JP 4-02.1 JTTP for Healt Service Logistics Support in ...97).pdf · Health Service Logistics...

6 October 1997

Joint Tactics,Techniques, and Procedures

forHealth Service Logistics Support

in Joint Operations

Joint Pub 4-02.1

PREFACE

i

1. Scope

This publication provides for the planningand execution of theater health servicelogistics support (HSLS) for all Servicecomponents of a joint or multinational force,from alert notification to deployment to andredeployment from a theater. It providesfundamental principles and doctrine for HSLSin joint and multinational operations.

2. Purpose

This publication has been prepared underthe direction of the Chairman of the JointChiefs of Staff. It sets forth doctrine andselected joint tactics, techniques, andprocedures (JTTP) to govern the jointactivities and performance of the ArmedForces of the United States in joint operationsand provides the doctrinal basis for USmilitary involvement in multinational andinteragency operations. It provides militaryguidance for the exercise of authority bycombatant commanders and other jointforce commanders and prescribes doctrineand selected tactics, techniques, andprocedures for joint operations and training.It provides military guidance for use by theArmed Forces in preparing their appropriateplans. It is not the intent of this publication torestrict the authority of the joint forcecommander (JFC) from organizing the forceand executing the mission in a manner the JFCdeems most appropriate to ensure unity ofeffort in the accomplishment of the overallmission.

3. Application

a. Doctrine and selected tactics,techniques, and procedures and guidanceestablished in this publication apply to thecommanders of combatant commands,subunified commands, joint task forces, andsubordinate components of these commands.These principles and guidance also may applywhen significant forces of one Service areattached to forces of another Service or whensignificant forces of one Service supportforces of another Service.

b. The guidance in this publication isauthoritative; as such, this doctrine (or JTTP)will be followed except when, in the judgmentof the commander, exceptional circumstancesdictate otherwise. If conflicts arise betweenthe contents of this publication and thecontents of Service publications, thispublication will take precedence for theactivities of joint forces unless the Chairmanof the Joint Chiefs of Staff, normally incoordination with the other members of theJoint Chiefs of Staff, has provided morecurrent and specific guidance. Commandersof forces operating as part of a multinational(alliance or coalition) military commandshould follow multinational doctrine andprocedures ratified by the United States. Fordoctrine and procedures not ratified by theUnited States, commanders should evaluateand follow the multinational command’sdoctrine and procedures, where applicable.

DENNIS C. BLAIRVice Admiral, US NavyDirector, Joint Staff

For the Chairman of the Joint Chiefs of Staff:

ii

Preface

Joint Pub 4-02.1

Intentionally Blank

TABLE OF CONTENTS

iii

PAGE

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

CHAPTER IINTRODUCTION

• Health Service Support Mission................................................................................ I-1• Overview of Joint Health Service Support................................................................. I-1• Joint Health Service Logistics Support Mission......................................................... I-3• Principles of Health Service Support......................................................................... I-4• Responsibilities for Health Service Logistics............................................................. I-5

CHAPTER IIHEALTH SERVICE LOGISTICS CONSIDERATIONS

• Health Service Logistics Support in Joint Operations............................................... II-1• Planning for Joint Health Service Logistics Support................................................. II-1• Medical Threat and Medical Intelligence.................................................................. II-2• Joint Operation Planning and Execution System...................................................... II-3• Time-Phased Force and Deployment Data................................................................ II-3• Transportation Considerations.................................................................................. II-4• Communications Support Considerations................................................................. II-4• Operational Considerations in a Nuclear, Biological, or Chemical Environment....... II-6• Overview of Service Component Health Service Logistics Systems......................... II-6• Single Integrated Medical Logistics Manager........................................................... II-9

CHAPTER IIISTRUCTURING HEALTH SERVICE LOGISTICS SUPPORT

• Transition............................................................................................................... III-1• Combat Service Support......................................................................................... III-1• The Joint Force Surgeon........................................................................................ III-1• Planning Considerations Prior to Deployment Notification.................................... III-1• Deployment........................................................................................................... III-2• Captured Medical Materiel.................................................................................... III-2• Unit-to-Unit Exchange.......................................................................................... III-3• Aeromedical Evacuation Equipment and/or Patient Movement Items................... III-3

CHAPTER IVREDEPLOYMENT OF HEALTH SERVICE LOGISTICS INPOSTCONFLICT ENVIRONMENTS

• Redeployment Planning......................................................................................... IV-1• Joint Force Surgeon Responsibilities...................................................................... IV-1

iv

Table of Contents

Joint Pub 4-02.1

• Redeployment Phases............................................................................................. IV-1• Other Redeployment Considerations...................................................................... IV-3• Service Responsibility............................................................................................ IV-3

CHAPTER VHEALTH SERVICE LOGISTICS SUPPORT INMILITARY OPERATIONS OTHER THAN WAR

• Military Operations Other Than War....................................................................... V-1• The Role of Joint Health Service Logistics.............................................................. V-3• Operational Missions.............................................................................................. V-3• Domestic Support................................................................................................... V-4• Funding................................................................................................................... V-5• Planning Considerations.......................................................................................... V-5

CHAPTER VIBLOOD MANAGEMENT

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

• General.................................................................................................................. VI-1• Armed Services Blood Program Office.................................................................. VI-1• Service Blood Programs......................................................................................... VI-3• Geographic Combatant Commands........................................................................ VI-3

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

• Blood Distribution System..................................................................................... VI-4• Available Blood Products By Echelon.................................................................... VI-7• Blood Transfusion Practice By Echelon................................................................. VI-8

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

• Coordination.......................................................................................................... VI-8• Blood Planning.................................................................................................... VI-10• Host-Nation Support............................................................................................ VI-12• Logistical Considerations of Blood Support......................................................... VI-12• Maximum Capacities for Blood Product Shipments............................................. VI-13

CHAPTER VIIHEALTH SERVICE LOGISTICS SUPPORT IN MULTINATIONAL OPERATIONS

• Composition of Multinational Operations.............................................................. VII-1• Health Service Logistics Support Considerations.................................................. VII-1• Cultural Diversity and Language........................................................................... VII-2

v

Table of Contents

APPENDIX

A Aeromedical Support Equipment and Supplies................................................. A-1B Blood Management............................................................................................ B-1C Medical Logistic Systems for Battlefield Interoperability.................................. C-1D References........................................................................................................ D-1E Administrative Instructions............................................................................... E-1

GLOSSARY

Part I Abbreviations and Acronyms................................................................... GL-1Part II Terms and Definitions.............................................................................. GL-4

FIGURE

I-1 Health Service Support Echelons.................................................................... I-2I-2 Health Service Support Principles.................................................................. I-4I-3 Command Surgeon’s Health Service Logistics Support Responsibilities......... I-7II-1 Planning for Joint Health Service Logistics Support...................................... II-2II-2 Communications Support Considerations...................................................... II-5II-3 Single Integrated Medical Logistics Manager (SIMLM).............................. II-10III-1 Patient Movement Item System................................................................... III-4IV-1 Redeployment Issues................................................................................... IV-1IV-2 Redeployment Phases.................................................................................. IV-2V-1 Principles of Health Service Logistics Support in Military Operations

Other Than War........................................................................................ V-1V-2 Selected Types of MOOTW Operations....................................................... V-3V-3 Planning Considerations............................................................................... V-6VI-1 The Armed Services Blood Program........................................................... VI-1VI-2 The Armed Services Blood Program Office Organization and

Coordination............................................................................................ VI-2VI-3 Armed Service Blood Distribution System.................................................. VI-6VI-4 Blood Products (Class VIIIb) Available to the Theater................................ VI-8VI-5 Blood Transfusion Practices by Echelon...................................................... VI-9VI-6 Unit Group and Type Distribution............................................................. VI-11VI-7 Blood Component Planning Factors.......................................................... VI-12VI-8 Maximum Capacities for Blood Product Shipments................................... VI-14VII-1 Multinational Operations Problem Areas.................................................... VII-1B-1 Master Menu Codes...................................................................................... B-2B-2 Example of Message Blood Report............................................................... B-4B-3 Example of Voice Blood Report.................................................................... B-5B-4 Example of Blood Shipment Report.............................................................. B-6

vi

Table of Contents

Joint Pub 4-02.1

Intentionally Blank

EXECUTIVE SUMMARYCOMMANDER’S OVERVIEW

•

•

•

•

•

•

vii

The health servicesupport (HSS) mission toconserve the fightingstrength and provide thecombatant commanderwith a source of trainedmanpower is enhanced byhealth service logisticssupport (HSLS).

Introduction

Health service logistics support (HSLS) provides the requiredClass VIII materiel and equipment when and where it isneeded on the battlefield. In joint operations, the combatantcommander may exercise authority over the joint Class VIIIsystem by designating a single integrated medical logisticsmanager (SIMLM) to oversee Class VIII efforts. Healthservice support (HSS) in a theater of operations is providedby echelons. Each echelon reflects an increase in medicalcapability while retaining the capabilities found in thepreceding echelon. Within most theater of operations thereare four echelons of care, with Echelon V in the continentalUnited States (CONUS) support base. HSLS is one of thefunctional areas of HSS. As such, it requires comprehensiveplanning for inclusion in the HSS estimate and plan whichsupports the combatant commander’s operation plan(OPLAN). The joint HSLS mission is to provide Class VIIIsupplies and equipment (medical materiel to include medical-peculiar repair parts), optical fabrication, medical equipmentmaintenance and repair, blood management, and medicalgases.

Introduces Health Service Logistics Support (HSLS)Concepts

Covers Health Service Logistics Responsibilities andConsiderations

Discusses Structuring HSLS

Explains Health Service Logistics in PostconflictEnvironments and Military Operations Other Than War

Outlines Blood Management Programs, Support, andPlanning

Describes HSLS in Multinational Operations

viii

Executive Summary

Joint Pub 4-02.1

The Assistant Secretary of Defense for Health Affairs(ASD[HA]) establishes health policy and provides oversightof health policies being implemented by the Services’ SurgeonsGeneral. Within the Department of Defense, twoorganizations play a prominent role in management of ClassVIII materiel: the Defense Logistics Agency (DLA) and theDefense Medical Standardization Board. Upon therecommendation of the geographic combatant commander, theChairman of the Joint Chiefs of Staff advises the Secretaryof Defense on establishing a theater evacuation policy. TheServices’ Surgeons General provide guidance on HSLSpolicies to be implemented within their Services. Thecombatant commander has authority within his area ofresponsibility (AOR) for the execution of the HSLS mission.The command surgeon is the combatant commander’s principalHSS advisor in theater and will normally serve as the jointforce surgeon during joint operations. The command surgeonsupervises the planning and execution of the HSS mission.The Geneva Conventions provide specific safeguards whichapply to health service logistics materiel and personnel.

The health service logistics portion of the HSS estimate andplan ensures that a thorough and comprehensive analysis ofhealth service logistics requirements is accomplished andincorporated into the overall HSS plan. By obtaining medicalintelligence and by studying the medical threat, the healthservice logistician can predict, to some extent, the types ofmedical materiel that will be required for the mission. TheJoint Operation Planning and Execution System assiststhe HSS planner to determine the gross HSS requirementsbased upon variables input by the planner, such as forces-at-risk, casualty admissions rates, and the evacuation policy. Thetime-phased force and deployment data is the computersupported portion of the OPLAN; it contains time-phased forcenon-unit-related cargo and personnel data as well asmovement data for the OPLAN. The ability to transportneeded medical supplies and equipment to the requesting unitis an essential part of the HSLS effort. Communicationssystems must be able to communicate on a continuous basis,

The health servicelogistician needs tounderstand the principlesof HSS and apply them toHSLS operations.

For the HSS mission tobe successfullyaccomplished, theappropriate supplies,maintenance, andtransportation resourcesmust be available.

Responsibilities for Health Service Logistics

Health Service Logistics Considerations

ix

Executive Summary

be interoperable, accessible to all users, and able tocommunicate the Class VIII requisitions and requirementsfrom the forward battlefield to the supporting health servicelogistics facilities in the theater of operations and thesustaining base. The threat and possible use of nuclear,biological, and chemical weapons requires HSS personnelto protect themselves, their patients, equipment, and suppliesthroughout the AOR or joint operations area. The US Army,US Navy, US Marine Corps, and US Air Force each haveautomated systems to assist in medical materielmanagement. HSLS of special operations forces is missiondependent. When two or more Services are operating withinthe combatant commander’s AOR, he may designate a Serviceas the SIMLM . By exercising his authority over the HSLSarena, the combatant commander can centralize control,reduce duplication of services, and provide the support in amore economical and efficient manner.

The implementation and execution of combat service supportfunctions are the responsibility of the Services and the Servicecomponent commanders. The commander of a combatantcommand (CINC) will designate a joint force surgeon (JFS)who will be responsible for preparing and coordinating HSSwithin the joint force. Units deploying to the operationalarea will deploy with their authorized or tailoredrequirements in accordance with appropriate Servicedoctrine. The Service components are required to resupplytheir respective units until the SIMLM is established andoperational. As early as possible (OPLAN-dependent), anadvanced element from the assigned Service HSLSorganization should be deployed into the theater. Withinthe combat zone, medical units will normally accomplish aone-for-one exchange of medical equipment with thegaining activity at the time of patient transfer. The handlingand return of equipment within the aeromedical evacuationsystem requires a reliable supporting logistics infrastructureto ensure that patient movement items (PMIs) are availableand serviceable. The mission of the PMI system is to supportin-transit medical capability without removing equipmentfrom patients, to exchange in-kind PMIs without degradingmedical capabilities, and to provide prompt recycling of PMIs.

Transitioning from apeacetime environment tomobilization, todeployment, toredeployment, and todemobilization willrequire extensive priorplanning by thecombatant commanders,Military Services, and theJoint Staff.

Structuring Health Service Logistics Support

x

Executive Summary

Joint Pub 4-02.1

Based on the CINC’s plan, the Service componentcommanders issue a redeployment warning order thatconveys the CINC’s redeployment guidance. The commandsurgeon and staff must be actively involved in establishingtheir redeployment policy as it pertains to medical units.Redeployment is conducted in six phases: reconstitution forstrategic movement; movement to the redeployment assemblyareas; movement to port of embarkation; strategic lift; receptionat port of debarkation (POD); and onward movement fromPOD. Non-unit redeployed equipment and supplies areredistributed according to plans developed by the appropriateService, with input from combatant commanders. The DLAwill play a major role regarding any major redeployment ofmedical assets. The logistics officer, in coordination with theJFS, the DLA, and the Services, determines when the supplypipeline can be shut down. The Services are responsible forreconstitution of their Service elements used in the operation.

There are six joint principles which apply to militaryoperations other than war (MOOTW): objective, unity ofeffort, legitimacy, perseverance, restraint, and security. Themedical commander and the health service logistics plannermust use these principles to guide the planning and executionof the HSS mission. HSLS can provide traditional logisticsupport to deployed forces or may be incorporated intoOPLANs for other types of operations. Prior to a deploymenton a noncombatant evacuation operation, the senior medicalperson accompanying the force determines if there are anyspecial medical supply or equipment requirements. In disasterrelief operations, the management of Class VIII materiel iscritical to the successful completion of the mission. Inhumanitarian assistance operations, the health servicelogistics planner must obtain and coordinate transportationand receive, sort, store, and distribute Class VIII materiel. Innation assistance operations, health service logisticspersonnel can assist a host nation by conducting an assessmentof the military or civilian medical supply infrastructure andindustry. In peace support operations, the HSLS mission ismore the traditional support to a deployed force. Domesticsupport often includes disaster assistance based upon requestsfrom civil authorities as a result of natural or manmadedisasters.

Redeployment must beplanned and executed ina manner that facilitatesthe use of redeployingforces and sustainmentequipment and suppliesto meet a new crisis.

HSLS plays a significantrole in the delivery ofhealth care in militaryoperations other than war.

Health Service Logistics Support in MilitaryOperations Other Than War

Redeployment of Health Service Logistics in Postconflict Environments

xi

Executive Summary

A significantly important aspect of conducting MOOTWmissions is the funding mechanism for the operation. Thehealth service logistics planner must be knowledgeable ofthe funding and reimbursement mechanisms of the specificmission before obligating funds for health service materielpurposes. Planning for MOOTW uses the same planningprocess as that of any military operation.

Established by the ASD(HA), the Armed Services BloodProgram provides transfusion products when required to USforces worldwide. Tri-Service cooperative efforts betweenthe US Army, Navy, and Air Force enable blood and bloodproducts to be collected, tested, processed, and shipped tomilitary medical treatment facilities (MTFs) throughout theworld. The Armed Services Blood Program Office(ASBPO) is chartered by the ASD(HA) to coordinate thecollection and provision of blood products throughout theServices to meet medical requirements during nationalemergencies and overseas military operations.

The Chairman of the Joint Chiefs of Staff reviews andprovides guidance on all matters pertaining to bloodsupport in joint operation planning and execution as well asactivation of the ASBPO in contingency and war. Eachgeographic combatant command maintains a separateintegrated system for providing blood products to the variousService components’ MTFs within the CINC’s AOR. Thetheater combatant command Joint Blood Program Office(JBPO) serves as the overall blood manager within eachcommand. The command surgeon may recommend theestablishment of an Area Joint Blood Program Office(AJBPO) to provide regional blood management in the theater.

Blood requires handling by individuals specially trained inblood movement and storage. To be successful, blood supportmust be an organized and cooperative effort on the part ofhealth service logisticians, laboratory and blood bankpersonnel, transportation personnel, and primary health careproviders. Theater blood support during wartime is providedto US military facilities and potentially, pursuant to properauthority, allied and coalition military as well as indigenouscivilian medical facilities. Blood services in a theater ofoperations containing actual combat operations consist of acombination of operational capabilities. A JBPO or an

The planning andexecution for the effectivemanagement of bloodand blood products is acontinuing, dynamicprocess requiring acoordinated, highlyresponsive system thatextends from thecontinental United Statesto the battlefield.

Blood support in atheater of operationscontaining actual combatoperations is a dynamicand ever-evolvingprocess.

The Armed Services Blood Program

Blood Support in the Continuum of Care

xii

Executive Summary

Joint Pub 4-02.1

AJBPO will be responsible for the Joint Blood DistributionSystem within their geographic area.

MTFs will maintain blood products on hand necessary tomeet operational requirements and submit a daily Blood Reportto their supporting blood supply unit (BSU). The mission ofthe BSU is to receive, perform limited testing, store, process,and distribute blood products to its supported MTFs. The BSUmay also collect blood on an emergency basis. The BloodProduct Depots (BPDs) have been built into theatercombatant commands to provide storage for frozen red bloodcells and fresh frozen plasma. Theater combatant commandsare responsible for ensuring that BPDs are maintained,manned, equipped, and supplied during peacetime operation.The Blood Transshipment Centers and TransportableBlood Transshipment Centers are managed by the US AirForce at primary airfields within the theater of operations.They receive blood products from the Armed Services WholeBlood Processing Laboratory, store them, and re-ice anddistribute them to BSUs or MTFs when required.

A coordinated effort between the theater JBPO and the theateroperations officer and plans officer is required for successfulplanning. Blood Transshipment Center personnel must haveknowledge of the available Army blood bank platoons, BSUs,and the types and locations of the MTFs in the combat zonefor proper planning. Blood planning factors are programmedby the Joint Data Systems Support Center and subsequentlyused by the respective combatant command medical plannersto generate daily blood product requirements for theoperational area. Pre-positioned frozen blood products orblood shipped from CONUS will reduce the requirements tocollect blood in the operational environment. Capabilities tocollect and process blood in the theater are limited.

Once located in the operational area, it is necessary for theJBPO to maintain current information on the combatsituation and on the anticipated actions of friendly and enemyforces. Medical intelligence will provide additionalinformation upon which to base host-nation related decisions.After the decision has been made on where to locate the bloodbanks and the concept of operations for blood support has beenestablished, plans must be coordinated to effect the timelydistribution of blood and blood products throughout the theaterof operations.

