. Operating Room B. This section provides orthopedic surgical services with two OR tables for a total of 36 hours of table time per day. The staff is composed of orthopedic surgeons, OR nurses, nurse anesthetists, OR NCO, and OR specialists (Table 2-13). This OR may be used by the oral surgeon in
DODDOA-00681 3
http://atiam.train.anny.mil/portal/atia/adlsc/view/public/296784-1/fin/8... 112/28/2004
performing oral and maxillo-facial surgery.
Table 2-13. Operating Room B Organization
OPERATING ROOM
ORTHOPEDIC SURGEON MAJJ61M00 MC (21 OPERATING ROOM NURSE CPT 66E00 AN 121 CLINICAL NURSE,
ANESTHETIST CPT BEFOG AN i21
OPERATING ROOM NCO SSG 91030 SPECIA_IST SGT 91D20 SPECIALIST SPC 91D10 SPECIALIST PFC 91010
(1)
Orthopedic surgeons (61M00). The senior physician is responsible to the Chief, Surgical
Service for operations of the OR. These physicians examine, diagnose, and treat or prescribe
courses of treatment and surgery for patients having disorders, malfunctions, diseases, and/or
injuries of the musculoskeletal system.

(2)
Remaining staff The duties and responsibilities of the remaining OR B staff are the same as the corresponding staff identified in paragraph I. The OR specialist (91D10) is the designated vehicle operator for this section.

n. Orthopedic Cast Clinic. This clinic is responsible to the senior orthopedic surgeon for casting, splinting, and traction services for the hospital. The staff is composed of an orthopedic NCO and orthopedic specialists (Table .?-14).
Table 2-14. Orthopedic Cast Clinic Organization
ORTHOPEDIC CAST CLINIC
ORTHOPEDIC NCO SGT 91320 SPECIALIST SPC 91310 SPECIALIST PFC 91810
(1)
Orthopedic noncommissioned officer (91B20, ASI P1). This NCO is responsible to the senior orthopedic surgeon for the operation of this clinic. He supervises the other specialists.

(2)
Orthopedic specialists (91B10, ASI P1). Under professional supervision, these specialists
provide patient care within their scope of practice.

o. Central Materiel Service. This section operates two CMS units which provide sterilization of OR equipment, surgical instruments, and supplies, as well as sterile supplies for other patient care areas. The staff is composed of two CMS sergeants and six CMS specialists (Table 2-15).
DODDOA-006814
http://atiam.train.army.miUportal/atia/adlsc/view/public/296784-1/fin/8-... 112/28/2004
Table 2-15. Central Materiel Service
Organization
CENTRAL MATEREL SERVICE (21
CENTRAL MATERIEL SERVICE SPECIALIST SGT 91D20 NC (2) SPECIALIST SPC 91010 (2) SPECIALIST PFC 91D10 (4)
(1)
Central materiel service specialists (91D20). These NCOs work under the supervision of the CMS NCO of the OR/CMS control team. They supervise the activities of the CMS specialists. They ensure that sterilization techniques and procedures are applied and further ensure that safe sterile supplies are provided to users on a timely basis. They also supervise operator-level maintenance on CMS equipment.

(2)
Central materiel service specialists (91D10). These CMS specialists are responsible to the CMS section sergeants. They perform CMS functions within their scope of responsibility.

p. Dental Services. This section provides dental services and consultation for patients and staff. During mass casualty situations, the dentists assist in the delivery of ATM. The oral surgeon uses the ORB or the dental operatory to perform oral and maxillofacial surgery. The staff is composed of an oral surgeon, a comprehensive dental officer, a preventive dental NCO, and a dental specialist (Table 2 -16).
Table 2-16. Dental Services Organization
DENTAL SERVICES
ORAL AND MAXILLOFACIAL
SURGEON MAJJ63N00 DC
COMPREHENSIVE DENTAL
OFFICER CPT 63800 DC
PREVENTIVE DENTAL NCO SGT 91E20 NC
DENTAL SPECIALIST SPC 91E10 DODD0A-00681 5

(1)
Oral and maxillofacial surgeon (63N00). This officer examines, diagnoses, and treats or prescribes courses of treatment for conditions which involve oral surgical procedures, including oral and maxillofacial injuries, wounds, and infections. Additionally, treatment is provided to patients referred by other dental and medical facilities when required oral and maxillofacial care is beyond the capability of the referring facility. This officer is responsible to the Chief, Professional Services for the technical and administrative management of the section.

(2)
Comprehensive dental officer (63B00). This officer provides emergency care to staff and in­patients. When work load permits, this officer provides maintaining-level dental care to the same population and to patients referred from other dental and medical facilities when the required dental treatment is beyond the capability of the referring facility. In addition, he provides OR assistance and support to the oral and maxillofacial surgeon, when requested. He also augments the ATM capability of the hospital, particularly during mass casualty situations.

(3)
Preventive dental noncommissioned officer (91E20). This NCO assists the dental officers in prevention, examination, and treatment of diseases of teeth and oral region. He also performs

http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... 112/28/2004 those administrative tasks as directed by the oral surgeon. He supervises operator-level maintenance of the dental equipment. This NCO holds the ASI X2, designating formal dental hygiene training.
(4) Dental specialist (91E10). This specialist is responsible to the preventive dental NCO. He assists in the prevention, examination, and treatment of diseases of teeth and oral region. He performs operator-level maintenance of dental equipment.
q. Inpatient Medicine A. This section provides medical services such as consultations, as requested; evaluation and treatment of infectious disease and internal medicine disorders; evaluation and treatment of skin disorders; and treatment of patients with gynecological disease, injury, or disorders. Staffing includes internists, primary care physicians, and an obstetrician and gynecologist (Table 2-17).
Table 2-17. Inpatient Medicine A Organization
INPATIENT MEDICINE A
OBSTETRICIAN AND
GYNECOLOGIST MAJ 60J00 MC
INTERNIST MAJ 61 F00 MC (2)
PRIMARY CARE PHYSICIAN CPT 61 HOD MC (2)

(1)
Obstetrician/gynecologist (60J00). This physician provides medical care during pregnancy, performs obstetric deliveries, and examines, diagnoses, and treats or prescribes courses of treatment for patients who have gynecological disease, injury, or disorders. He is responsible to the Chief, Professional Services for the technical and administrative management of this section.

(2)
Internists (61F00). These internists examine, diagnose, and treat patients with medical illnesses and recommend courses of management for those illnesses.

(3)
Primary care physicians (61H00). These physicians provide comprehensive health care to patients in the areas of general medicine, OB/GYN, psychiatry, PVNTMED, pediatrics, and orthopedics in both inpatient and outpatient care. They may be used to augment surgical specialties in triage and preoperative care.

r. Intensive Care Unit Wards. These three 12-bed intensive care units (ICUs) provide for critically injured or ill patients. As ICU nurses, the clinical nurses hold an ASI of 8A. This section is under the supervision of the nursing service control team. Nursing care is performed for those patients who require close observation and vital sign monitoring, complex nursing care, and mechanical respiratory assistance. The ICU is also used as a postanesthesia recovery area for patients after surgery. Intensive care is provided by a staff of a clinical head nurse, clinical nurses, a wardmaster, practical nurses, and medical and respiratory specialists (Table 2 18).
-
DODDOA-006816
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... 112/28/2004
Table 2-18. Intensive Care. Unit Ward Organization
INTENSIVE CARE UNIT WARD (31 INTENSIVE CARE UNIT
CLINICAL HEAD NURSE MAJ 661-100 AN (3)
CLINICAL NURSE CPT 661100 AN (9)
CLINICAL NURSE LT 661-100 AN (6)
WARDMASTER SFC 91C40 NC (3)
PRACTICAL NURSE SSG 9100 NC (9)
RESPIRATORY NCO SSG 91V30 NC (31
PRACTICAL NURSE SGT 91C20 NC (9)
RESPIRATORY SERGEANT SGT 91V20 NC (3)
MEDICAL SPECIALIST SPC 91E110 (6)

(1)
Clinical head nurses, intensive care unit (66H00). These officers are responsible to the nursing service control team for managing the operations of the ICU to include the development of nursing policies and procedures and the scheduling and supervision of nursing staff. They are responsible for the quality of nursing care. They supervise all other ICU nursing personnel.

(2)
Clinical nurses, intensive care unit (66H00). These clinical nurses are responsible to the clinical head nurse for planning and providing nursing care of a specialized and technical nature for the care and treatment of critically injured or ill and postanesthesia patients. They supervise enlisted nursing personnel.

(3)
Wardmasters (91 C40). These NCOs work under the supervision of the ICU head nurses. They also work in concert with the chief wardmaster of the nursing control team. They manage and supervise enlisted personnel and assist in the planning and operation of the ICU.

(4)
Practical nurses (91 C30). These practical nurses are responsible to the wardmaster. They provide direct patient care under professional supervision within their scope of practice. They also assist in supervising the subordinate enlisted nursing staff.

(5)
Respiratory noncommissioned officers (91 V30). These NCOs provide technical guidance and training of subordinate personnel. They manage the respiratory care functions under the supervision of a physician or nurse anesthetist.

(6)
Practical nurses (91 C20). These practical nurses perform preventive, therapeutic, and emergency nursing care procedures under professional supervision within their scope of practice.

(7)
Respiratory sergeants (91 V20). These respiratory sergeants provide treatment for patients with cardiopulmonary problems under the supervision of a physician or nurse anesthetist. Included is emergency care in cases of heart failure, shock, treatment of acute respiratory symptoms in cases of head injuries, and respiratory complications in patients having thoracic or abdominal surgery.

(8)
Medical specialists (91B10). These specialists provide direct patient care within their scope of practice under the supervision of a clinical or practical nurse.

s. Intermediate Care Wards. These seven intermediate care wards (ICWs) with 20 beds per ward are identical in personnel and equipment. They are under the supervision of the nursing service control team. -These wards provide care for patients whose conditions vary from acute to moderate. The nursing
DODDOA-006817
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
care staff consists of a clinical head nurse, clinical nurses, a wardmaster, practical nurses, and medical specialists (Table 2-19). The responsibilities and functions of the clinical head nurses, clinical nurses (66H00), wardmasters, practical nurses, and medical specialists are the same as those identified in paragraph r above, The clinical nurses (66J00) assist the clinical head nurse in their duty performance. They perform first-level nursing care duties within their scope of clinical nursing activities. The lowest­grade medical specialist is the designated vehicle operator for the section.
Table 2-19. Intermediate Care Ward
Organization

INTERMEDIATE CARE WARD 171
CLINICAL
HEAD NURSE MAJ 66H00 AN (3) NURSE CPT 66H00 AN (7) NURSE LT 66H00 AN (7) NURSE LT 66J00 AN 17)
WARDMASTER SFC 91C40 NC (71 PRACTICAL NURSE SSG 91C30 NC (141 PRACTICAL NURSE SGT 91C20 NC (35) MEDICAL SPECIALISTS SPC 911310 471 MEDICAL SPECIALISTS PPC 91B 10 171
t. Neuropsychiatric Ward and Consultation Service. This section provides NP diagnosis and consultation to all areas of the hospital; it staffs a 20-bed ward for inpatient stabilization of NP patients. The staff for this section consists of a psychiatrist, psychiatric nurses, clinical nurses, a social worker, a behavioral science NCO, an occupational therapy NCO, and psychiatric specialists (Table 2-20). Medical group and brigade headquarters integrate the CSH NP section's operations with those of the division and ASMB mental health sections, and with the CSC units in the area. To the extent possible, the CSH NP ward should receive only those NP and/or stress casualties who are too disturbed to receive restoration treatment at Echelon II MTFs or CSC fatigue centers. These casualties include--

Cases of psychosis, paranoia, mania, and suicidal depression.


Substance overdose or withdrawal requiring detoxification.


Mental or bodily symptoms which require CSH laboratory and x-ray capability to rule out life-or limb-threatening organic causes.

DODDOA-006818
http://atiam.train.army.mil/portallatia/adlsc/view/public/296784-1/fin/8... .12/28/2004
Table 2-20. Neuropsychiatric Ward and Consultation Service Organization
NEUROPSYCHIATRIC WARD AND CONSULTATION SERVICE
PSYCHIATRIST MAJ 60W00 MC PSYCHIATRIC:MENTAL HEALTH NURSE MAJ 66C00 AN
NURSE CPT 66CC0 AN 12) SOCIAL WORK OFFICER CPT 73A8 MS C_INICAL NURSE LT 66H00 AN PSYCHIATRIC
NCO SSG 91F30 NC WAROMASTER SSG 91F30 NC NCO SGT 91F20 NC 13)
BEHAVIORAL SCIENCE NCO SGT 91620 NC OCCUPATIONAL THERAPY NCO SGT 91820 NC PSYCHIATRIC
SPECIALIST SPC 91F10 12) SPECIALIST PFC 91F10
The mission of the NP ward is to provide brief (2 to 4 days) stabilization. The patients are then reevaluated to determine if they should be--

Evacuated to a GH in the COMMZ (or to CONUS) for further stabilization and evacuation,
definitive treatment, or administrative discharge.


Evacuated to a FH or CSC company in the COMMZ for RTD after 14 to 28 days of further
reconditioning (depending on the theater evacuation policy).


Returned to duty in the CZ, usually after transfer to a CSC unit's reconditioning center for 4 to 10 days further treatment.

The CSC reconditioning center may be collocated with the CSH. The CSC center will maintain its separate, nonhospital identity, but coordinates closely with the CSHs NP service. The CSC reconditioning center, if attached to the CSH, will require administrative and logistical support. The NP section's consultation mission provides--

Diagnosis and recommendations for treatment for medical/surgical patients with organic mental
disorders on all other CSH wards and in-patient admissions (emergency room).


Assistance, including stress debriefings, to all RTD and NRTD patients with stress issues.


Assistance, including routine and special stress debriefings, to all CSH staff, in close cooperation with leadership and the chaplains.

Stress casualties (battle fatigue and misconduct stress behaviors) may be brought to the hospital who do not require in-patient admission. Those cases must be triaged by the NP service and treated and released to their units for duty, administrative action, or rest and outpatient follow-up.
(1) Psychiatrist (60W00). This officer is responsible to the Chief, Professional Services for the technical and administrative management of this section. He supervises the NP service staff, advises the CSH commander, and provides technical supervision of NP/mental health activities throughout the CSH. He examines, diagnoses, treats and or prescribes treatment, and recommends disposition for patients and staff with NP and stress disorders.
DODDOA-006819
http://atiam.train.army.mil/portaliatia/adlsc/view/public/296784-1/fin/8... 112/28/2004
(2)
Psychiatric/mental health nurse (66C00). This officer is responsible for the technical and professional management of the NP ward nursing staff He provides psychiatric nursing consultation to all other wards of the CSH. He provides specialized nursing services for patients with psychiatric and emotional problems and promotes mental health within the hospital and support area. This nurse performs liaison, consultative, and training functions throughout the CSH to enhance the continuity and quality of patient care.

(3)
Psychiatric/mental health nurses (66C00). These officers are responsible to the psychiatrist and head nurse in the operation of the ward and consultation throughout the hospital. They develop and carry out nursing care plans for each NP ward patient. These nurses also assist in the training, supervising, and technical management of subordinate NP ward staff, including the nonpsychiatrically trained nurses and augmenting technicians.

(4)
Social work officer (73A67). This officer is responsible to the psychiatrist. He provides stress control prevention and treatment throughout the hospital, and especially to the minimum care (RTD-oriented) wards. He supports the NP ward by evaluating the RTD potential of patients, based on interviews with the soldier, plus data from the soldier's unit. He coordinates RTD, administrative disposition, or transfer to the CSC reconditioning center. The social work officer also assures effective use of social service support agencies for patients and CSH staff members.

(5)
Clinical nurse (66H00). This clinical nurse is responsible to the head nurse for direct and surgical nursing care to patients on the ward. He is cross-trained in stress control techniques and procedures.

(6)
Psychiatric noncommissioned officer (91F30). This NCO assists the wardmaster in the performance of his duties. He provides psychiatric nursing care duties within his scope of practice under professional supervision.

(7)
Psychiatric wardmaster (91F30). This NCO assists the psychiatrist and nursing staff with the management and administrative functions of the ward. He provides psychiatric nursing care duties within his scope of practice under professional supervision.

(8)
Psychiatric noncommissioned officers (91F20). Under professional supervision, these NCOs provide psychiatric nursing care within their scope of practice.

(9)
Behavioral science noncommissioned officer (91 G20). Under professional supervision, this NCO provides mental health assessment and care within his scope of practice.

( 1 0) Occupational therapy noncommissioned officer (91B20, ASI N3). This NCO is responsible to the head nurse for establishing and conducting the work therapy and recreational programs throughout the CSH, and especially the minimal care wards. Under professional supervision, he provides occupational therapy within his scope of practice.. If additional clinical guidance is required for planning and implementing occupational therapy programs, occupational therapists (65A) are assigned to CSC companies and detachments, FHs, and GHs.
(11) Psychiatric specialists (91F10). These specialists are responsible to the psychiatric NCOs. Under professional supervision, they provide care and treatment for psychiatric, drug, and alcohol patients within their scope of practice.
u. Minimal Care Wards. These two minimal care wards of 20 beds each provide care for patients whose
DODDOA-006820
http://atiam.train.army.mil/portal/atiaJadlsc/view/public/296784-1/fin/8... 112/28/2004 conditions vary from moderate to minimal. These are convalescent patients with minimal requirements for nursing and medical treatment. Staffing is composed of clinical nurses, a wardmaster, practical nurses, and medical specialists (Table 2-21). Resupply of consumables is similar to that described for the ICU.
Table 2-21. Minimal Care Ward Organization
MINIMAL CARE WARD 121
CLINICAL NURSE LT 66H00 AN (2}
WARDMASTER SSG 91C30 NC
PRACTICAL NURSE SGT 91C20 NC
MEDICAL SPECIALISTS SPC 91810 (2)
MEDICAL SPECIALISTS PFC 91810 (2)

(1)
Clinical nurses (66H00). These nurses are responsible to the nursing service control team for management and operations of the ward. They supervise the enlisted nursing staff and perform appropriate nursing duties.

(2)
Wardmaster (91C30). This NCO assists the clinical nurses in ward management. He provides nursing care leadership and supervises subordinate staff. This NCO also works in concert with the chief wardmaster of the nursing service control team.

(3)
Practical nurse (91C20). This practical nurse is responsible to the wardmaster and, under professional supervision, performs nursing care duties within his scope of practice.

(4)
Medical specialists (91B10). Under professional supervision, these specialists provide medical treatment to patients within their scope of practice.

v. Pharmacy Services. The pharmacy is responsible for quality control of pharmaceuticals, distribution of bulk drugs, maintenance and publication of the hospital formulary, and the intravenous (IV)-additive program. This section maintains a registry for controlled drugs. The pharmacy provides discharge medications for the required number of days to complete therapy and/or a 5-day supply of medications required for air evacuation out of theater. The pharmacy requisitions required supplies through the logistics section to the supporting MEDLOG battalion (forward). The staff is composed of pharmacy officers, NCOs, and specialists (Table 2-22). Three of the enlisted staff hold the ASI Y7 (sterile pharmacy specialty) for the IV-additive program.

DODDOA-006821
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... 112/28/2004
Table 2-22. Pharmacy Services Organization
PHARMACY SERVICES
CHIEF, PHARMACY SERVICES MAJ 67E00 MS
PHARMACY
OFFICER CPT 67E00 MS
NCO SFC 91Q40 NC
NCO SSG 91Q30 NC
STERILE PHARMACY NCO SSG 91Q30 NC
PHARMACY SPECIALIST SPC 9 1Q10
STERILE PHARMACY SPECIALIST SPC 91Q10
PHARMACY SPECIALISTS PFC 91Q10
STERILE PHARMACY SPECIALIST PFC 91Q10

(1)
Chief pharmacy services (67E00). This officer is responsible to the Chief, Professional Services (or the designated chief of ancillary service). He directs, plans, and participates in all hospital pharmaceutical activities. He is responsible for and maintains security within the pharmacy area and monitors the storage, security, and control to include inventories and audit trails of controlled substances. He also acts as a liaison between the professional staff and the logistics office for requisition of pharmaceutical items.

(2)
Pharmacy-officer (67E00). This officer assists the Chief, Pharmacy Services in the performance of his duties. He supervises other pharmaceutical staff and collects data for required reports.

(3)
Pharmacy noncommissioned officer (91Q40). This NCO serves as the noncommissioned officer in charge (NCOIC), pharmacy services. He is responsible for the work schedule of subordinate specialists; he is also responsible for ensuring adequate training for all subordinate specialists. He prepares, controls, and issues pharmaceutical products under the supervision of a pharmacist. He also assists with the supervision of the section, providing technical guidance to subordinate persormel.

(4)
Pharmacy and sterile pharmacy noncommissioned officers (91Q30). These NCOs assist the pharmacy officer and NCO in their duty performance. They prepare, control, and issue pharmaceutical products, ensuring compliance with Army and Federal rules, laws, and regulations relative to pharmacy operations. One of these specialists holds the Y7 ASI. This specialist serves as the NCOIC of the sterile products service. He performs sterile technique procedures in the preparation of items such as IV-additives which are used to combat infection and to restore and maintain electrolyte and nutritional balance.