Continuous planning formobilization and othercontingencies enables theServices to rapidlyrespond to situationsrequiring blood support.

Planning for Effective Blood Management

xiii

Executive Summary

Logistics support in multinational operations presentnumerous challenges due to a variety of different policies,procedures, and practices. Some of the problem areas thatmay be confronted include a difference in doctrine, differingstockage levels, logistics mobility, interoperability concerns,competition between participants for common support, andresource limitations. Close coordination and continuousliaison with all parties to an alliance or coalition is the key to asuccessful operation. The North Atlantic Tr eatyOrganization Standardization Agreements and theQuadripartite Standardization Agreements have provideda mechanism for standardizing medical materiel. Based onthese agreements, the HSLS planner can better estimate theinteroperability capabilities of the combined forces. Inmultinational operations, significant differences in bothlanguage and customs will exist between the variousparticipants. Each individual Service member must besensitive to these differences and accommodate them whenpossible.

This publication provides for the planning and execution oftheater HSLS for all Service components of a joint or combinedforce, from alert notification to deployment to andredeployment from a theater. It provides fundamentalprinciples and doctrine for HSLS in joint and multinationaloperations.

Health Service Logistics Support in Multinational Operations

CONCLUSION

xiv

Executive Summary

Joint Pub 4-02.1

Intentionally Blank

CHAPTER IINTRODUCTION

I-1

1. Health Service SupportMission

The health service support (HSS) missionto conserve the fighting strength andprovide the combatant commander with asource of trained manpower is enhancedby health service logistics support (HSLS).HSLS provides the required Class VIIImateriel and equipment where needed on thebattlefield. It is a Service componentresponsibility to provide Class VIII supportto its own forces. In joint operations, thecombatant commander may exercisedirective authority over the joint Class VIIIsystem by designating a single integratedmedical logistics manager (SIMLM) tooversee Class VIII efforts.

2. Overview of Joint HealthService Support

a. HSS in a theater of operations isprovided within echelons of care. Eachechelon reflects an increase in medicalcapability while retaining the capabilitiesfound in the preceding echelon, as shown inFigure I-1. Within a theater of operationsthere are four echelons of care, with EchelonV in the continental United States (CONUS)support base.

• Echelon I Care. Care is rendered atthe unit and includes first aid (self-aid,buddy aid, and combat lifesaver [USArmy] care), examination, andemergency lifesaving measures such as

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

Admiral Lord Nelson

Health service logistics support ensures that equipment and materiel isprovided where needed on the battlefield.

I-2

Chapter I

Joint Pub 4-02.1

maintenance of an airway, control ofbleeding, prevention and control ofshock, and prevention of further injury.This echelon of care may include an aidstation that has a physician and/ormedical officer or physician assistant.The elements of medical care andmanagement at this echelon preparepatients for return to duty or evacuationto a higher echelon of care.

• Echelon II Care. Echelon II careincludes basic resuscitation andstabilization and may include limitedsurgical capability as well as basiclaboratory, pharmacy, and temporaryholding facilities. Surface or airevacuation to a medical treatmentfacility (MTF) is available for patientswho require more comprehensivetreatment.

• Echelon III Care. Care administeredat Echelon III requires clinicalcapabilities normally found in an MTFstaffed, equipped, and located in a lowerlevel threat environment. Echelon IIIcare may be the first step towardrestoration of functional health, ascompared to procedures to stabilize acondition or prolong life. Echelon IIIcare may not have the crisis aspects ofinitial resuscitative care. Therefore, careat this echelon can proceed with greaterdeliberation. Limited specialty surgicalcapability is also available at thisechelon.

• Echelon IV Care. Care is provided inan MTF staffed and equipped fordefinitive care and includes specializedsurgical capability.

Figure I-1. Health Service Support Echelons

HEALTH SERVICE SUPPORT ECHELONS

ECHELON I

ECHELON II

ECHELON III

ECHELON IV

ECHELON V

!

!

Care rendered at unitFirst aid, examination, andemergency lifesaving measures

!

!

Basic resuscitation andstabilizationSurface or air evacuationavailable

!

!

Clinical capabilitiesRestoration of functional health

!

!

Definitive careSpecialized surgical capability

! Convalescent, restorative,rehabilitative

Support inthe theaterofoperations

ContinentalUSsupportbase

I-3

Introduction

• Echelon V Care. Care is convalescent,restorative, and rehabilitative and isnormally provided by CONUS-basedmilitary, Department of Veterans Affairs,and/or National Disaster Medical System(NDMS) hospitals.

b. Medical units plan and provideevacuation; hospitalization; health servicelogistics; medical laboratory service; bloodmanagement; preventive medicine; dentalsupport; veterinary support; combat stresscontrol; and command, control, andcommunications.

• Minimally, they should address:

•• Preventative medicine aspects of thefood sanitation and water resources.

•• Command emphasis on hot or coldweather injury prevention.

•• Field sanitation procedures.

•• An aggressive program to protect USforces, to include disease surveillance,diagnosis, and early treatment.

•• Veterinary aspects of food sources.

• The nature of the mission in peaceoperations may result in more frequentand direct contact with the localpopulation and increase the risk ofacquiring many of the infectious andcontagious endemic diseases of thecountry involved. For example, themalaria risk could be high because ofincreased mosquito vector populationsfrom pools of water and favorablebreeding sites following the monsoonseason in some countries.

• Preventive medicine measures, diseasesurveillance and reporting, rapid diseaseoutbreak investigation, field sanitation,water and ice quality analysis, veterinary

surveillance of food supplies and sources,command emphasis, and troop disciplineat all levels significantly limit infectiousdisease and environmental healthproblems.

3. Joint Health Service LogisticsSupport Mission

HSLS is one of the functional areas ofHSS. As such, it requires comprehensiveplanning for inclusion in the HSS estimateand plan which supports the combatantcommander’s operation plan (OPLAN).

a. The joint HSLS mission on thebattlefield is to provide:

• Class VIII supplies and equipment(medical materiel to include medical-peculiar repair parts).

• Optical fabrication.

• Medical equipment maintenance andrepair.

• Blood management.

• Medical gases.

• Contract support

b. The Class VIII category is subdividedinto Class VIIIa and Class VIIIb. (For thepurposes of this publication, when the termClass VIII is used it refers to both Class VIIIaand Class VIIIb.)

• Class VIIIa consists of all medicalsupplies and materiel, optical lensfabrication, medical equipmentmaintenance (to include medical-peculiar repair parts), and medicalgases. The subclasses which comprisethis category include: controlledsubstances; tax-free alcohol; preciousmetals; nonexpendable and expendable

I-4

Chapter I

Joint Pub 4-02.1

medical and dental items; all drugs andrelated items listed in Federal Class 6505but not otherwise restricted; designatedcontrolled items on the advice of thecommand surgeon to the geographiccombatant commander; and Servicecontrolled sensitive items.

• Class VIIIb is comprised of blood andblood products. The subclasses whichcomprise this category include: wholeblood, packed red blood cells (RBCs),frozen RBCs, fresh frozen plasma (FFP),and platelet concentrate.

c. The commander of a combatantcommand (CINC) may determine that thejoint HSLS mission may be moreeffectively accomplished by a SIMLM.

4. Principles of Health ServiceSupport

There are six principles of HSS shownin Figure I-2. The health service logisticianneeds to understand these principles and applythem to HSLS operations.

a. Conformity. The HSLS plan mustsupport and be in consonance with the jointforce commander’s (JFC’s) OPLAN. Byparticipating in the development of thecommander’s OPLAN, the health servicelogistics planner can:

• Determine requirements.

• Plan the support needed to conform tothe tactical operations.

Figure I-2. Health Service Support Principles

HEALTH SERVICE SUPPORT PRINCIPLES

Conformity

Control

Continuity

Mobility

Flexibility

Proximity

I-5

Introduction

b. Proximity. HSS must be provided tosick, injured, and wounded Servicemembers at the right place to keepmorbidity and mortality to the minimum.HSS resources are employed as close to thecombat area as possible. Medical suppliesand blood need to be moved to where theyare accessible by forward treatment elementsyet do not interfere with combat operations.

c. Flexibility. The health servicelogistician must remain abreast of the situationduring war or military operations other thanwar (MOOTW) in order to reallocate orcross-level Class VIII items as changes tothe OPLAN occur.

d. Mobility. Medical command andcontrol headquarters must continually assessand forecast uni t movement andredeployment. Health service logistics unitsmust be prepared to move with the flow ofthe tactical operation or redeployment ofsupported units.

e. Continuity . Optimum care andtreatment of the sick, injured, or wounded areprovided by a progressive, phased echelon ofcare system. To ensure that treatmentresources are maximized and morbidity andmortality reduced, HSLS must provide theneeded Class VIII supplies in the right

quantity at the right time and to the rightplace on the battlefield. Continuity of qualityhealth care is in part dependent upon theHSLS provided.

f. Control. HSS resources must remainunder the control and supervision of thecommand surgeon. The uniquerequirements for the handling and storage ofmedical materiel is best accomplished byretaining control of a dedicated HSLS system.

5. Responsibilities for HealthService Logistics

a. The Assistant Secretary of Defensefor Health Affairs (ASD[HA]). TheASD(HA) establishes health policy andprovides oversight of health policies beingimplemented by the Services’ SurgeonsGeneral. Within the Department of Defense(DOD), two organizations play a prominentrole in management of Class VIII supplies.

• The Defense Logistics Agency (DLA)is responsible for wholesale logisticoperations. The DLA, through theDirectorate of Medical Materiel, DefensePersonnel Support Center (DPSC), is themedical commodity manager. Theagency obtains supplies at the wholesalelevel and coordinates transportation of

HEALTH SERVICE SUPPORT IN KOREA

We moved into Koto-ri, nine and one half miles south of Hagaru, on the eveningof November 25. There were no buildings to use and the temperature haddropped far below zero. The ground was frozen to a depth of 18 inches, makingit impossible to use our regulation wooden tent pegs in anchoring the tents.We finally found a substitute ... Our original blood supply froze and hemolized;zepherin chloride solutions froze, plazma units froze....Plazma could be thawedsuccessfully but when cold water was added, the solution gelatized and refusedto flow into a man’s blood stream. We finally tied hot water bottles around thesolution flask to administer plazma...At times the blood froze on the doctor’sgloves during an operation.

SOURCE: After Action Report1st Marine Medical Battalion In North Korea

November 1950

I-6

Chapter I

Joint Pub 4-02.1

those supplies to the port of embarkation(POE). For certain health servicelogistics, it will also coordinatetransportation to the port of debarkation(POD) upon the redeployment of forces.

• The Defense Medical StandardizationBoard (DMSB) coordinates andstandardizes the clinical and technicalaspects of medical materiel for use byall Services by:

•• Directing the development andstandardization of approved deployablemedical systems (DEPMEDS).

•• Directing the development andmodification of computer simulationmodeling used to determine joint materielrequirements.

•• Developing medical items substitutionlists.

•• Serving as the point of contact andmaintaining liaison with the DLA andother government agencies for all clinicaland technical matters pertaining tomedical materiel.

b. Chairman of the Joint Chiefs of Staff(CJCS). In military operations, the chain ofcommand emanates from the NationalCommand Authorities, to the respectiveCINC . Upon the recommendation of thegeographic combatant commander, theChairman of the Joint Chiefs of Staff advisesthe Secretary of Defense on establishing atheater evacuation policy. This policyestablishes, in a number of days, themaximum period of noneffectiveness(hospitalization and convalescence) thatpatients may be held within the theater fortreatment. This policy, in turn, is one of thedetermining factors governing theestablishment and operation of HSLS

facilities within the area of responsibility(AOR).

c. The Services’ Surgeons General. TheServices’ Surgeons General provideguidance on HSLS policies to beimplemented within their Services. TheServices coordinate the clinical, technical,and logistic aspects of all medical materiel.Each Service component has organizationalstructures for coordinating medical anddental materiel support for units of theoperating force and to cooperate with otheroffices, commands, and agencies in matterspertaining to health service logistics. TheServices provide this support through thefollowing agencies:

• Fleet Hospital Program Office (PML-500).

• Naval Supply Systems Command(NAVSUP).

• Naval Medical Logistics Command(NAVMEDLOGCOM).

• Air Force Medical Logistics Office(AFMLO).

• US Army Medical Materiel Agency(USAMMA).

• Marine Corps Systems Command.

d. The G e o g r a p h i c CombatantCommanders. The CINC has directiveauthority within the AOR for the executionof the HSLS mission, normally with theadvice of the joint force surgeon (JFS). Oneway this authority may be exercised is bydesignating one of the Services within theAOR as the SIMLM. This facilitates thedelivery of HSLS by centralizing control,reducing costs, and reducing redundancy ofservices within the theater of operations.

I-7

Introduction

e. Command Surgeon. The commandsurgeon is designated to supervise theplanning for the accomplishment of theHSS mission. The command surgeon’s HSLSresponsibilities are shown in Figure I-3.

f. The Law of Armed Conflict. The fourGeneva Conventions of 1949 are a part of thelaw of armed conflict. These conventionsprovide specific protections for medicalpersonnel, facilities, vehicles, and equipmentthat will apply, under most circumstances, tohealth service logistics materiel and personnelduring an armed conflict.

• Medical personnel considered to beprotected persons at all times and in allplaces include: (1) those personnel

exclusively engaged in the search for,collection, transport, or treatment of thewounded or sick or in the prevention ofdisease; and (2) staff exclusively engagedin the administration of medical unitsand establishments. Under thisprotection HSLS personnel are notsubject to attack, but are subject to lawfulcapture unless serving on board ahospital ship. If captured, they are notprisoners of war and may be retainedonly so long as the state of health of alliedprisoners of war require.

• Auxiliary medical personnel aremembers of the armed forces speciallytrained for employment (should the needarise) as hospital orderlies, nurses, or

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

COMMAND SURGEON'S HEALTH SERVICELOGISTICS SUPPORT RESPONSIBILITIES

1. Maintain liaison with component surgeons and resolve healthservice logistics support (HSLS) conflicts surfaced by the joint taskforce (JTF) components2. Provide detailed HSLS guidance, assign HSLS tasks, and developa joint concept of operations. In the interest of maximizing the use ofpotentially limited health service support (HSS) resources, the JTFsurgeon recommends to the JTF commander the joint use of HSSassets3. Monitor JTF medical readiness to include component status onpatient beds and health service logistics to include blood managementand staffing4. Coordinate HSLS provided to or received from allies or host nationsduring multinational operations5. Prepare Annex Q for all JTF plans and orders6. Advise the JTF commander on HSS aspects of the GenevaConventions and the Law of Land Warfare7. Supervise the activities of the Area Joint Blood Program Office, ifestablished8. Advise the commander on the disposition of captured enemymedical materiel

I-8

Chapter I

Joint Pub 4-02.1

auxiliary stretcher-bearers in the searchfor, collection, transport, or treatment ofthe wounded and sick. If they arecarrying out these duties at the timewhen they come into contact with theenemy, they are also consideredprotected persons and not subject toattack; however, auxiliary medicalpersonnel who are captured are prisonersof war and may be retained until the endof hostilities.

• The status of HSLS personnel as eithermedical personnel or auxiliary medicalpersonnel should be determined by thecommander and appropriateidentification cards should be issued inaccordance with DOD directives. Thesepersonnel may be lightly armed for self-defense and should wear appropriate

markings identifying their status. Theymust also refrain from committing actsharmful to the enemy to retain theirprotected status.

• Fixed medical establishments and mobilemedical units may not be attacked underany circumstances but must, as far aspossible, be situated in such a mannerthat attacks against military objectivescannot imperil their safety. Theseestablishments and units should beproperly marked and may not be usedin a manner constituting a hostile act.Medical material and stores may not beintentionally destroyed unless done soin the normal course of medicalprocedures, such as destroyingmedicines that are past their expirationdate.

CHAPTER IIHEALTH SERVICE LOGISTICS CONSIDERATIONS

II-1

1. Health Service LogisticsSupport in Joint Operations

Health service logistics is an integral partof the HSS system. Timely and efficientHSLS enhances the quality of medical caredelivered on the modern battlefield. Theexecution of military missions in today’senvironment usually entails a joint force.Normally, each Service component isresponsible for providing HSLS to its ownforces for the duration of an operationunless a SIMLM is appointed by the CINC.However, even if a SIMLM has beenestablished to manage and provide Class VIIIsupport within the AOR, each Servicecomponent remains responsible for providingService unique health service logistics items.

2. Planning for Joint HealthService Logistics Support

a. For the HSS mission to be successfullyaccomplished, the appropriate supplies,maintenance, and transportation resourcesmust be available. The health servicelogistics portion of the HSS estimate andplan ensures that a thorough andcomprehensive analysis of health servicelogistics requirements is accomplished andincorporated into the overall HSS plan.Due to the technical nature of HSLS, coupledwith the rapidly changing battlefield, thehealth service logistics planner must developflexible plans.

b. The health service logistics estimateand plan are based on the elements inFigure II-1.

c. To develop a comprehensive plan, thejoint health service logistics planner musthave a thorough understanding of theoperational and tactical plans. He must beaware of the potential for contingencymissions beyond those for which a publishedplan has been developed. These contingencymissions may arise with little or no priornotice. The HSLS plan must also besufficiently flexible to accommodate changesin the stated mission and desired end state, asoften occurs in MOOTW.

d. The joint health service logisticsplanner determines the requirements for:

• Sizes and locations of health servicelogistics organizations and installationsrequired.

• Types of medical supplies needed.

• Supply procedures to be followed.

• Stock levels to be maintained.

• Medical equipment maintenanceprocedures.

• Optical fabrication procedures.

“There are no stores, no surgeons, no drugs, and the hammocks are infectedand loathsome, and the men stink as they go, and the poor rags they haveare rotten and ready to fall off.”

Sir John PenningtonOf conditions in the British Fleet, 1626

II-2

Chapter II

Joint Pub 4-02.1

• Procedures for obtaining medical oxygenand other medical gases.

• Disposal of unserviceable or outdated USmedical equipment and supplies.

• Disposition of captured medical materiel.

• Preventative medicine support for allphases of the operation.

3. Medical Threat and MedicalIntelligence

a. A significant planning considerationwhen developing the HSS estimate and planis the medical threat. The medical threat isa composite of all ongoing or potential

enemy actions and environmentalconditions that may render a Servicemember combat-ineffective. The Servicemembers’ reduced effectiveness results fromsustained wounds, injuries, stress-inducedperformance deterioration, or diseases. Theelements of the medical threat include, butare not limited to:

• Diseases endemic to the AOR.

• Environmental factors (heat, cold,humidity, and significant elevationsabove sea level).

• Level of compliance with the Law ofLand Warfare and Geneva Conventionrequirements regarding respect and

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

PLANNING FOR JOINT HEALTH SERVICELOGISTICS SUPPORT

Concept of theoperation andcommander's

guidance

Availability of pre-positioned war

reserves

Type of operationExpected durationof the operation

Medical threat inthe area ofoperations

Anticipatednumber and types

of casualties

Size of the forceto be supported

Theaterevacuation policy

Health Service LogisticsEstimate and Plan

II-3


protection of medical personnel,facilities, transportation, and medicalmateriel.

• The potential use of weapons of massdestruction.

b. In developing the HSLS estimate andplan, the health service logistician obtainsupdated medical intelligence throughstandard intelligence sources. Medicalintelligence is the product resulting from thecollection, evaluation, analysis, integration,and interpretation of all available generalhealth and bioscientific information. Medicalintelligence is concerned with one or more ofthe medical aspects of foreign nations or theAOR. Until medical information isappropriately processed (ordinarily on thenational level by the Armed Forces MedicalIntelligence Center), it is not considered to beintelligence.

c. By obtaining medical intelligence andby studying the medical threat, the healthservice logistician can predict, to someextent, the types of medical materiel thatwill be required for the mission. Further,when this prediction is considered in light ofthe casualty estimate, theater evacuationpolicy, and anticipated duration of theoperation, the health service logistician canalso forecast the expected quantities ofmateriel items that will be required.