(5)
Pharmacy/sterile pharmacy specialists (91Q10). Under professional supervision, these specialists perform pharmaceutical duties within their scope of duties. Two of these specialists will hold the Y7 ASI. Their duties as sterile pharmacy specialists will be the same as those identified in paragraph (4) above.

w. Laboratory Services. This section performs a limited array of analytical procedures in hematology, urinalysis, chemistry, microbiology, and blood bank. The staff is composed of a clinical laboratory officer, laboratory NCOs, and medical laboratory specialists (Table 2-23). The 91K10 specialists hold the M4 ASI in blood banking procedures in order to provide back up capability for the blood bank section.
DODDOA-006822
http://atiam.train.anny.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... 112/28/2004
Table 2-23. Laboratory Services Organization
LABORATORY SERVICES
CLINICAL LABORATORY OFFICER CPT 71E67 MS MEDICAL LABORATORY
NCO SFC 911(40 NC
SPECIALIST SSG NC a)
91K30
SPECIAUST SGT 91K20 NC
SPECIALIST SPC 91K10 (2)
SPECIALIST PFC 911(10 (4)
(1)
Clinical laboratory officer (71E67). This officer is responsible to the Chief, Professional Services (or the designated chief of ancillary services) for management and operation of the laboratory section. He directs the performance of laboratory procedures used in the detection, diagnosis, treatment, and prevention of disease. He establishes and supervises an appropriate laboratory quality control program. He also supervises the blood bank activities.

(2)
Medical laboratory noncommissioned officer (91K40). This NCO advises and assists the laboratory officer in laboratory operations, supply economy and inventory management, advanced technical procedures, and administrative requirements. He provides technical guidance and supervision to the subordinate staff.

(3)
Medical laboratory specialists (91K30). These specialists Perform elementary and advanced examinations of patient-derived specimens (including suspect biological warfare specimens) to aid in the diagnosis, treatment, and prevention of disease.

(4)
Medical laboratory specialist (91K20). This laboratory specialist performs clinical laboratory procedures in hematology, biochemistry, serology, bacteriology, parasitology, and urinalysis. He collects and processes specimens for shipment to supporting laboratories and stores and issues blood.

(5)
Medical laboratory specialists (91K10) (ASI M4). These specialists perform elementary clinical laboratory and blood banking procedures under the supervision of the laboratory NCO.

x. Blood Bank. This section provides all routine blood grouping and typing, abbreviated cross-matching procedures, emergency blood collection, and blood inventory management. It has the capacity to store and issue liquid blood components and fresh frozen plasma. Staffing for this section includes a medical laboratory NCO and medical laboratory specialists (Table 2-24). All blood bank personnel hold the M4 ASI.
Table 2-21 Blood Bank Organization
BLOOD BANK
MEDICAL LABORATORY
NCO SSG 911(30 NC
SPECIALIST SGT 911(20 NC
SPECIALIST SPC 91K10 (3)
SPECIALIST PFC 91K1C
SPECIALIST PFC 911(10 13)

DODDOA-006823
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... 112/28/2004
(1)Medical laboratory noncommissioned officer (91K30). This NCO is responsible to the Chief, Laboratory Services for the management and operation of this section. He performs advanced procedures in all phases of blood banking. He supervises subordinate specialists in the performance of their duties.
(2) Medical laboratory specialists (91K20/91K10). The duties and functions of the remaining staff are the same as the corresponding staff in paragraphs w(4) and (5).
y. Radiology Service. This section provides radiological services to all areas of the hospital and operates on a 24-hour basis. Staffing includes a radiologist, x-ray NCOs, and x-ray specialists (Table 2-25).
Table 2-25. Radiology Service Organization
RADIOLOGY SERVICE
DIAGNOSTIC RADIOLOGIST MAJ 61R00 MC
RADIOLOGY
SPECIALIST SSG 91P30 NC
SERGEANT SGT B1P20 NC
SPECIALIST SPC 91P10 421
SPECIALIST PFC 91P10 12)

(1)
Diagnostic radiologist (61R00). This officer is responsible to the Chief, Professional Services (or the designated chief of ancillary service) for the management and operation of this section. He performs and interprets all diagnostic radiological and fluoroscopic procedures, including special vascular studies and imaging, on patients referred by other physicians.

(2)
Radiology specialist (91P30). This specialist assists the radiologist in the performance of his duties, to include technical guidance to subordinate personnel. He assists in the technical and administrative management of this section.

(3)
Radiology sergeant (91P20). This NCO performs duties within his scope of training under the supervision of the radiology specialist.

(4)
Radiology specialists (91P10). These specialists perform duties within their scope of training under the supervision of the x-ray NCOs. They also perform vehicle operator duties for the section.

z. Physical Therapy Service. This section provides inpatient physical therapy services and consultation for patients. The primary wartime role of this section is evaluating and treating neuromusculoskeletal conditions and providing burn/wound care to patients with potential for RTD within the corps evacuation policy. During mass casualty situations, physical therapy personnel may be utilized in managing minimal or delayed patients, or augmenting the orthopedic staff. The staff is composed of a physical therapist and physical therapy sergeants (Table 2-26).
DODDOA-006824

http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/frn/8... 112/28/2004
Table 2-26. Physical Therapy Service Organization
PHYSICAL THERAPY SERVICE

PHYSICAL THERAPIST.CPT.65800.SP PHYSICAL THERAPY
SERGEANT SGT 91920 (2)
1Ag¦11¦1=
(1)
Physical therapist (65B00). This officer is responsible to the Chief, Professional Services (or the designated chief of ancillary service) for the management and supervision of physical therapy services. The physical therapist plans and supervises physical therapy programs upon referral from medical officers. This officer also provides guidance in the areas of physical fitness, physical training, and injury prevention.

(2)
Physical therapy sergeants (91B20, ASI N9). These physical therapy sergeants are responsible to the physical therapist. They provide physical therapy treatment to patients within their scope of practice.

aa. Hospital Ministry Team. This section is composed of a chaplain, a senior chaplain's assistant, and a chaplain's assistant to provide religious support and pastoral care ministry for assigned staff and patients (Table 2-27).
Table 2-21 Hospital Ministry Team Organization
HOSPITAL MINISTRY TEAM
HOSPITAL CHAPLAIN CPT 56A00 CH
SENIOR CHAPLAIN'S
ASSISTANT SGT 71M20 NC
CHAPLAIN'S ASSISTANT PfC 71M10

(1)
Hospital chaplain (56A00). This chaplain, supervised by the hospital headquarters chaplain, coordinates the program of religious ministries, including workshops, pastoral counseling, and religious education for the hospital. He supervises the activities of the other ministry team staff.

(2)
Senior chaplain's assistant (71M20). This senior chaplain's assistant is responsible to the hospital chaplain and assists him in his duties. He also supervises the activities of the chaplain's assistant.

(3)
Chaplain's assistant (71M10). This assistant is responsible to the senior chaplain's assistant. He prepares the chapel for worship and prepares sacraments of Protestant, Catholic, Orthodox, and Jewish faiths.

.
DODDOA-006825
2-6. The Hospital Unit, Surgical
The HUS augments the HUB to form the CSH. The HUS is composed of the following sections:
a. Unit Headquarters. This section provides augmentation to the HUB to assist in nursing supervision,
http://atiam.train.anny.mil/portallatia/adlsc/view/public/296784-1/fin/8... 112/28/2004 hospital operation, and company headquarters operation. The staff is composed of the HUS commander, an assistant chief nurse, a field medical assistant, a detachment NCO, and a patient administration specialist (Table 2 28).
-
Table 2-28. Hospital Unit, Surgical Headquarters Organization
UNIT HEADQUARTERS
COMMANDER LTC 61J00 MC
ASSISTANT CHIEF
NURSING SERVICE LTC 66A00 AN
FIELD MEDICAL ASSISTANT CPT 70667 MS
DETACHMENT NCO SFC 91840 NC
PATIENT ADMINISTRATION
SPECIALIST SPC 71G10

(1)
Hospital commander (61J00). This officer, in his capacity as the HUS commander, ensures a smooth and functional integration of unity of the HUS with the HUB. Once the two units are combined to form a CSH, this officer performs the duties of a surgeon in OR C.

(2)
Assistant chief nursing service (66A00). This officer functions in unison with the chief nurse of the HUB in providing the necessary planning, execution, and direction for the HUS.

(3)
Field medical assistant (70B67). This officer assists the HUS commander in the areas of organizational administration, supply, training, operation, transportation, and patient evacuation. When collocated with the HUB, this officer will perform duties as the hospital plans officer.

(4)
Detachment noncommissioned officer (91 B40). The detachment NCO is the principal enlisted assistant to the HUS commander. He maintains liaison between the HUS commander and assigned NCOs, provides guidance to enlisted members of the HUS, and represents them to the commander. When the HUB and HUS unite to form a CSH, he also functions as the first sergeant of the medical holding detachment. As such, he is supervised by the HUB company headquarters commander who functions as the commander, medical holding detachment.

(5)
Patient administration specialist (71G10). This specialist works in concert with the PAD of the HUB in preparing and maintaining patient records, to include statistical data for required reports.

b. Supply and Service Division (Augmentation). Because of the increased work load associated with the HUS, this section augments the supply and service division of the HUB. Staffing includes a medical supply sergeant, a supply sergeant, medical supply specialists, and supply specialists (Table 2 29).
-

DODDOA-006826
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... 112/28/2004
Table 2.29. Supply and Service Division Org,aniza tion
SUPPLY AND SERVICE DIVISION
MEDICAL SUPPLY SERGEANT.SGT.76J20.NC
SUPPLY SERGEANT.SGT.92Y20.NC MEDICAL SUPPLY SPECIALIST SPC.76J10 SUPPLY SPECIALIST.SPC.92Y10 MEDICAL SUPPLY SPECIALIST .PPC.76J10 SUPPLY SPECIALIST.PFC.92Y10
(1)
Medical supply sergeant (76J20). This NCO is responsible to the medical supply NCO (HUB) for medical supply operations, stock control, and medical assemblage management. He is responsible for the development and preparation of plans, maps, overlays, sketches, and other administrative procedures related to employment of the HUS supply and service division.

(2)
Supply sergeant (92Y20). This NCO is responsible for general supply operations, to include supervision of the supply specialists. He maintains accountability for all equipment organic to the HUS.

(3)
Medical supply specialists (76J10). These specialists are responsible to the medical supply sergeant for performing designated medical supply and equipment functions.

(4)
Supply specialists (92Y10). These supply specialists assist the supply sergeant in his duty performance. They request, receive, inspect, load, unload, segregate, store, issue, and turn in organizational supplies and equipment. One of the specialists will function as the armorer. The armorer maintains the weapons storage area, issues and receives small arms and ammunitions, and performs small arms unit maintenance.

c. Operating Room/Central Material Service Control Team. This team provides augmentation to the HUB to assist in supervising and scheduling the nursing staff and in preparing and maintaining the OR/CMS. The ranks and titles of the personnel (Table 2-30) are designed to interface with the HUB OR/CMS control team (Table 2-11) to provide support without duplicating duties and responsibilities.
Table 2-30. Operating Room/Central Materiel Service Control Team Organization
OPERATING ROOM/CENTRAL MATERIEL SERVICE CONTROL TEAM
ANESTHESIOLOGIST LTC.60N00.MC
CLINICAL HEAD NURSE, ANESTHETIST LTC.6000.AN
ANESTHESIOLOGST MAJ 80N00 MC
ASSISTANT CLINICAL HEAD NURSE. OPERATING ROOM MAJ.66E00.AN DODDOA-006827

(1)
Anesthesiologists (60N00). This physician administers or supervises administration of anesthetics to patients.

(2)
Clinical head nurse, anesthetist (66F00). This officer performs nursing duties in the care of

http://atiam.train.army.mil/portal/atia/adlseview/public/296784-1/fin/8-... .12/28/2004
patients requiring general or regional anesthesia, respiratory care, cardiopulmonary resuscitation,
and/or fluid therapy. Under the supervision of an anesthesiologist, he administers general and
regional anesthesia for surgical patients as required.
(3) Assistant head nurse, operating room (66E00). This assistant head nurse performs nursing duties in any phase of the operative process for patients undergoing all types of surgery and provides safe supplies and equipment for operative services.
d. Triage/Preoperative/Emergency Medical Treatment Section. This section provides for the receiving, triaging, and stabilizing of incoming patients. The staff receives patients, assesses their medical condition, provides EMT, and triages them to the appropriate nursing unit or health service. The staff will be trained in both advanced ACLS and ATM. The staff monitors patient conditions and prepares those requiring immediate surgery for the OR. This section works in conjunction with the triage/preoperative/EMT section, located in the HUB, to handle the overall work load for the hospital. This section gives the hospital commander several options:

Personnel can be used to supplement HUB EMT with its equipment remaining loaded for use as a jump or movement echelon.


Part of the equipment and staff can be used to have a sick call or minor injury area with all major trauma sent to the main EMT.


The hospital can have two fully operational EMTs. This would require the headquarters to carefully monitor and evaluate the admissions and OR requirements of these two sections if both were treating major trauma patients.

The staffing of this section is identical to that of the HUB (Table 2-9). The duties and responsibilities are the same for the corresponding positions as identified in paragraphs 2-5i(1)--(8).
e. Operating Room C. This section provides general and ear, nose, and throat (ENT) surgical services with two OR tables for a total of 36 hours of table time per day. The staff for this section includes general surgeons, clinical and OR nurses, an OR NCO, and OR specialists (Table 2-31).
Table 2-31. Operating Room C Organizatlion
OPERATING ROOM C
GENERAL SURGEON LTC 61J00 MC'
GENERAL SURGEON MAJ 61J00 MC t3I
OPERATING ROOM NURSE CPT 66E00 AN i5;
CLIMCAL NURSE,
ANESTHETIS - CPT 66F00 AN (5I
'OPERATING ROOM
NCO SSG 91D30 NC
SPECIALIST SOT 91D20 NC
SPECIALIST SPC 91D10
SPECIALIST PFC 911)10 i3)

" THE HUS COMMANDER ALSO FUNCTIONS AS GENERAL SURGEON IN OR C.
DODDOA-006828
(1) General surgeons (61J00). These surgeons examine, diagnose, treat or prescribe courses of treatment and surgery for patients having injuries or disorders with surgical conditions, and perform required surgery. As noted in Table 2-31, the commander, HUS also functions as a
http://atiam.train.army.mil/portal/ati a/adlsc/view/public/296784- 1 /fm/8- 1 0- 1 4/Ch2.htm .12/28/2004
general surgeon in OR C. This requirement is accounted for in the unit headquarters and is not
included in the total authorizations for the OR.
(2) Other assigned personnel. The duties and responsibilities of the OR nurse, clinical nurse (anesthetist), OR NCO, and OR specialists are the same as identified in paragraphs 2-51(3) through (6).
f Operating Room D. This section provides primarily orthopedic, thoracic, and uro-logical surgical
services with two OR tables for a total of 36 hours of table time per day. Staffing for this section
includes a thoracic surgeon, a urologist, an orthopedic surgeon, a clinical nurse (anesthetist), an OR nurse, an OR NCO, and OR specialists (Table 2-32).
Table 2-32. Operating Room D Organization
OPERATING ROOM D
UROLOGIST MAJ 60K00 MC
THORACIC SURGEON MAJ 61KCO MC
ORTHOPEDIC SURGEON MAJ 61M00 MC 11
CLINICAL NURSE, ANESTHETIST MA., 66F00 AN
OPERATING ROOM NURSE CPT 66E00 AN
CLNICAL NURSE, ANESTHETIST CPT 66F00 AN 44)
OPERATING ROOM
NCO SSG 91D30 NC
SPECIALIST SGT 91020 NC
SPECIALIST SPC 91010 (2)
SPECIALIST PFC 91010 13)

(1)
Urologist (60K00). The urologist examines, diagnoses, and treats or prescribes courses of treatment or surgery for patients having diseases, injuries, or disorders of the genitourinary tract. He performs required surgery.

(2)
Thoracic surgeon (61K00). This physician examines, diagnoses, and treats or prescribes courses of treatment and surgery for patients having surgical diseases or injuries of the thorax and vascular system. He performs required surgery.

(3)
Orthopedic surgeons (61M00). These surgeons examine, diagnose, and treat or prescribe courses of treatment and surgery for patients having disorders, malformations, diseases, or injuries of the musculoskeletal systems. They perform surgical operations as required.

(4)
Clinical nurse, anesthetists (66F00). These anesthetists perform nursing duties in the care of patients requiring general or regional anesthesia, respiratory care, cardiopulmonary resuscitation, and/or fluid therapy. Under the supervision of an anesthesiologist, they administer general and regional anesthesia for surgical patients, as required.

(5)
Operating room nurses (66E00). These nurses perform nursing duties in any phase of the operative process for patients undergoing surgery. They also provide safe supplies and equipment for operative services.

(6)
Other assigned personnel. The duties and responsibilities of the remaining OR D staff will be the same as the corresponding staff in paragraph 2-51, with one exception. The OR specialist, 91D10, is the designated vehicle operator for this section. 1

DODDOA-006829
http://atiam.train.arrny.mil/portal/atia/adlsc/view/public/296784-1/fin/... 112/28/2004 g. Orthopedic Cast Clinic. This section augments the orthopedic cast clinic of the HUB to provide casting, splinting, and traction services throughout the hospital. As with the multiple triage, preoperative, and EMT sections, this second orthopedic and cast clinic gives the hospital commander various employment options. The staffing consists of orthopedic NCOs and an orthopedic specialist (Table 2-33).
Table 2-33. Orthopedic Cast Clinic
Organization

ORTHOPEDIC CAST CLINIC
ORTHOPEDIC NCO.SSG.91B30.NC NCO.SGT.91820.NC
SPECIALIST.KC.91810
(1)
Orthopedic noncommissioned officer (91B30, ASI P1). This NCO supervises the orthopedic personnel in both the HUB and HUS and performs technical and administrative duties as directed by the orthopedic surgeon.

(2)
Orthopedic noncommissioned officer (91B20, ASI P1). This NCO helps in the treatment of orthopedic patients and supervision of subordinate orthopedic specialists. He organizes work . schedules, assigns duties, counsels personnel, and prepares evaluation reports under the supervision of the orthopedic NCO.

(3)
Orthopedic specialist (91B10, ASI PI). The duties and responsibilities of this specialist are identical to those listed in paragraph 2-5n.

h.
Central Materiel Service. This section operates two CMS units which provide for the sterilization of OR equipment, surgical instruments, and supplies, as well as for sterile supplies for other patient care areas. This section operates in conjunction with the CMS section of the HUB under the control of the OR/CMS control team. Normally, each CMS would function primarily to support the activities of its associated OR and wards. The staffing, duties, and responsibilities are identical to those identified in Table 2-15 and paragraphs 2-5o(1) and (2).

i.
Intensive Care Ward. These nursing units provide five ICUs of 12 beds each for critically injured or ill patients. The clinical nurses hold an ASI (8A) as ICU nurses. When functioning as a CSH, this section is under the supervision of the Nursing Service Control Team (HUB). The staff performs recovery room nursing care for those patients who require close observation, vital sign monitoring, IV fluid replacement, and respiratory assistance. The staff consist of a clinical head nurse, clinical nurses, a wardmaster, practical nurses, and medical and respiratory specialists (Table 2-34). The duties and responsibilities are the same as the corresponding positions identified in paragraphs 2-5r(1) through (8).

DODDOA-006830
http://atiam.train.army.mil/portallatia/adlsciview/public/296784-1/fm/8-... .12/28/2004
Table 2.34. intensive Care Ward Organization
=M.
INTENSIVE CARE WARD 151
CLINICAL HEAD NURSE, ICU MAJ 661100 AN (5)
CLINICAL NURSE, ICU CPT 0eH00 AN (15)
CLINICAL NURSE, ICU LT 50H00 AN 1101
WARDMASTER SFC 91C40 NC (5)
PRACTICAL NURSE SSG 01C30 NC (15)
RESPIRATORY NCO SSG 01V30 NC (5)
PRACTICAL NURSE SGT 9 ;C20 NC (15)
RESPIRATORY SERGEANT SGT 91v20 NC 15)
MEDICAL SPECIALIST SPC 91B10 (10)

j. Radiology Service. This section provides augmentation to the radiology section of the HUB. Staffing consists of a radiologist, x-ray NCOs, and x-ray specialists (Table 2-35).
Table 2-35. Radiology Service Organization
RADIOLOGY SERVICE
DIAGNOSTIC RADIOLOGIST MAJ 61R00 MC
RADIOLOGY
NCO SSG 91P30 NC (2)
SERGEANT SGT 91P20 NC
SPECIALIST SPC 91P10 (2)
SPECIALIST PFC 91P10

(1)
Diagnostic radiologist (61R00). This officer conducts, interprets, and directs x-ray and fluoroscope examinations to include administration of ionizing radiation and patient care..He assists the radiologist, radiology service, HUB with the management of the section. He also provides technical supervision to the subordinate staff.

(2)
Other assigned personnel. The duties and responsibilities of the remaining staff are the same as those identified in paragraphs 2-5y (2), (3), and (4).

DODDOA-006831
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
CHAPTER 3
COMMAND, CONTROL, AND COMMUNICATIONS OF THE
COMBAT SUPPORT HOSPITAL

3-1. Command and Control
The medical command (MEDCOM) is the senior medical headquarters assigned to a TO. It controls the
majority of its assigned units through subordinate COMMZ medical brigades. The medical brigade
assigned to the COSCOM is the senior medical C2 headquarters in the corps; it controls nondivisional
medical units assigned to the corps through its subordinate medical group headquarters. The medical
group with its attached units provides corps-level support to the divisions and area CHS to troops
operating within its sector of responsibility. The CSH is normally employed in DS of a division and GS
of a corps. The hospital is assigned to a medical brigade for C2. It may be further assigned to a medical
group. The designation of the type of C2 headquarters depends on factors such as mission, size of force,
type of operation, anticipated duration, and medical resources assigned to the deployed force. When the
CSH is DS, it will establish liaison and provide medical advice to the supported unit. During initial
buildup or contingency operations, the senior medical C2 headquarters may be a medical brigade or
medical group.
3-2. Communications
Management and control of CHS operations is dependent on the hospital headquarters' ability to
communicate with its staff, the corps medical brigade or group, elements of the medical evacuation
battalion, and other CSS units. Hospital communications assets include amplitude modulation (AM) and
FM radios and mobile subscriber equipment (MSE). See Appendix E, Communications, Automation,
and Position/Navigation Systems. Communications support is provided by the area support signal unit.
a.
Staff Responsibilities Each staff element of the hospital is responsible for adhering to signal support policies, procedures, and standards in their daily operations. The hospital communications chief coordinates telecommunications interface requirements with higher headquarters and with the supporting signal unit.

b.
Mobile Subscriber Equipment Area Communications System. Mobile subscriber equipment is the area common-user voice communications system within the corps. It is the backbone of the corps system and is deployed from the corps rear boundary forward to the maneuver battalion's main command post. It provides a secure mobile, survivable communications system capable of passing voice, data, and facsimile (FAX) throughout the corps. Additionally, it provides a direct interface to echelon above corps, other Services, NATO, combat net radio (CNR), and commercial communications systems. This system is composed of multiple communications nodes with network features which automatically bypass and reroute communications around damaged or jammed nodes. It integrates the functions of transmission, switching, control, and terminal equipment (voice and data) into one system and provides the user with a switched telecommunications system extended by mobile subscriber radio telephones. It is integrated within the corps and division force structure. Nodes are deployed from the corps rear boundary forward to the maneuver brigade rear area based on geographical and subscriber density factors. Node centers (NCs) makeup the system's assemblage. Extension switches permit wire-line terminal subscribers (telephone, FAX, and data) to enter into the total area communications system. Radio access units (RAUs) let the users of mobile subscriber radiotelephone terminals (MSRTs) communicate with other mobile and wire telephone users throughout the AO. The system control centers

• DODDOA-006832
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... Juin.12/28/2004 (SCCs) provide the processing capability to assist in overall network management. The MSE system lets subscribers communicate with each other using fixed directory numbers regardless of a subscriber's battlefield location. The MSE system is comprised of the following five functional areas:

Area coverage.


Subscriber terminals.


Wire subscriber access.


Mobile subscriber access.


System control.

The CSH will participate in the first four of the above functional areas. Figure 3-1 shows how the system integrates the functions of transmission, switching, control, and terminal equipment.
Figure 3-1. Typical mobile muhscriber connertivity.
(1)
Area coverage. Area coverage means that MSE provides common-user support to a geographic area, as opposed to dedicated support to a specific unit or customer. Node centers are under the control of the corps signal officer.

(2)
Subscriber terminal (fixed). The MSE telephone, mobile radiotelephone, FAXs, and data terminal, as part of the area common-user system (ACUS), are user-owned and operated. The hospital's communications chief is responsible for running wire to the designated junction boxes. These boxes tie the hospital MSE telephones into the extension switches which access the system. The subscriber terminals used by the hospital are digital, four-wire voice, as well as data ports for interfacing the. AN/UXC-7 FAX, the TACCS and the Medical Transportable Computer Unit (MEDTCU) as depicted in Figures 3-2 and 3-3.

DODDOA-006833

http://atiam.train.army.mil/portallatia/adlsc/view/public/296784-1/fin/8... .12/28/2004
FM 8-10-14 Chptr 3 Command, Control, And Communications Of The Combat Support li...Page 3 of 13
LEGEND: DATA.TACTICAL ARMY CSS COMPUTER SYSTEM / NC NODE CENTER ARMY TACTICAL CT SYSTEM / MEDTCU .SCC SYSTEM CONTROL CENTER
FAX.AN UXC-J FACSIMILE. SEN SMALL EXTENSION NODE (SWITCHBOARD) LEN.LARGE EXTENSION NODE ISWITC1430ARD).TP DIGITAL MONSECUIE VOICE TELEPHONE MEDTCU MEDICAL TRANSPORTABLE COMPUTER UNIT ION VT-TATITS
Figure 3-2. Example of fixed subscriber terminals.
DODDOA-006834
http://atiam.train.anny.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
TACTICAL
OP

Vii/.Vii/
w
w
MI SCE
x
TY..
x
X
x
AMA
NM
x
NMI. w
x
Ai&
!EP IDE
pH 41.6.
4111111/ 1
011
:11
111101.
(
xx
xx
4111111k STASH
MOOD:
MALL
w
EXTENSION NOCE WREN
WOE

.
NOM THERE ARE 224 SMALL EXTENSION NODES IN A TYPICAL CORPS NETWORK
Figure 3-3. Typical division small extension node deployment.
(3) Wire subscriber access. Wire subscriber access points provide the entry points (interface) between fixed subscriber terminal equipment owned and operated by users and the MSE area system operated by the supporting signal unit. Figure 3-4, Figure 3-5 and Figure 3-6 show the MSE switchboard configurations through which the hospital may tie into the area system. The two types of interface equipment are--
DODDOA-006835
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004

The signal distribution panel (junction box) J-1077. Each panel provides up to 13 subscriber access points.


Remote multiplexer combiners which provide access for 8 subscriber access points.

14 14

SEN IV11 13 213
WF-16 FIELD WIRE
LEGEND: di. DIGITAL NONSECtIRE OR SECURE VOICE TERMINAL
Figure 3.4. Small extension node switchboard interface (V1).
DODDOA-006836
http://atiam.train.anny.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
••¦
Cr 27
144
34
LEGBID:.DIGITAL NONSECURE OR SECURE VOICE TERMINAL
Figure 3-5. Small extension ?lade switchboard interface Mi.
DODDOA-006837
ht-tp://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8-10-14/Ch3.htm .12/28/2004
FM 8-10-14 Chptr 3 Command, Control, And Communications Of The Combat Support H...Page 7 of 13

.o 4
• 4-1077 J-1077
2 m.• tz
14•
12
it 8
SWITCHING
14 SHELTER
• 12 .1-1077 .4 V
4-1077
14
J-1077
t2
4 14• 12 4-1077 tr V
.1-1077 ••
8-4.f 4 .= 12
84 WF•111 POMO WIRE
1 V
s G s V

LEGEND! DIGITAL NONSECURE VOICE TERMINAL OR SECURE VOCE TERMINAL
REmon MULTIPLEXER COMBINER
Figure 3-6. Large extension node switchboard interface.
See FM 11_730 for definitive information pertaining to an MSE area communications system. Figure _ 3 77, Figure 3-8, and Figure 3-9 depict examples of the hospital's wire net diagram. The hospital commander will designate the hospital's wire net system based on the mission.
DODDOA-006838 http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
WIRE NET DIAGRAM

COMMANDER
CHIEF, NUR SVC
CHIEF, MED SVC HOSP CHAPLAIN MED OPS OFFICER
PLANS OFFICER COMPANY CDR 1SG
SUPPLY SGT
O.
SUPPLY SPC
O.
140SP ADJUTANT
O.
PSNCO
O.
PAT ADMIN OFFICER
O.
PAT ADMIN NCO
O.
HOSPITAL DIETITIAN
O.
HOSP FOOD SVC NCO
HLTH SVC MAT OFFICER
MED SUPPLY SGT
MOTOR SPC
UTIL OP AND
MAINT TECH
SBWD #1.
MED EQUIPMENT
REPAIR TECH
SB-86/P

LAUNDRY BATH NCO ASST CHIEF NURSE
TRIAGE/PRE-0P/ EMT #1 TRIAGE/PRE-OP/ EMT #2 TRIAGE/PRE-OP/ EMT #3 TRIAGE/PRE-OP/ EMT #4
TO AREA SWITCHBOARD

a

0
.0
.0

0

Figure 3.7. Wire net diagram, CSH, switchboard I.
DODDOA-006839
http://ati am. train. army.mil/portal/atia/adlsc/vi ew/public/296784-1/ftn/8-10-14/Ch3 .htm .12/28/2004
WIRE NET DIAGRAM
OR A #2 OR B #1 OR B 02 ORTHO CAST CLINIC INTERMEDIATE CARE 15 INTERMEDIATE CARE #6 INTERMEDIATE CARE #7 NP WARD 0
CMS #1 SBWD #2 MINIMAL CARE #1
CMS #2 ORAL SURGEON SB-86/P MINIMAL CARE S2 PHARMACY SVC .0
INPATIENT MED A LABORATORY SVC
INTENSIVE CARE #1 BLOOD BANK
O O O INTENSIVE CARE #2 INTENSIVE CARE #3 I NTER MEDIATE CARE #1 INTERMEDIATE CARE #2 INTERMEDIATE CARE #3 INTERMEDIATE CARE #4 RADIOLOGIST RADIOLOGY NCO PT SERVICE CHAPLAIN LITTER BEARER SEC .0 .0 .0 .0

Figure 38. Wire net diagram, switchboard 2.
-
DODDOA-006840

http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
WIRE NET DIAGRAM
0
COMMANDER OR D #2
.
0
0
MED SUPPLY SGT ORTHO CAST CLINIC
.
0
OR/CMS CNTRLTEAM CMS #1
TRIAGE/PRE-OP/
.
0
EMT #1 CMS #2 TRIAGE/PRE-OP/
.0
0
EMT #2 INTENSIVE CARE #1 SBWD #3
.
0
TRIAGE/PRE-OPI INTENSIVE CARE #2
EMT #3
TRIAGE/PRE-OP/ TA 207-P

0
EMT #4 INTENSIVE CARE #3
.0
INTENSIVE CARE #4
0
OR C #1
.0
C) OR C #2 INTENSIVE CARE #5
.0
OR D #1 RADIOLOGY SVC
.0 .O 0. .O
.O 0. .O
NOTE; ONE OF THE SB-111131Ps IS AUGMENTED WITH A TA 207-P (SIGNAL ASSEMBLY SIMTCHBOARDI TO PROVIDE 30 ADDITIONAL SWITCHBOARD LINES.
Figure 3-9. Wire net diagram, HUS, switchboard 3. .DODDOA-006841
c. Mobile Subscriber Terminal. The MSE terminal is the AN/VRC-97 MSRT. The MSRT, which consists of a very high-frequency radio and a digital secure voice terminal, is a vehicle-mounted assembly. It interfaces with the MSE system through an RAU. The primary use of the MSRT is to provide mobile subscriber access to the MSE area network. The MSRTs also operate in command posts to allow access to staff and functional personnel. The MSRT user has a KY 99 minterm telephone connected to the radio mounted in his vehicle. As long as the radio unit has line of sight contact with the RAU and the operator has properly affiliated, it connects to the area system. The operational planning range is 15 kilometers from any RAU. Figure 3-10 is a typical MSRT interface into the area system.
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
NOTE
ALL MOBILE SUBSCRIBERS ARE ECUPPED
WITH TELEPHONE TERMINALS AND
CAPABILITY FOR FAX DATA TERMINALS

WHIP ANTENNA MAST-MOUNTED ANTENNA
WORT ASSEMBLAGE
FAX TERMINAL
OR
DATA TERPAINAL

-
Figure 310. Mobile subacriber interface.
d. Combat Net Radio System. The CNR equipment in the hospital includes both the improved high­frequent y radio (IHFR) system and the single channel ground and airborne radio system (SINCGARS). These systems will serve as a primary means for voice transmission of C2 information and as a secondary means for data transmission. Data transmission will be required when data transfer requirements cannot be met by the MSE system. The improved high-frequency AM radio series provide mid-to-far-range communications capability. They interface with other AM high-frequency radios and have push-button frequency selection. The SINCGARS series' FM radios are designed for simple and quick operation using a 16-element keypad for push-button tuning. They are capable of short-range operation for voice or digital data communications and interfacing with the ANNRC-12 series of FM radios. They also can operate in a jam-resistant, frequency-hopping mode.
•. DODDOA-006842
http://atiam.train.army.mil/portal/atiaJadlsc/view/public/296784-1/fm/8-... .12/28/2004
e. Combat Support Hospital Radio Nets. The CSH and its staff depend on both AM and FM radios and area communications systems to operate. The hospital FM radio net is shown in Figure 3-11 (also see Appendix E). The hospital monitors the following FM nets:
•• Hospital commander--medical brigade/group command net.

S2/S3--medical brigade/group command net.
•• Supported CSS FM nets.
•• S4 (Supply Officer, [U. S. Army])--supporting and supported logistical CSS FM nets.


Triage/preoperative/EMT--used to control operation of the medical evacuation and heliport

operations.
•• Commander, HUS--hospital command net.

HOSPITAL UNIT, BASE
COMMAND NET-PM

MEDICAL GROUP NET HUB OPNS SECTIONS/NCS
MEDICAL GROUP NET
SUP/SVC DIV
HUB COMMANDER
AN/VRC-90A II AN/VRC•90A I
EMT/7RIAGE IHUB AND HU* AN/VRC-90A
HEurao OPNS
HOSPITAL UNIT, SURGICAL
I AN/VRC-80A 1 TOE 03737L000

Figure 3-11. Combat support hospital net—FM.
f Combat Support Hospital Operations Net--AM-IHFR. The hospital operations net (Figure 3-12) uses
an AN/GRC193A radio. This net is used to facilitate patient management, air and ground evacuation, and medical regulation of patients. This net links the hospital with the medical brigade/medical group which is the net control station (NCS) for the corps CHS operations net.
DODDOA-006843
http://atiam.train. army.mil/portal/atia/adl sc/view/public/296784-1/fin/8-1 0-14/Ch3.htm.12/28/2004
HOSPITAL UNIT, BASE
MEDICAL EVACUATION NET - AM

MEDICAL GROUP
I ANIGRC-193A

Figure 3-12. Combat support hospital net—AM-1HFR.
g. Signal Security. As part of the overall security program, CSH elements must practice signal security. The hospital operations section is responsible for signal and communications security. Some considerations include--

Using terrain features such as hills, vegetation, and buildings to mask transmissions.


Maintaining radio and radio-listening silence; using the radio only when absolutely necessary.


Distributing codes on a need-to-know basis.


Using only authorized call signs and brevity codes.


Using authentication and encryption codes specified in the current signal operation instructions (SOI).


Keeping transmissions short (less than 20 seconds if possible).


Reporting all COMSEC discrepancies to appropriate authorities.

DODDOA-006844
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8.... h3.htm.12/28/2004
CHAPTER 3
COMMAND, CONTROL, AND COMMUNICATIONS OF THE
COMBAT SUPPORT HOSPITAL

3-1. Command and Control
The medical command (MEDCOM) is the senior medical headquarters assigned to a TO. It controls the
majority of its assigned units through subordinate COMMZ medical brigades. The medical brigade
assigned to the COSCOM is the senior medical C2 headquarters in the corps; it controls nondivisional
medical units assigned to the corps through its subordinate medical group headquarters. The medical
group with its attached units provides corps-level support to the divisions and area CHS to troops
operating within its sector of responsibility. The CSH is normally employed in DS of a division and GS
of a corps. The hospital is assigned to a medical brigade for C2. It may be further assigned to a medical
group. The designation of the type of C2 headquarters depends on factors such as mission, size of force,
type of operation, anticipated duration, and medical resources assigned to the deployed force. When the
CSH is DS, it will establish liaison and provide medical advice to the supported unit. During initial
buildup or contingency operations, the senior medical C2 headquarters may be a medical brigade or
medical group.
3-2. Communications
Management and control of CHS operations is dependent on the hospital headquarters' ability to
communicate with its staff, the corps medical brigade or group, elements of the medical evacuation
battalion, and other CSS units. Hospital communications assets include amplitude modulation (AM) and
FM radios and mobile subscriber equipment (MSE). See Appendix E, Communications, Automation,
and Position/Navigation Systems. Communications support is provided by the area support signal unit.
a.
Staff Responsibilities. Each staff element of the hospital is responsible for adhering to signal support policies, procedures, and standards in their daily operations. The hospital communications chief coordinates telecommunications interface requirements with higher headquarters and with the supporting signal unit.

b.
Mobile Subscriber Equipment Area Communications System. Mobile subscriber equipment is the area common-user voice communications system within the corps. It is the backbone of the corps system and is deployed from the corps rear boundary forward to the maneuver battalion's main command post. It provides a secure mobile, survivable communications system capable of passing voice, data, and facsimile (FAX) throughout the corps. Additionally, it provides a direct interface to echelon above corps, other Services, NATO, combat net radio (CNR), and commercial communications systems. This system is composed of multiple communications nodes with network features which automatically bypass and reroute communications around damaged or jammed nodes. It integrates the functions of transmission, switching, control, and terminal equipment (voice and data) into one system and provides the user with a switched telecommunications system extended by mobile subscriber radio telephones. It is integrated within the corps and division force structure. Nodes are deployed from the corps rear boundary forward to the maneuver brigade rear area based on geographical and subscriber density factors. Node centers (NCs) makeup the system's assemblage. Extension switches permit wire-line terminal subscribers (telephone, FAX, and data) to enter into the total area communications system. Radio access units (RAUs) let the users of mobile subscriber radiotelephone terminals (MSRTs) communicate with other mobile and wire telephone users throughout the AO. The system control centers

DODDOA-006845
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004 (SCCs) provide the processing capability to assist in overall network management. The MSE system lets subscribers communicate with each other using fixed directory numbers regardless of a subscriber's battlefield location. The MSE system is comprised of the following five functional areas:

Area coverage.


Subscriber terminals.


Wire subscriber access.


Mobile subscriber access.


System control.

The CSH will participate in the first four of the above functional areas. Figure 3-1 shows how the system integrates the functions of transmission, switching, control, and terminal equipment.
Figure 3-1. Typical mobile subscriber connectivity.
(1)
Area coverage. Area coverage means that MSE provides common-user support to a geographic area, as opposed to dedicated support to a specific unit or customer. Node centers are under the control of the corps signal officer.

(2)
Subscriber terminal (fixed). The MSE telephone, mobile radiotelephone, FAXs, and data terminal, as part of the area common-user system (ACUS), are user-owned and operated. The hospital's communications chief is responsible for running wire to the designated junction boxes. These boxes tie the hospital MSE telephones into the extension switches which access the system. The subscriber terminals used by the hospital are digital, four-wire voice, as well as data ports for interfacing the. AN/UXC-7 FAX, the TACCS and the Medical Transportable Computer Unit (MEDTCU) as depicted in Figures 3-2 and 3-3.

DODDOA-006846

http://atiam.frain.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
LEGEND:
DATA.TACTICAL ANAY CSS COMPUTER SYSTEM I NC NODE CENTER

ARMY TACTICAL Ca SYSTEM iMEDTCU.SCC SYSTEM CONTROL CENTER FAX.
AN UXC-7 FACSIENLE. SEN SMALL EXTENSION NODE (SWITCHBOARD) LEN.LARGE EXTENSION NODE ISW(TIONOARD).TP DIGITAL NO MECUMS VOICE TELEPHO NE MEDTCU MEDICAL TRANSPORTABLE COMPUTER UNIT
ION WT-TA1S35
Figure 3-2. Example of fixed subscriber terminals.
DODDOA-006847
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
NOTE: THERE ARE VA MAIL EXTENSION NOOES IN A TYPICAL CORPS NETWORK.
Figure 3-3. Typical division small extension node deployment.
(3) Wire subscriber access. Wire subscriber access points provide the entry points (interface) between fixed subscriber terminal equipment owned and operated by users and the MSE area system operated by the supporting signal unit. Figure 3-4, Figure 3-5 and Figure 3-6 show the MSE switchboard configurations through which the hospital may tie into the area system. The two types of interface equipment are--
•. DODDOA-006848
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004

The signal distribution panel (junction box) J-1077. Each panel provides up to 13 subscriber access points.


Remote multiplexer combiners which provide access for 8 subscriber access points.

14
i ii •
. y3.1077 SEN
k
L
13.WF-16 HEW SATIRE
LEGEND: el: DIGITAL NONSECURE OR SECURE VOICE TERMINAL
Figure 3.4. Small extension node switchboard interface (V1).
DODDOA-006849
http://atiam.train.anny.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
34
LEGEND:.DIGITAL NONSECURE OR SECURE VOICE TERMINAL
Figure 35. Small extension node -switchboard interface (V2).
-
DODDOA-006850 http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
14 41.4
.1-1071 J-107?
2 or
J-1071
12 4
e
SWITCHING
SHELTER
• J-1077
12 14
4 ECM
u J-1077 k 8
14 J-1077 4
1 Li 8
J-1077
8 ti 4 12
s rlri WF•IIIFELD WIRE

1

s
LEGEND:
DIGITAL NONSECUPE VOICE TERMINAL OR SECURE VOCE TERMINAL REMOTE MULTIPLEXER COMBINER
Figure 3-6. Large extension node switchboard interface.
See FM 11-30 for definitive information pertaining to an MSE area communications system. Figure 3-7, Figure 3-8, and Figure_3 9 depict examples of the hospital's wire net diagram. The hospital commander
-
will designate the hospital's wire net system based on the mission.
DODDOA-006851
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
WIRE NET DIAGRAM
0
COMMANDER HOSP FOOD SVC NCO CD HLTH SVC MAT CHIEF, NUR SVC OFFICER
0
CHIEF, MED SVC MED SUPPLY SGT 0
0
0
HOSP CHAPLAIN MOTOR SPC UTIL OP AND T MED OPS OFFICER MAINT TECH
SBWD #1
MED EQUIPMENT PLANS OFFICER REPAIR TECH SS-86/P
COMPANY CDR LAUNDRY BATH NCO 0
O.
ASST CHIEF
1SG NURSE

O. TRI AGE/PRE-OP/ .0
0
0
0
0
SUPPLY SGT EMT #1 TRIAGE/PRE-OP/ 0 SUPPLY SPC EMT N2 TRIAGE/PRE-OP/ HOSP ADJUTANT EMT #3 TRIAGE/PRE-OP/ PSNCO EMT #4 CLINICAL HEAD PAT ADMIN OFFICER NURSE OR
PAT ADMIN NCO OR A #1
0
HOSPITAL DIETITIAN
TO AREA SWITCHBOARD
Figure 3-7. Wire net diagram, CSH, switchboard 1.
DODDOA-006852
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
WIRE NET DIAGRAM
INTERMEDIATE
OR A #2 CARE 85
INTERMEDIATE
OR B #1 CARE 16
INTERMEDIATE
OR B #2 CARE #7
0. ORTHO CAST CLINIC NP WARD .0
0. CMS #1 SBWD #2 MINIMAL CARE #1
CMS #2 SI1.86/P MINIMAL CARE #2
ORAL SURGEON PHARMACY SVC
INPATIENT MED A LABORATORY SVC
INTENSIVE CARE #1 BLOOD BANK
INTENSIVE CARE 82 RADIOLOGIST
0 INTENSIVE CARE #3 INTER MEDIATE RADIOLOGY NCO
CARE #1 PT SERVICE
INTERMEDIATE
CARE 82 CHAPLAIN
INTERMEDIATE
CARE #3 INTERMEDIATE UTTER BEARER SEC .0
CARE 84 .0

Figure 3-8. Wire net diagram, switchboard 2.
DODDOA-006853
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
WIRE NET DIAGRAM
0
COMMANDER OR D it2
.0

0
MED SUPPLY SGT ORTHO CAST CLINIC
.0

OR/CMS CNTRLTEAM CMS #1
.0

...1. . TRIAGE/PRE-OP/
EMT #1 CMS 82 TRIAGE/PRE•OP/
.0

EMT #2 INTENSIVE CARE #1 SBWD #3
.0

TRIAGE/PRE-OP/ INTENSIVE CARE #2
EMT *3
TA 207-P
.0

TRIAGE/PRE-OP/
CD
EMT .4 INTENSIVE CARE #3
.