4. Joint Operation Planningand Execution System

The Joint Operation Planning andExecution System (JOPES) containsmedical planning tools. These tools assistthe HSS planner to determine the gross HSSrequirements based upon variables input bythe planner such as forces-at-risk, casualtyadmissions rates, and the evacuation policy.The module uses these variables to calculatetime-phased requirements for HSS. Theserequirements include:

a. Medical treatment facilities (beds andoperating rooms).

b. Whole blood and fluids.

c. Class VIII supplies (by weight).

d. Medical evacuation resources.

5. Time-Phased Force andDeployment Data

a. Units and cargo deploying to a theaterdo so in a time-phased manner. The time-phased force and deployment data(TPFDD) is a computer-supported portionof the OPLAN; it contains time-phased forcedata, non-unit-related cargo and personneldata, and movement data for the OPLAN,including:

• In-place units.

• Units to be deployed to support theOPLAN with a priority indicating thedesired sequence for their arrival at thePOD.

• Estimates of non-unit-related cargo andpersonnel movements to be conductedconcurrently with the deployment offorces.

• Estimate of movement requirements thatmust be fulfilled by common-user liftresources as well as those requirementsthat can be fulfilled by assigned orattached transportation assets.

b. Health service logistics units and theirassociated cargo are prioritized formovement on the time-phased force anddeployment list.

c. To ensure continuous HSLS, the healthservice logistician must factor in thepriority of health service logistics unit andnon-unit-related cargo for deployment.

II-4

Chapter II

Joint Pub 4-02.1

This can be accomplished by ensuring thatunits deploy with an adequate number ofdays’ supply to satisfy requirements until thenon-unit-related medical materiel flow isestablished. This is accomplished by ensuringthat units maintain their basic unit load in acombat-ready state.

6. TransportationConsiderations

The ability to transport needed medicalsupplies and equipment to the requesting unitis an essential part of the HSLS effort. Healthservice logistics planners at all echelonsmust ensure timely transport and deliveryof Class VIII items. The US TransportationCommand provides strategic lift into thetheater of operations. The health servicelogistics planner must ensure that Class VIIImateriel is properly prioritized on theTPFDD to ensure its timely arrival in theoperational area. The health service logisticsplanners within the AOR plan for thetransportation of medical materiel from thePOD to supporting supply facilities and thenon to the requesting unit. Health servicelogistics organizations use organic orassigned vehicles to transport the ClassVIII materiel , however they may require

transportation support from supportingcommunications zone (COMMZ) or corpstransportation units. Medical evacuationvehicles returning to forward areas canbackhaul Class VIII materiel to forward-deployed units. To retain the protectionsafforded under the Geneva Conventions,medical vehicles can only backhaul medicalmateriel. To carry other classes of supplywould jeopardize this protected status.

7. Communications SupportConsiderations

See Figure II-2.

In joint operations, the Services must beable to communicate on a continuous basis;this is especially true in the HSLS arena.Interoperability issues must be resolvedearly on to ensure that timely and effectiveHSLS can be provided. Interoperability issuesinclude not only hardware systems but alsoautomated information systems (AIS) used byeach Service.

a. Communications systems used canrange from the simplest form such as amessenger or liaison officer to sophisticatedsatellite communications systems. Regardless

Medical supplies are deployed by use of the medical planningmodule, which is an element of JOPES.

II-5


of the method employed, it must be accessibleto all users and must be able to communicatethe Class VI I I requ is i t ions andrequirements from the forward battlefield tothe supporting health service logistics facilitiesin the theater of operations and the sustainingbase. Requests should be made via thejoint task force (JTF) common-usercommunications infrastructure.

b. Class VIII requisitions must beprocessed as expeditiously as possible. Thehealth service logistician will track the status

of each requisition and, when required, stressthe criticality of the item within the commandstructure. Access to the Defense AutomaticAddressing System Office (DAASO), whichis the hub for passing supply requisition filesbetween the retail and wholesale levels, isessential and is accessible by the Unclassifiedbut Sensitive Internet Protocol RouterNetwork, through the JTF communicationsarchitecture, or through available commercialcommunications. Additional information isprovided in Appendix C, “Medical LogisticSystems for Battlefield Interoperability.”

Figure II-2. Communications Support Considerations

COMMUNICATIONS SUPPORT CONSIDERATIONS

interoperable accessible toall users

able tocommunicate on

a continuousbasis

able tocommunicaterequisitions

andrequirements

Hardware Systems/Automated Information

Systems

II-6

Chapter II

Joint Pub 4-02.1

8. Operational Considerationsin a Nuclear, Biological, orChemical Environment

a. The threat and possible use of nuclear,biological, and chemical (NBC) weaponsrequires HSS personnel to protectthemselves, their patients, equipment, andsupplies throughout the operational area. Thethreat forces may introduce chemical orbiological agents into MTFs, water sourcesor supplies, or foodstuffs. Further, suppliesand equipment can become contaminated andmay be damaged by some chemical agents ordestroyed by nuclear weapons.

b. Health service logisticians must planto protect themselves and the Class VIIIsupplies for which they are responsible.Health service logistics planners should planon:

• Providing protection of medical unitsfrom NBC contaminants in order tosurvive and continue their mission.

• Protecting supplies during shipment andstorage.

• Preventing the spread of contaminationinto storage and distribution areas.

• Monitoring exposure of Class VIIIsupplies to NBC agents during shipmentto forward-deployed forces.

• Maintaining and enhancing survivabilityof vehicles and medical equipment.

• Decontaminating medical equipment.

c. After NBC attacks, each affected unitmust establish an inspection anddecontamination point. The inspection anddecontamination process is conducted inaccordance with the unit’s OPLAN.

9. Overview of ServiceComponent Health ServiceLogistics Systems

a. United States Air Force. Duringcontingency operations, the United States AirForce (USAF) uses the medical logistics(MEDLOG) system, mobile medicallogistics (MOMEDLOG) , or medicallogistics, junior (MEDLOG JR) to assistin medical materiel management.(MEDLOG JR is a smaller, moretransportable computer system that caninterface with laptop computers;MOMEDLOG is a laptop version ofMEDLOG with similar capabilities, and iscapable of stand-alone operation, completewith finance and procurement sourceinterface.) Contingency hospitals (CHs) areequipped with a full sized MEDLOG AIS.The air transportable hospitals (ATHs) areequipped with MOMEDLOG. TheMEDLOG JR is a simple inventorymanagement tool that runs on a laptopcomputer in a disk-operating systemenvironment, capable of producingdocuments for transmission to a supplysource. Its use is normally restricted toassemblages other than CHs and ATHs.Contingency HSLS operations mirrornormal support to peacetime MTFs. Boththe ATH and the MTF health servicepersonnel have the same health servicelogistic mission when deployed. Storedoperating supplies are funded through AirForce Working Capital Fund (AFWCF)assets. As issues are processed, the AFWCFis reimbursed with operation andmaintenance (O&M) funds. USAFassemblages are normally issued up frontusing a line of the USAF O&M funds toreimburse the AFWCF. Each assemblagedeploys with a set number of days of supplyand will require resupply support before theSIMLM is in place (if designated). TheAFMLO has the capability of developing Air

II-7


Force Class VIII sustainment requirementsdata for specific operation plans.Contingency hospitals and ATHs can beequipped to requisition and receive suppliesin a stand-alone mode from their home base,another support base, or other source ofsupply. A CH or ATH may be designatedas a SIMLM for a particular geographicarea and a temporary period of time. Thedesignation is specified in the combatantcommander’s OPLAN. Transportation andcommunications augmentation must beprovided from within theater to fulfill thismission.

b. United States Navy. The United StatesNavy (USN) operational concept is the samein peacetime as in war. The USN supplysystem is integrated with the DLA supplysystem.

• The primary contact points of all forcesafloat, including the casualty receivingand treatment ships and the hospital ships(T-AHs), are the Fleet and IndustrialSupply Centers (FISC) and the combatlogistics force (CLF) replenishmentships. Supply is accomplished on arequisition demand basis via militarystandard requisitioning and issueprocedures (MILSTRIPs). Ifdesignated, a SIMLM manager canprovide medical supply support, ifrequested, to forces afloat for commonuse, recurring demand-supportedmedical materiel items. Assistance, ifrequested, can be provided to the T-AHby the N AV M E D L O G C O M t oobta in nonstandard medical materiel.

• The CONUS MTFs are resuppliedthrough the FISC, DPSC, andcommercial sources using the Micro-Medical Inventory Control System(MICRO-MICS).

• Outside of CONUS, resupply of MTFsis provided through the FISC systems

such as either Medical Inventory ControlSystem, MICRO-MICS, or the UniformedAutomated Data Processing System andmay interface with the StreamlinedAutomated Logistics Transfer System(SALTS) for transmitting requisitions andsupply status.

• Fleet Hospitals use the ManagementInformation System called OperationalFleet Hospital Information System(OFHIS) for medical resupply and usethe Micro-Shipboard Non-TacticalAutomated Data Processing System(MICRO-SNAP) for nonmedicalresupply and financial management.Both OFHIS and MICRO-SNAP haveinventory management capabilities andoperate on stand alone personalcomputers (PCs). Resupply for CombatZone Fleet Hospitals will be normallythrough the SIMLM.

• Hospital ship resupply is providedthrough the FISC and CLF ships usingthe NAVSUP’s MICRO-SNAP Supplyand Financial Management module,which interfaces with SALTS. Duringcontingency operations, the SIMLM maybe able to provide common-use,recurrent-demand medical materielitems.

c. United States Marine Corps (USMC).As a general rule, the USMC requisitionsClass VIII materiel through the same channelsas the other classes of supply. The SupportedActivities Supply System (SASSY) is theUSMC supply system. The authorizedmedical allowance list (AMAL) and theauthorized dental allowance list (ADAL) arelisted on the tables of equipment of a Marineexpeditionary force (MEF) in an estimatedworst case scenario through a 60-day periodo f c o m b a t . A M A L a n d / o r A D A Lrequirements for medical and dental battalionscan be task-organized to support the Marineair-ground task force (MAGTF) mission.

II-8

Chapter II

Joint Pub 4-02.1

• Under normal operating conditions, themedical logistics company (MEDLOGCO),supply battalion of the force servicesupport group (FSSG) can interface withthe US Army MEDLOG battalionwithin the operational area.

• The AMAL and ADAL held in supportof an MEF are categorized as eitherinitial or war reserve. The initial issuequantities, both equipment andconsumable, are employed by the usingunit in support of peacetime deploymentsand training exercises. Use of an initialissue AMAL or ADAL carries with itan obligation and responsibility toreplenish and maintain them in acombat-ready state. The war reserveAMALs or ADALs are maintained withthe medical logistics companies, supplybattalion, FSSGs, and with the maritimepre-positioned force squadrons.

• All HSS elements of an MAGTFdeploy (mountout) with equipmentand medical materiel sufficient tosupport a projected 15 days(minimum) of combat operations. Themedical and evacuation sections of theassault echelon are responsible forbringing ashore an initial 3 to 5 daysupply of medical materiel. This isaccomplished with mobile loadingvehicles. Equipment and suppliesremaining afloat are transferred to shoreeither on a demand basis or scheduledwith ensuing waves of the assaultechelon.

• Resupply under all circumstances is acommand responsibility. Medicaldepartment personnel needing resupplysubmit their requirements to the SASSYmanagement unit (SMU) of the supplybattalion, FSSG. The SMU will processand pass requisitions if unable to fill therequirement from its Class VIII

inventory. There are MEDLOGCOrepresentatives attached to all combatservice support detachments and combatservice support elements, and should beconsidered during HSS planning.

d. United States Army. The USAMMA,a subordinate command of the US ArmyMedical Research and Materiel Command,maintains the Class VIIIa portion of the Armyreserve (AR) materiel in accordance with USArmy guidelines. Class VIIIa war reserve(WR) requirements are identified throughthe Army’s WR automated process.Methods to fulfill the AR requirements arerefined through a series of conferences withthe combatant commands and theircomponent commands. The USAMMA hasthe capability of developing Army Class VIIIsustainment requirements data for a theaterof operations.

• There are four health service logisticsorganizations within the Army structure.These organizations are the TheaterMedical Materiel Management Center(TMMMC); the MEDLOG battalion,forward; the MEDLOG battalion, rear;and MEDLOG support detachments.

• Requests for Class VIII items atEchelons I, II, and attached forwardsurgical teams in the division is initiallyprovided by preconfigured pushpackages until line item requisitionprocedures can be established.Movement of medical materiel toforward-deployed units will beaccomplished by ambulance backhaul orsupply point distribution methods.Resupply of Class VIII items in thedivision is accomplished by informalrequest of the lower element to thehigher element. For example, thecombat medic is resupplied by thebattalion aid station (BAS), and the BASis resupplied by the forward support

II-9


medical company. Resupply of themedical companies is performed by theDivision Medical Supply Office(DMSO).

• The MEDLOG battalion providessupply, maintenance, and opticalfabrication support to the DMSO andelements located in the corps and, whensituated in the COMMZ, supports allmedical organizations located in echelonsabove corps.

• Health service materiel management isexecuted through the use of the TheaterArmy Medical Management InformationSystem.

• In a mature theater, a TMMMC may beestablished. It is responsible for thecentralized management of theater-levelHSLS activities. Using automatedsystems, the TMMMC manages ClassVIII materiel, contracting services,and end items. The TMMMC maintainsin-transit visibility, redirects shipmentsupon CINC approval, and recommendstheater-wide cross-leveling of Class VIIIassets. If a SIMLM is designated for atheater of operations, the TMMMC maybe designated.

e. Special Operations Forces. Thecommander-in-chief, US Special OperationsCommand, is a supporting CINC principallyresponsible for providing special operationsforces (SOF) to the geographic combatantcommanders.

• Health service logistics support of SOFis mission-dependent. The HSLSrequirements are determined prior todeployment and are integrated into theOPLAN.

• SOF are responsible for deploying withsufficient health service logisticsmateriel to support their operationsuntil the supporting HSLS system isestablished. Once the HSLS system isestablished, SOF will receive support onan area-support basis.

10. Single Integrated MedicalLogistics Manager

See Figure II-3.

a. When two or more Services areoperating within the CINC’s AOR, aService may be designated as the SIMLM.The SIMLM system encompasses theprovision of medical supplies, medicalequipment maintenance and repair, bloodmanagement, and optical fabrication to alljoint forces within the theater of operationsincluding, on an emergency basis, USN shipsfor common-use items. By exercisingdirective authority over the HSLS arena forthe accomplishment of assigned missions, theCINC can centralize control, reduceduplication of services, and provide thesupport in a more economical and efficientmanner. Further, it is the CINC’sresponsibility to ensure coordinationoccurs among the Services HSLS systems,that critical health service logistics resourcesare properly allocated, and that medicalmateriel requirements are accurately stated.The SIMLM assumes responsibility forplanning and executing the HSLS missionfor common-use medical items in that AOR.

b. In the European and Korean theaters, theUS Army has been designated as the SIMLM.Although the US Army may be designated asthe SIMLM in future missions because of alarger commitment of ground forces, eachService should devise plans in the eventthey are designated the SIMLM.

II-10

Chapter II

Joint Pub 4-02.1

SINGLE INTEGRATED MEDICAL LOGISTICSMANAGER (SIMLM)

SIMLM

medical supplies

medical equipmentmaintenance and repair

bloodManagement

Opticalfabrication

Centralizedcontrol

reduced duplicationof services

economical andefficient support

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

CHAPTER IIISTRUCTURING HEALTH SERVICE LOGISTICS SUPPORT

III-1

1. Transition

Defense Planning Guidance tasks theMilitary Services to prepare for major theaterwars and MOOTW. In support of theseoperations, the CINC may elect to exercisecombatant command (command authority)through a JTF. Transitioning from apeacetime environment to mobilization, todeployment, to redeployment (Chapter IV,“Redeployment of Health Service Logisticsin Postconflict Environments”) and todemobilization will require extensive priorplanning by the CINCs, Military Services,and the Joint Staff.

2. Combat Service Support

Elements of the US forces must be readyto deploy with supply stock levelscommensurate with the OPLAN. Theimplementation and execution of combatservice support (CSS) functions are theresponsibility of the Services and theService component commanders. TheCINC exercises authority for logistics asspecified in Joint Pub 0-2, “Unified ActionArmed Forces (UNAAF).” Normally, thisauthority is exercised through subordinateJFCs and Service and/or functionalcomponent commanders. The CINCs’directive authority over CSS operationsdoes not release the Services from theirresponsibility to staff, equip, train, andsustain their own forces. A SIMLM maybe designated to provide centralized HSLSto all participating Services in the CINC’sAOR.

3. The Joint Force Surgeon

The CINC may designate a JFS who willbe responsible for preparing andcoordinating HSS within the joint force.Planning must concentrate on the CINC’s CSSpriorities, deploying force structure, and themission. The JFS and his staff should considerand coordinate the use of all WR assets.Proper planning will provide the CINC witha tailorable force, deployment flexibility, andenhance force closure and sustainment ofoperations.

4. Planning ConsiderationsPrior to DeploymentNotification

a. Health Services Logistics Operations

• Medical Supply Support. Unitsdeploying to the operational area willdeploy with their authorized ortailored requirements in accordancewith appropriate Service doctrine. TheService components are required toresupply their respective units until theSIMLM is established and operational.The CINC ensures that statements of theassigned forces’ requirements areprepared and submitted in accordancewith existing directives of the Secretary ofDefense, the Secretaries of MilitaryDepartments, and the Chiefs of theServices. Stock levels will be consistentwith the nature of the contingency mission,the medical threat, climate, geography, andother factors related to the AOR.

“For the accommodation, comfort, and health of the Troops, the hair is to becropped without exception, and the General will give the example.”

General Order of the ArmyPittsburgh, 30 April 1801

III-2

Chapter III

Joint Pub 4-02.1

• Single Integrated Medical LogisticsManagement. The SIMLM mustrecognize and support line itemdifferences which exist between variousService medical sets and assemblies. Aconsolidated recurring item list will bedeveloped and maintained for medicalline items required for support to theServices. This list should be used inconjunction with the D-Day SignificantItem List, maintained by the DMSB, asthe baseline catalog for support by theSIMLM. The SIMLM will also serve asthe source of supply for obtainingnonrecurring requirements, includingService-unique items. This is necessaryto avoid overwhelming the supply systemwith requirements not normally part of aunit’s authorized allowance list. It isimperative that unit commandersexercise supply discipline by orderingnon-standard items on an emergencybasis only. Both push package and pullsupply concepts will be employed in theresupply of deployed units. Maximummedical standardization should be animportant part of any joint HSLS plan.

b. Support Considerations

• Refrigeration and temperature-controlled requirements. Ensure thatrefrigeration and temperature-controlledstorage is available.

• Special handling. Ensure that medicalsupplies, such as cylinders containingoxygen and medical gases, code R items,blood, and other hazardous materialsrequiring special handling are identified.

• Facilities. Facilities for forward medicallogistics units must be planned for duringthe initial stages of deployment. Theseunits require facilities with nearby linesof communications (LOCs) to establishfull operations. Buildings of opportunity

are the first priority. If buildings are notavailable, tentage will have to suffice.

5. Deployment

Deployment is the relocation of forcesand material to desired areas of operations.Deployment encompasses all activities fromorigin or home stations through destination,specifically including intra-continental US,intertheater, and intratheater movement legs,staging, and holding areas (Joint Pub 4-0,“Doctrine for Logistic Support of JointOperations”).

a. Advanced Deployment. As early aspossible (OPLAN-dependent) an advancedelement from the assigned Service HSLSorganization should be deployed into thetheater. This advance element provides acadre of personnel who can deploy in advanceof follow-on HSLS forces to arrange andinitiate required support such as, but notlimited to, planning, coordinating, andimplementing line item requisitioning andstatus, transportation, distribution,warehousing, and security. These activitiesshould be under the supervision of the seniorlogistics headquarters in the operational area.

b. Mobility. The HSLS advanced elementshould be equipped so that it is 100 percentmobile to enhance its support mission.

6. Captured Medical Materiel

Captured medical materiel is not to beused for treatment of US personnel withoutspecific approval of the command surgeon.After clearance for safety and potentialmilitary medical intelligence, capturedmedical supplies and equipment may be usedto treat enemy prisoners of war (EPWs) anddetainees, and to provide humanitarianassistance for indigenous populations.Medical materiel is protected by the GenevaConventions from intentional destruction.

III-3


7. Unit-to-Unit Exchange

Within the combat zone, medical units willnormally accomplish a one-for-oneexchange of medical equipment with thegaining activity at the time of patient transfer.

8. Aeromedical EvacuationEquipment and/or PatientMovement Items

See Figure III-1.

The medical equipment and suppliesrequired to support the patient duringevacuation are referred to as patient movementitems (PMIs). The handling and return ofequipment to the aeromedical evacuation(AE) system requires a reliable supportinglogistics infrastructure to ensure that PMIsare available and serviceable. The plan fora PMI exchange system and the ultimate returnof AE equipment and PMIs to the originatingtheater should be addressed in the OPLANs.

a. When a patient requires evacuation, itis the originating MTF’s responsibility toprovide the PMIs required to support the

patient during evacuation. The PMIsaccompany a patient throughout the chainof evacuation from the originating medicalunit to the destination MTF, whether it isan intratheater or intertheater transfer. TheServices will include and maintain initialquantities of DMSB-standardized PMIs inthe appropriate medical assemblages. Theyshould not assume or plan for shortfalls ofPMIs being satisfied by PMI centers. TheServices, through the DMSB, will identifyand approve PMI equipment items such asthose currently listed in Appendix A,“Aeromedical Support Equipment andSupplies.” Medical equipment for use inAE must be certified for aircraft use bythe Services’ testing agencies. To reducemedical equipment shortfalls experiencedwithin the theater, the JFC must ensureprocedures are established to resupply andrefurbish PMIs.

b. Patient Movement Item System. Themission of the PMI system is to support in-transit medical capability without removingequipment from patients, to exchange in-kind PMIs without degrading medicalcapabilities, and to provide prompt

Patient movement items accompany the patient through theaeromedical evacuation system.

III-4

Chapter III

Joint Pub 4-02.1

recycling of PMIs. The PMI systemcomprises the management of PMIequipment and materiel. The PMI system willprovide seamless in-transit visibility for anequipment management process frominitial entry to the patient’s final destination,the patient evacuation system. The DefenseMedical Logistics Standard Support and/orTransportation Command’s Regulating andCommand and Control Evacuation Systeminterface will be used ultimately to facilitatethe management of PMIs. The PMI systemwill deploy with the AE system, be managedby the AE system, be supplied through thenormal supply system, and collocated withthe AE theater and/or strategic interfaces inorder to provide initial AE operationalcapability, sustainment of AE operations, andminimize equipment turn around time.

c. PMI Operations. Establishment oftheater PMI centers is the responsibilityof the USAF. Air Force medical units willbe tasked, trained, organized, and equippedto perform AE missions, including PMI

operations. PMI centers will be establishedto support worldwide theater requirements.PMI centers will be located at POEs and/orPODs within and outside CONUS to matchAE support plans. PMI centers areresponsible for the overall management, in-transit visibility, and tracking of PMIs. PMIcenters will receive, refurbish (includestechnical inspection, calibration, repair, andprovide 3 days of expendable supplies),redistribute, and return PMIs collected fromMTFs. The USAMMA may be required toprovide the same level of maintenancesupport in CONUS if required. PMI centerscan be augmented with personnel andequipment from the other Services in theevent of surge and sustained requirements.Service liaison personnel can also beassigned. At the time an MTF initiates apatient movement request requiring PMIs,the PMI center or cell will initiate action forexchange of in-kind PMIs. The MTFs willclean the PMI equipment before returning itto another facility, PMI cell, center, ortransportation point. Intratheater

Figure III-1. Patient Movement Item System

PATIENT MOVEMENT ITEM SYSTEM

supports in-transitmedical capability

provides aseamless in-transitpatient/equipment

managementprocess

patientmovement item

centers responsiblefor overall

management, in-transit visibility, &

tracking

deploys with and ismanaged through the

aeromedical evacuationsystem and suppliedthrough the normal

supply system

PatientMovement Item

System

III-5


movement of PMI equipment is theresponsibility of the CINC, executed by AEforces.

d. PMI centers incorporate and supportPMI cells. PMI cells are a flexible subset ofthe PMI center, capable of establishing aforward PMI equipment exchangelocation. PMI cells will support PMIexchange as far forward as theater AE patientmovement is approved to operate. PMI cellswill be deployed to forward operatinglocations to support one or more forwardmedical elements by pushing PMIs to thoselocations. These PMI centers and cells willrequire base operating support supplied bylocal operational support elements. As thetheater matures and a SIMLM is established,the PMI centers and cells will coordinateas necessary with the SIMLM to obtain

support in the areas of requisitioning, storage,maintenance, and battlefield distribution ofPMI-related items. Forward battlefielddistribution and exchange of PMIs will be aSIMLM or Service responsibility. The planfor a PMI exchange system and the return ofPMIs to the originating MTF will beaddressed in theater OPLANs.

e. Initial theater PMI requirements willbe supported by deployable modular kitscalled patient evacuation contingency kits(PECKs), to be provided by the PMI centersand cells. PECKs will augment theater PMIcenters and cells until they are fullyestablished with their preplanned inventorylevels. A PECK supports the medicalevacuation of 30 patients (see Appendix A,“Aeromedical Support Equipment andSupplies,” for contents).

III-6

Chapter III

Joint Pub 4-02.1

Intentionally Blank

CHAPTER IVREDEPLOYMENT OF HEALTH SERVICE LOGISTICS IN

POSTCONFLICT ENVIRONMENTS

IV-1

1. Redeployment Planning

Redeployment must be planned andexecuted in a manner that facilitates theuse of redeploying forces and sustainmentequipment and supplies to meet a newcrisis. In most cases, redeployment isintertheater or strategic. Redeployment is, infact, a new deployment; either back to a unit’soriginal home station, or to new duty stationsto meet new crises. (The key to redeploymentis that it should not be considered as aretrograde movement, but in fact, a newdeployment.) Based on the CINC’s plan, theService component commanders issue aredeployment warning order that conveysthe CINC’s redeployment guidance. Thisguidance may include disposition instructionsfor Class VIII materiel or for reconstitutionof forces.

2. Joint Force SurgeonResponsibilities

The JFS must be actively involved inestablishing redeployment policy as itpertains to medical units. The items shownin Figure IV-1 are some critical issues thatthe HSS planner must consider whenredeploying.

3. Redeployment Phases

During redeployment, contracts fortransportation of materiel and maintenancecan be used extensively to reconstitute theforce. Redeployment is conducted in sixphases shown in Figure IV-2.

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

Lord St. Vincent

Figure IV-1. Redeployment Issues

REDEPLOYMENTISSUES

Equipment and supplydisposition1

Destruction of unserviceable(non-repairable) or outdated

medical materiel2

Turn-in and dispositionprocedures3

Role of all Service medicallogistics elements4

Role of DLA* and DefenseReutilization Management

Office5

Transfer of medical itemsto foreign military sales

customers6

Approval for the transfer ofmedical items for

humanitarian assistance7

Disposition of specialequipment items such asAE** medical equipment

8

Component accountabilityprocedures9

* Defense Logistics Agency** Aeromedical Evacuation

IV-2

Chapter IV

Joint Pub 4-02.1

a. Phase I: Reconstitution for StrategicMovement. Once the forces move back tothe tactical assembly area, the major focusshould be on rebuilding unit integrity andaccountability to the maximum extentpossible for units, individuals, materiel,supplies, and equipment. Commander’sactions include:

• Turn-in of excess Class VIII supplies andunique medical equipment.

• Reconstitution and/or initial cross-leveling of medical materiel.

• Cleaning, repacking, and loadingcontainers under US Customs and USDepartment of Agriculture supervision(if necessary). Hospital assemblagesshould be packed in order to avoiddamage during shipment.

b. Phase II: Movement to theRedeployment Assembly Areas (RAAs).Once the medical component is moved intothe RAA, the commander completes theactivities that could not be accomplishedin Phase I, such as washing major end items,palletizing equipment, and obtaining USCustoms and Department of Agricultureinspections on all unit equipment.

c. Phase III: Movement to the Port ofEmbarkation. Movement to POE mayrequire a separate, agriculturally sterilearea. Proximity to the loading dock mayreduce and/or eliminate agricultural clearancecompromises.

d. Phase IV: Strategic Lift. The CINCcoordinates the use of land, sea, and airtransportation assets, facilities assigned to thecommand, and the use of allocated common-user resources.

e. Phase V: Reception at the POD.Commanders should provide advance partiesto coordinate the reception and processingof redeploying forces and their equipmentat the POD and for the movement to theirfollow-on destinations. Onward movementwill heavily involve Military TrafficManagement Command.

f. Phase VI: Onward Movement fromthe POD. This phase begins withreorganization of forces, receipt and repair ofsustainment equipment and supplies, and

Figure IV-2. Redeployment Phases

REDEPLOYMENTPHASES

Reconstitution for StrategicMovement

Movement to theRedeployment Assembly

Areas

Movement to the Port ofEmbarkation

Strategic Lift

Reception at the Port ofDebarkation

Onward Movement from thePort of Debarkation

Phase I

Phase II

Phase III

Phase IV

Phase V

Phase VI

IV-3


movement to designated marshalling areasoutside the processing area, and concludeswith arrival at their destination.

4. Other RedeploymentConsiderations

a. Non-unit redeployed equipment andsupplies are redistributed according to plansdeveloped by the appropriate Service, withinput from CINCs. Priority of effort isgenerally given to Service forcescommitted to CJCS-approved OPLANs.Other recipients may include US ArmyMateriel Command, DLA, and GeneralServices Administration distribution centers.In the redistribution process equipment maybe available for foreign military sales, or agrant program such as excess defense articles,to support national interests and policies.

b. The DLA will play a major roleregarding any major redeployment ofmedical assets. Unified and componentMEDLOG organizations must coordinate withDLA representatives in the following ways:

• The Defense Reutilization MarketingService. Medical logistics planners

must coordinate with DLA as theydevelop redeployment plans andincorporate disposal support into theseplans.

• The Defense Logistics Agency Depots.As HSS planners develop plans forredeployment of medical units, they mustalso take into consideration possibleturn-in of excess equipment and returnof medical assemblages to DLA depots.Procedures for these actions must becoordinated with the DLA liaisonpersonnel in the theater or referred foraction to the DLA.

5. Service Responsibility

As an operation nears completion,medical materiel is often both on-requisition and en route in the distributionsystem. The Services will continue to requiresupplies, but some categories will not berequired in the quantity that wasrequisitioned. The logistics officer, incoordination with the JFS, the DLA, and theServices, determines when the supplypipeline can be shut down. The Servicesare responsible for reconstitution of their

In postconflict environments, logistics plans must accommodateredeployment of medical equipment.

IV-4

Chapter IV

Joint Pub 4-02.1

Service elements used in the operation. Theprocedures for redeployment from theSIMLM are as follows:

a. US Army Redeployment.Commanders and planners must plan andexecute redeployment in an efficientmanner that facilitates the use of redeployingunits, individuals, and materiel to meet newcrises. Unit integrity should be maintainedto the maximum extent possible. By doingso, units can be diverted anywhere, ready tocontinue the HSS mission. The focus ofindividual manpower and materielredeployment is total accountability andefficient handling of all HSS equipmentand medical materiel. The desired end stateafter redeployment is the restoration of theArmy’s capability to conduct futureoperations.

• In order to conduct an effective andefficient redeployment operation,specific units, individuals, andequipment and supplies must beidentified and allocated to theoperation. The CINC must identify astructure to support the redeploymentoperation.

• Medical care, life support, and otherservices, as well as supplies and materiel,must be provided.

• The redeploying command uses ad hocport support teams provided by themoving units to finalize the preparation


At Hagaru-ri, when the casualties started to flow from north and south, C andE Medical Companies (with a listed bed capacity of 60 each) expanded theirfacilities over and over again. C Company, for instance . . . treated 400 patientssimultaneously; E Company handled 600 patients at one time.

SOURCE: After Action Report1st Marine Medical Battalion In North Korea

November 1950

and loading of vehicles and equipmentfor shipment.

• Maintaining unit integrity duringredeployment is as critical to readinessas it is during deployment. Whenpossible, containerized unit equipmentwill be shipped with the unit’s non-containerized cargo. This requires in-transit visibility of the cargo to facilitatediversion en route, if required.

b. USAF Redeployment

• Pre-positioned assets (CHs, mobileaeromedical staging facility, aeromedicalstaging facilities, blood donor centers[BDCs], and blood transshipmentcenters [BTCs]) are normallyreconstituted “in-place” unless theyare being deactivated. A completeinventory is conducted, table ofallowances are validated, andappropriate records adjusted. Qualityassurance data is collected and recorded.Requirements are identified “up-channel” for funding if necessary. Itemsnot in an applicable table of allowanceare segregated and reported as excess.This work is normally accomplishedprior to redeployment of personnel totheir home stations.

• Mobility assets (ATHs, air transportableclinics, and transportable bloodtransshipment centers [TBTCs]) arenormally redeployed to their home

IV-5


base after a complete inventory andcollection of quality assurance data.Assets could also be shipped to AFMLOand/or operating location-2 forrefurbishment. If deployed withMOMEDLOG and a stock recordaccount number, all appropriatetransactions (including table ofallowance validation) can be processedon site. Excess materiel may betransported to the home station forfinal disposition or transferred to theSIMLM or other authorized activities inthe AOR, as directed by higherheadquarters. The mode of shipment forredeployment determines packingmethods. Normally, 463L pallets areused for airlift, and seavans for sealift.Coordination with the supportingtransportation activity is required. Afterthe ATH is received at the home base,requirements are identified for fundingto support reconstitution.

c. USN Redeployment. Upon receipt ofdeactivation orders, Navy MTFs discontinueaccepting patients and begin to arrange forevacuation of patients to an appropriatefacility that can best treat their injuries. Fleethospitals will normally be redeployed to aCONUS location for reconstitution after aconflict. A thorough identification togetherwith appropriate packing, labeling,blocking, and bracing of all appropriatemateriel into International Organization forStandardization containers is required. All

materiel will not be returned to CONUS. Inmaking decisions as to what items to retain,it is imperative to consider the total cost ofan item that must be shipped, refurbished,repackaged, and redeployed. Assistanceteams will be deployed in theater tofacilitate the deactivation of the hospital andto work with the hospital staff in providingfor an orderly redeployment of hospital assets.

d. USMC Redeployment. Uponconclusion of the operation, theMEDLOGCO commanding officer ,through the chain of command, will requestcancellation of outstanding and/or openrequisitions through the SIMLM. Excessmedical materiel which is on hand or in-transit will be evaluated to ensure the mostefficient and effective redistribution plan isenacted. Existing excesses should bereported to the in-theater DefenseReutilization Marketing Office;consideration should be given to cross-leveling medical materiel items with othermedical elements experiencing shortfalls.Medical materiel which was deployed intothe theater of operations by a MEDLOGCOand medical and dental battalions will beretrograded using the same procedures.Maritime pre-positioning ships’ assetswhich were off-loaded and used will bereturned to the maritime pre-positioning forceprogram. All remaining expired andnonfunctional medical materiel will bedisposed of in accordance with local laws andDOD directives.

IV-6

Chapter IV

Joint Pub 4-02.1

Intentionally Blank

CHAPTER VHEALTH SERVICE LOGISTICS SUPPORT IN MILITARY

OPERATIONS OTHER THAN WAR

V-1

1. Military Operations OtherThan War

MOOTW encompass a wide range ofactivities where the military instrument ofnational power is used for purposes other thanthe large scale combat operations normally

“Generally, management of the many is the same as management of thefew. It is a matter of organization.”

Sun Tzu, The Art of W ar400-320 BC

associated with war. There are six jointprinciples which apply to MOOTW, and themedical commander and the health servicelogistics planner must use these principles toguide the planning and execution of the HSSmission. These principles are shown in FigureV-1 and discussed below.

Figure V-1. Principles of Health Service Logistics Support inMilitary Operations Other Than War

PRINCIPLES OF HEALTH SERVICELOGISTICS SUPPORT IN MILITARYOPERATIONS OTHER THAN WAR

Principles of HealthService Logistics

Unity ofEffort

Restraint

Objective

Security

Legitimacy

Perseverance

V-2

Chapter V

Joint Pub 4-02.1

a. Objective. The HSS commanderdirects every HSS mission toward a clearlydefined, decisive, and attainable objective.The military effort must be integrated intothe total effort in achieving strategic aims andculminating in the desired end state. Thejoint health service logistics planner mustunderstand the strategic, operational, andtactical aims, set appropriate objectives, andexecute the HSLS mission in consonance withthe HSS portion of the OPLAN.

b. Unity of Effort. The joint health servicelogistics planner must seek unity of efforttoward every objective. This entailsensuring that close coordination is maintainedwith all Service participants in the HSLSarena, as well as other US agencies, allied andcoalition forces, host nation (HN),nongovernmental organizations (NGOs), andreligious groups. Health service logisticsplanning must address the militarycontribution to MOOTW initiatives that arepolitical, economic, psychological, andmilitary in nature.

c. Legitimacy. Legitimacy involvessustaining the people’s willingness to acceptthe right of the government to govern or of

a group or agency to make and carry outdecisions. For example, in nation assistanceprograms, HSS operations should notundermine the confidence people have in theirnation’s government. HSS operationsshould complement, not detract from, thelegitimate authority of the HN government.US forces are also concerned with thelegitimacy issue when involved with foreigninterventions. Due to its acceptance by thecivilian population, HSS can assist inmitigating the adverse impacts that other USmilitary interventions may cause in a region.

d. Perseverance. In MOOTW, strategicgoals may be accomplished by long-terminvolvement, plans, and programs. Shortduration operations will occur, but theseoperations must also be viewed as to theirimpact on the long-term strategic goals.Therefore, HSS planners must prepare for themeasured, protracted application ofmilitary HSS to support the desired end state.

e. Restraint. MOOTW place constraintson the potential actions that can beundertaken to achieve military objectives.The rules of engagement (ROE) governingthese actions reflect those constraints.

The health services logistics planner must ensure that adequate personneland materiel are available to provide necessary health services.

V-3

Health Service Logistics Support in Military Operations Other Than War

Imprudent action outside of the ROE may,in fact, have a detrimental effect on theattainment of strategic goals and objectives.All forces participating in these types ofoperations must incorporate restraint andadherence to established ROE, laws,regulations, policies, and norms to ensure thefurtherance of the mission accomplishment.

f. Security. The security of US forcesabroad is paramount. Commanders andplanners at all echelons must be aware of theever present danger that can exist from variousgroups, factions, or other governments. Evenin a peacetime environment, US forces canbe targeted for terrorist activities. Healthservice logistics planners must ensure theyinclude force security measures as well assecurity measures for safeguarding healthservice logistics materiel from contamination,destruction, or theft.