0

INTENSIVE CARE #4
0
OR C *1
.0

OR C INTENSIVE CARE #5
.

0

C.
RADIOLOGY SVC

OR D #1
.0

o--.0

0. .0

.

0

0

0. .
0. .0

NOTE: ONE OF THE SB-SbIPs IS AUGMENTED WITH A TA 207-P (SIGNAL ASSEMBLY SWITCHBOARD, TO PROVIDE 30 ADDITIONAL SWITCHBOARD LINES.
DODDOA-006854
Figure 3-9. Wire net diagram, HUS, switchboard 3.
c. Mobile Subscriber Terminal. The MSE terminal is the ANNRC-97 MSRT. The MSRT, which consists of a very high-frequency radio and a digital secure voice terminal, is a vehicle-mounted assembly. It interfaces with the MSE system through an RAU. The primary use of the MSRT is to provide mobile subscriber access to the MSE area network. The MSRTs also operate in command posts to allow access to staff and functional personnel. The MSRT user has a KY 99 minterm telephone connected to the radio mounted in his vehicle. As long as the radio unit has line of sight contact with the RAU and the operator has properly affiliated, it connects to the area system. The operational planning range is 15 kilometers from any RAU. Figure 3-10 is a typical MSRT interface into the area system.
http://atiam.train.anny.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
NOTE
ALL MOBILE SUBSCRIBERS ARE EOUPPED
WITH TELEPHONE TERMINALS AND
CAPABILITY FOR FAX DATA TERMINALS

WHIP ANTENNA •.• MAST-MOUNTED ANTENNA
/WIT ASSEMBLAGE
FAX TERMINAL
OR.

DATA 'TERMINAL
77--
Figure 3-10. Mobile subscriber interface.
d.
Combat Net Radio System. The CNR equipment in the hospital includes both the improved high­frequent y radio (IHFR) system and the single channel ground and airborne radio system (SINCGARS). These systems will serve as a primary means for voice transmission of C2 information and as a secondary means for data transmission. Data transmission will be required when data transfer requirements cannot be met by the MSE system. The improved high-frequency AM radio series provide mid-to-far-range communications capability. They interface with other AM high-frequency radios and have push-button frequency selection. The SINCGARS series' FM radios are designed for simple and quick operation using a 16-element keypad for push-button tuning. They are capable of short-range operation for voice or digital data communications and interfacing with the ANNRC-12 series of FM radios. They also can operate in a jam-resistant, frequency-hopping mode.

e.
Combat Support Hospital Radio Nets. The CSH and its staff depend on both AM and FM radios and area communications systems to operate. The hospital FM radio net is shown in Figure 3-11 (also see Appendix E). The hospital monitors the following FM nets:


Hospital commander--medical brigade/group command net.


S2/S3--medical brigade/group command net.


Supported CSS FM nets.


S4 (Supply Officer, [U. S. Army])--supporting and supported logistical CSS FM nets.


Triage/preoperative/EMT--used to control operation of the medical evacuation and heliport operations.


Commander, HUS--hospital command net.

DODDOA-006855
http://atiam.train.anny.mil/portaPatia/adlsc/view/public/296784-1/fm/8-1... 112/28/2004
HOSPITAL UNIT, BASE
COMMAND NET • ROI

MEDICAL GROUP NE7 HUB OPNS SECTIONS/NCS
MEDICAL GROUP NET
it

SUP/SVC DIV
HUB COMMANDER
AN/VRC•90A II AN / VRC•90A I
EMT/TRULGE
IHUB AND HUSI
[ AN/VRC•90A I
HEupao OPNES
1
HOSPITAL UNIT, SURGICAL
I Alwyn-NA TOE 09737L000 Figure 3-11. Combat support hospital net—FM.
-
f Combat Support Hospital Operations Net--AM-IHFR. The hospital operations net (Figure 3 12) uses
an AN/GRC193A radio. This net is used to facilitate patient management, air and ground evacuation, and medical regulation of patients. This net links the hospital with the medical brigade/medical group which is the net control station (NCS) for the corps CHS operations net..
DODDOA-006856
http://atiam. train. army.mi l/portal/ati a/adlsc/vi ew/pub lic/296784-1/fin/8-10-14/Ch3 .htin .12/28/2004
HOSPITAL UNIT, BASE
MEDICAL EVACUATION NET -AM

MEDICAL GROUP
AN/GRC-193A
I 1
1
Figure 3-12. Combat support hospital net— AM-IHFR.
g. Signal Security. As part of the overall security program, CSH elements must practice signal security. The hospital operations section is responsible for signal and communications security. Some considerations include--

Using terrain features such as hills, vegetation, and buildings to mask transmissions.


Maintaining radio and radio-listening silence; using the radio only when absolutely necessary.


Distributing codes on a need-to-know basis.


Using only authorized call signs and brevity codes.


Using authentication and encryption codes specified in the current signal operation instructions (SOI).


Keeping transmissions short (less than 20 seconds if possible).


Reporting all COMSEC discrepancies to appropriate authorities.

DODDOA-006857
http://atiam.train.army.mil/portallatia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
CHAPTER 4

DEPLOYMENT AND EMPLOYMENT OF THE COMBAT
SUPPORT HOSPITAL

4-1. Threat
a.
The military threat facing the US Armed Forces is massive. For years, the Communist military forces were considered to be our major adversary. Now we must not only remain cognizant of the potential threat of major global powers, but we must also maintain an awareness of the various threats and trouble spots of Third World countries. Once considered not to be a major threat, the Third World regional powers pose a threat to US security and interests worldwide. These countries now have the capability of conducting hostile activities, and during wartime or periods of crisis, of supporting espionage, subversion, and sabotage operations. Highly destructive regional wars remain a danger. Potential aggressors will be well armed with modern aircraft and armored forces. They will likely be equipped with highly sophisticated and state-of-the-art weaponry systems. The proliferation and use of NBC weapons by developing nations will continue to pose a threat. They could attack using NBC weapons, powerful conventional weapons, or an assortment of both. The US Army will most likely face regional threats attempting to expand their sphere of influence by force.

b.
Another major threat to US forces deployed outside continental United States (OCONUS) is that of a medical threat. Elements of the medical threat include naturally occurring infectious diseases (also referred to as endemic diseases), environmental extremes, and combat stress. For a detailed discussion of medical threat elements, see FM 8-10.

4-2. Planning Combat Health Support Operations
Combat health support is an integral part of the force structure and is vital to all contingencies for the
sustainment of forces. Planning CHS is a continuous and demanding process. The hospital commander
and his staff must constantly assess new information for its impact on current and future support
requirements. Hospital commanders must understand how their actions should complement their higher
headquarters plan. Misinterpretations can lead to counterproductive actions and potentially disastrous
results. Two primary factors hospital planners must be knowledgeable of are the higher commander's
intent and the mission, enemy, terrain, troops, and time available (METT-T). The planning process for
future missions should not be isolated from current support actions. The planning process should be
flexible and adaptive to the situation and the hospitals' mission. Combat health support elements should
be deployed in the appropriate mix, in a logical sequence, based on the supported forces.
4-3. Mobilization
DODDOA-006858
a. Concept of Operations.
(1) In the event of contingencies in support of OOTW or war, the DOD initiates appropriate action for the deployment of forces in response to the scenario. Based on the situation, selected Active Component (AC) and Reserve Component (RC) CSHs and other units are alerted through command channels. For those units located in CONUS, the United States Army Forces Command (FORSCOM) uses the appropriate CAPSTONE trace and programs, the Time-Phased Force Deployment Data List (TPFDDL) based on the theater commander's requirements, and the air and sea resources available. For deployable AC hospitals, an increase in readiness posture (defense
http://atiam.train.army.mil/portal/atia/adlsc/view /public/296784-1/fin/8-10-14/Ch4.htm .12/28/2004 readiness conditions [DEFCON]) is directed by the post or installation commander, or by higher headquarters. For RC hospitals, mobilization notification constitutes an increase in readiness posture.
(2)
Deployment operations for hospital readiness validation are controlled through the post or installation emergency operations center (EOC) according to established plans and regulations. The EOC plans and coordinates all deployment preparation support for the deploying hospital and monitors and controls all facets of the deployment operation s to include reporting to higher headquarters.

(3)
The hospitals may deploy by land, sea, or air (or a combination of these modes) from locations designated by higher headquarters. Priority of effort is given to those modes of movement outlined in current plans.

(4)
Active Component hospitals maintain the capability for emergency deployment on short notice to execute assigned missions.

(5)
RC hospitals must attain and maintain the capability for mobilizing on short notice and arriving at their designated mobilization site according to unit mobilization plans.

(6)
Once mobilization is validated, hospitals prepare for deployment on short notice (72 hours or less). During validation, appropriate status reports are submitted to higher headquarters.

b. Conduct of Operations.
(1)
Commanders of deploying hospitals develop movement plans and TSOPs to accomplish the necessary preparations for deployment. Provisions for accomplishing all required training and other requirements to be accomplished during all phases of the deployment are identified. The checklists contained in Appendix F can be used as a guide for developing deployment operation procedures in support of movement by air and surface modes, or a combination thereof. The checklists are applicable to both AC and RC units. The checklists are detailed only as a guide for commanders. Installation mobilization stations and/or higher headquarters may prescribe different procedures for your unit.

(2)
Active Component hospitals maintain the capability necessary to achieve a deployment posture in the time required by any alert warning order or deployment instructions received. For planning purposes, the readiness posture maintained is consistent with the shortest notification period presented in the mobilization plan.

(3)
Reserve Component hospitals maintain the readiness posture necessary to meet planned deployment dates contained in current FORSCOM and mobilization documents. Upon arrival at the designated mobilization site, hospitals are placed in an increased or advanced deployability posture based on the published priorities of plans for which the hospitals are listed. The hospitals are managed through the RC chain of command, with input by the mobilization installation commander during the premobilization period.

(4)
All hospitals are scheduled for deployment validation by unit line number based on the published validation schedule. Hospitals can be expected to deploy within 72 hours following validation. Actual deployment date and times are as directed by higher headquarters.

DODDOA-006859
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
4-4. Deployment
a. When directed by higher headquarters through the port call or airlift message, the CSH will move to the port of embarkation (POE) for deployment. Deployment from the POE will be as directed by the United States Transportation Command. Upon arrival at the theater point of entry, it is essential that contact with the assigned medical brigade or group be made immediately. Normally, the medical brigade or group has liaison personnel to meet and assist the hospital staff with coordination and movement to its AO. As equipment and supplies are off-loaded, they are moved to a designated receiving area for consolidation and movement. An inventory for accountability and damage assessment is conducted. Vehicles are serviced and necessary repairs are made, or coordination is made with the supporting maintenance element for the repairs. Documentation for replacement of unusable supplies or equipment damaged beyond repair is initiated through the medical brigade or group headquarters element. Vehicle loads are adjusted for convoy operations. For equipment that was transported separately from the hospital, coordination is made for receiving and transporting it upon arrival. Once the hospital has moved to its AO, the medical brigade or group staff elements conduct formal personnel in-processing and an orientation on current operating policies and procedures. The orientation includes information on the following:

Mission update, to include geographical support area.


Combat health support issues.


Host-nation (FIN) support.


Local laws and customs.


Threat update.


Security requirements.


Personnel restrictions.


Personnel replacements.


Uniform requirements.


Emergency warning signals.


Religious support.


Vehicle and unit movement requirements.


Geneva Conventions (see Appendix G).

DODDOA-006860
• Supply support activities and procedures (all classes).
b.
In a force projection Army, METT-T will drive the amount of supplies required to support the force. For planning purposes, the hospital normally deploys with 10 days of medical supplies; the medical assemblage for each work area contains a basic load of 3 days of supply; and the medical supply set maintained by the supply and service division contains a 7-day basic load for the entire hospital. In a maturing theater, medical resupply is accomplished by preconfigured resupply packages until the corps MEDLOG battalion (forward) has been established. These "push packages" are throughput directly to the hospital via the transportation system. These packages may be pre-positioned "mobilization stocks," or may be built and shipped from the Defense Logistics Agency (DLA) depot system. Hospital logistics personnel coordinate with their next higher command headquarters for all logistical support to include resupply. Early deploying hospitals that arrive prior to their higher medical C2 headquarters must coordinate with port transportation personnel for shipment and receipt of supplies and equipment. Once the MEDLOG battalion (forward) has been established, hospital logistics personnel coordinate directly with the MEDLOG battalion for resupply of Class VIII materiel. All other resupply is requisitioned through higher headquarters with the appropriate supporting organization. Effective coordination is the key to responsible logistical support. To be effective it must be early and it must be often.

c.
For maximum use of the CSH, the entire organization should deploy together. However, due to its limited mobility and availability of transportation support requirements, it may be necessary to deploy

http://atiam.train.army.mil/portallatia/adlsciview/public/296784-1/fin/8... .12/28/2004 by echelons. If required to move by echelons, the following sequence is recommended:
(1)
First echelon. Advanced/quartering party.

(2)
Second echelon. This echelon should include--HUB:


Hospital Headquarters


Operating Room A Module


Two ICWs


Laboratory


Blood Bank


X-Ray


Pharmacy


Litter Bearer Section

--HUS:

Supply and Service Division


Triage/Preoperative/EMT


Operating Room/CMS Control Team


Two ICU Wards


Two CMSs


Ortho Cast Clinic

Elements of the following should also be included to provide necessary support: company headquarters
(HUB), supply and service division (HUB), PAD, and nutrition care division. It is critical to the
operation of the hospital that the first echelon include a heavy complement of utilities personnel and
equipment.
(3) Third echelon. This echelon should include--HUB:

Neuropsychiatric Service and Ward


Operating Room B Module


Inpatient Medicine A Module


Two ICWs


Two Minimal Care Wards


Two CMSs

--HUS:
• Two ICU Wards
Elements of the following should be included in this echelon: company headquarters (HUB), supply and service division (HUB), and PAD.
(4) Fourth echelon. All remaining elements of the hospital. .
DODDOA-006861
4-5. Employment
a. The CSH is normally employed in the corps AO on the basis of 2.4 per division supported. It will
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004 provide hospitalization for those patients who require stabilization for further evacuation, or who will
RTD within the corps evacuation policy. Patients are received from the MASH and supported corps area
by air and ground ambulance. The patients are triaged, treated, and evacuated, or RTD.
b. It is estimated that the hospital will require an area approximately 350 meters X 350 meters to establish and operate. The total area is dependent upon the hospital's mission and terrain feature. This facility, by virtue of its dependency on other support units, must locate in an area where it can be easily supported by elements of the corps support group, the corps signal brigade, the corps engineer brigade, and the COSCOM movement control center (MCC). Direct coordination between the CSH is usually required with--

The multifunctional corps support battalion (CSB) and its subordinate elements for specific-type logistics support (to include mortuary affairs [MA] and evacuation support for deceased patients).


The corps signal battalion or area support signal unit for external signal support.


The corps engineer-battalion or area support engineer unit for engineer support.


The COSCOM MCC or servicing MCC for transportation support and highway clearance.


The corps provost marshal or base commander for security.


The medical brigade or group for air and ground ambulance support.

Appendix H depicts an example of a functional layout using the DEPMEDS tent, extendable, modular,
personnel (TEMPER) and international organization for standardization (ISO) system. See TC 8-13 for a
recommended design of these systems for hospital operations. Because of its size, relocating the CSH
should be limited. With required personnel, it is estimated that 72 hours are needed to erect the hospital
completely for operations. The same amount of time is needed to prepare for relocation. The commander
may designate certain hospital elements to be erected on a priority basis to expedite the receiving of
patients upon relocation.
c.
The CSH can be tailored to support specific military operations. It may have surgical and/or medical teams attached to enhance its capabilities. When the HUS is employed separately from the CSH, it requires attachment to another unit for support.

d.
The CSH may be employed to support rear operations in the corps or COMMZ.

e.
The size and composition of health services in support of military operations will be tailored based on--


Mission.


Size of force being supported.


Projected patient work loads.


Anticipated civic action programs.


Availability of evacuation assets.


Evacuation policy.

f During the initial stages of military operations, CHS to the US forces will be austere and limited to the unit's organic medical capabilities. A short theater evacuation policy is normally established and tailored hospital support is required. Projected patient work loads will dictate the composition of these hospitals. The modular design of these hospitals allow augmentation as needed.
4-6. Hospital Displacement
DODDOA-006862
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/frn/8... .12/28/2004
a. Concept of Operations.
(1)
The medical brigade or group commander moves the CSH in support of sustainment operations. Hospital displacement may be in response to forward moves in support of tactical operations, or rearward moves during a retrograde to maintain appropriate distances from the forward line of own troops (FLOT). The medical brigade or group commander normally issues orders, either verbally or in writing, to the hospital commander. Frequently, the time to respond to orders is short; therefore, the hospital commander must disseminate his guidance to his staff in the most expedient method. Upon receiving the commander's guidance, the hospital staff conducts the mission analysis, incorporating changes based on new information or situation. The hospital saves time by rehearsing moves, using knowledge from past experience, and maintaining a detailed TSOP.

(2)
The hospital operations section develops the OPORD in accordance with the medical brigade's or group's plan, FM 101-5, FM 8 55, and the TSOP. The hospital commander, in consultation

-
with the hospital XO, approves the OPORD. The hospital commander ensures that the move is coordinated with higher headquarters and all supported elements. All supported elements must be aware of when medical operations at the current location will be curtailed and the date and time of opening of the operation at the new site. Hospital displacement necessitates the transfer of patients and medical operations to other MTFs. To minimize hospital operations disruption, the CSH should move in echelons. Displacement by echelons is contingent upon the higher commander's intent, the tactical situation, and the availability of support requirements.
b. Conduct of Operations.
(1) Warning order.
(a)
A move is usually initiated by a warning order issued by the medical brigade or group headquarters: The warning order serves notice of a contemplated action or order that is to follow. The amount of detail included in a warning order depends on the time available, the means of communications, and the information necessary for the hospital commander. Warning orders are brief oral or written orders.

(b)
Upon receiving the warning order, the hospital commander analyzes the mission and provides planning guidance to his staff. Using the medical brigade's or group's service support annex, status reports, and other appropriate documents, the hospital staff formulates the hospital service support estimate for the commander's approval. (Field Manual 8-55 discusses staff estimates and functions in greater detail.) With the acceptance and approval of the staff estimates, the hospital commander provides his decision and concept of operations. Concurrently with the staff estimate sequence, other hospital personnel conduct preliminary equipment checks and equipment loading procedures. Based on the commander's decision, the PAD coordinates with the medical brigade or group to effect the transfer of patients to other MTFs.

(c)
In preparation for displacement, the hospital commander should organize the hospital into manageable echelons, preserving hospital integrity as much as possible. Preparation for displacement requires--


Identifying external support requirements; for example, MHE.


Phasing down and transferring hospital operations.

DODDOA-006863
http://atiam.train.army.mil/portal/atia/adl sc/vi ew/public/296784-1/frn/8-10-14/Ch4.htm .12/28/2004

Performing map, ground, and/or air reconnaissance of the routes, and selecting the new site when possible.


Selecting routes.


Designating start points (SPs) and release points (RPs).


Reconnoitering the route to the SP.


Providing for security, maintenance, supply, and evacuation.


Determining the march order (echelons), rate of march, maximum speed of vehicles, and distance between vehicles.


Establishing checkpoints and halts.


Establishing communications security procedures.


Issuing strip maps.


Dispatching reconnaissance and advanced parties.


Controlling traffic.


Issuing orders.

(2) Operation order.
(a) The operations officer has staff responsibility for formulating, publishing, and obtaining the commander's approval of and distributing the OPORD. The OPORD provides hospital staff and personnel the information needed to carry out an operation. Preparation of this order normally follows the completion of area reconnaissance and an estimate of the situation. When time is available and the existing tactical situation conditions prevent detailed planning or area reconnaissance, the medical brigade or group prepares an initial march plan and issues fragmentary orders (FRAGOs) to modify these plans as needed. If conditions and time permit, information in the OPORD includes--

Destination and routes.