2. The Role of Joint HealthService Logistics

a. Health service logistics plays asignificant role in the delivery of health carein MOOTW. As most MOOTW missionsare conducted within an immature theater orunder disaster conditions, the full complementof logistics capabilities and services may notbe in place or may have been destroyed. Thehealth service logistics planner must beflexible and innovative to be able to bridgethe gap between the requirements generatedby the operation and the capability to providethe necessary Class VIII materiel.

b. Each Service should deploy with anadequate number of days’ supply of healthservice materiel to accomplish the missionuntil push package resupply or a line itemrequisition support is established.

c. To ensure that the correct mix ofpharmaceuticals and equipment are availablefor the mission, the health service logistics

planner must maintain close coordinationwith the clinicians.

3. Operational Missions

HSLS can provide traditional logisticsupport to deployed forces or may beincorporated into OPLANs for other typesof operations shown in Figure V-2.

a. Prior to a deployment on anoncombatant evacuation operation(NEO), the senior medical personaccompanying the force should be providedinformation by regional CINC or major Armycommand level personnel (such as a CountryTeam) to determine if there are any specialmedical supply or equipment requirements.These items could include pediatric orgeriatric medicines and medical equipment,depending on the composition of theevacuees. Under most circumstances, theClass VIII supplies and equipment theforce brings with them is all that they willhave to sustain themselves and the evacuees.In a permissive NEO, it may be possible toobtain more medical supplies or equipment

Figure V-2. Selected Types ofMOOTW Operations

SELECTED TYPESOF MOOTW

OPERATIONS

!

!

!

!

Noncombatant evacuation

Humanitarian assistance

Nation assistance

Peace operations

V-4

Chapter V

Joint Pub 4-02.1

locally; however, these supplies andequipment must meet stringent USrequirements. Further, caution must be usedwhen acquiring medical equipment locally,as the equipment may not be approved foruse on USAF aircraft.

b. In disaster relief operations, themanagement of Class VIII materiel iscritical to the successful completion of themission.

• An assessment of the disaster area (toinclude coordination with other agenciesor countries providing assistance) mustbe accomplished to determine howmany victims requiring assistance thereare and what types and quantities ofsupplies and equipment are required andwhether the materiel is currentlyavailable or anticipated to be donated.

• The JTF commander may task-organize an HSLS element to providefor the management, receipt, sorting,storage, repackaging, distribution, andaccounting for donated medical suppliesand equipment. This task-organizedelement would further be responsiblefor the requisition, receipt, andaccountability of Class VIII resourceswhich are required but cannot be metthrough donated materiel.

c. In humanitarian assistance operations,the health service logistics planner mustobtain and coordinate transportation andreceive, sort, store, and distribute ClassVIII mat eriel. Depending upon the scopeof the operation, there may also be donatedmedical supplies which must be handled,stored, repackaged, and distributed. Dueto the remote locations of manyhumanitarian assistance missions,transportation of medical personnel andmedical materiel is critical to the successfulcompletion of the missions.

d. In nation assistance operations, healthservice logistics personnel can assist an HNby conducting an assessment of the militaryor civilian medical supply infrastructureand industry. In many countries, a formalhealth service logistics system does not existor is rudimentary in nature. Health servicelogistics personnel can provide an analysis,assist in establishing a system, and providetraining in materiel handling, storage, anddistribution techniques.

e. In peace operations, the HSLS missionis more the traditional support to adeployed force. Due to the austere staffingand troop ceilings placed on many of thesemissions, the health service logistics elementmay be restricted in size. Other than thestrategic delivery of materiel, the functionsof receiving, storing, accounting for,requisitioning, repackaging, opticalfabrication, and managing blood and bloodproducts may be accomplished in anothercountry or safe haven.

4. Domestic Support

Throughout the history of the UnitedStates, military personnel have been calledupon to provide assistance to federal, state,and local governments during times of need.This assistance can take the form of disasterrelief as occurred following HurricaneAndrew in 1992, community assistance,environmental assistance, and lawenforcement support. Because the lawsgoverning military assistance to state andlocal governments and agencies are complex,the commander receiving the request forassistance should review it cautiously andobtain an opinion from the support staff judgeadvocate.

a. Humanitarian assistance includesthose disaster and civil defense activities,functions, and missions in which theDepartment of Defense has legal authority

V-5


to act. The Department of Defense providesdisaster assistance to states, the District ofColumbia, and US territories and possessions.Assistance is based upon requests from civilauthorities and usually as a result of naturalor manmade disasters, such as hurricanes,earthquakes, or massive explosions. PublicLaw 93-288 (as amended) is the authorityfor the Federal Response Plan. Theemergency support function (ESF) #8 is theHealth and Medical Services Annex of theFederal Response Plan. The purpose of thisfunction is to provide US Governmentassistance to supplement state and localresources in response to public health andmedical care needs following a significantnatural disaster or manmade event. Theassistance provided under ESF #8 is directedby the Department of Health and HumanServices (DHHS) through its executive agent,the Assistant Secretary for Health.

• In civil emergencies, the principalinterface for the Department of Defensewill be with the Federal EmergencyManagement Agency, the DHHSregional coordinators, and the state’smedical and health coordinators.

• At the onset of the operation, criteria foreligibility for care must be established,an assessment of the assistance neededmust be conducted, the duration of theoperation must be estimated, and the endstate of transitioning control back to thecivil authority planned. In the HSLSarena, a determination must be made ofwhat supplies and services arereimbursable and what governmentalagency or organization is responsible forthis reimbursement.

• Depending on the magnitude of thedisaster, the local civilian hospitals andother medical resources may beoverwhelmed. In the event thecommunity’s medical infrastructure isnot sufficient to handle the emergency,

the NDMS may be activated. TheNDMS is a nationwide network of over100,000 nonfederal acute care hospitalbeds. Other in-place resources to executerelief operations include communicationsnetworks, transportation systems, andmedical regulating systems. Thenational medical mutual aid responsenetwork provides disaster medicalassistance teams, available militarymedical units, and supplementarymedical supplies and equipment.

b. HSLS to the other categories ofdomestic support are limited. Supportwould normally be only that which is requiredfor the deployed military personnelparticipating in the operation.

c. Refer to Joint Pub 3-07.7, “Joint Tactics,Techniques, and Procedures for DomesticSupport Operations,” for an in-depthdiscussion of domestic support operations.

5. Funding

A significantly important aspect ofconducting MOOTW missions is the fundingmechanism for the operation. Funding cancome from a variety of sources, such asinternal DOD sources, funds approved byCongress for a specific operation, other USgovernmental agencies, internationalgovernments or organizations, and NGOs (toinclude charitable and religious groups). Thehealth service logistics planner must ensurethat he is knowledgeable of the funding andreimbursement mechanisms of the specificmission before obligating funds for healthservice materiel purposes.

6. Planning Considerations

See Figure V-3.

Planning for MOOTW uses the sameplanning process as that of any militaryoperation. The health service logistics

V-6

Chapter V

Joint Pub 4-02.1

planner, however, must use innovativethinking and incorporate flexibility into theHSLS plan to ensure responsive support in achallenging and possibly novel environment.

a. The type and duration of theoperation will influence the composition ofthe health service logistics element, the typesand quantities of medical materiel required,and the level of development of the HSLSsystem facilities. Further, troop ceilinglimitations may also restrict the number ofHSLS personnel in the operational area.

b. In many developing countries,obstacles to rapid and efficient

transportation may present unrecognizedchallenges. The HSLS planner must considerexistence and capabilities of port facilities(such as depth of the harbor, availability ofmaterials handling equipment, or refrigeratedstorage capabilities) and the state ofdevelopment of the country’s road network.Many developing countries do not haveextensive improved roadways and, as theoperation moves away from populated areas,the road networks deteriorate or cease toexist. In humanitarian assistance and disasterrelief operations, it often requiresnontraditional approaches to maintain acontinuous flow of medical materiel intoisolated areas.

Figure V-3. Planning Considerations

PLANNING CONSIDERATIONS

Type andduration ofoperation

Obstacles torapid andefficient

transportation

Diverseethnic,

cultural, andreligiouspractices

Sources ofsupport

Endemicdiseases, poor

sanitaryconditions

PLANNINGCONSIDERATIONS

Increasedexposure todisease indevelopingcountries

V-7


c. Due to the prevalence of endemicdiseases, poor sanitary conditions, andincreased exposure to disease in developingcountries, HSLS must closely coordinatewith medical treatment elements to ensurethat appropriate quantities and types ofmedicines needed to counter the threat areavailable.

d. Diverse ethnic, cultural, and religiouspractices challenge the HSLS planner tobe cognizant of the sensibilities of the

population supported in the health servicelogistics area.

e. Other sources of support should beconsidered by the HSLS planner. Thissupport may come from the other federalagencies, allied or coalition forces, or theHN. Due to stringent federal regulationsconcerning drug standards and the highlysophisticated technology of medicalequipment, the availability of this type ofsupport may be limited.

V-8

Chapter V

Joint Pub 4-02.1

Intentionally Blank

CHAPTER VIBLOOD MANAGEMENT

VI-1

SECTION A. THE ARMEDSERVICES BLOOD

PROGRAM

1. General

Established by the ASD (HA), the ArmedServices Blood Program (ASBP) providestransfusion products when required to USforces worldwide. Tri-Service cooperativeefforts between the US Army, Navy, and AirForce enable blood and blood products to becollected, tested, processed, and shipped to

“Blood is the price of victory.”

ClausewitzOn War, 1832

military MTFs throughout the world. Theplanning and execution for the effectivemanagement of blood and blood productsis a continuing, dynamic process requiringa coordinated, highly responsive system thatextends from CONUS to the battlefield. Thevarious aspects of this coordination aredepicted in Figure VI-1.

2. Armed Services BloodProgram Office

The Armed Services Blood Program Office(ASBPO) (Figure VI-2) is chartered by the

Figure VI-1. The Armed Services Blood Program

THE ARMED SERVICES BLOOD PROGRAM

MilitaryDepartments

DOD Health AffairsOASD (HA) Policy

CivilianBlood Agencies

Military BloodResearch

Laboratories

FederalAgencies

Armed Services WholeBlood Processing

Laboratories

Allied BloodPrograms

Defense MedicalStandardization

Board

ASBPO

The Joint Staff J-4(MRD) Operations

Unified CommandJBPOs

Armed Services Blood Program OfficeDepartment of DefenseDirector for Logistics, Joint StaffJoint Blood Program OfficeMedical Regulating DivisionOffice of the Assistant Secretary of Defense (Humanitarian Assistance)

ASBPODODJ-4JBPOMRDOASD (HA)

VI-2

Chapter VI

Joint Pub 4-02.1

Department of Defense to coordinate theprovision of blood products throughout theServices to meet medical requirementsduring national emergencies and overseasmilitary operations . The ASD (HA) willprovide overall policy guidance in bloodprogram matters.

These programs shall adhere to ASD (HA)policies, and meet the Food and DrugAdministration (FDA) regulations publishedin the Code of Federal Regulations and ArmyField Manual 8-70, NAVMED P-5120, AFI160-11, and follow the procedures of theAmerican Association of Blood Banks(AABB) as established in Army TechnicalManual 8-227-3, NAVMED P-5101, AFM160-50. The Chairman of the Joint Chiefsof Staff reviews and provides guidance onall matters pertaining to blood support injoint operation planning and execution aswell as activation of the ASBPO incontingency and war. The ASBPOcoordinates implementation of the ASD (HA)policies and DOD procedures for the ASBP.The ASBPO is under the policy guidance ofthe ASD (HA). The ASBPO:

a. Coordinates and monitors the bloodprograms of the US Army, Navy, and AirForce and that of each geographic combatantcommand.

b. Coordinates standardization of policiesthrough the ASD (HA) for the collection ofblood and the operation of the Services’ bloodprograms.

c. Coordinates the development andsubmission of specifications on the essentialcharacteristics of required blood programequipment to the DMSB.

d. Performs liaison with other federal,civilian, and allied and coalition agenciesconcerning blood-related matters. TheSecretary of the Army shall provideappropriate support personnel, facility, andbudgetary resources as required to ensure thatthe responsibilities of the ASBPO can beproperly discharged.

e. Directs the Services, upon mobilizationor during periods of increased blood needsfor contingency operations, to meet required

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

THE ARMED SERVICES BLOOD PROGRAMOFFICE ORGANIZATION AND COORDINATION

Deputy Director(Modernization)

Armed ServicesBlood ProgramOffice Director

Deputy Director(Operations)

VI-3

Blood Management

quotas of blood or blood products to beshipped to designated Armed Services WholeBlood Processing Laboratories (ASWBPLs).

3. Service Blood Programs

The US Army, USN, and USAF maintainseparate blood programs to meet normalpeacetime requirements. To meet ASBPcontingency requirements, the Services directexpansion of their BDCs to rapidly expandtheir blood collecting capabilities. Additionalresponsibilities of the Services with regard tothe ASBP are described in DOD Directive6000.12, “Health Services Operations andReadiness,” and DODI 6480.4, “ArmedServices Blood Program (ASBP) OperationalProcedures.”

4. Geographic CombatantCommands

Each geographic combatant commandmaintains a separate integrated system forproviding blood products to the variousService components’ MTFs within theCINC’s AOR. The geographic combatantcommand Joint Blood Program Office(JBPO) serves as the overall blood managerwithin each command. In support ofgeographic command OPLANs, the ASBPOestablishes shipment requirements forliquid and frozen blood products fromCONUS ASWBPLs to the respectivegeographic commands. Frozen bloodproducts can be pre-positioned in designatedgeographic combatant commands to augmentblood requirements during the initial days ofan armed conflict.

a. Joint Blood Program Office. TheJBPO is under the staff supervision of thecombatant command surgeon. This office isresponsible for the joint blood programmanagement in the theater of operations.The organization of the JBPO depends on theoverall command mission. Personnel areassigned from all Service components asnecessary to meet the blood operationalrequirements. The JBPO:

• Advises the geographic combatantcommander on all matters pertaining totheater blood management activities.This shall include the development of theconcept of operations for the bloodprogram and the writing of the supportingOPLANs using command mobilizationplanning factors. Mobilization planningfactors will include the establishment andcoordination of Area Joint BloodProgram Office (AJBPOs) as necessary.

• Ensures ASBP policies are followed byevaluating BDCs and Blood ProductDepots (BPDs) to ensure compliancewith policies, standards, and regulations

Efficient blood management and distribution oftenis the difference between life and death in the field.

VI-4

Chapter VI

Joint Pub 4-02.1

of the ASBPO, the FDA, and the AABB.

• Provides managerial and technicaloversight of all DOD military bloodactivities within the AOR, to include thecoordination of Service component bloodprograms, blood product requirements,and capabilities within the theater ofoperations.

• Maintains direct liaison with theASBPO.

• Plans and executes Joint BloodProgram exercises.

• Evaluates the AJBPO, BDC, BPD,BTC, and blood supply units (BSUs)to ensure that personnel, equipment, andresource requirements are addressed inthe geographic combatant commandOPLANs.

b. Area Joint Blood Program Office.The combatant command surgeon may directthe establishment of AJBPO to provideregional blood management in the theater.The AJBPO may be established uponactivation of a JTF as outlined in therespective OPLAN or operation order. Thefunctions of an AJBPO are similar to aJBPO, but in a limited geographical area.The AJBPO:

• Coordinates blood requirements anddistribution of blood and bloodproducts to support all the BSUs andMTFs in the AJBPO area regardless ofService component. This includesdefining the distribution system for bloodand blood products at all echelons, fromthe supporting BTC or BSU down to theMTF.

• Evaluates BDC, BPD, BTCs, BSU, andMTF transfusion services within theoperational area to ensure therequirements of the JBPO are supported or

addressed in the geographic combatantcommand and/or JTF OPLAN.

SECTION B. BLOODSUPPORT IN THE

CONTINUUM OF CARE

5. Blood Distribution System

Blood and blood products are more thanjust another commodity of medical supply.Blood is a live tissue and, as such, requireshandling by individuals specially trainedin blood movement and storage.

a. Blood support in a theater of operationscontaining actual combat operations is adynamic and ever-evolving process, heavilyinfluenced by:

• Stringent storage and handlingrequirements.

• Inventory management constraints.

• Limited potency periods.

• Available technology.

b. To be successful, blood support mustbe an organized and cooperative effort onthe part of health service logisticians,laboratory and blood bank personnel,transportation personnel, and primary healthcare providers.

c. Theater blood support duringwartime is provided to US military facilitiesand, as directed, allied and coalition militaryand indigenous civilian medical facilities.Service components under the geographiccombatant commands maintain individualpeacetime blood programs to meet theirindividual needs. These programs interfacewith CONUS blood bank services and receiveblood components directly from establishedDOD joint programs.

VI-5

Blood Management

d. Theater blood support may consist ofa combination of liquid and frozen bloodcomponents. The actual ratio of liquid tofrozen blood components is determined by theurgency of need and availability of resourceswithin the theater of operations to handlefrozen blood.

e. Blood services in a theater ofoperations containing actual combatoperations consist of a combination ofoperational capabilities. Of importance arethe following:

• Receiving blood components from thesupporting base.

• Moving, storing, and distributing bloodcomponents to primary users.

• Storing, processing, and distributingpreviously frozen blood components pre-positioned within the theater.

• Collecting and processing blood in thetheater of operations. (This may beaccomplished on a routine or anemergency basis depending on thecombat intensity.)

f. T h e A r m e d S e r v i c e s B l o o dDistribution System from the supportingbase to the MTF is depicted in Figure VI-3.A JBPO or an AJBPO will be responsiblefor the Joint Blood Distribution Systemwithin their geographic area. The JBPOworks for the geographic combatant commandsurgeon. The AJBPO, when formed, maywork for the JTF surgeon of a subordinate JTFor for a component command surgeon. TheAJBPO mission is based on a geographic areaas well as a specific command. Therefore,AJBPO shall plan and train for jointoperations and shall coordinate with theJBPO for all blood operations. Geographiccombatant command, subunified commandand JTF OPLANs will include projectedblood requirements developed by JOPES.

These requirements are documented inAppendix 2 of Annex Q, “Medical Servicesto the Unified Command” OPLAN asprescribed in CJCSM 3122.03, “JointOperation Planning and Execution System,Vol II: (Planning Formats and Guidance).”

g. MTFs will:

• Maintain an amount of blood productson hand necessary to meet operationalrequirements, yet minimize waste dueto out-dating. MTFs have the capabilityto collect blood in emergencies. Thispractice is not encouraged, however,since the MTF does not have thecapability to perform serological testingof these units for infectious diseases. Asample of serum must be kept of allemergency donations for retrospectivetesting purposes. In addition, theattending physician must certify inwriting that the use of blood not fullytested is required to sustain the life of thepatient.

• Submit a daily blood report(BLDREP) (Appendix B, “BloodManagement”) to their supportingBSU, as designated by the JBPO orAJBPO. This BSU may be from anyService component. In certain jointoperations, such as small contingencyoperations or in MOOTW, MTFs maydeploy with blood if a requirement to useblood prior to establishment of theresupply chain is anticipated. In this case,the ASBPO should be notified tocoordinate the provision of the necessaryblood products.

h. A BSU can usually support amaximum of 12 MTFs depending on thesituation, and may include forces afloat. Themission of the BSU is to collect blood on anemergency basis and receive, perform limitedtesting, store, process, and distribute bloodproducts to its supported MTFs. A BSU:

VI-6

Ch

ap

ter V

I

Join

t Pu

b 4

-02

.1 Figure VI-3. Armed Services Blood Distribution System

ARMED SERVICE BLOOD DISTRIBUTION SYSTEM

US ArmyBlood Donor Center

US Air ForceBlood Donor Center

US NavyBlood Donor Center

CivilianBlood Donor Center

JointStaff

Armed Service BloodProgram Office

Armed Services WholeBlood Processing

Laboratory

Unified Command

Joint BloodProgram

Office

Area Joint BloodProgram Office

Blood TransshipmentCenter

Transportable BloodTransshipment Center

Division MedicalSupply Office 2E

US Air Force MedicalTreatment Facility

US Army MedicalTreatment Facility

US Navy MedicalTreatment Facility

US Navy Ships MedicalTreatment Facility

2 E MedicalTreatment Facility

Blood SupplyUnit

US MarineCorps BloodSupply Unit

BloodProductDepot

US Army, Air Force,and Navy BloodProgram Offices

COORDINATIONBLOOD FLOWREPORTS

Supporting Base Theater ofOperations

VI-7

Blood Management

• Is responsible for maintaining aminimum of a 5-day supply of bloodproducts based on MTF BLDREPrequirements.

• Is deployable with blood products whenthe operation involves immediateconflict.

• Is tailored to force packages forcontingency operations.

• Can be tasked by the geographiccombatant commander to manage a BPD.

• Can be tasked by the senior medicalauthority to collect, process, store, anddistribute platelets within a theater.

• Can provide a consolidated BLDREP(from its MTFs) to the AJBPO.

i. The BPDs have been built intogeographic combatant commands toprovide storage for frozen RBCs and FFP.(Frozen platelets have not been licensed bythe FDA. Once this product is licensed, itmay also be stored in BPDs.)

• Blood product depots:

•• Are needed to offset strategicshortages of blood products during theinitial stages of an operation until theliquid RBC units can be shipped into thetheater.

•• Provide frozen blood products to shipsoffshore.

•• Have the capabilities to distributefrozen products as well as todeglycerolize frozen RBCs.

•• Issue blood and blood products toBSUs, as required.

•• Act as a BSU and distribute blood andblood products to MTFs.

•• Provides daily BLDREP to theirrespective AJBPO or JBPO, whenoperational.

• Geographic combatant commands areresponsible for ensuring that BPDs aremaintained, manned, equipped, andsupplied during peacetime operation.

j. The BTCs and TBTCs are managedby the USAF at primary airfields withinthe operational area. They receive bloodproducts from the ASWBPL, store them, andre-ice and distribute them to BSUs or MTFswhen required. They provide dailyBLDREPs to their respective AJBPO orJBPO. The TBTCs may be airlifted todesignated airports or landing zones tomaximize blood distribution and to providefor BTC operations not otherwise availablein the theater.

NOTE: Assets to meet anticipated EPW,civilian, and valid allied or coalition personnelworkload must be included in the TPFDD asdocumented in accordance with CJCSM3122.03, “Joint Operation Planning andExecution System, Vol II: (Planning Formatsand Guidance).” Additionally, a 5-day safetyfactor will normally be added to the bloodrequirements in combat zone, operations zoneI to take into account LOCs disruption,damage, and in-transit spoilage.

6. Available Blood Products ByEchelon

Figure VI-4 provides a summary of theblood products now available to the theater,as well as the echelon at which they areprovided.

a. The storage temperature for liquidRBCs is 1 to 6° Centigrade (C).

VI-8

Chapter VI

Joint Pub 4-02.1

b. The storage temperature for frozenRBCs is -65°C or colder. Once frozen bloodhas been deglycerolized, it can be stored upto 3 days at 1-6°C prior to transfusion.

c. Fresh frozen plasma is stored at -18°Cor colder. Once FFP is thawed, it must betransfused within 24 hours.

d. Platelet concentrates are normally keptat room temperature, 20-24°C.

e. Frozen blood shelf life has beenlicensed by the FDA for 10 years and 24 hourspost thaw. However, the DMSB allows for21 years/3 days post thaw for wartimerequirements.

7. Blood Transfusion PracticeBy Echelon

Figure VI-5 provides the blood productsavailable by echelon as well as the bloodtyping system (ABO) and Rhesus (Rh) factorgroup for each echelon.

SECTION C. PLANNING FOREFFECTIVE BLOOD

MANAGEMENT

8. Coordination

Continuous planning for mobilizationand other contingencies enables the Servicesto rapidly respond to situations requiringblood support.

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

BLOOD PRODUCTS (CLASS VIIIb) AVAILABLE TO THE THEATER

PRODUCT UNITOF

ISSUE

SHELFLIFE FORSTORAGE

ECHELONAVAILABILITY

DISTRIBUTION

O A B AB

RBCs APPROX250ml

35 DAYS(42 DAYSWITH ADSOL)

IIIII & IV

100%50%

---40%

---10%

------

FROZENDEGLYC-EROLIZEDRBCs

APPROX250ml

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

FFP APPROX250ml

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

PLATELETCONCEN-TRATE

APPROX300ml

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

LEGEND: APPROX-APPROXIMATELY ml-MILLILITERS

VI-9

Blood Management

Figure VI-5. Blood Transfusion Practices by Echelon

BLOOD TRANSFUSION PRACTICES BY ECHELON

ECHELON BLOODPRODUCT

ABO & RhGROUP

TRANS-FUSION

SERVICE

STORAGECAPACITY

BLOODRESUPPLY

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

II RBCsRh+-

O ABO GROUPDONORRBCs**

50 UNITS PERMED FLDREFRIG-ERATION

IIIBLOODSUPPLY

UNITS (BSU)

IIID304(1)*

RBCsRh+-

O,A,B ABO & Rh 480 UNITSLIQUID

IIIBSU

MAJOR SIDECROSS-MATCH

(IS)

IIID304(2)*

RBCs O,A,BRh+-

SAME ASD304

475 UNITSFZ

480 UNITSLQ

IIIBSU

FRESHFROZEN

PLASMA (FFP)

A,B,ABRh+-

NONE 20 UNITS IIIBSU

PLATELETCONCEN-

TRATE (ASNEEDED)

O,ARh+-

NONE 5 UNITS IIIBSU

UNITS

IV SAME ASD404

SAME ASD404

SAME ASD404

SAME ASD404

IVBSU

*CAPABILITY TO COLLECT AND PERFORM THE ABO AND Rh GROUP DETERMINATION ON 180UNITS OF WHOLE BLOOD FOR EXTREME EMERGENCIES.**NOT NECESSARY IF ASWBPL HAS VERIFIED THE ABO GROUP.

NOTE: (1 )D304 IS A LIQUID-ONLY DEPMEDS MODULE. (2) D404 IS A HYBRID LIQUID-FROZEN DEPMEDS MODULE.

VI-10

Chapter VI

Joint Pub 4-02.1

a. A coordinated effort between the theaterJBPO and the theater operations officer andplans officer is required for successful planning.Operation plans dictate blood managementstrategy. Some issues include:

• Will blood be required immediately uponarrival of the combat units?

• Should blood be brought into the AORwith the initial medical units?

• Will there be multinational operationsand will the JBPO be responsible forblood requirements of multinationalforces?

• Do the storage capabilities of the BTCsand/or TBTCs, BSUs, and BPDs supportthe blood product requirements?

• Will BPD and/or MTF capabilities todeglycerolize frozen RBCs meet bloodrequirements prior to shipments of liquidRBCs from the supporting base?

• Are transportation assets readily availablefor emergency blood productdistribution?

• Where will the air terminals be located?

b. Location of BTCs is dependent uponthe location of air terminals andoperational necessity. Blood storagecapability at a BTC is usually 3,600 to 7,200units. With additional personnel andequipment, this may be expanded to meetoverall command requirements. BTCpersonnel must have knowledge of theavailable Army blood bank platoons, BSUs,and the types and locations of the MTFs inthe combat zone for proper planning.

c. Timely communication with the nexthigher echelon of support usually ensures thatadequate supplies of blood and blood productsare available.

9. Blood Planning

a. Product Availability. Liquid RBCs andFFP are available for use. Frozen plateletconcentrates are not yet available, and it isdifficult to provide liquid platelet concentratesto the AOR within the current 5 day datingperiod.

b. Shipping Red Blood Cells. Subject toavailability, RBCs shipped from CONUS arepacked with the unit group and typedistributions as depicted in Figure VI-6.

c. Blood Planning Factors. Blood planningfactors are programmed in the medicalplanning module by the Joint Data SystemsSupport Center and subsequently used by therespective combatant command medicalplanners to generate daily blood productrequirements (Class VIIIb) for the theater ofoperations. Generally, 20 percent of all RBCswill be given at Echelon II, 60 percent at EchelonIII, and 20 percent at Echelon IV.

d. Blood Support to Rh Patients

• Females. Transfusing Rh positiveRBCs to Rh negative females atEchelon II facilities, where bloodgrouping and typing capabilities are notavailable, may result in futurecomplications if the female is of child-bearing age.

• Males. Although the impact ofsensitization on males and the health caresystem is not as great, the proceduralchanges for transfusions at Echelon IIwill also help to reduce sensitization toRh negative males.

e. Total Blood Product Requirements.Initial blood planning factors to determine theestimated total blood product requirementsfor the theater of operations as established inthe geographic combatant commander’sOPLAN are listed in Figure VI-7.

VI-11

Blood Management

f. Pre-positioned Frozen BloodProducts. Pre-positioned frozen bloodproducts or blood shipped from CONUS willreduce the requirements to collect blood inthe operational environment. Capabilitiesto collect and process blood in the theaterare limited, but when required, may provideplatelets. Theater collection capabilities existat DEPMEDS-equipped Echelon III MTFs(180 units) and at certain BSUs, BPDs, andUSN vessels. This capability is not meant tosupply local needs. The health servicelogistics planner must realize that Echelon IIand III facilities generally do not have thepersonnel, supplies, or equipment forextended donor operations or for serologicaltesting for diseases such as humanimmunodeficiency virus, hepatitis, andsyphilis.

g. Armed Services Blood ProgramOffice Reaction Time. The reaction timeof the ASBPO or other supporting JBPO must

be considered. Optimally, receipt by therequesting command of blood or bloodproducts for sustainment of operationsshould take no longer than 72 hours. Withinsome Unified Commands, BPDs with pre-positioned frozen blood products have beenconstructed to provide blood products priorto the delay in receiving liquid blood productsfrom CONUS. This is especially importantin theaters where the command anticipatesshort notice or no notice of impending combatoperations where large numbers of casualtiescan be expected. Most MTFs should planto keep a 3-day supply of blood and bloodproducts on hand. Most BSUs should havea 5-day inventory goal. Realistically, aplanner may expect a 4- to 5-day resupplyresponse time from outside the theaterdependent upon at least two factors:

• Availability of air transportation.

• Location of the operational needs.

h. Red Blood Cells Shelf Life. Currently,the health service logistics planner canexpect RBCs to be at least 8- to 10-days oldupon receipt. Blood collected in CPDA-1(an anticoagulant preservative solution) andstored at 1° to 6°C expires 35 days aftercollection. This leaves a maximum shelf lifeof 25 to 27 days for use within the theater.However, with use of an additive solution, theshelf life of the RBCs is extended 7 moredays (or for a maximum shelf life of 42 daysafter collection).

i. Needs for Intelligence. Once locatedin the AOR, it is necessary for the JBPO tomaintain current information on thecombat situation and on the anticipatedactions of friendly and enemy forces. Thebest sources of this information are the jointforce intelligence officer and the operationsofficer. As required, the health servicelogistics planner can anticipate increasingrequirements for the AOR as a whole, or hemay reallocate resources within the AOR to

Figure VI-6. Unit Group and TypeDistribution

UNIT GROUP AND TYPEDISTRIBUTION

BLOODGROUP/TYPE

DISTRIBUTION

O Rh POSITIVE 40%

O Rh NEGATIVE 10%

A Rh POSITIVE 35%

A Rh NEGATIVE 5%

B Rh POSITIVE 8%

B Rh NEGATIVE 2%

VI-12

Chapter VI

Joint Pub 4-02.1

support specific operations. A goodreporting and inventory control system iscrucial:

• How much blood is in the command?

• Where is it concentrated?

• Is it where the “action” is?

• Should blood or blood components berelocated?

10. Host-Nation Support

a. Host-Nation Blood Bank Support.The health service logistics officer will contactthe CINC’s staff to determine if there areexisting bilateral agreements in place, andto evaluate if health service issues and/orrequirements have been determined. Medicalintelligence will provide additionalinformation upon which to base a decisionon the comparability of HN blood withreference to required FDA level of bloodtesting and the willingness and ability ofthe HN to provide blood bank support.This support could take the form of additionalunits of blood or RBCs, additionalrefrigerators in local hospitals or hotels, ice-making capability, or sources for dry ice tostore FFP or frozen RBCs.

b. Obtaining Alternative Ice Sources.Blood bank units and MTFs, along withunits involved primarily with the storage andshipment of blood and blood components,must develop alternative sources for iceand refrigeration in case of equipmentfailure. These alternative sources can includeother military units in the area or HN sources.

11. Logistical Considerations ofBlood Support

a. After the decision has been made onwhere to locate the blood banks and theconcept of operations for blood support hasbeen established, plans must be coordinatedto effect the timely distribution of blood andblood products throughout the theater ofoperations. Prior planning must beaccomplished with the joint movement centerto establish procedures for the emergencymovement of blood. Specific informationrequired when shipping blood by air includesweight, number of units, and number ofboxes.

b. After transportation requirements andpriorities have been established, planningconsideration must be given to maintainingadequate levels of required supplies for theplanned operational scenario. If the Army isthe dominant user, a MEDLOG battalion will

Figure VI-7. Blood Component Planning Factors

BLOOD COMPONENT PLANNING FACTORS

RBC 4 UNITS FOR EACH WOUNDED IN ACTION(WIA) AND EACH NONBATTLE INJURY (NBI)CASUALTY INITIALLY ADMITTED TO AHOSPITAL

FFP 0.08 UNITS FOR EACH HOSPITALIZED WIA ORNBI

PLATELETCONCENTRATE

0.04 UNITS FOR EACH HOSPITALIZED WIA ORNBI

VI-13

Blood Management

usually be augmented to perform Class VIIImanagement functions and assume the roleof the SIMLM for the AOR. The SIMLMwill have liaison officers from supportedServices to assist in coordinating logisticssupport requirements during joint orcombined operations. Examples of requiredsupplies include:

• Blood bags with the appropriate anti-coagulant preservative solutions.

• ABO grouping and Rh typing antiserum.

• Test tubes.

• Blood shipping boxes.

• Plastic bags.

• Adequate supply of ice for maintenanceof required blood temperature duringtransit.

12. Maximum Capacities forBlood Product Shipments

Figure VI-8 depicts the maximumcapacities for blood product shipments.

VI-14

Chapter VI

Joint Pub 4-02.1

MAXIMUM CAPACITIES FOR BLOOD PRODUCT SHIPMENTS

1. PALLET, 463L.A. MISSION/CAPABILITIES.

(1) PROVIDES ONE STANDARD SIZE PALLET CAPABLE OFTRANSPORTING 54 BOXES CONTAINING A MAXIMUM OF 972 UNITS OFFROZEN RBCs.

(2) THE 463L STANDARD PALLET MEASURES 108 X 88 X 4 INCHES.THE MAXIMUM LOADED HEIGHT IS 96 INCHES AND MAXIMUMALLOWABLE WEIGHT IS 8,000 POUNDS. A PALLET WITH CARGO NETWEIGHS 354 POUNDS.

B. CHARACTERISTICS OF LOADED PALLETS.(1) A LOADED PALLET WITH 54 BOXES OF 18 UNITS EACH

WEIGHS 4,350 POUNDS AND HAS A VOLUME OF 432 CUBIC FEET. BOXESARE STACKED 3 WIDE X 6 LONG X 3 HIGH. TOTAL CAPACITY IS 3,600UNITS OF RBCs.

(2) A LOADED PALLET WITH 120 BOXES OF FROZEN PLASMAWEIGHS 6,000 POUNDS AND HAS A VOLUME OF 360 CUBIC FEET. TOTALCAPACITY IS 2,160 UNITS (IF FFP UNITS ARE PACKAGED INDIVIDUALLY)OR 4,320 UNITS (IF FFP UNITS ARE PACKAGED IN PAIRS).

(3) A LOADED PALLET WITH 120 BOXES OF FROZEN BLOODWEIGHS 6,000 POUNDS AND HAS A VOLUME OF 360 CUBIC FEET. TOTALCAPACITY IS 1,560 UNITS OF FROZEN BLOOD (13 UNITS PER BOX WITHDRY ICE). A NEW FROZEN BLOOD SHIPPING CONTAINER USING ANEUTECTIC LIQUID FOR FREEZING INSTEAD OF DRY ICE IS CURRENTLYUNDER DEVELOPMENT AND TESTING. ONCE IT IS STANDARDIZED,PALLET CHARACTERISTICS WILL BE PROVIDED.

2. INSULATED BLOOD SHIPPING CONTAINERS.A. SPECIFICATIONS.

(1) NSN 8145-01-357-1551.(2) EMPTY WEIGHT IS 56 POUNDS WITH 5 EUTECTICS.(3) CUBIC FEET IS 8.0(4) EXTERIOR DIMENSIONS—26 INCHES LONG X 17 INCHES

WIDE X 32 INCHES HIGH.B. CAPACITY: FROZEN RBC OR FFP; 18 UNITS, WEIGHT 18 POUNDS.

Figure VI-8. Maximum Capacities for Blood Product Shipments

CHAPTER VIIHEALTH SERVICE LOGISTICS SUPPORT IN

MULTINATIONAL OPERATIONS

VII-1

1. Composition of MultinationalOperations

a. Multinational operations occur whentwo or more nations join their armed forcesto accomplish a common objective. Theseoperations can occur in war and in MOOTW.

• Alliances are the result of formalagreements between two or morenations to accomplish broad, long-termobjectives. The alliances normally adoptinteroperability standards and procedureswhich are codified in standardizationagreements. The North Atlantic TreatyOrganization (NATO) is an example ofan alliance.

• Coalitions are ad hoc arrangementsbetween two or more nations for theaccomplishment of a specific objective.Once the objective is accomplished, thecoalition is disbanded.

b. Multinational operations must maintaina unified effort toward the common objective.

2. Health Service LogisticsSupport Considerations

a. Logistics support in multinationaloperations presents numerous challengesdue to a variety of different policies,procedures, and practices. Some of theproblem areas that may be confronted areshown in Figure VII-1.

b. Close coordination and continuousliaison with all parties to an alliance or

“Even the bravest cannot fight beyond his strength.”

Homer, The Iliad

coalition is the key to a successful operation.This is especially true in the health servicelogistics arena. Each nation is responsible forproviding HSS to its own forces unless anagreement defining a different arrangementhas been reached. Usually, allied patientsreceived at US MTFs are stabilized andevacuated to their own nations’ facilities oncetheir medical condition permits. In thefunctional area of health service logistics,common medical items which meet thespecifications of all involved nations enhancesthe ability of the HSLS planner to cross-levelmedical materiel, alleviate shortages, andensure continuous HSLS.

Figure VII-1. Multinational OperationsProblem Areas

Difference in doctrine

Differing stockage levels

Logistics mobility

Interoperability concerns

Competition betweenparticipants for commonsupport

Resource limitations

MULTINATIONALOPERATIONS

PROBLEM AREAS

VII-2

Chapter VII

Joint Pub 4-02.1

c. The NATO Standardization Agreementsand the Quadripartite StandardizationAgreements have provided a mechanism forstandardizing medical materiel. Theseagreements describe the specifications for anumber of medical items as well as describingechelons of care, markings on medicalvehicles, patient classifications, andevacuation priorities. Based on theseagreements, the HSLS planner can betterestimate the interoperability capabilities ofthe combined forces. An example of thisstandardization is ensuring that all nations areusing the same size litter so that it will fit intoan evacuation vehicle from any party to thealliance.

d. HSLS faces greater challenges incoalition operations because standardizationof medical materiel has not beenaccomplished over time. As with alliedoperations, each member nation isresponsible for the provision of HSS to itsown forces unless other arrangements havebeen formalized. In coalition operations,however, it may not be possible to cross-levelmedical materiel due to differentspecifications and quality of medical items.