Rate of march, maximum speeds, and order of march.


Start points and SP times.


Scheduled halts, vehicle-distances, and RPs.


Required communications.


Strip maps.

(Ap_pendix_I provides a sample OPORD with annexes; FM 101-5 contains more detailed OPORD
information.)
(b) Each hospital division or section reports its supply, vehicle, equipment, work load, and maintenance status to the operations officer. This information is used in coordination with higher headquarters to finalize the convoy organization, compute additional transportation and external support requirements, and perform march computations. (For additional information on march computations, see FM 55-30.)
(3) Area reconnaissance.
(a) The medical brigade or group headquarters normally prescribes the reconnaissance route. The hospital operations section uses a map reconnaissance in such cases to confirm checkpoints, identify problem areas, and begin planning positions of the CSH in the new area. If the route is not prescribed and the CSH is not included as part of a reconnaissance party with other units, the operations section briefs the reconnaissance team on the displacement plan, provides the team with a strip map and the designated MOPP level, and
DODDOA-006864
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004 notifies higher headquarters of the route selected. The composition of the reconnaissance team is directed by the hospital commander.
(b) The reconnaissance party wears the designated MOPP gear and monitors all radiological and chemical detection devices, It performs duties to--

Verify map information.


Note capabilities of road networks.


List significant terrain features and potential problem areas.


Compute travel times and distances.


Perform route and ground reconnaissance to include hospital site selection and layout. (See TC 8-13 for a detailed discussion on site selection, layout, and support requirements.)

(4)
Advanced party. The advanced party moves before the main body and is dispatched as directed by the hospital commander, Its composition is recommended by the medical operations officer and approved by the hospital commander. It normally consists of representatives from Echelon II of the convoy organization (see paragraph 4-4c(2) above). It prepares the new site for arrival of the main body. The advanced party performs duties to--


Conduct a security sweep of the new site to ensure the area is free of enemy activity. This is normally done by security support forces.


Position chemical alarms.


Establish communications with higher headquarters and old location.


Designate boundaries of hospital elements based on unit defense plan and consistency with types of weapons and personnel availability.


Increase security by manning key points along the perimeter.


Establish a command post.


Stake the hospital layout (see TC 8-13).


Establish landline communications for critical areas.


Ensure personnel follow dispersion and other measures.


Position personnel to guide main body from the RP to designated locations.

(5)
Main body. The main body moves as directed in the OPORD. The last echelon normally closes out any remaining operations, ensuring the old site is clear of evidence of intelligence valuable to the enemy, and moves to the new site. This echelon includes maintenance elements to deal with disabled vehicles. It also picks up guides and markers along the route. As the main body arrives at the new site, it is met by the advanced party and guided to designated positions. Erection of the hospital and the establishment of hospital operations follows the priorities set by the commander.

(6)
Crossing a nuclear, biological, and/or chemical contaminated area. When the hospital commander is directed by higher headquarters, or when the tactical situation dictates, the hospital may have to cross a contaminated area or an area designated as a contaminated area. Should this situation occur, the following are recommended procedures:

(a) Operations section.

The operations officer conducts a map reconnaissance of the area and briefs the commander on the best possible route.


Based on the commander's approval, a route reconnaissance is conducted prior to

DODV0A-006865
http://atiam.train.army.mil/portal/atia/adIsc/view/public/296784-1/fin/8... .12/28/2004 moving the convoy through the contaminated area.

The reconnaissance team wears the appropriate MOPP level and carries monitoring equipment.


The route selected should minimize hospital exposure when crossing the area.

(b)
Convoy operations.


The convoy travels at a maximum safe speed with no scheduled stops within the contaminated area.


Prior to convoy operations, the commander designates the MOPP level.


The lead vehicle of each segment of the convoy has monitoring capabilities and survey instruments, with a map indicating areas of contamination. The map includes data from the reconnaissance party report. Continuous monitoring is conducted through the contaminated area.


Spacing of vehicles should take into consideration dust generated by the next forward vehicle.


Disabled vehicles are abandoned after personnel are recovered with notation of location.

(c)
Decontamination.


Immediately upon completion of the move, personnel and equipment are decontaminated. The hospital is responsible for decontaminating its personnel and equipment (see FM 3-5). Decontamination beyond the capability of the hospital will be requested from the supporting chemical company.


The decontamination site is annotated on the map.

(d) Reports. Upon completion of the move, the operations officer reports immediately to the hospital commander and higher headquarters any contamination acquired during the move. Other required reports are also included.
4-7. Emergency Displacement
When confronted with an adverse tactical situation anchor when directed by higher headquarters, the
CSH may be required to relocate expeditiously. Movement procedures identified above may be modified
to accommodate the situation. As soon as the threat appears inevitable, all available means are used for
evacuation of casualties, hospital personnel, and equipment. Wounded soldiers have priority on
transportation assets. The critically wounded who cannot be moved are left behind with medical
personnel, supplies, and equipment. The decision to leave patients behind is made by the tactical
commander. Medical supplies and equipment are not intentionally destroyed, even to prevent them from
falling into enemy hands. Paragraph 5 of Article 12, Geneva--Wounded and Sick (GWS), provides that
if we must abandon wounded or sick, we have a moral obligation to, "as far as military considerations
permit," leave medical supplies and personnel to assist in their care.
4-8. Nuclear, Biological, and Chemical Operations
As stated earlier in the threat, the corps' and division's sustainment capabilities are prime targets for the
enemy's NBC weapons. Although the hospital may not be specifically targeted, locating it close to other CS and CSS units, major airfields, and road junctions makes it vulnerable to NBC weapons. The hospital's TEMPERs are relatively permeable. Without increased protection, hospital assets can be
DODDOA-006866
http://atiam.train.anny.mil/portaUatia/adlsc/view/public/296784-1/fm/8-1... .12/28/2004
expected to experience a significant amount of contamination and damage when exposed to NBC strikes. The distance of the CSH from other support units and interposed terrain features as protective factors must be balanced against accessibility and time required for patient transport. Prompt notification of, and reaction to, downwind messages in the event of NBC employment will enhance hospital operations and patient and individual protective measures. However, NBC defense includes all measures to minimize casualties and enhance the effectiveness of hospital operations under NBC conditions.
These measures may be proactive or reactive in nature. They include contamination avoidance and
control, protection, and decontamination. For a comprehensive discussion on hospital operations in a
NBC environment, see FM 8-10-7 and FM 8-285.
DODDOA-006867 http://atiam.train.army.tnil/portallatia/adlseview/public/296784-1/fm/8-... .12/28/2004
APPENDIX A

TACTICAL STANDING OPERATING PROCEDURE FOR
HOSPITAL OPERATIONS

A-1. Tactical Standing Operating Procedure
This appendix provides a sample TSOP for a CSH. It provides the tactics, techniques, and procedures
for hospital operations; however, it should not be considered as all-inclusive. It may be supplemented
with information and procedures required for operating within a specific command, contingency, or
environment.
A-2. Purpose of the Tactical Standing Operating Procedure
The TSOP prescribes policy, guidance, and procedures for the routine tactical operations of a specific
unit. It should cover broad areas of unit operations and be sufficiently detailed to provide newly
assigned personnel the guidance required for them to perform their mission. A TSOP may be modified
by TSOPs and operation plans (OPLANs)/OPORDs of higher headquarters. It applies to a specific unit
and all subordinate units assigned and attached. Should a TSOP not be in conformity with the TSOP of
the higher headquarters, the higher headquarters' TSOP governs. The TSOP is periodically reviewed and
updated annually.
A-3. Format for the Tactical Standing Operating Procedure
a.
There is not a standard format for all TSOPs; however, it is recommended that a unit TSOP follow the format used by its higher headquarters. The TSOP can be divided into sections (specific functional areas or major operational areas). The TSOP may contain one or more annexes, each of which may have one or more appendixes. The appendixes may each have one or more tabs. Appendixes can be used to provide detailed information on major subdivisions of the annex, and tabs can be used to provide additional information (such as report formats or area layouts) addressed in the appendix.

b.
Regardless of the format used, the TSOP follows a logical sequence in the presentation of material. It should discuss the chain of command, major functions and staff sections of the unit, operational requirements, required reports, necessary coordination with higher and subordinate elements for mission accomplishment, programs (such as command information, PVNTMED measures, and CSC), and other relevant topics.

c.
Pagination of the TSOP can be accomplished by starting with page 1 and numbering the remaining pages sequentially. If the TSOP is subdivided into sections, annexes, appendixes, and tabs, a numbering system that clearly identifies the location of the page within the document should be used. Annexes are identified by letters and are listed alphabetically. Appendixes are identified by numbers and arranged sequentially within a specific annex. Tabs are identified by a letter and are listed alphabetically within a specific appendix. After numbering the initial sections using the standard numbering system (sequentially starting with page 1 through to the end of the sections), number the annexes and their subdivisions. They are numbered as the letter of the annex, the number of the appendix, the letter of the tab, and the page number. For example, page 4 of Annex D is written as "D-4"; page 2 of Appendix 3 to Annex D is written as "D-3-2"; page 5 of Tab A to Appendix 3 of Annex D is written as "D-3-A-5." This system of numbering makes the pages readily identifiable as to their place within the document.

DODDOA-006868
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
d.
In addition to using a numbering system to identify specific pages within the TSOP, descriptive heading should be used on all pages to identify the subordinate elements of the TSOP.

(1)
The first page of the TSOP should be prepared on the unit's letterhead. The remaining pages of the sections should include the unit identification in the upper right hand corner of the paper (for example: "XXX Combat Support Hospital").

(2)
A sample heading for an annex is: "Annex Q (Nursing Service) to XXX Combat Support
Hospital."

(3)
A sample heading for an appendix to Annex Q is: "Appendix 4 (Patient Food Service) to
Annex Q (Nursing Service) to XXX Combat Support Hospital."

(4)
A sample heading for a tab to Appendix 4 to Annex Q is: "Tab C (Diet Roster) to Appendix 4 (Patient Food Service) to Annex Q (Nursing Service) to XXX Combat Support Hospital."

e.
As the TSOP is developed there may be an overlap of material from one annex to another. This is due in part to similar functions that are common to two or more staff sections. Where overlaps occur, the material presented should not be contradictory. All discrepancies will be resolved prior to the authentication and publication of the TSOP. The TSOP will be authenticated by the hospital commander.

A-4. Sample Tactical Standing Operating Procedure (Sections)
The information contained in this paragraph can be supplemented. It is not intended to be an all­
inclusive listing. Different commands will have unique requirements that need to be included.
a.
The first section of the TSOP identifies the specific unit/headquarters that developed the TSOP.

(1)
Scope. This paragraph establishes and prescribes procedures to be followed by the CSH and its assigned, attached, or operational control (OPCON) units/elements.

(2)
Purpose. This paragraph provides policy and guidance for routine tactical operations of the headquarters and its assigned, attached, or OPCON units.

(3)
Applicability. Except when modified by SOPs and OPLANs/OPORDs of higher headquarters, this paragraph applies to the hospital and to all units assigned, attached, or OPCON for combat operations. These orders, however, do not replace judgment and common sense. In cases of nonconformity, the document of the higher headquarters governs. Each subordinate element will prepare a unit TSOP, conforming to the guidance herein.

(4)
General information. This paragraph discusses the required state of readiness of the unit; primary, secondary, and contingency missions; procedures for operating within another command's AO; and procedures for resolution of conflicts with governing regulations, policies, and procedures.

(5)
References. This paragraph can include any pertinent regulations, policy letters, higher
headquarters TSOP, or other appropriate documents.

b.
The second section of the TSOP discusses the hospital organization. .

DODDOA-006869
http://atiam.train.army.mil/portallatia/adlsc/view/public/296784-1/fin/8... .12/28/2004
(1)
Organization. The unit is organized and equipped in accordance with the applicable MTOE an/or other staffing documentation. The applicable MTOE and other staffing documentation should be listed in this paragraph.

(2)
Succession of command. The guidance for determining the succession of command is
discussed.

(3)
Task organization. Task organization is contingent on the mission and will be approved by the headquarters ordering deployment.

(4) Organizational charts. Contained in Annex A.
c.
The third section of the TSOP discusses hospital functions. It will supplement the hospital organizational chart(s). The functions of the various hospital divisions/sections, to include personnel and some of their responsibilities, are provided in Chapter 2 of this publication. For a more detail description of personnel duties, see FM 101-5, AR 611-201, and AR 611-101.

d.
The fourth section of the TSOP pertains to division/section operations and is subdivided into annexes.

A-5. Sample Tactical Standing Operating Procedure (Annexes)
Annexes are used to provide detailed information on a particular function or area of responsibility. The
commander determines the level of specificity required for the TSOP. Depending upon the complexity
of the material to be presented, the annex may be further subdivided into appendixes and tabs. If the
annex contains broad guidance or does not provide formats for required reports, paragraphs may be
used. The annex should not require further subdivision. However, as the material presented becomes
more complex, prescribes formats, or contains graphic materials, the annex will require additional
subdivision. Applicable references, such as ARs, FMs, and TMs, should be provided in each annex. The
number of annexes and their subdivisions should be based on command/contingency requirements. Each
annex should contain information relating to mission, organization, duties and/or responsibilities, and
procedures. The following sample annexes are provided as a guide and are not considered all-inclusive.
a. Annex B, Hospital Headquarters. This annex discusses the hospital commander and his responsibilities. The hospital commander is the senior MC officer assigned or as appointed by higher headquarters. The hospital commander, assisted by the chiefs of surgery, nursing, and medicine, XO, chaplain, and CSM, provides the C2 necessary to accomplish the mission. The day-to-day operations shall include a review of hospital activities occurring during the preceding shift and the implementation of directives received from higher headquarters.
(1)
The daily assessment of hospital operations is accomplished via a report(s) on admissions, dispositions, bed census (by type), unusual occurrences, and significant seriously ill patients. The chief of professional services reports on bed availability by type bed and service capabilities that can be provided. This information must also be provided daily to the PAD for medical evacuation and patient regulating operations.

(2)
The commander and his staff, in the conduct of daily operations, can use personal and telephonic contact to become aware of personnel, logistical, and administrative problems which may affect the overall hospital operations.

(3)
Regularly scheduled meetings and review of reports and programs can be used to monitor the

DODDOA-006870
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004 effectiveness and efficiency of hospital operations.
(4)
The hospital commander, during command visits or contacts with the medical group, can be apprised of the tactical situation. The hospital commander provides higher headquarters the hospital's overall status to include patient work load, hospital capability, personnel status, logistical requirements, and other information as he deems appropriate. The hospital commander maintains liaison with the MEDLOG battalion, medical evacuation battalion, MASH, and corps support organizations.

(5)
The hospital commander may activate the TOC based on the tactical situation. (See Annex D for a discussion on TOC operations.)

(6)
This annex should also address the hospital hours of operation, to include the hospital staff and personnel shifts.

b. Annex C, Company Headquarters. This annex discusses the C2 structure for all assigned or attached officers and enlisted personnel of the hospital. The annex outlines procedural guidance for, but not limited to, the following:

Unit-level administration.


Reenlistment and extension programs.


Billeting, to include fire safety, sanitation, and key control.


Security, assignment, accountability, and maintenance of weapons.


Perimeter security.


Life support and site improvement.


Welfare and recreational activities.


Unit supply.


Duty rosters.


Physical fitness.


Training.


Uniform Code of Military Justice actions.

c. Annex D, Tactical Operations Center. Areas covered by this annex include--
(1)
Definition. The TOC is the command element of the hospital containing communications and personnel required to command, control, and coordinate hospital and CHS operations.

(2)
Purpose. The purpose of the TOC is to provide a secure area where the commander and key staff can assemble to estimate the situation, assess the requirements, and react to varying problems such as area defense, NBC operations, mass casualty situations, and CHS operations.

(3)
Responsibilities. The hospital commander has overall supervision and control over the TOC. The hospital XO has primary staff responsibility in the absence of the commander. Daily operations of the TOC are the responsibility of the operations section.

(4)
Operations. The TOC operates on a 24-hour basis. It is principally staffed by each primary staff section. furnishing necessary manpower as required. The TOC will be adjacent to the communications facility, as well as in proximity to the emergency room and triage areas. The TOC should be of sufficient size to allow for establishment of maps, storage of individual weapons and chemical defense equipment, and facilitate communications among the staff.

DODDOA-006871
http://atiam.train.army.mil/portal/atia/adIsc/view/public/296784-1/fm/8-... .12/28/2004
Telephone communications connect the TOC to other staff sections within the hospital, higher headquarters, and other appropriate units. The CNR will also provide the appropriate communications for CHS. Access to the TOC is strictly controlled by means of an access roster and, if available, security badges. Only essential personnel and authorized visitors are allowed to enter. Each hospital element maintains a TSOP on the organization and operation of its section. All elements within the TOC maintain, when appropriate, a current situational map of their specific operations. Discussion and portrayal of tactical plans outside of the security area are prohibited.
(5)
Composition of the tactical operations center. This is a listing of those personnel comprising the TOC. It normally includes the commander, XO, CSM, principal staff members, and other specific staff members as required.

(6)
Tactical operations center configuration. This is a schematic representation of the physical layout of the TOC. It can be included as an appendix to the annex.

(7)
Message center. This paragraph establishes procedures for the handling of classified messages; provides delivery and service of IMMEDIATE and FLASH messages to the appropriate staff section; and provides procedures for preparing outgoing messages and delivery service to the servicing message center for the transmission of outgoing messages.

(8)
Appendixes. The addition of appendixes to this annex is permissible and may cover topics such as--


Schematics of the physical layout.


Change of shift procedures.


Security requirements, to include guard duties and identification badges.


Briefing requirements.


Overlay preparation.

(9)
Camouflage. This paragraph discusses what camouflage procedures are required, to include type and amount of required camouflage materials (such as nets and terrain features); display of the Geneva Conventions distinctive emblem on facilities and vehicles; and other pertinent. information. See FM 8-10 for information concerning the camouflaging of medical units.

d. Annex E, Operations. This annex establishes procedures for the operations section within the hospital and provides a basis for standardization of CHS operations in a tactical environment. It is essential that these procedures be standardized to ensure common understanding, facilitate control and responsiveness, and enhance mission accomplishment. Although intelligence and hospital defense are functions of the hospital operations section, they may be addressed in separate annexes. For simplicity and coherency, these areas are discussed in paragraphs e and f, respectively. Commanders may elect to consolidate the S2/S3 functions into a single annex. Appendixes to this annex should include the following areas:
(1)
Operational situation report. Requirements for format, preparation, and submission of this report are discussed in this appendix.

(2)
Operations security. This appendix provides the guidance and procedures for secure planning and conduct of combat operations.

DODDOA-006872
http://atiam.train.anny.mil/portal/atia/adIsc/view/public/296784-1/fm/8-... .12/28/2004
(a)
Responsibilities. The commander is ultimately responsible for denying information to the enemy. The operations officer is responsible to the commander for the overall planning and execution of operations. He has the principle staff interest in assuming the required degree of OPSEC and has the primary staff responsibility for coordinating the efforts of all other staff elements in this regard. The operations officer is responsible for the preparation of the essential elements of friendly information (EEFI) and for providing classification guidance. Additionally, the OPSEC officer identifies the priorities for OPSEC analysis and develops OPSEC countermeasures. Coordination is effected with higher headquarters in planning an OPSEC analysis of operations and analyzing EEFI.

(b)
Classified and sensitive information. Document classification, downgrading, and declassification is the responsibility of the operations section. Classified and sensitive information, such as the status of the forces, readiness condition, equipment status, and other information relative to the hospital's ability to perform its mission, will be limited to those individuals with a security clearance and the need to know.

(3)
Hospital relocation. This appendix provides the procedures for hospital relocation. Because of the hospital's limited mobility, transportation support and other site preparation are required from COSCOM assets. The operations officer, in conjunction with the supply and service division, plans and coordinates hospital movement. Considerations should include, but not be limited to, the following:


Coordination with higher headquarters.


Patient relocation.


Tactical situation.


Transportation requirements availability.


Convoy operations (to include clearance and security).


Terrain analysis and site selection.


Availability of required support (engineer, communications, and supply).

(4)
Communications-electronics. This appendix establishes communications policies, procedures, and responsibilities for the installation, operation, and maintenance of communications-electronics (CE) equipment. Responsibilities of the CE NCO include--


Advising the hospital commander and operations officer on CE matters.


Determining requirements for communications support.


Radio communications.


Radio teletypewriter communications.


Message and communications center service.


Message handling procedures.


Wire communications.


Switchboard operations.


Communications security and operations.


Security violations. This prescribes procedures for reporting any event or action which may jeopardize communications security.


Daily shift inventory.. DODDOA-006873


Physical security of communications equipment.


Transmission security.


Security areas. This discusses access procedures and rosters, access approval requirements, and prohibited items.


Communications security officers and custodians. The appointment procedures, orders

http://atiam.train.army.mil/portaliatia/adlsc/view/public/296784-1/fm/8-... .12/28/2004 requirements, and duties of personnel are described.

Safety. This discusses requirements for the grounding of, handling, and storage of COMSEC equipment.


Power units.


Emergency destruction of classified operating instructions and associated materials.

e.
Annex F, Intelligence and Security. This annex pertains to intelligence requirements and procedures and operational security considerations. Appendixes to this annex may include the following subjects:

(1)
Intelligence. The operations section has the responsibility of collecting information to assist the commander in reaching logical decisions as to the best courses of action to pursue. Essential elements of information (EEI) include, but are not limited to, the location, type, and strength of the enemy threat; location of area of casualty concentration; known or suspected NBC activity; and issues which the commander considers to be EEI.