3. Cultural Diversity andLanguage

In multinational operations, significantdifferences in both language and customswill exist between the various participants.Each individual Service member must besensitive to these differences and toaccommodate them when possible.Misunderstandings due to differences inlanguages can be mitigated by usingtranslators. In the HSS arena, however, it iscritical for the health care provider to beable to understand what a patient is tellinghim. To facilitate this process the multi-Service publication, “Medical ServiceMultilingual Phrase Book” (DA Pamphlet40-3, Department of the Navy MedicalPublication 5104, and Department of the AirForce Manual AFMAN 48-142) wasdeveloped for NATO operations. If thelanguages present in the AOR are not includedin this publication, the JFS should develop acommand publication for use by JTF healthservice personnel. This measure wouldenhance the ability of US health servicepersonnel providing medical treatment andmedical administration (to include HSLS) toallied or coalition forces.


I drove on the ice and headed north catching inaccurate enemy rifle andmachine gun fire as I went. Finally, after driving about three and a half miles,I spotted some men lying and crawling around on the frozen reservoir, andsome crawling down the slope leading to the ice. These men had come fromthe convoy of wounded soldiers (31st and 32d Infantry and 57th Field Artillery)trying, as one said, ‘to get to Hagaru the best way we could.’... So I beganbringing them down and sending them to the rear by jeep and sled. Later inthe day Lieutenant Fred Van Brunt and a hospital corpsman joined my jeepdriver, Private Ralph Milton, and me. Altogether we rescued over 300 soldiersfrom the 26 truck convoy. As long as we carried no weapons the Chinese heldtheir fire...I noticed, however, that they had killed all the truck drivers. Theirbodies were still slumped over their wheels.

SOURCE: Lieutenant Colonel Olin L. BeallCommander, Marine Motor Transport Battalion In North Korea

1 December 1950

APPENDIX AAEROMEDICAL SUPPORT EQUIPMENT AND SUPPLIES

A-1

1. Aeromedical EvacuationPatient Support Equipmentand Supplies

Patient support equipment and supplies foruse aboard AE aircraft are contained in 3general subcategories or kits as listed below:

a. Standardized AE In-flight Kits (AirForce TA 887) will remain with the assignedAE crews and will be managed separatelywithin the AE system:

• Cardiac monitor and defibrillator

• 1 pulse oximeter

• 1 oxygen analyzer

• 3-4 continuous intermittent suction units

• Emergency supplies to include:

•• Tracheostomy tubes

•• Chest tube insertion kit

•• Laryngoscope and endotracheal tubes

•• Oral airways

•• AMBU bags

•• First line cardiac drugs (bicarbonate,epinephrine, lidocaine and bretylium)

•• Routine medical supplies (intravenoussupplies, Foley Catheters, nasogastrictubes, reinforcement dressings)

•• Limited amounts of morphine andmeperidine for emergency use only

•• Heimlich valves

b. The following is the DMSB-approvedlist of AE PMIs. The quantities listed equalthe initial PMI requirements contained indeployable modular kits called patientevacuation contingency kits (Air Force TA887D)

NOMENCLATURE QUANTITY

Ventilator 4Pulse Oximeter 4Oxygen Analyzer 4Cardiac Monitor and Defibrillator 4Vital Signs Monitor 4Suction (Continuous or Intermittent) 8Infusion Pump 4Turning Frame 1Locking Restraints 1Spinal Board 10Litter 30IV Pole 30Blankets 30Litter Pads 30Litter Straps 60Traction Appliance 1

Note: Items not listed above will not bemanaged by the PMI return system and arethe responsibility of the originating MTF.

2. The PMIs used in support of the AEmission must be AE-certified by ArmstrongLaboratories, Brooks AFB, Texas, and theAeromedical Evacuation Proponency, Ft.Rucker, Alabama, to ensure proper form, fit,and functionality for fixed- and rotary-wingmilitary aircraft. Refer to USAFSAM-90-26,“Status Report on Medical Material ItemsTested and Evaluated for Use in the USAF

A-2

Appendix A

Joint Pub 4-02.1

Aeromedical Evacuation System” and J/AFI41-30 (draft) for detailed lists of certifiedequipment. An aeromedical certification labelis required to designate AE certification for

all PMI equipment. The DOD standard labelmust be affixed to each piece of AE certifiedequipment.

APPENDIX BBLOOD MANAGEMENT

B-1

1. Purpose of the StandardizedBlood Reporting System

The purpose of the standardized bloodreporting system is to effectively manageblood and blood products, project bloodrequirements, request blood, report bloodinventories, and provide information on theoverall blood element operations of all Servicecomponents in the theater of operations. TheASBPO has developed the contingencyBLDREPs. Use of the Joint Message TextBLDREPs are mandated by CJCSM 6120.05,“Tactical Command and Control PlanningGuidance and Procedures for Joint Operations- Joint Interface Operational Procedures(JIOP) Message Text Formats,” CJCS5725.04, “US Message Text FormattingProgram,” and CJCSM 6120.01, “TacticalCommand and Control Planning Guidanceand Procedures for Joint Operations - JointInterface Operational Procedures (JIOP)Planning Guidance.” The two standard jointmessage text format reports used to reportcontingency blood program operations are theBLDREP and the blood shipment report(BLDSHIPREP).

2. Use of the Blood Report

The BLDREP provides a standardizedmessage format that is used to report bloodinventories, request blood, and projectrequirements. The BLDREP in its full orabbreviated form is used throughout all echelonsof the blood management system. All MTF ormedical treatment elements, including EchelonII, will use the standard BLDREP format. TheJoint Interoperability Tactical Command andControl Systems’ Automated MessagePreparation System and the Message TextFormat Editor are two software programs thatmay be available to automate the BLDREPformatting. Telephonic BLDREPs may be used

in theater. To help reduce the length of themessages, a master menu of BLDREP codeshas been standardized as shown in Figure B-1.

a. The theater blood program manager mayassign brevity codes and designate those linesto be utilized in daily reporting. Locations ofactivities will be reported only on the firstreport or upon relocation.

b. Requests for RBCs should normally bebased on a random distribution of blood groupsand types (that is, 40 percent O positive; 10percent O negative; 35 percent A positive; 5percent A negative; 8 percent B positive; and 2percent B negative). At Echelons III and IV,group and type-specific RBCs should betransfused whenever possible. Certaindesignated MTFs will require Group O RBCsonly. Upon activation, each MTF should requesta base load of blood components.

c. Medical treatment facilities shouldsubmit a daily BLDREP to their bloodsupplier. A complete BLDREP shouldinclude the following:

• Heading of message: from and toaddressees, information copy addressee(s),message classification, operation name,report identification, date and time ofmessage, reference to other messages andthe following lines:

•• Line 1, as of date/time group(ASOFDTG): date and time zone of theBLDREP.

•• Line 2, reporting unit (REPUNIT):name, designator code, and activitybrevity code of the REPUNIT.

•• Line 3, blood inventory: Used toreport the total number of each blood

B-2

Appendix B

Joint Pub 4-02.1

product on hand at the end of the reportperiod. Provide the REPUNIT code orname and activity code when reportinganother blood program activity and/orunit. Total the blood products at the endof the reporting period.

•• Line 4, blood request: Used to reportthe total number of each blood product

requested and time frame needed.Provide the REPUNIT code or name andactivity code when reporting anotherblood program activity and/or unit.

•• Line 5, blood expiration: Used toreport the estimate of the number of eachblood product which will expire withinthe next 7 days.

Figure B-1. Master Menu Codes

MASTER MENU CODES

MANAGEMENT ABC

DEFGHI

JKLMNOP

QRSTUV

WXY

Z

Joint Blood Program OfficeArea Joint Blood Program OfficeArmed Services Whole Blood ProcessingLaboratoryBlood donor centerBlood products depotBlood transshipment centerBlood supply unitMedical treatment facilityNaval vessel

Red blood cellsWhole bloodFrozen red blood cellsFrozen plasmaPlateletsCryoprecipitateTo be determined

Random Group and Type O, A, BRandom Group and Type O, ARandom Type ORandom Type ARandom Type BRandom Type AB

Required within 12 hoursRequired within 24 hoursRequired within 48 hours

Not applicable or see remarks

BLOOD PRODUCTS

TIME FRAME

CATEGORY CODE DEFINITION

BLOOD GROUPS

1. There currently are no frozen platelets. However, this code is used when dealing with plateletconcentrates when they are pooled random donor platelets or platelet pheresis concentrates.

MISCELLANEOUS

B-3

Blood Management

•• Line 6, blood estimate: Used to reportthe estimate of the total number of eachblood product required for resupplywithin the next 7 days. Provide thereporting code or name and activity codewhen reporting another blood programactivity and/or unit (See Figure B-1).

•• Line 7, CLOSTEXT or RMKS: Usedto provide additional amplifyinginformation if required.

•• Line 8, DECL: Mandatory if themessage is classified.

3. Transmission of the BloodReport

a. Method. Message is the primary method,with voice as alternate. Communicationscapabilities of originator and addressee, as wellas urgency of the message subject and/or textmaterial, will determine the method. Messagesshould be sent in immediate precedence becauseof short blood expiration dates. Correct plainlanguage addresses from a current directory mustbe used. The BLDREPs may be transported bycourier if that is more practical and expedient.

b. Frequency. Required as follows unlessotherwise directed:

• MTF (including Echelon II) to blooddonor unit: daily as of 2359Z; reportrequired not later than 0400Z.

• BSU to an AJBPO: daily as of 2359Z;report required not later than 0400Z.

• BPD to an AJBPO: daily as of 2359Z;report required not later than 0400Z.

• BTC to an AJBPO: daily as of 2359Z;report required not later than 0400Z.

• AJBPO to JBPO: daily as of 0400Z;report required not later than 0800Z.

• JBPO to ASBPO: daily as of 0800Z;report required not later than 1200Z.

4. Blood Report Policies

a. Information copies should be kept to aminimum and be specifically required by therespective OPLAN. Increased quantities ofinformation copies overload the messagechannels.

b. If an AJBPO is not established, the BSUand BTC will report directly to the JBPO.

c. The addressee will normally be the nexthigher organization level with whom thereporting unit (originator) is authorized directcommunication: MTF to blood supplier;blood supplier to AJBPO (if established);blood supplier to JBPO (if AJBPO notestablished); BTC to JBPO (if AJBPO notestablished); AJBPO to JBPO (if AJBPO isestablished); JBPO to ASBPO.

d. A BSU of one Service component mayreceive blood reports from an MTF of anotherService component when the BSU is in anarea support role.

e. All BLDREPs should be classified at thelowest level required to meet operationalconstraints.

f. Each MTF, including those at EchelonII, will submit a BLDREP to the supportingBSU as required.

g. The BSU will submit a BLDREP toAJBPO on the status of blood componentsin the BSU, as required. Report will reflectBSU inventory and anticipated bloodrequirements.

h. The BTC blood manager will submit aBLDREP to the AJBPO on the status of bloodcomponents in the BTC.

B-4

Appendix B

Joint Pub 4-02.1

i. The BPD blood manager will submit aBLDREP to the AJBPO on the status of theblood components in the BPD.

j. The AJBPO will submit a BLDREP tothe JBPO on the status of blood componentsin the BTCs and BSU, as required.

k. The JBPO will submit a consolidatedBLDREP to the ASBPO on the status of bloodcomponents in each geographic combatantcommand Joint Blood Program area.

l. Examples of completed BLDREPs(message and voice) are shown in Figure B-2 and Figure B-3.

5. Blood Shipment Report

a. The BLDSHIPREP provides astandardized message format that is usedworldwide in the ASBPOs to report bloodshipments (See Figure B-4).

b. In lieu of standard nomenclature therespective JBPO may assign brevity codes forindividual component blood programelements. The Joint Interoperability TacticalCommand Automated Message Preparationand the MTF may be available to automatethe BLDSHIPREP formatting. To reduce thelength of the messages, a master menu ofBLDSHIPREP codes has been standardized.

Figure B-2. Example of Message Blood Report

EXAMPLE OF MESSAGE BLOOD REPORT

FM:CDR 51ST MEDGP OSAN KOR/BTC//TO: USFKSURGEON SEOUL KOR/KAJBPO//UNCLASOPER/SMITH//MSGID/BLDREP/OSAN BTC/1012221//REF/A/CDRUSFK/090300ZJAN96/-/NOTAL//ASOFDTG/100001ZJAN96REPUNIT/BLUE1/F/OSAN KOR//BLDINVT/-/900JQ/60LS/60MV//RMKS/ONE WALK-IN REFRIGERATOR NEEDS REPAIR//FM:CDR 32ND MEDLOGBN/BSU//TO:CDR JTF CHARLIE SURGEON/AJBOP//INFO:CDR 16MEDGRP/LOG//CONFIDENTIALOPER/VALIANT ENTERPRIZE//MDGID/BLDREP/BSU/1012221//REF/A/CDRUSACOM/090300ZJAN96/-/NOTAL//ASOFDTG/100001ZJAN96//REPUNIT/32ND MEDLOGBN/G/BZ44327432//BLDINVT/-/-/300JQ/60MV//BLDEZP/-/-/15JQ//BLDEST/-/-/3--JQ/30MV//RMKS/COLLECTED 12 UNITS KQ BLOOD FOR EMERGENCY PLATELETREQUEST FOR 5TH EVAN HOSP.SHIPD 12 UNITS WHOLE BLOOD PLUS30 UNITS JQ TO 5TH EVAC THIS REPORTING PERIOD.

B-5

Blood Management

These codes are the same as used for theBLDREP (See Figure B-2).

c. The heading of the BLDSHIPREPmessage includes: from and to addresses,information copy addressee(s), messageclassification, operation name, reportidentification, date and time of message,references to other messages, and thefollowing lines:

• Line 1, ASOFDTG: date and time zoneof the blood shipment.

• Line 2, REPUNIT: name, designatorcode, activity brevity code of theREPUNIT, location of unit.

• Line 3, 1SHIPD: blood products, codes,and/or number of units shipped and/ortotal number of units shipped.

• Line 4, BLDSHIP: blood shipment orair bill control number, aircraft flightnumber, and/or estimated time of arrival.

• Line 5, POC: point of contact at shippinglocation (names, rank, phone number,location).

• Line 6, CLOSTEXT: additionalcomments, such as when the blood willneed re-icing.

• Line 7, DECL: message downgradinginstructions. Required if classified.

d. Example of a completed BLDSHIPREPis shown in Figure B-4.

Figure B-3. Example of Voice Blood Report

EXAMPLE OF VOICEBLOOD REPORT

BLUE THIS IS RED; BLOODREPORT OVERTHIS IS RED; IMMEDIATE,UNCLASSIFIEDLINE 1: 102359ZLINE 2: 32CSH-HLINE 3: 100JS, 80JT, 20JR,50MVLINE 4: 100JQXLINE 5: 25JS, 5JTLINE 6: 700JQLINE 7: RECEIVED 100JQ,TRANSFUSED 100JQEXPIRED 10JS;REFRIGERATOR NEEDSREPAIR K

B-6

Appendix B

Joint Pub 4-02.1

Figure B-4. Example of Blood Shipment Report

EXAMPLE OF BLOOD SHIPMENT REPORT

FR: CDR USAMEDDAC FT KNOX KY//HSLBB//TO; ASWBPL MDGUIRE AFB NJINFO: CDRUSAHSC FT SAM HOUSTON TX/MCHO-CL-R//UNCLASOPER/DULL BRASS//MSGID/BLDSHIPREP/FT KNOX BDC/10122ZJAN96REF/A/CDRUSAMEDCOM/090300ZJAN96/-/NOTAL//ASOFDTG/100001ZJAN96//REPUNIT/CMBC/D/FT KNOX KY//ISHIPD/DP/OPOS/ONEG/APOS/ANEG/BPOS/BNEG/ABPOS/ABNEG/TOTAL///J160/ 140/ 32/ 40/ 20/ 8/ 0/ 0/ 400///M/ 0/ 0/ 0/ 0/ 0/ 24/ 0/ 24//BLDSHIP/AB12134/DELTA32/101500ZJAN96/14//POX/NEVAREZZ/SSG/PRIPHN:DSN555-1212/-FT LMPX LUSE[JM"555-1213//CLOSTEXT/BLOOD NEEDS RE-ICED BY 130001AJAN96/CMBC SHIPMENTNO1//

APPENDIX CMEDICAL LOGISTICAL SYSTEMS FOR

BATTLEFIELD INTEROPERABILITY

C-1

1. Interoperability among the Services is ofparamount importance to the successfulcompletion of a joint mission. The oftenmentioned interoperability problem on after-action reports is a shortcoming of theMEDLOG communications system. TheMEDLOG problems encountered by all jointUS forces, especially when supported by theSIMLM concept during the Gulf War, onceagain highlighted the same communicationsand interoperability issues that have alwaysplagued HSLS. These HSLS issues haveproven to be most difficult in finding apermanent fix that meets all needs, gains theapproval of all of the Services, and isaffordable to implement. Communicationissues have received much attention at alllevels of command. All four Services haveconducted extensive interoperability testingsince the Gulf War.

2. The intent of this appendix is to acquaintHSLS personnel with what works today inthe critical area of MEDLOG interoperability.The most current information oncommunications is presented in thispublication. These procedures will work intime of war or MOOTW and during a nationalemergency within CONUS or US territories.Emerging technology will keep this topic in aconstant state of change for the foreseeablefuture; it will not stay static. Servicecomponents are now able to transmit andreceive medical requisition files and/orstatuses that are in a compatible andinteroperable format within the respectiveService MEDLOG AIS.

3. Prototype systems have been tested andrefined for battlefield MEDLOG systemsinteroperability and use the DAASO as theMEDLOG AIS communications focal point.Each of the Services sends and receives

requisitions and supply statuses usingDefense Data Network, land lines, or satellitecommunications to the Defense AutomaticAddressing System (DAAS) located inDayton, Ohio. DAAS routes all thetransactions according to DOD rules.

4. Each of the Services incorporates eitherof two software communication packages forcommunicating with the DAASO, which hasa mailbox service within the DAASO DAASAutomated Message Exchange System(DAMES). The DAMES and the SALTS,which supports standard USN logistics andadministrative systems provide thecommunications software necessary toprovide MEDLOG interoperability via theDAASO.

a. The DAASO routinely provides thefollowing services: receives, processes,routes, and transmits supply requisitions andrelated information; determines sources ofboth depot and commercial supplies;provides an on-line redistribution network formaterials; provides users with up-to-datestatus of requirements; analyzes databasesand prepares logistics reports; customizesreporting as requested; and maintains officialrepository for logistics-related databases andpublications.

b. DAMES and SALTS software on a unitPC provides the capability to communicatewith DAAS, sending and receiving logisticstransactions and narrative text through amodem using standard telephone lines and/or via military or civilian satellite systems.

• Each Service requisitioning element isassigned a separate mailbox at DAASO.Their Department of Defense activityaddress code (DODAAC) is then

C-2

Appendix C

Joint Pub 4-02.1

matched to the mailbox and theirmessages are stored. A group ofDODAACs may be assigned to a singlemailbox, if necessary.