(2)
Intelligence reports. The operations section is responsible for disseminating all applicable estimates, analyses, periodic intelligence reports, and intelligence summaries generated within the hospital or received from higher headquarters. Information on submission of reports and suspenses on intelligence products and reports should also be addressed in this appendix.

(3) Counterintelligence.

Camouflage. When ordered or directed by the tactical commander all units will initiate and continually strive to improve camouflage operations of positions, vehicles, and equipment. Noise and light discipline is emphasized at all times.


Communications security. These measures are enforced at all times. Specific requirements and considerations are included.


Signs and countersigns. This paragraph outlines procedures for establishing signs and countersigns to be used during hours of darkness. It also includes reporting requirements and procedures if the sign/countersign is lost or compromised.


Document security. This paragraph discusses the procedures for inventorying, marking, safeguarding, and destroying classified material, both work documents and completed documents. Reporting requirements in the event of compromise are also included.

(4)
Captured personnel, equipment, supplies, and documents. This appendix provides specific guidance on the handling of captured personnel, equipment, supplies, and documents. The disposition of captured medical equipment and supplies is governed by the Geneva Conventions and is protected against intentional destruction.

(5)
Security. This appendix discusses weapons security, SOI (communications) security, TOC security, and Sensitive Item Status Report policies, guidance, or procedures.

f.
Annex G, Hospital Defense. This annex describes procedures for security of the hospital in a wartime environment. Security should be a part of an integrated defense plan (base cluster commander and FIN base defense plan). Within the theater area, the base cluster and base commanders are appointed by the area commander. These commanders have the overall responsibility for the base cluster defense and base defense organizations and plans. The hospital should be included as a part of the base cluster/base plan as established by the base cluster/defense commander. This annex addresses, as a minimum, the following:

DODDOA-006874
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004

Sustainment operations.


Defense reaction force(s).


Hospital movement.


Terrain management.


Medical unit self-defense according to the Law of Land Warfare (see Appendix G). For a
comprehensive discussion on the Law of Land Warfare, see FM 8-10 and FM 27-10.

g. Annex H, Administration and Personnel. This annex outlines procedures relating to administrative and personnel matters and associated activities. The theater surgeon has assignment, reassignment, and career management authority for all AMEDD officer and WO personnel arriving into or within the theater during mobilization and wartime. Request for personnel and administrative support will be submitted through the medical group (S1 [Adjutant, U. S. Army]) to the appropriate supporting regional personnel center. Paragraphs of the annex or attached appendixes should discuss the following:
(1)
Personnel loss estimate. Initially, FM 101-10-1/1 and FM 101-10-1/2 will be used as a basis for the computation of gross and special personnel loss estimates. Factors and loss rate tables in the FMs may not accurately reflect current situations and should be modified as actual experience factors are developed.

(2)
Emergency personnel replacements. A request for hospital personnel replacement is submitted to the medical group Si when there are unexpected losses for which no replacements are allocated.

(3)
Personnel daily summary (PDS). This paragraph provides the procedures for filling out and submitting a daily personnel status report. The instructions may include requirements for encrypting the report prior to transmission, specific guidance on time of submission, corrections, or other administrative requirements.

(4)
Casualty reports. This paragraph applies to all US military personnel who are serving within the hospital's area of support and become casualties in areas under US control. It is also applicable to EPWs and civilian internees who become casualties while under control of US units.


Casualty feeder report. This report is submitted on DA Form 1156. Instructions on the completion of the form and submission requirements are included.


Witness statements on individuals (DA Form 1155). This statement is completed only when the recovery of a body is not possible, or cannot be identified. It is to be submitted to the S 1 within 24 hours of the incident. The paragraph should contain information on obtaining the form, instructions for completing it, and other relevant information or procedures.


This section may also include other reports required by the command.

(5) Personnel management.

Replacements. Individual replacements will not be readily available during the initial phases of operations. The administrative division will automatically initiate replacement requests for personnel who are reported on the PDS report as wounded in action, missing in action, or killed in action.


Assignments and reassignments. This paragraph will address the actions required for patients and permanent party personnel.


Leaves. Ordinary and emergency leave procedures are outlined in AR 630-5. Policies established by the theater will take precedence.

DODID0A-006875
http://atiam.train.anny.mil/portal/atia/adlsc/view/public/296784-1/frn/8... .12/28/2004

Personnel actions. All personnel actions are channeled through the administrative division. Division/section chiefs and NCOICs are the hospital points of contact. Actions will be handled expeditiously and meet suspense dates (tactical situation permitting).


Efficiency reports. This paragraph describes the pertinent information needed for the completion and submission of these reports.


Award recommendations. This paragraph delineates the responsibilities and guidance for submitting recommendations for awards and for scheduling and conducting award ceremonies.


Promotions. This paragraph discusses the procedures for submitting recommendations for promotion and for scheduling and conducting promotion ceremonies.


Correspondence. All correspondence addressed to higher headquarters is submitted through the administrative division. Requirements for submission, preparation, and approval are also provided.


Personnel records. This paragraph discusses requirements for coordination of this support. It also discusses the procedures for having correspondence included in the official military personnel records of personnel assigned and attached.

(6) Personnel services. Personnel services are those activities pertaining to soldiers as individuals. Unless prohibited by the tactical situation, the services listed below will be available to all assigned and attached units.
DODDOA-006876

Sporting activities and morale and welfare activities. .


American Red Cross.


Finance. This service includes disbursements and currency control, payday activities, currency conversion, check cashing, and the appointment of Class A agents.


Legal services. Information and specific guidance on administrative boards, courtmartial authority and jurisdiction, legal assistance, and general services should be provided.


Religious activities. Religious activities include chaplain support, services available for different faiths, schedule of services, and hospital visitations.


Postal services. This includes hours of operation and services available. Emergency destruction, prisoner of war mail, and mail restriction policies will be outlined. Postal services should be addressed in an appendix to this annex.


Post exchange services. This includes hours of operation and availability.


Distribution. Pick up and delivery schedules and any command-specific issues and procedures are provided.

(7) Mortuary affairs. Commanders at all levels are responsible for unit MA and the search, recovery, and evacuation of remains to collection points. Selected hospital personnel should be trained on MA tasks to ensure proper handling of remains and the deceased's personal effects.

Responsibilities. This paragraph discusses hospital responsibilities and the relationship with the medical group and supporting MA activity.


Disposition. Specific guidance on procedures, MA collection points, transportation requirements, and handling of remains is provided.


Hasty burials. Specific requirements for conducting hasty burials and marking and reporting of grave sites are included.


Personal effects. Guidance on accounting for personal effects and requirements for burial should a hasty burial be required is contained in this paragraph.


Disposition of civilian and EPW remains. The local civilian government is responsible for the burial of remains of its citizens. The remains of EPWs are buried in separate cemeteries from US and allied personnel. If this is not possible, a separate section of the same cemetery

http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/firi/... .12/28/2004 is used and will be properly marked.
• Contaminated remains. This paragraph discusses handling and disposition requirements (to include protective clothing), procedures, and marking and reporting of burial site.
(8)
Public information. This appendix contains procedures for obtaining approval on the public release of information to include the hometown news release programs.

(9)
Maintenance of law, order, and discipline. This appendix should provide applicable regulations, policy, and command guidance on topics such as serious incident reports, notifications and submission formats, straggler control, confinement of military prisoners, and EPWs (also discussed in (10) below).

(10)
Enemy prisoners of war. This appendix discusses the unit responsibility for EPWs captured by or surrendered to the unit. These procedures do not pertain to EPW patients captured by other units. Medical personnel do not guard, search, or interrogate EPWs while in the CHS system; guards are provided by nonmedical personnel designated by the tactical commander for these duties. Until EPW personnel can be evacuated to an EPW collection point, medical personnel should remember and enforce the basic skills: segregate, safeguard, silence, secure, speed, and tag. (The speed portion of evacuating EPWs to designated collection points is of paramount importance to medical units.)

NOTE
The treatment of EPWs is governed by international and US law and the provisions of
the Geneva Conventions. Personnel should be aware of these requirements and have
ready access to the applicable regulations and policy guidance (see FM 8 7 10 and AR 190-8).
(1 1) Records disposal procedures. The emergency disposal of files, when hostile action is imminent and if retention is prejudicial to the interest of the US, will be outlined. Nonemergency disposal, to include lost or destroyed files, will be included.
(12) Appendixes. The following appendixes should be developed as part of this annex:

Human relations and equal opportunity.


Civilian personnel.


Provost marshal.


Safety (see Appendix D).


Postal operations.


Command message center.

h. Annex I, Chaplain. This annex outlines the duties and responsibilities of the hospital chaplain and the hospital ministry team. Although the chaplain reports directly to the hospital commander, his activities will be coordinated with the hospital adjutant.
(1) Chaplain support and coverage. This paragraph will address the following:

Normal and emergency chaplain duties


Religious services.


Visitation.

DODDOA-006877
http://atiam.train.anny.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004

The seriously ill.


Death.


Burial services.


Reports.

(2) Chaplain funds. Procedures will be outline for the establishment of a non-appropriated
chaplain's fund upon mobilization.

i.
Annex J, Nuclear, Biological, and Chemical Defense. This annex provides general guidance regarding unit and individual defense against NBC attacks, decontamination procedures, and care of NBC casualties.

(1)
The NBC NCO is the technical advisor to the hospital commander and the operations officer on all matters pertaining to NBC operations. Procedures should be developed for--


Organizing and training the required NBC teams.


Establishing a warning and alarm system. The system will include vocal, visual, and sound.


Training hospital personnel on MOPP and other NBC defensive measures.


Advising the hospital commander on activation of the appropriate MOPP level, to include masking and unmasking procedures, based on the tactical situation.


Maintaining NBC records and submitting the required reports.


Establishing collective shelters. The operations section will determine the requirements for NBC collective shelters, The responsibility for establishing and maintaining NBC shelters rest with the section being hardened.


Publishing radiation exposure guidance. This includes methods to minimize exposure and protect against electromagnetic pulses.


Maintaining and distributing unit NBC defense equipment.


Maintaining accountability and proper stockage of NBC defense equipment and PLL items.

(2)
This annex should include the following appendixes:


Appendix 1--NBC Teams.


Appendix 2--Decontamination Procedures.


Appendix 3--Operating in an NBC Environment.


Appendix 4--Individual and Collective Protective Plan.


Appendix 5--Handling and Patient Care of NBC Patients.


Appendix 6--Handling Contaminated Patients.


Appendix 7--Establishing Decontamination Sites.


Appendix 8--Locating Contaminated Areas (to include traffic control in and out of the area).


Appendix 9--NBC Reporting.


Appendix 10--Hospital Recovery.


Appendix 11--Radiation Exposure Guidance.


Appendix 12--References.

j.
Annex K, Nutrition Care. This annex outlines procedures relating to patient nutrition management and Army medical field feeding operations. The annex addresses the nutrition care division's organization and staff responsibilities. The organization and a detailed discussion of the following specific areas should be included as appendixes:

• Organization.
DODDOA-006878
http://atiam.train.army.rnil/portal/atia/adlsc/vi ew/public/296784-1/fm/8-10-14/Appa.htm .12/28/2004

Medical rations.


Patient meal delivery.


Staff and ambulatory patient feeding.


Safety.


Sanitation.


Nutritional support.


Nourishments, to include forced fluids.


Ration accountability.


Ration procurement.


Equipment maintenance.


Training.


References.

k. Annex L, Logistics. This annex outlines sources, procedures, requirements, responsibilities, and planning guidance for logistical support for a CSH.
(1) Specific areas which are addressed are listed below. The discussion to the areas should be provided in appendixes with the inclusion of tabs, if appropriate.

Supply and services.


Medical supply.


General supply.


Maintenance (less medical).


Medical equipment maintenance.


Waste disposal.


Linen.


Interface with the MEDLOG battalion (forward).


Transportation and mobility.


Supply and distribution.


Engineer support.


Quartermaster support.


Hospital safety.


Blood component resupply.

Logistics applications of automated marking and reading symbols (LOGMARS), TACCS, MEDTCU, and test, measurement, and diagnostic equipment are included in the discussions when appropriate.
(2)
Transportation and movement requirements. This appendix covers the following areas:
applicability; responsibilities; policies on speed, vehicle markings, transporting flammable
materials, transporting ammunition and weapons, convoy procedures; safety; and accident
reporting.

(3)
Fire prevention and protection. Guidance on the use of flammable materials, use of cigarettes, matches, and lighters, electrical wiring and appliances, safety of tents and occupants, spacing of tents, stoves and ranges, and firefighting equipment are presented in this appendix.

(4)
Field hygiene and sanitation. This appendix provides uniform guidance and procedures for the performance of functions related to field hygiene and sanitation. It includes policies, communicable disease control, field water supply, water trailers and cans, fabric water storage

DODDOA-006879
http://atiam.train.amw.mil/portal/atia/adlsc/view/public/296784-1/fin/8-... .12/28/2004
containers, food sanitation, latrines, liquid waste disposal, and garbage and rubbish disposal. For
additional information on field hygiene and sanitation, see FMs 21-10 and 21-10-1.
(5)
Conventional ammunition down/upload procedures. This appendix delineates responsibilities; provides guidance and procedures for the requisition, storage, and distribution of ammunition and weapons, reporting requirements, arid safety.

(6)
Petroleum, oils, and lubricants accounting.

(7)
Health service logistics support. The health service logistics concept of operations, requisition, and distribution procedures, accountability, and reports are provided in this appendix.

1. Annex M, Laboratory. This annex prescribes laboratory policies and procedures in support of the hospital. Procedural guidance will include, but not be limited to--

Hematology and urinalysis.


Performing white cell count.


Performing complete blood count (red blood cell [RBC], white blood cell [WBC], hemoglobin [Hgb], and hematocrit [Hct]).


Determining Hct.


Determining WBC differential


Determining prothrombin time.


Determining partial thromboplastin time (APTT).


Performing cerebrospinal fluid (CSF) cell count and differential.


Performing urinalysis (dipstick).


Performing urinalysis (microscopic).


Performing platelet estimate.


Performing platelet count.


Determining fibrinogen level.


Determining fibrin degradation products.


Biochemistry.


Performing blood gas analysis.


Performing electrolyte levels (Na, K, Cl, and CO2).


Determining total serum protein.


Determining serum creatinine.


Determining serum amylase.


Determining serum AST activity.


Determining serum ALT activity.


Determining serum CK activity.


Determining serum glucose.


Determining serum T. bilirubin.


Determining serum calcium.


Determining CSF glucose.


Determining CSF protein.


Determining urine protein.


Determining urine glucose.


Microbiology and serology.


Performing occult blood test.


Performing thick and thin smears for malaria.


Performing gram stains.


Performing RPR test (syphilis)..

DODDOA-006880
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004

Performing 1M (infectious mononucleosis) tests.


Examining feces for ova, cysts, and parasites.


Performing potassium hydroxide (KOH) preps


Performing pregnancy tests.


Microbiology (capabilities available with specific augmentation).


Performing urine cultures (colony counts and sensitivity).


Performing wound culture and sensitivity.


Performing culture and sensitivity for gonorrhea.


Performing throat cultures.


Quality control procedures.


Reports.


Infectious, chemical, hazardous, and solid waste disposal.


Safety.

m.
Annex N, Blood Bank Services. This annex prescribes hospital blood bank policies and procedures. It addresses procedures for--


Storing, collecting, and administering blood and blood products.


Performing blood group and type (ABO, RH).


Performing abbreviated blood crossmatching procedures.


Thaw and issue fresh frozen plasma.


Blood planning factors.


Reports.


Automated blood management system.

n.
Annex 0, Dental Services. This annex outlines policies and procedures for dental clinic operations in a CSH. Procedures include--


Priority of treatment.


Dental records.


Narcotics and drug control.


Dental supply and maintenance operations.


Precious metal control.


Mercury hygiene and syringe and needle security.


Sterilization and infection control.


Safety.

o.
Annex P, Pharmacy Service. The pharmacy operation is centered around an inpatient and outpatient system, distribution of bulk drugs, and the IV-additive program. This annex addresses the following procedures:


Storing, safeguarding, labeling, and dispensing pharmaceutical and drug products.


Operating an IV-additive program.


Controlling drugs (Q and R).


Preparing signature cards.


Accessing letters.


Rotating stockage of drugs and medication.


Requisitioning drugs and supplies.


Preparing reports.

DODDOA-006881
http://atiam.train.army.mil/portal/atia/adisc/view/public/296784-1/fm/8-... .12/28/2004
p.
Annex Q, Patient Administration Division. This annex outlines the general functions for the PAD. Procedural guidance is identified for the following:


Maintenance and accountability for clinical records.


Admittance, discharge, and transfer of patients (surface and air movement).


Processing and disposition of weapons, ammunition, maps, and classified and sensitive documents taken from patients admitted to the hospital.


Medical statistics and reports.


Claims.


Processing hospital deaths.


Theater Army Medical Management Information System MEDPAR and MEDREG.

q.
Annex R, Nursing Service. This annex provides administrative and operational guidance for all nursing service personnel throughout the hospital. It provides nursing care standards, policies, and procedures which are applicable to all wards,lo include ORs and the triage, EMT, and preoperative treatment sections. Areas addressed should include, but not be limited to, the following:


Nursing documentation.


Scope of nursing practices.


Standards of nursing practice.


Standards of patient care.


Assignment of personnel.


Infection control.


Special category patients.


Procedures available in radiology.


Procedures available in laboratory.


Admission and discharge.


Procedures for cardiopulmonary resuscitation.


Mass casualty plan.


Preoperative care of the patient.


Postoperative care of the patient.


Care of patient with indwelling catheters


Care of patient with central IV lines.


Care of patient with tracheostomy.


Care of patient with chest tube.


Death procedures.


Hazardous and medical waste disposal.


Bedpan and urinal washing and disinfecting procedures.

r.
Annex S, Radiological Services. This annex establishes policies and procedures for requesting radiological services, preparation of patients, and use of x-ray films.

(1) Request for diagnostic procedures is outlined for the following examinations:

Routine.


Emergency.


Bedside.


Special (upper gastrointestinal series, gallbladder).


Urological.


Preoperative chest x-rays.

DODDOA-006882
http://atiam.train.anny.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004 (2) Appendixes to the annex may include other information to assist daily operations. Suggested areas are--

Radiation safety.


Radiation protection.


Equipment records.


Radiographic film security.


Filing procedures.

s.
Annex T, Medical Services. This annex prescribes the duties and procedures for medical services in the treatment of all patients admitted to the hospital. Areas to be addressed include, but are not limited to--


Treatment protocols.


Examination procedures.


Evaluation and treatment of infectious diseases.


Evaluation and treatment of internal medicine disorders.


Evaluation and treatment of skin disorders.


Treatment of patients with gynecological diseases, injuries, or disorders.


Medical supply and resupply procedures.


Consultation services.


Infection control (procedures to be followed to reduce the threat of infection in an austere
environment).


Fire evacuation plan.


Reports.

t.
Annex U, Surgical Services. This annex outlines diagnostic and surgical treatment procedures for the hospital. It should include, but not be limited to, the following:


Scheduling procedures, to include after-hours and emergency cases.


Aseptic (sterile) techniques.


Maintenance of registry.


Scrub attire and surgical hand-scrub procedures.


Environmental safety.


Electrosurgical unit safety.


Operating room environmental sanitation.


Counts of sponges and sharps.


Bullet removal evidence and property custody document.


Death procedures.


Notifications.


Autopsy, to include coordination with HN health officials or compliance with valid agreements.

,

Disposition.


Cardiac arrest procedures.


Traffic patterns.


Transportation of patients to and from the OR.


Transportation of sterile, clean, and dirty equipment.


Evacuation of personnel and patients during contingencies. . DODDOA-006883


Handling contaminated needle and s syringes.

u. Annex V, Operating Room/Central Materiel Service Control Team. This annex outlines the functional procedures of the OR, CMS, and anesthesia services, and the preparation and maintenance of OR-related
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
equipthent. With exception of CMS, the OR and anesthetists are not a separate paragraph in the L­edition series TOE. As an entity, these elements are under the supervision of the senior anesthesiologist or the officer appointed by the hospital commander. The operational guidance includes, but is not limited to--
(1)
Operating room service.


Verifying personnel qualifications for assigned duties.


Scheduling nursing staff.


Providing immediate postoperative care of surgical patients (recovery room/ICUs).


Availability of ORs.


Operating room space utilization.


Medical resupply, to include time lines.


Medical maintenance, to include organic and depot.

(2)
Anesthesia services.


Standards.


Duty roster and on-call requirements.


Master list of clinical procedures.


Equipment checklists.


Classification of patients.


Narcotics control.


Infection control in work area.


Anesthesia carts.


Disposition of hazardous or infectious waste.


Storage of combustibles and cleaning schedule.


Quality control procedures for equipment.


Verifying personnel qualifications for assigned duties.

(3)
Central materiel service.


Loading and unloading the steam sterilizer.


Monitoring the sterilization process.


Labeling and monitoring shelf life of sterile items.


Providing tray setup and wrapping procedures, to include cleaning and preparing equipment and supplies for sterilization.

i'. Annex W, Emergency Medical Services. This annex outlines the procedures for receiving patients,
performing patient assessments, providing EMT, and transporting patients to the appropriate element of the hospital. Procedures include--

Continuous 24-hour emergency treatment service.


Verification of personnel qualification.


A 24-hour physician and nursing service coverage plan.


Patient registration ledger.


Triage.


Scope of practice of MOS 91B personnel.


Routine patient care management.


Emergency patient care management.

DODDOA-006884
http://atiam.train.army.mil/portallatia/adlsc/view/public/296784-1/fin/8... .12/28/2004

Care of HN military and dependents (as required).


Care of HN contract civilian and other HN medical care requirements.


Admission and transfer of patients.


Mass casualty operations.


Medical treatment for chemical and biological agent patients.


Medical evacuation.


Utilization of the hospital litter team.


Medical resupply and maintenance.


Care of refugees and displaced persons.


Assessment and emergency treatment of patients undergoing and awaiting NBC decontamination.

w.
Annex X, Neuropsychiatric Service and Ward. This annex outlines procedures for hospital NP service including diagnosis and consultation to all areas within the hospital and to others as may be directed by the command. Procedures include, but are not limited to--


Screening of patients by a psychiatrist.


Ward support for nonambulatory or secluded patients.


Patient ledger and transfer coordination.


Patient restraining.


Enemy prisoner of war patient support augmentation.


Records and administration.


Drug control.


Identifying and monitoring suicidal and homicidal patients.


Neuropsychiatric and combat fatigue-related casualties.


Medical supplies and maintenance.


Stress control to patients and staff of other wards.

x.
Annex l', Physical Therapy. This annex outlines procedures for the utilization and support of physical therapy services. Areas to be addressed include, but are not limited to, the following:


Verification of personnel qualification.


Scope of practice of physical therapy personnel.


Assignment of physical therapy personnel.


Services provided.


Referral procedures.


Mass casualty role.


Utilization of radiology and pharmacy services.


Injury prevention programs.


Logistical support.

y.
Annex Z, Mass Casualty. This annex outlines procedures to enable the hospital to respond effectively to a variety of emergency, external, and internal disaster situations. In any situation, the hospital must be prepared to receive, triage, treat, and hospitalize large numbers of casualties within a short period of time. The development of this plan is the responsibility of the operations section, or as directed by the hospital commander. Procedures include--

DODDOA-006885

Planning and training requirements.


Medical cadre positions.


Nonmedical personnel positions and duties, including litter teams, perimeter guard, crowd control, and information personnel.


Location of services, to include triage, delayed care, immediate care, minimal care, and expectant

http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004 care areas.

Support requirements beyond hospital capability.


Evacuation.


Discharge of patients.


Records and reports.

z. Annex AA, Civil-Military Operations. This annex discusses participation in civil-military operations (CMO). Medical elements are often involved in CMO, humanitarian assistance, and disaster relief operations. The activities which may be covered include providing medical treatment within the capabilities of the hospital and providing training to a HN's medical infrastructure. The responsibility for this annex is the operations officer, or as directed by the hospital commander.
DODDOA-006886
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
APPENDIX B
HOSPITAL PLANNING FACTORS
B-1. General
This appendix provides information for the hospital commander, his staff, and assigned personnel. It
contains planning factors for personnel, transportation and movement, supply, personnel service support,
CHS planning for hospitalization, engineer, and force requirements as of 1 January 1993. The data is an
estimate and is not intended to be all inclusive. Fluctuations and changes in the data presented are
contingent upon modifications to the TOE, its mission, and the scenario. The data is based upon TOE
08-705L00, Medical Force 2000 Hospital Planning Factors prepared by the Directorate of Combat and
Doctrine Development, Army Medical Department Center and School; FM 101-10-1/2 (Staff Officers'
Field Manual--Organizational, Technical, and Logistical Data Planning Factors, Volume 2); and
.
mobilization planning factors obtained from the US Air Force (USAF).
B-2. Personnel and Equipment Deployable Planning Factors
a. Personnel.
Officer.175
Enlisted.429
TOTAL.604

b. Weight and Cube--Personnel and Equipment.
Personnel-weight (combat equipped, includes
.
15 lb hand-carry bag) 190 lb/man (303) 57,570 lbs
.

Personnel-weight (with M-16) 200 lb/man (275) 55,000 lbs
.

Personnel-weight (with 9 MM) 195 lb/man (26) 5,070 lbs
.

Personnel-cube 11 cu ft/man 6,644 cu.ft
.

Mobilization bag-weight 25 lb/man 15,100 lbs
.

Mobilization bag-cube 1 cu ft/man 604 cu.ft
.

Check-in baggage-weight 70 lb/man 42,280 lbs
.

Check-in baggage-cube 3 cu ft/man 1,812 cu.ft
TOTAL
..
Personnel-weight and cube with all gear 175,020 lbs 9,060 cu ft
..

Weight and cube TOE equipment 1,373,943 lbs 339,175 cu ft
DODDOA-006887
.
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... 12/28/2004 Weight and cube, common table of allowances
(CTA) deployable equipment 245,763 lbs.25,296 cu ft
Weight and cube of personnel, TOE equipment
and CTA deployable equipment 1,794,726 lbs.373,531 cu ft
c. Transportation Reference Data.
(1) Semitrailer requirements.
M871 semitrailer, platform, break-bulk,
container transporter, 221/2 ton,
length = 29.8 ft; width = 8 ft,
height = 4.6 ft 30 each

(2) Railcar transportation requirements.
Railcar = 80 ft 38 each
(3) Tactical aircraft airlift requirements.
Cargo compartment data: . C-141.vs.C-5A Length (inches). 840. 1,454 Width (inches). 123. 228 Height (inches). 109. 162 Allowable cargo load (lbs) .50,000. 150,000 Troop Seats. 102. 20/73 Aircraft Requirement. 15. 11 Strategic Deployment
(4) Commercial cargo capacities and configurations.
DODDOA-006888
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
Cargo Bulk.
Number Maximum Capacity
Capacity Bin.of
Cargo Bins.Cargo Door Sizes
(cu ft) cu ft).Containers
(lbs). (inches)
TRISTAR L-1011-250
2,385.700.16 (L0-3).53,650.FWD.70W.68H AFT.70W 6811 Bulk compartment 44W 48H
TRISTAR L-1011.500
2,831.435.19 (LD-3).61,500.FWD 104W.68H AFT..70W.6811 Bulk compartment 44W.4811
Cargo.Bulk Number Maximum Capacity
Capacity.Bin of Cargo Bins Cargo DooT Sizes rcu ft).(co ft.) Contai (ler 8 ()hi) (inches)
BOEING 767.200
2.508.430 22 t LD-2) 46,050 FWD.70W.6911 AFT.70W.6911
Bulk compartment 38W.4811
BOEING 787-200
4,770.430 ao (LD•2) 69,850 FWD.70W.6911 AFT.70W.6911
Bulk compartment
38W.4811
BOEING 757.900
3,728 25,700 FWD.55W.421I AFT.55W.4411
BOEING 727-200
1,454 19,000 FWD.55W.4211 AFT.55W.4411
Rear compartment
48W.3011
MD-88
1.253 21,855 Three cargo bin doors 4411
52W.2911
BOEING 137-200
850 12,985 Fwr).48W.3411 AFT.48W.3511
BOEING 787-300
1,068 12,634 FWD.48W.34H AFT.48W.3511
DOUGLAS DC-9-32
760 11,150 FWD.53W.31H AFT.36W.30H

DODDOA-006889
http://atiam.train.anny.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
COMMERCIAL CONTAINER DESCRIPTION
79 IN
62 IN 123 IN
LD-3 LD-11CARRIER OWNED CARRIER OWNED
155 CUBIC FEET 260 CUBIC FEET
3,500 LBS MAXIMUM GROSS WEIGHT 7,000 LBS MAXIMUM GROSS WEIGHT CARRIED ON 1-1011 AIRCRAFT
CARRIED ON-1011 AIRCRAFT (TYPE 8 -WHEN USING INTERNATIONALLY)
61.5 IN
63 IN
641N
LD-2.1:ffi:;0.4 IN
40 IN. 125 IN
CARRIER OWNED.L-7 124 CUBIC FEET. PALLET 2,700 LBS MAXIMUM GROSS WEIGHT.9,500 LBS MAXIMUM GROSS WEIGHT CARRIED ON 767 AIRCRAFT. {TYPE 5 FOR INTERNATIONAL USE ONLY)
CARRIED ON L-1011 500 AIRCRAFT
Cffl 24 IN
ff 25.5 IN 24 1N 361N
EH.
42 IN SHIPPER OWNED.29 SHIPPER OWNED 18 CUBIC FEET 12 CUBIC FEET 500 LBS MAXIMUM GROSS WEIGHT 250 LBS MAXIMUM GROSS WEIGHT CARRIED ON ALL DELTA AIRCRAFT
(5) Sealift planning factors.
Ship Type. Square Foot Capacity
Fast-sealift ship. 150,000 sq ft
Roll-on/roll-off. 100,000 sq ft
Break-bulk. 40,000 sq ft
Container ship. 600 containers
B3. Hospital Operational Space Requirements
-
It is estimated that the hospital will require an area approximately 350 meters X 350 meters for its full
DODDOA-006890
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/finJ8... .12/28/2004
.
complement of personnel and equipment.
B-4. Logistics Planning Factors (Class I, II, HI, IV, VI, VIII)
a. Classes of Supply Planning Factor Rates.
(1) Planning factor rates.
Class I. A Ration. 2.410 lbs/meal B Ration. 1.278 lbs/meal T Ration. 2.575 lbs/meal MRE. 1.470 lbs/meal Medical B Ration. 1.393 lbs/meal RSSP. 0.410 PMD LRPP. 0.900 PMD FHC. 0.030 PMD
Class II. 3.670 PMD
Class III. (Packaged). 0.590 PMD
Class IV. 8.500 PMD
Class VI. 2.060 PMD (Temperate)
3.400 PMD (Tropic/Arid)
1.790 PMD (Arctic) Class VIII. 1.550 PMD Legend: MRE. Meal(s), Ready to Eat
RSSP. Ration Supplement Sundries Pack LRPP. Long-Range Patrol Pack FHC. Female Health and Comfort Items
PMD. Pounds Per Man Per Day
(2) Class VI requirements (personal demand items).
Departments Arid/Tropic Temperate Arctic
Tobacco Products 0.055 0.055 0.055
Snacks 0.455 0.455 0.455
Beverage 2.800 1.467 1.186
Personal Hygiene 0.047 0.047 0.047

DODDOA-006891
http://atiam.train.anny.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
General 0.048 0.048 0.048
TOTAL (lbs/man/day by climate) 3.395 2.058 1.791

Female health and comfort packets are made available in a TO for issue, pending establishment of adequate exchange facilities. A packet weight is not available, but planners can use an estimated factor of 0.03 lbs/person/day based on the FHC items listed in AR 700-23.
(3) Female health and comfort items.
Item Number Item Description Unit of Issue Allowance
1 Cream, Cleansing, 2 oz Tube 25 2 Lotion, Hand/Body, 2 oz Tube 40 3 Napkin, Sanitary, 12S Box 25 4 Paper, Toilet, 24 Sheets - Package 500 5 Tampon, Sanitary, 12S Box 25 6 Tissue, Cleansing, 12S Package 250
(1 Pack/25 Females/30 Days)--Federal Stock Number 8970-01-185-2590
b. Class 1 Subsistence. Description of rations and packets.
(1) A Rations consist of both perishable and semiperishable food. It is intended for use primarily under stable conditions and during static phases of military operations when normal cooking and refrigeration are available.
A Ration Planning Factors
Factor Percent of Per Man Per 100 Men Per 1,000 Men Per Total Weight Per Day Per Day Day
Average weight 100 7.23 723 7,230
including packing
Semiperishable 35 2.56 256 2,560
Perishable 65 4.67 467 4,670
Chill 48 3.50 350 3,500
Freeze 16 1.18 118 1,180
Ventilated 9 0.67 67 670

(2) B Rations consist of approximately 100 semiperishable items, mainly canned and dehydrated, and are supplied in bulk. B Rations are used when there are kitchen facilities but no refrigeration.
Standard B Ration Planning Factors .
DODDOA-006892
http://atiam.train.army.mil/portallatia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
Factor Per Man Per 100 Per 1,000 Per Day Men Men
Net Regular Menu Items 3.198 319.80 3,198.0
Weight
(Pounds) Alternate Menu Items 3.683 368.30 3,683.0

Gross Regular Menu Items 3.834 383.40 3,834.0
Weight
Pounds) Alternate Menu Items 4.368 436.80 4,368.0
Gross Regular Menu Items 0.1226 12.62 122.6
Cube
(Cubic Feet) Alternate Menu Items 0.1200 12.00 12.0
(3)
The MRE is designed for use as individual meal packets, or in multiple of three for a complete ration. This packet is not to be used for extended periods. It comes in a pouch that can be torn • open. Heating of meat components is desirable. Twelve different menus are available.

(4)
The MRE is not authorized as the sole ration source for a period in excess of 10 days per guidance from the current Surgeon General. They are not authorized for patient use at any level within the theater medical system unless it is the only ration available because the effect on immobilized, traumatized patients is unknown.

(5)
T Ration is a ready-to-heat and serve tray pack. It is used under conditions when kitchen facilities and normal refrigeration do not exist. The container package is designed for immersion heating in boiling water. Included are disposable eating utensils. There are a total of 28 T Rations menus; 10 breakfasts with 4 alternates, and 10 dinners with 4 alternates. T Rations are not authorized for feeding hospitalized patients except in emergencies when other rations are not available,

(6)
Ration supplement sundries pack is composed of items necessary to the health and comfort of troops such as essential toilet articles, tobacco, and confections that are usually obtained at an exchange. This packet is made available in a TO for issue, pending establishment of adequate service facilities. (See AR 700-23.) National Stock Number (NSN): 8970-00-268-9934.

c. Planning Guidance for Operational Rations.
..
Time Rations Served Daily Guidance ..
D--D-10 3 MRE Order pouch bread, and flameless ration heater .
D-11--D-30 2 MRE, 1 T Ration.Augment with milk, fresh fruit, vegetables, and pouch bread
DODDOA-006893
http://atiam.train.anny.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
.

D-31--D-90. 1 MRE, 2 T Rations Augment with milk, fresh fruit, vegetables,
and pouch bread
d. Characteristics of Rations and Subsistence Items.

Item Contents.Net Weight (Pounds) Volume.Cases (Cubic Feet) . Per Pallet
Standard B Ration Regular 300 Meals (100 . 319.8 12.26
Menu men per day)
MRE 12 meals. 17 0.83.48

NSN 8970-00-149-1094
Unitized Tray Pack.36 trays 80--90.2.67 (T-Ration)
LRP Food Packets 40 packets.36.1.84.24 NSN 8970-00-926-9222
Ration Supplement Sundries 1 packet (100 men.41.1.67.24 Pack per day) NSN 8970-00-268-9934
Ration Supplement Beverage 2 packs serve 200.22.0.99 Pack men NSN 8970-01-108-2858
Ration Supplement 1 packet (100 8-.16.1.01.39 Aid Station OZ drinks) NSN 8970-00-128-6404
..
General-Purpose 24 packets.20 0.43.90 Food Survival Packet NSN 8970-00-082-5665
e. Army Medical Field Feeding Policy. The medical Army feeding policy for hospitalized patients is three hot meals daily. The meals will consist of Medical B Rations. A Ration meals or components will be used when the tactical and logistical situation permits. Meals, ready to eat and T Rations are NOT AUTHORIZED for feeding hospitalized patients EXCEPT IN EMERGENCIES when other rations are not available.
f Army Medical Field Feeding Inpatient Census and Accounting.
(1)
Inpatient census is obtained from the Recapitulation Table of the Admissions and Disposition Report, which is prepared daily by the hospital PAD. Inpatient figures reflect the number of hospital beds occupied as of 2400 hours of the previous day.

(2)
Inpatient (accounting) strength will be recorded in the Remarks Section of the DA Form 5913-R (Strength and Feeder Report) for information purposes. Patient strength will not be included in the present-for-duty section of DA Form 5913-R.

g. Standard Medical B Ration Purpose/Policy..
DODDOA-006894
http://atiam.train.army.mil/portal/atia/adlseview/public/296784-1/fm/8-1... .12/28/2004
(1)
Standard Medical B Ration is planned for subsisting patients in Armed Forces MTFs when semiperishable food is required.

(2)
Patients are exempt from the theater ration policy and will receive three hot prepared meals per day.

(3)
Staff assigned to medical units will be fed according to the service theater ration policy. To simplify procurement, menu preparation, and service when hot meals are served to medical personnel, they will be served the regular diet from the Medical B Ration.

(4)
In unusual circumstances (for example, facility relocation/movement), operational rations may be required for staff (not to exceed ten days).

h.
Standard Medical B Ration Meals.

(1)
To support 24-hour patient care, the hospital must prepare four meals per day: breakfast, lunch, dinner, and a night meal. The night meal may utilize a breakfast or lunch/dinner menu according to local procedures.

(2)
Patients requiring late meals will be served as complete a meal as possible with items from the preceding meal.

(3)
Late meals will be served in accordance with dietary constraints, local procedures, and
PVNTMED sanitation guidelines.

i.
B Ration Weight and Cubage.

.
Net Weight of Ration 3.0857 lbs
.

Gross Weight of Ration 3.6390 lbs
.

Gross Cube of Ration 0.1173 cu ft
j. Estimated Combat Support Hospital Logistics Planning Factors (Class I, IL IV, VI, and VIII).
.
Class. Lbs/Man/Day.Lbs/Unit/Day.STONS/enit. Day
4.47.2,699.88 1.35
I.Subsistence.
11.Supplies.3.67.2,216.68 1.11
IV.Barrier.4.00.2,416.00 1.21
0.00.2,727.00 1.36
VI.Personal.2.06.1,244.24 0.62

936.20 0.47
VIII.Medical.1.55.
TOTAL. 12,240.00 6.07
k Planning Combat Support Hospital Blood Requirements.
(1) The management and distribution of resuscitative fluids in the TO, including blood and blood products, are functions of health service logistics. In the mature theater, blood management is based on resupply of needs from the CONUS donor base. In a developing theater during the
DODDOA-006895
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004 buildup period, immediate blood requirements may be provided by pre-positioned frozen blood. These pre-positioned stocks are designed to meet initial blood requirements until the logistical system can deliver liquid blood to the TO.
(2) Blood and blood products enter the theater through the USAF Blood Transshipment Centers for further distribution to the Army blood bank platoons located in the MEDLOG battalion (forward or rear). The CSH is supplied with blood and blood products by a blood bank platoon assigned to the MEDLOG battalion (forward).
(3)* Blood shipped into the AO will be packed RBCs only. Frozen plasma and platelets are also available. Subject to availability, RBCs shipped from CONUS are packed with the following unit group and type distribution:
Blood Group/Type Distribution
O Rh Positive 40%
0 RE Negative 10%
A Rh Positive 35%
A Rh Negative 5%
B Rh Positive 8%
B Rh Negative 2%
(4) Blood planning factors.
Blood Component. Planning Factor
RBCs. *4 units for each wounded in action (WIA) and each nonbattle injury
(NBI) casualty initially admitted to a hospital

Frozen Plasma. 0.08 units for each hospitalized WIA or NBI
Frozen Platelet.0.04 units for each hospital WIA or NBI
Concentrate

* For blood planning purposes, only count the WIA or NBI once in the system, not each time the patient is seen or admitted.
(5) The expected admission rates per day are critical in computing initial blood requirements. These rates, along with the above blood planning factors, provide the planner with an initial estimate of daily blood requirements.
Sample Calculations for Initial Blood Requirements.
Expected Initial Admission Rate for WIA and NBI = 8 per 1,000 per day
DODDOA-006896
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
Total Personnel = 10,000
RBC Planning Factor = 4 units
Formula:

(Total Personnel/1,000) X Admission Rate Per Day X Factor = Blood or Blood Component Per Day Example: (10,000/1,000) X 8 X 4 = 320 units of RBCs per day
(6) It is estimated that the CSH will require 113 units of blood per day. It has the capability to store 160 units. It stores RBCs of various groups and types. The CSH has emergency blood collection capability but does not have the capability to perform serological testing of the donor units (for example, hepatitis, human immunodeficiency virus, and syphilis testing). Blood collection in the theater is governed by theater policy, but normally is done to provide platelets for emergency situations. Limited testing of blood drawn in the theater is done to minimize danger to recipients.
1. Estimated Combat Support Hospital Oxygen Planning Factors and Requirements.
(1) Estimated planning factors.
OR Table:. 2.8 liter/Min during operational time.
ICU Beds:. 4.5 liter/min for 17 percent of the total ICU beds (patients on
resuscitator/ventilator).

ICU Beds:. 3.1 liter/min for 17 percent of the total ICU beds (patients on nasal
cannula/mask).

Miscellaneous
Requirements:. An additional factor of 10 percent is applied to the total of OR and ICU requirements to account for oxygen requirements in other areas of the hospital.
(2) Oxygen conversion factors.
1 gallon (gaseous oxygen). =.0.1333 cu ft
95 gallon "D" cylinder. =.12.7 cu ft
1,650 gallon "H" cylinder. =.220 cu ft
1 cu ft (gaseous oxygen) . =.28.317 liters
95 gallon "D" cylinder. =.359.63 liters
1,650 gallon "H" cylinder . =.6229.74 liters
(3) Estimated oxygen requirements.
DODDOA-006897
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/ftn/8... .12/28/2004
OR Table Hours (HUB) 96,788 liters/day
OR Table Hours (HUS? 193,536 liters/day
ICU Beds On Vent. (HUB) 191,601 liters/day
ICU Beds On Vent (Hts) 266,112 liters/day
EMT and Other Oxygen Requirements 77.760 liters/day
Pneumatic Instruments 17340 liters/day

,
TOTAL DAILY REQUIRED 84.3,117 liters/day
m. Class VIII Planning Factor.
(1) Class VIII composition.
FSC. Item. Percentage of PMD
6505.Drugs/biologicals and other official reagents . 77.1
6510.Surgical dressings. 6.8
6515.Medical/surgical supplies. 8.0
Other FSCs.X-ray film/development lab reagents, test . 8.1

kits, patient care accessories
(2) Class VIII PMD planning factors (based on TAA 93 NATO scenario).
Troop. Weight.Planning Factor.PMD Level. Strength.(lbs/day)
Division. 412,001. 269,413. 0.65
Combat Zone. 668,607. 978,712. 1.46
Theater. 834,014.1,297,156. 1.55

(3) Supply requisitions.
924 per day.10,499 per month
(4) Class VIII weight and cube (Codes P, G, W, and Q and R).
Weight. Cube
Code P. 29,369.59 lbs.1,013.496 cu ft

(potency period/expiration date)
Code G. 1,493.14 lbs.67.15 cu ft
(between 35 to 46 degrees Fahrenheit)

DODDOA-006898
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
FM 8-10-14 Appendix B. Page 13 of 17 Code W.
0.04 lbs.0.003 cu ft
(must be frozen for preservation) Code Q/Code R. 573.11 lbs.32.111 cu ft
n. Estimated Combat Support Hospital Petroleum, Oil, and Lubricants/Fuel Consumption.
(1)
HUB

(2)
HUS

Gal/Day Weight Cube
Gasoline 66110 4,098.87 the 803.588 cm ft
Diesel 1129.08 7 931. W, the 151.2!)3 cu It
TOTAL 17,fifir.8 12,036.15 the 239.881 cu ft

Gasoline 60.83 427.05 lbs 9.729 tu ft Diesel 254.81 1.791.31.Ths 34.144 cu It TOTAL 32J.69 2.21U6
41.173 cu ft
(3) HUB/HUS TOTAL
Gasoline 720.98 4,525.92 lbs 97.817.tuft Diesol 1,383.87 93213.59 lbs 185.437 cu ft
(4) Petroleum storage capability (based on hospital TOE):
.
Lin/Nomenclature Quantity. Gallons
VI5086 Tank fabric collapsible 3,000 gallons. 1. 3,000 Z94047 Truck tank POL MTV W/E 1,500 gallons. 1. 1,500 Total Storage capability (gallons): . 4,500
o. Water Planning Factors (Gallons of Water Per Day).
DODDOA-006899
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
.

(1) Total patients (beds) X 17.25 gal =
Surgical cases X 13.0 gal =
Staff X 10.25 gal . .
Bed patients X 22_0 gal = .
Minimal care patients X 10.0 gal =.
Staff x 9.4 gal =
Decontamination
7 gallons per individual
380 gallons per major end item
Vehicle maintenance

1/2 gal per vehicle ',temperate)
I gal per vehicle (hot climate)
Loss/waste factor = 10 percent of total requirement

(2) Hospital water requirement (consumptive factors).
.
Staff Water Requirement
Drinking 1.5.gal/man/day Hygiene 1.7.gal/man/day Food prep 1.75 gal/man/day Extra showers 5.3.gal/man/day Unit wastewater generation 7.gal/man/day
Patient Care Water Requirement
Cleanup 1.0 gal/bed/day Heat treatment 0.2 gal/bed/day Bed bath 5.0 gal/bed/day Hygiene 1.7 gal/bed/day Bed pan wash 1.5 gal/bed/day Laboratory 0.2 gal/bed/day Sterilizer 0.2 gal/bed/day X-ray 0.2 gal/bed/day Handwashing 2.0 gal/bed/day Cleanup 1.0 gal/bed/day Unit wastewater generation 12.gal/bed/day
DODDOA-006900

http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
Surgical. Water Requirement
Scrub. 8.0 gal/case/day Instrument wash. 2.0 gal/case/day OR cleanup. 3.0 gal/case/day Unit wastewater generation .I3.gal/case/day
Hospital Laundry. Water Requirement
Bed patients. 22.0 gal/bed/day Ambulatory patients. 10.0 gal/bed/day Staff smocks. 9.4 gal/bed/day Unit wastewater generation .41.4 gal/bed/day
Decontamination. Water Requirement
Individual. 7 gal/decon
Major end item. 380 gal/decon
Vehicle. 450 gal/decon
.
Wastewater generation To be determined
(3) Water usage table for food and beverage preparation patient menu (gallons per meal per 100 portions).
3denu Alternata Menu
B 1, D Total B I.D 'fatal
Day 1 Day 2 Dv 3 Day II Day 5 Day 6 Day 7 Day 8 Day 9 Day 10 TOTAL 52 50 48 56 49 53 51. 44 61 62 29 40 34 40 42 34 36 38 25 36 32 39 32 27 36 35 36 36 26 29 113 129 114 132 128 123 122 116 122 137 WM 45 44 23 45 48 36 45 41 49 46 23 33 29 34 37 34 38 36 33 31 35 23 13 34 34 31 33 31 37 31 108 111 71 114 118 100 117 107 114 108 717
DODDOA-006901

http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
Note: Per 100 patients an additional 30 gallons of water per meal is required to preheat insulated food and beverage containers for decentralized ward service.
(4) Water usage table for food and beverage preparation staff menu (gallons per meal per 100 portions).
Alternate Menu B L D Total B L D Total
Menu..
(6)352.t2 8ti12 8
25 32 87

33 30

37 33 96

32 31 94

37 31 100

31 SI 98

33 30 97

33 29 85

30 34 92

28 30 88

Day 1 36 27 2.8 91
35 39 38 112

Day 2
Day 3
31 32 30 92

Day 4 42 39 35 116
32 44 32 108

Days
Day 6
42 31 34 107

Day 7 36 34 34 102
26 38 SS

Day 8
35 32 33 101

Day 9
33 38 105

Day 10 26
927
1035
TOTAL

Daily water consumption (patient and staff): 12,180 gal/day. Laundry daily water consumption (patient and staff): 11,650 gal/day. TOTAL water consumption: 23,830 gal/day.
(5) Estimated water consumptive factors (under chemical environment, 72 hour scenario).
Staff
Drinking (1.5 gal/man/day) 905
Hygiene (1.0 gal/man/day) 604
Feeding (0.25 gal/man/day) 453 Patient Care (4 gal/patient/bed/day) 1,184 Surgical (3 gal/case/day) 72 TOTAL DAILY WATER REQUIREMENT: 3,218
(6) Water storage capability (based on hospital TOE):
Lin/Nomenclature Quantity Gallons
D69050
Drum, fabric, collapsible. 500 gal G68996 6, 3,000
Drum, fabric, collapsible, 250 gal T19033 4 1,000
Tank assembly, fabric, collapsible. 3,000 gal W98825 6 18,000
Trailer tank 11/2 ton 2 wheel 400 gal 2 800
TOTAL STORAGE CAPABILITY .:GALS':: 22,800
DODDOA-006902

http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
p. Laundry.
(1)
The Surgeon General's policy statement (theater hospital laundry support). Hospitals operating in the CZ will have a basic organic laundry capability to meet mission needs. As a minimum, this is the capability to process hospital linens, patient hospital clothing, and unit-owned duty personnel work garment. Bath capability and laundry support for hospital staff may be obtained from available quartermaster sources.

(2)
Basic formulas for determining laundry requirements for permanent party hospital personnel are--


Formula 1: 42 lbs (6 lbs clothing per person per day X 7 days) X 75 percent of assigned personnel = weekly laundry requirement for patient care personnel.


Formula 2: 6 lbs clothing per person per week X 25 percent of assigned personnel = weekly laundry requirement for hospital support personnel.


Weekly laundry requirement (Formula 1 + Formula 2) divided by number of assigned personnel = average laundry requirement per person per week.

q. Showers. Minimum frequency for showering and laundering from a health maintenance perspective is deemed to be once weekly regardless of location, season, or level of combat activity. (Source: Office of The Surgeon General, Department of the Army, 31 January 1983.)
r.
Solid Waste Factors.

(1)
Solid waste calculation (estimated):
Total patients (beds) X 15 lbs = total patient solid waste
Staff X 12.5 lbs = total staff solid waste

(2)
Hospital infectious waste planning factors (estimated):
3 lbs per cubic foot of infectious waste
3 lbs of infectious waste generated per bed per day

(3)
Hospital infectious waste:

s.
Wastewater Planning Factors.

888 lbs per day.296 cu ft per day
Wastewater calculations (estimated):
Total wastewater 21,394 gallons per day (estimated).
Assume that 80 percent of patient care and staff water requirements become wastewater, and all laundry
water requirements become wastewater.
t. Power Requirements. It is estimated that 823.1317 kilowatts of power will be required on a daily basis.
DODDOA-006903
http://atiam.train.anny.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
APPENDIX B
HOSPITAL PLANNING FACTORS
B-1. General
This appendix provides information for the hospital commander, his staff, and assigned personnel. It contains planning factors for personnel, transportation and movement, supply, personnel service support, CHS planning for hospitalization, engineer, and force requirements as of 1 January 1993. The data is an estimate and is not intended to be all inclusive. Fluctuations and changes in the data presented are contingent upon modifications to the TOE, its mission, and the scenario. The data is based upon TOE 08-705L00, Medical Force 2000 Hospital Planning Factors prepared by the Directorate of Combat and Doctrine Development Army Medical Department Center and School; FM 101-10-1/2 (Staff Officers' Field Manual--Organizational, Technical, and Logistical Data Planning Factors, Volume 2); and mobilization planning factors obtained from the US Air Force (USAF).
B-2. Personnel and Equipment Deployable Planning Factors
a. Personnel.
Officer.175
Enlisted.A29
TOTAL.604

b. Weight and Cube--Personnel and Equipment.
Personnel-weight (combat equipped, includes
.
15 lb hand-carry bag) 190 lb/man (303) 57,570 lbs
.
Personnel-weight (with M-16) 200 lb/man (275) 55,000 lbs
.

Personnel-weight (with 9 MM) 195 lb/man (26) 5,070 lbs
.

Personnel-cube 11 cu ft/man 6,644 cu ft
.

Mobilization bag-weight 25 lb/man 15,100 lbs
.

Mobilization bag-cube 1 cu ft/man 604 cu ft
.

Check-in baggage-weight 70 lb/man 42,280 lbs
.

Check-in baggage-cube 3 cu ft/man 1,812 cu ft
TOTAL
Personnel-weight and cube with all gear 175,020 lbs 9,060 cu ft
Weight and cube TOE equipment 1,373,943 lbs 339,175 cu ft
DODDOA-006904
.
http://atiam.train.army.mil/portallatia/adIsc/view/public/296784-1/fin/8... 12/28/2004
Weight and cube, common table of allowances
..
(CTA) deployable equipment 245,763 lbs 25,296 cu ft
Weight and cube of personnel, TOE equipment
..
and CTA deployable equipment 1,794,726 lbs 373,531 cu ft
c. Transportation Reference Data.
(1) Semitrailer requirements.
M871 semitrailer, platform, break-bulk,
container transporter, 221/2 ton,
length = 29.8 ft; width = 8 ft,
height = 4.6 ft 30 each

(2) Railcar transportation requirements.
Railcar = 80 ft 38 each
(3) Tactical aircraft airlift requirements.
Cargo compartment data: . C-141.vs.C-5A Length (inches). 840. 1,454 Width (inches). 123. 228 Height (inches). 109. 162 Allowable cargo load (lbs).50,000. 150,000 Troop Seats. 102. 20/73 Aircraft Requirement . 15. 11 Strategic Deployment
(4) Commercial cargo capacities and configurations.
DODDOA-006905
http://atiam.train.army.mil/portallatia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
FM 8-10-14 Appendix B.
Cargo.
Bulk.Number.Maximum Capacity
Capacity.Bin.of.
Cargo Bina.Cargo Door Sizes
(cu ft).f: cu ft).Contai ners.
rlbs).
(inchea)
TRISTAR L-1011.260
2,385.700.16 (LD-3i.53,650.FWD.70W.6811 AFT.TOW 6811 Bulk compartment 44W 4811 TRISTAR L-/ 011 -500
.
2,831
435.19 (L-a).61,500.FWD 104W.68H.' AFT.70W 6811 Bulk compartment
44W.4811
Cargo.Bulk Number Maximum Capacity Capacity.Bin of Cargo Bins Cargo Door Sizes 'Cu ft).(Cu fk.) Containers (lbs) (inches)
BOEING 767.200
2,508.430 22 (LD-2) 46,050 FWD.TOW.6911 AFT.70W.6911
Bulk compartment 38W.4811
BOEING 767-200
4,770.430 30 (LD4) 69,860 FWD.70W.6911 AFT.70W.6911
Bulk compartment
38W.4811
BOEING 767.200
3,728 25,700 FWD.65W.42H AFT.65W.4411
BOEING 727.200
1,464 19,000 FWD.55W.42H AFT.55W.4411
Rear compartment
48W.3011
MD-88
1.253 21,856 Three cargo bin donre 4411
52W.2911
BOEING 737-200
850 12,985 FWD.48W.34H AFT.48W.3511
BOEING 737400
1.068 12.634 FWD.48W.3411 AFT.48W.3511
DOUGLAS DC-9-32
760 11,150 FWD.53W.31H
AFT.36W.30H

DODDOA-006906
http://atiam. train. army.mil/portal/ati a/adlsc/view/public/296784-1/fin/8-10-14/Appb.htm .12/28/2004
COMMERCIAL CONTAINER DESCRIPTION
79 IN
.
62 IN 123 IN
LD•3
LD-11
CARRIER OWNED CARRIER OWNED
155 CUBIC FEET 260 CUBIC FEET
3,500 LOS MAXIMUM GROSS WEIGHT 7,000 LBS MAXIMUM GROSS WEIGHTCARRIED ON L-1011 AIRCRAFT
CARRED ON L-1011 AIRCRAFT
(TYPE 8 - WHEN USING INTERNATIONALLY/

51.5 IN 63 IN64 IN
60.4 IN
LO-2.
40 IN. 125 IN
CARRIER OWNED.L-7 124 CUBIC FEET. PALLET 2,700 LBS MAXIMUM GROSS WEIGHT.9,500 LBS MAXIMUM GROSS WEIGHT CARRIED ON 767 AIRCRAFT. {TYPE 5 FOR INTERNATIONAL USE ONLYI
CARRIED ON L-1011 500 AIRCRAFT 24 IN
ff 25.5 IN 24 IN 36 IN
E. EH.
42 IN
SHIPPER OWNED.SHIPPER OWNED

28 IN 18 CUBIC FEET 12 CUBIC FEET 500 LBS MAXIMUM GROSS WEIGHT 250 LBS MAXIMUM GROSS WEIGHT CARRIED ON ALL DELTA AIRCRAFT
(5) Sealift planning factors.
Ship Type. Square Foot Capacity
Fast-sealift ship. 150,000 sq ft
Roll-on/roll-off. 100,000 sq ft
Break-bulk. 40,000 sq ft
Container ship. 600 containers
B-3. Hospital Operational Space Requirements
It is estimated that the hospital will require an area approximately 350 meters X 350 meters for its full
DODDOA-006907
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004 complement of personnel and equipment.
B-4. Logistics Planning Factors (Class I, II, III, IV, VI, VIII)
a. Classes of Supply Planning Factor Rates.
(1) Planning factor rates.
Class I. A Ration. 2.410 lbs/meal B Ration. 1.278 lbs/meal T Ration. 2.575 lbs/meal MRE. 1.470 lbs/meal Medical B Ration. 1.393 lbs/meal RSSP. 0.410 PMD LRPP. 0.900 PMD FHC. 0.030 PMD
Class II. 3.670 PMD
Class III. (Packaged). 0.590 PMD
Class IV. 8.500 PMD
Class VI. 2.060 PMD (Temperate)
3.400 PMD (Tropic/Arid)
1.790 PMD (Arctic) Class VIII. 1.550 PMD Legend: MRE. Meal(s), Ready to Eat
RSSP. Ration Supplement Sundries Pack LRPP. Long-Range Patrol Pack FHC. Female Health and Comfort Items PMD. Pounds Per Man Per Day
(2) Class VI requirements (personal demand items).
Tobacco Products Departments Arid/Tropic 0.055 Temperate 0.055 Arctic 0.055
Snacks 0.455 0.455 0.455
Beverage Personal Hygiene 2.800 0.047 1.467 0.047 1.186 0.047
DODDOA-006908

http://atiam.train.anny.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
General 0.048 0.048 0.048
TOTAL (lbs/man/day by climate) 3.395 2.058 1.791

Female health and comfort packets are made available in a TO for issue, pending establishment of adequate exchange facilities. A packet weight is not available, but planners can use an estimated factor of 0.03 lbs/person/day based on the FHC items listed in AR 700-23.
(3) Female health and comfort items.
Item Number Item Description Unit of Issue Allowance
1 Cream, Cleansing, 2 oz Tube 25 2 Lotion, Hand/Body, 2 oz Tube 40 3 Napkin, Sanitary, 12S Box 25 4 Paper, Toilet, 24 Sheets Package 500 5 Tampon, Sanitary, 12S Box 25 6 Tissue, Cleansing, 12S Package 250
(1 Pack/25 Females/30 Days)--Federal Stock Number 8970-01-185-2590
b. Class I Subsistence. Description of rations and packets.
(1) A Rations consist of both perishable and semiperishable food. It is intended for use primarily under stable conditions and during static phases of military operations when normal cooking and refrigeration are available.
A Ration Planning Factors
Factor Percent of Per Man Per 100 Men Per 1,000 Men Per Total Weight Per Day Per Day Day
Average weight 100 7.23 723 7,230
including packing
Semiperishable 35 2.56 256 2,560
Perishable 65 4.67 467 4,670
Chill 48 3.50 350 3,500
Freeze 16 1.18 118 1,180
Ventilated 9 0.67 67 670

(2) B Rations consist of approximately 100 semiperishable items, mainly canned and dehydrated, and are supplied in bulk. B Rations are used when there are kitchen facilities but no refrigeration.
Standard B Ration Planning Factors
DODDOA-006909
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004
Factor Per Man Per 100 Per 1,000 Per Day Men Men
Net Regular Menu Items 3.198 319.80 3,198.0
Weight
(Pounds) Alternate Menu Items 3.683 368.30 3,683.0

Gross Regular Menu Items 3.834 383.40 3,834.0
Weight
Pounds) Alternate Menu Items 4.368 436.80 4,368.0
Gross Regular Menu Items 0.1226 12.62 122.6
Cube
(Cubic Feet) Alternate Menu Items 0.1200 12.00 12.0
(3)
The MRE is designed for use as individual meal packets, or in multiple of three for a complete ration. This packet is not to be used for extended periods. It comes in a pouch that can be torn open. Heating of meat components is desirable. Twelve different menus are available.

(4)
The MRE is not authorized as the sole ration source for a period in excess of 10 days per guidance from the current Surgeon General. They are not authorized for patient use at any level within the theater medical system unless it is the only ration available because the effect on immobilized, traumatized patients is unknown.

(5)
T Ration is a ready-to-heat and serve tray pack. It is used under conditions when kitchen facilities and normal refrigeration do not exist. The container package is designed for immersion heating in boiling water. Included are disposable eating utensils. There are a total of 28 T Rations menus; 10 breakfasts with 4 alternates, and 10 dinners with 4 alternates. T Rations are not authorized for feeding hospitalized patients except in emergencies when other rations are not available.

(6)
Ration supplement sundries pack is composed of items necessary to the health and comfort of troops such as essential toilet articles, tobacco, and confections that are usually obtained at an exchange. This packet is made available in a TO for issue, pending establishment of adequate service facilities. (See AR 700-23.) National Stock Number (NSN): 8970-00-268-9934.

c. Planning Guidance for Operational Rations.
. .
Time Rations Served Daily Guidance ..
D--D-10 3 MRE Order pouch bread, and flameless ration heater
D-11--D-30 2 MRE, 1 T Ration.Augment with milk, fresh fruit, vegetables, and pouch bread
DODD0A-0069 10
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fin/8... .12/28/2004
.
FM 8-10-14 Appendix B Page 8 of 17
.
D-31--D-90.1 MRE, 2 T Rations Augment with milk, fresh fruit, vegetables, and pouch bread
d. Characteristics of Rations and Subsistence Items.
. ...
Item Contents Net Weight Volume Cases
..
(Pounds) (Cubic Feet) Per Pallet ...
Standard B Ration Regular Menu. 300 Meals (100 men per day) 319.8 12.26
MRE . 12 meals. 17. 0.83.48
NSN 8970-00-149-1094
Unitized Tray Pack 36 trays 80--90. 2.67
(T-Ration)
LRP Food Packets 40 packets 36. 1.84.24
NSN 8970-00-926-9222
Ration Supplement Sundries 1 packet (100 men 41. 1.67.24
Pack per day)
NSN 8970-00-268-9934
Ration Supplement Beverage 2 packs serve 200 22. 0.99
Pack men
NSN 8970-01-108-2858
Ration Supplement 1 packet (100 8-.16. 1.01. 39
Aid Station OZ drinks)
NSN 8970-00-128-6404
General-Purpose. 24 packets. 20 . 0.43.90
Food Survival Packet NSN
8970-00-082-5665

e. Army Medical Field Feeding Policy. The medical Army feeding policy for hospitalized patients is three hot meals daily. The meals will consist of Medical B Rations. A Ration meals or components will be used when the tactical and logistical situation permits. Meals, ready to eat and T Rations are NOT AUTHORIZED for feeding hospitalized patients EXCEPT IN EMERGENCIES when other rations are not available.
f Army Medical Field Feeding Inpatient Census and Accounting.
(1)
Inpatient census is obtained from the Recapitulation Table of the Admissions and Disposition Report, which is prepared daily by the hospital PAD. Inpatient figures reflect the number of hospital beds occupied as of 2400 hours of the previous day.

(2)
Inpatient (accounting) strength will be recorded in the Remarks Section of the DA Form 5913-R (Strength and Feeder Report) for information purposes. Patient strength will not be included in the present-for-duty section of DA Form 5913-R.

g. Standard Medical B Ration Purpose/Policy. •.
DODDOA-006911
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296784-1/fm/8-... .12/28/2004

Doc_nid: 
2618
Doc_type_num: 
75