• Messages and/or files received andtransmitted by DAAS follow the JointArmy, Navy, Air Force Publication(JANAP) 128 procedures. DAMEStransaction files, produced by userprograms, are built into standardJANAP-data pattern, formattedcommunications messages fortransmission. Messages containingnarrative text, messages containingMILSTRIP logist ics transactions,and messages containing nonstandardpart number requisitions may also bebuilt interactively at the keyboard.

c. Protocols for use of SALTS software canbe found in USN procedural guides.

d. DAASO supplies the DAMES softwareafter units register and are assigned DAMESmailboxes. The DAMES user cancommunicate with DAAS using eitherasynchronous protocol at 1200 baud to 9600baud or bisynchronous 2780 or 3780 protocolat 2400 or 4800 baud. The software used tocreate messages for transmission and thesoftware used to process received messagesis the same in both the DAMES asynchronouspackage and the DAMES bisynchronouspackage. The main difference in the twopackages is the actual communicationssoftware.

e. The DAMES general systemrequirements are a PC system capable ofrunning MS-DOS and a minimum of 256 KRAM; hard disk drive; printer (configure asLPT1); modem; and access to a telephone line.

f. The transactions to be sent throughDAAS can be loaded on to the DAMES PCusing a floppy from the respective ServiceMEDLOG AIS. The transactions will be an

American Standard Code for InformationExchange (ASCII) formatted file on a disk.If the PC is on a local area network, thetransactions can be transferred to the DAMESPC using a file transfer utility. The ASCIIfile in both approaches has one transactionper line separated by hard returns. DAMEScan accept the transaction file with or withoutthe JANAP headers and trailers included inthe file. The DAMES software first sendstransactions that are waiting on the PC. Aftersending the transactions through DAMES toDAAS, DAMES then checks for transactionsin the mailbox at DAAS to pull back to thePC. A DAMES user may also dial in to checkand/or download their mailbox without havingany transactions to send.

5. Communications software packages canreside on the Services’ MEDLOG system oron a separate DOD-based PC. A modemprovides communications across land lines orsatellite connections.

6. Several issues are raised concerning theuse of commercial satellite for transmittingmedical information in support of militaryoperations. The medical information passedis by commercial satellites because militarysatellites systems become saturated withtraffic of higher priority than medicalinformation. The primary commercialsatellite system used by the military is throughCommunications Satellite Corporation,which is the US signatory to the Conventionon the International Maritime SatelliteOrganization Treaty. The internationalsatellite system:

a. Offers analog voice and data service ona global basis. Has digital voice capabilityon a soon-to-be global basis.

b. Is used extensively by the USN, thoughit is not limited to maritime purposes.

c. Is intended to support peacefuloperations, though its use was approved when

C-3

Medical Logistical Systems for Battlefield Interoperability

under the auspices of the United NationsCouncil Organization.

d. Article 34 of the 1949 GenevaConvention for the Amelioration of theCondition of Wounded, Sick, andShipwrecked Members of the Armed Forcesat Sea provides that “hospital ships may notpossess or use encryption for their wirelessor other means of communications.” Allcommunication security hardware would be

removed from the hospital ships and storedin order to comply with this regulation.Hospital ships may continue to utilize satellitesystems in a nonencrypted mode.

7. Processing rules for DOD users tointerface through the DAAS are found inDOD Directive 4000.25-1-M, “MilitaryStandard Requisitioning and IssuingProcedures (MILSTRIP).”

C-4

Appendix C

Joint Pub 4-02.1

Intentionally Blank

APPENDIX DREFERENCES

D-1

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

1. US Code (Armed Forces).

Title 10, United States Code — Armed Forces. (As amended by DOD Reorganization Actof 1986)

2. Multinational Documents.

NATOSTANAG TITLE

288 Intravenous Replacement Fluids289 Minimum Essential Characteristics of Blood Products Shipping Containers2061 Procedures for Disposition of Allied Patients By Medical Installations2068 Emergency War Surgery2105 NATO Table of Medical Equivalents AMEDP1-(D)2122 Medical Training in First-Aid, Basic Hygiene, and Emergency Care2126 First-Aid Kits and Emergency Medical Care Kits2127 Medical, Surgical, and Dental Instruments, Equipment, and Supplies2135 Procedures for Emergency Logistic Assistance2342 Minimum Essential Medical Equipment and Supplies for Motor

Ambulances at All Levels2367 Minimum Essential Medical Supply Items in Theaters of Operations2907 Procedures for Reporting and for Initial Disposition of Unsatisfactory

Medical Materiel and Drugs2939 Medical Requirements for Blood, Blood Donors, and Associated Equipment3204 Aeromedical Evacuation

ABCAQSTAG TITLE

815 Blood Supply in the Area of Operations (AO)850 Blood Donor and Transfusion Equipment Requirements-Amendment No. 2

3. Department of Defense Directives.

a. DOD 4000.25-1-M, “Military Standard Requisitioning and Issue Procedures(MILSTRIP).”

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

c. DOD 6420.1, “Organization and Functions of the Armed Forces Medical IntelligenceCenter (AFMIC).”

D-2

Appendix D

Joint Pub 4-02.1

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

4. Joint Publications.

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

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

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

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

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

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

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

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

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

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

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

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

5. Air Force Regulations.

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

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

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

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

6. Army Regulations.

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

D-3

References

7. Multi-Service Publications.

TM 8-227-11, NAVMED P-5123/AFI 44-118, “Operational Procedures for the Armed ServicesBlood Program Elements,” 1 September 1995.

8. US Army Field Manuals.

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

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

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

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

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

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

g. FM 100-17, “Mobilization, Deployment, Redeployment, Demobilization,” 28 October1992.

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

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

j. FM 101-10-1, “Organizational, Technical, and Logistical Data, Planning Factors,” 7October 1987.

9. US Navy and Marine Corps Publications.

a. FMFM 4, “Combat Service Support.”

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

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

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

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

D-4

Appendix D

Joint Pub 4-02.1

Intentionally Blank

APPENDIX EADMINISTRATIVE INSTRUCTIONS

E-1

1. User Comments

Users in the field are highly encouraged to submit comments on this publication to theJoint Warfighting Center, Attn: Doctrine Division, Fenwick Road, Bldg 96, Fort Monroe,VA 23651-5000. These comments should address content (accuracy, usefulness,consistency, and organization), writing, and appearance.

2. Authorship

The lead agent for this publication is the United States Army. The Joint Staff doctrinesponsor for this publication is the Director for Logistics (J-4).

3. Change Recommendations

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

TO: HQDA WASHINGTON DC/DASG-HCD-D//INFO: JOINT STAFF WASHINGTON DC//J7-JDD//

Routine changes should be submitted to the Director for Operational Plans andInteroperability (J-7), JDD, 7000 Joint Staff Pentagon, Washington, DC 20318-7000.

b. When a Joint Staff directorate submits a proposal to the Chairman of the JointChiefs of Staff that would change source document information reflected in thispublication, that directorate will include a proposed change to this publication as anenclosure to its proposal. The Military Services and other organizations are requestedto notify the Director, J-7, Joint Staff, when changes to source documents reflected inthis publication are initiated.

c. Record of Changes:

CHANGE COPY DATE OF DATE POSTEDNUMBER NUMBER CHANGE ENTERED BY REMARKS__________________________________________________________________________________________________________________________________________________________________________________________________________________

E-2

Appendix E

Joint Pub 4-02.1

4. Distribution

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

b. Only approved pubs and test pubs are releasable outside the combatant commands,Services, and Joint Staff. Release of any classified joint publication to foreigngovernments or foreign nationals must be requested through the local embassy (DefenseAttache Office) to DIA Foreign Liaison Office, PSS, Room 1A674, Pentagon,Washington, DC 20301-7400.

c. Additional copies should be obtained from the Military Service assignedadministrative support responsibility by DOD Directive 5100.3, 1 November 1988,“Support of the Headquarters of Unified, Specified, and Subordinate Joint Commands.”

By Military Services:

Army: US Army AG Publication Center SL1655 Woodson RoadAttn: Joint PublicationsSt. Louis, MO 63114-6181

Air Force: Air Force Publications Distribution Center2800 Eastern BoulevardBaltimore, MD 21220-2896

Navy: CO, Naval Inventory Control Point700 Robbins AvenueBldg 1, Customer ServicePhiladelphia, PA 19111-5099

Marine Corps: Marine Corps Logistics BaseAlbany, GA 31704-5000

Coast Guard: Coast Guard Headquarters, COMDT (G-OPD)2100 2nd Street, SWWashington, DC 20593-0001

d. Local reproduction is authorized and access to unclassified publications isunrestricted. However, access to and reproduction authorization for classified jointpublications must be in accordance with DOD Regulation 5200.1-R.

GLOSSARYPART I—ABBREVIATIONS AND ACRONYMS

GL-1

AABB American Association of Blood BanksABO blood typing systemADAL authorized dental allowance listAE aeromedical evacuationAFMLO Air Force Medical Logistics OfficeAFWCF Air Force Working Capital FundAIS automated information systemsAJBPO Area Joint Blood Program OfficeAMAL authorized medical allowance listAOR area of responsibilityAR Army reserveASBP Armed Services Blood ProgramASBPO Armed Service Blood Program OfficeASCII American Standard Code for Information ExchangeASD(HA) Assistant Secretary of Defense for Health AffairsASOFDTG as of date/time groupASWBPL Armed Services Whole Blood Processing LaboratoryATH air transportable hospital

BAS battalion aid stationBDC blood donor centerBLDREP blood reportBLDSHIPREP blood shipment reportBPD Blood Product DepotBSU blood supply unitBTC blood transshipment center

C CentigradeCH contingency hospitalCINC commander of a combatant commandCJCS Chairman of the Joint Chiefs of StaffCLF combat logistics forceCOMMZ communications zoneCONUS continental United StatesCSS combat service support

DAAS Defense Automatic Addressing SystemDAASO Defense Automatic Addressing System OfficeDAMES DAAS Automated Message Exchange SystemDEPMEDS Deployable Medical SystemsDHHS Department of Health and Human ServicesDLA Defense Logistics AgencyDMSB Defense Medical Standardization BoardDMSO Division Medical Supply Office

GL-2

Glossary

Joint Pub 4-02.1

DOD Department of DefenseDODAAC Department of Defense activity address codeDPSC Defense Personnel Support Center

EPW enemy prisoner of warESF emergency support function

FDA Food and Drug AdministrationFFP fresh frozen plasmaFISC Fleet and Industrial Supply CentersFSSG force service support group

HN host nationHSLS health service logistics supportHSS health service support

JANAP Joint Army, Navy, Air Force PublicationJBPO Joint Blood Program OfficeJFC joint force commanderJFS joint force surgeonJOPES Joint Operation Planning and Execution SystemJTF joint task force

LOC line of communications

MAGTF Marine air-ground task forceMEDLOG medical logistics (USAF AIS)MEDLOGCO medical logistics companyMEDLOG JR medical logistics, junior (USAF AIS)MEF Marine expeditionary forceMICRO-MICS Micro-Medical Inventory Control SystemMICRO-SNAP Micro-Shipboard Non-Tactical Automated

Data Processing SystemMILSTRIP military standard requisitioning and issue proceduresMOMEDLOG mobile medical logistics (USAF AIS)MOOTW military operations other than warMTF medical treatment facility

NATO North Atlantic Treaty OrganizationNAVMEDLOGCOM Naval Medical Logistics CommandNAVSUP Naval Supply Systems CommandNBC nuclear, biological, and chemicalNDMS National Disaster Medical SystemNEO noncombatant evacuation operationNGO nongovernmental organization

O&M operation and maintenanceOFHIS Operational Fleet Hospital Information System

GL-3

Glossary

OPLAN operation plan

PC personal computerPECK patient evacuation contingency kitPMI patient movement itemPOD port of debarkationPOE port of embarkation

RAA redeployment assembly areaRBC red blood cellREPUNIT reporting unitRh RhesusROE rules of engagement

SALTS Streamlined Automated Logistics Transfer SystemSASSY Supported Activities Supply SystemSIMLM single integrated medical logistics managerSMU SASSY management unitSOF special operations forces

T-AH hospital shipTBTC transportable blood transshipment centerTMMMC Theater Medical Materiel Management CenterTPFDD time-phased force and deployment data

USAF United States Air ForceUSAMMA United States Army Medical Materiel AgencyUSMC United States Marine CorpsUSN United States Navy

WR war reserve

aeromedical evacuation. The movement ofpatients under medical supervision to andbetween medical treatment facilities by airtransportation. Also called AE. (Joint Pub1-02)

aeromedical evacuation system. A systemwhich provides: a. control of patientmovement by air transport; b. specializedmedical attendants and equipment for in-flight medical care; c. facilities on or in thevicinity of air strips and air bases, for thelimited medical care of intransit patientsentering, en route via, or leaving the system;and d. communication with originating,destination, and en route medical facilitiesconcerning patient transportation. (JointPub 1-02)

clinic. A medical treatment facility primarilyintended and appropriately staffed andequipped to provide outpatient medicalservice for nonhospital type patients.Examination and treatment for emergencycases are types of the services rendered. Aclinic is also intended to perform certainnontherapeutic activities related to thehealth of the personnel served, such asphysical examinations, immunizations,medical administration, and otherpreventive medical and sanitary measuresnecessary to support a primary militarymission. A clinic will be equipped withthe necessary supporting services toperform the assigned mission. A clinic maybe equipped with beds (normally fewer than25) for observation of patients awaitingtransfer to a hospital and for care of caseswhich cannot be cared for on an outpatientstatus, but which do not requirehospitalization. Patients whose expectedduration of illness exceeds 72 hours willnot normally occupy clinic beds for periodslonger than necessary to arrange transfer toa hospital. (Joint Pub 1-02)

evacuation. 1. The process of moving anyperson who is wounded, injured, or ill toand/or between medical treatmentfacilities. 2. The clearance of personnel,animals, or materiel from a given locality.3. The controlled process of collecting,classifying, and shipping unserviceable orabandoned materiel, United States andforeign, to appropriate reclamation,maintenance, technical intelligence, ordisposal facilities. (Joint Pub 1-02)

evacuation policy. 1. Command decisionindicating the length in days of themaximum period of noneffectiveness thatpatients may be held within the commandfor treatment. Patients who, in the opinionof responsible medical officers, cannot bereturned to duty status within the periodprescribed are evacuated by the firstavailable means, provided the travelinvolved will not aggravate theirdisabilities. 2. A command decisionconcerning the movement of civilians fromthe proximity of military operations forsecurity and safety reasons and involvingthe need to arrange for movement,reception, care, and control of suchindividuals. 3. Command policyconcerning the evacuation of unserviceableor abandoned materiel and includingdesignation of channels and destinations forevacuated materiel, the establishment ofcontrols and procedures, and thedissemination of condition standards anddisposition instructions. (Joint Pub 1-02)

health service logistics support. Afunctional area of logistics support thatsupports the joint force surgeon’s healthservice support mission. It includessupplying Class VIII medical supplies(medical materiel to include medicalpeculiar repair parts used to sustain thehealth service support system), optical

PART II—TERMS AND DEFINITIONS

GL-4 Joint Pub 4-02.1

fabrication, medical equipmentmaintenance, blood storage anddistribution, and medical gases. Alsocalled HSLS. (This term and its definitionis approved for inclusion in the next editionof Joint Pub 1-02.)

health service support. All servicesperformed, provided, or arranged by theServices to promote, improve, conserve, orrestore the mental or physical well-beingof personnel. These services include, butare not limited to, the management of healthservices resources, such as manpower,monies, and facilities; preventive andcurative health measures; evacuation of thewounded, injured, or sick; selection of themedically fit and disposition of themedically unfit; blood management;medical supply, equipment, andmaintenance thereof; combat stress control;and medical, dental, veterinary, laboratory,optometric, medical food, and medicalintelligence services. (Joint Pub 1-02)

hospital. A medical treatment facility capableof providing inpatient care. It isappropriately staffed and equipped toprovide diagnostic and therapeutic services,as well as the necessary supporting servicesrequired to perform its assigned mission andfunctions. A hospital may, in addition,discharge the functions of a clinic. (JointPub 1-02)

humanitarian assistance. Programsconducted to relieve or reduce the resultsof natural, or manmade disasters or otherendemic conditions such as human pain,disease, hunger, or privation that mightpresent a serious threat to life or that canresult in great damage to or loss of property.Humanitarian assistance provided by USForces is limited in scope and duration. Theassistance provided is designed tosupplement or complement the efforts ofthe host nation civil authorities or agencies

GL-5

Glossary

that may have the primary responsibilityfor providing humanitarian assistance.(Joint Pub 1-02)

intertheater evacuation. Evacuation ofpatients between the originating theater andpoints outside the theater, to include thecontinental United States and other theaters.En route care is provided by trained medicalpersonnel. (Joint Pub 1-02)

intratheater evacuation. Evacuation ofpatients between points within the theater.En route care is provided by trained medicalpersonnel. (Joint Pub 1-02)

joint force. A general term applied to a forcecomposed of significant elements, assignedor attached, of two or more MilitaryDepartments, operating under a single jointforce commander. (Joint Pub 1-02)

joint force commander. A general termapplied to a combatant commander,subunified commander, or joint task forcecommander authorized to exercisecombatant command (command authority)or operational control over a joint force.Also called JFC. (Joint Pub 1-02)

joint force surgeon. A general term appliedto an individual appointed by the joint forcecommander to serve as the theater or jointtask force special staff officer responsiblefor establishing, monitoring, or evaluatingjoint force health service support. (JointPub 1-02)

medical intelligence. That category ofintelligence resulting from collection,evaluation, analysis, and interpretation offoreign medical, bioscientific, andenvironmental information which is ofinterest to strategic planning and to militarymedical planning and operations for theconservation of the fighting strength offriendly forces and the formation of

GL-6

Glossary

Joint Pub 4-02.1

assessments of foreign medical capabilitiesin both military and civilian sectors. (JointPub 1-02)

medical regulating. The actions andcoordination necessary to arrange for themovement of patients through the levels ofcare. This process matches patients with amedical treatment facility which has thenecessary health service supportcapabilities, and it also ensures that bedspace is available. (Joint Pub 1-02)

medical treatment facility. A facilityestablished for the purpose of furnishing

medical and/or dental care to eligibleindividuals. (Joint Pub 1-02)

patient. A sick, injured, wounded, or otherperson requiring medical/dental care ortreatment. (Joint Pub 1-02)

triage. The evaluation and classification ofcasualties for purposes of treatment andevacuation. It consists of the immediatesorting of patients according to type andseriousness of injury, and likelihood ofsurvival, and the establishment of priorityfor treatment and evacuation to assuremedical care of the greatest benefit to thelargest number. (Joint Pub 1-02)

Assess-ments/

Revision

CJCSApproval

TwoDrafts

ProgramDirective

ProjectProposal

J-7 formally staffs withServices and CINCS

Includes scope ofproject, references,milestones, and who willdevelop drafts

J-7 releases ProgramDirective to Lead Agent.Lead Agent can beService, CINC, or JointStaff (JS) Directorate

STEP #2Program Directive

!

!

!

The CINCS receive the puband begin to assess it duringuse

18 to 24 months followingpublication, the Director J-7,will solicit a written report fromthe combatant commands andServices on the utility andquality of each pub and theneed for any urgent changes orearlier-than-scheduledrevisions

No later than 5 years afterdevelopment, each pub isrevised

STEP #5Assessments/Revision

!

!

!

ENHANCEDJOINT

WARFIGHTINGCAPABILITY

Submitted by Services, CINCS, or Joint Staffto fill extant operational void

J-7 validates requirement with Services andCINCs

J-7 initiates Program Directive

!

!

!

STEP #1Project Proposal

All joint doctrine and tactics, techniques, and procedures are organized into a comprehensive hierarchy asshown in the chart above. is in the series of joint doctrine publications. Thediagram below illustrates an overview of the development process:

Joint Pub 4-02.1 Logistics

JOINT DOCTRINE PUBLICATIONS HIERARCHYJOINT DOCTRINE PUBLICATIONS HIERARCHY

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

PERSONNEL

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

LOGISTICSINTELLIGENCE OPERATIONS C4 SYSTEMSPLANS

JOINTDOCTRINE

PUBLICATION

Lead Agent forwards proposed pub to JointStaff

Joint Staff takes responsibility for pub, makesrequired changes and prepares pub forcoordination with Services and CINCS

Joint Staff conducts formalstaffing for approval as a Joint Publication

STEP #4CJCS Approval

!

!

!

Lead Agent selects Primary ReviewAuthority (PRA) to develop the pub

PRA develops two draft pubs

PRA staffs each draft with CINCS,Services, and Joint Staff

!

!

!

STEP #3Two Drafts

JOINT PUB 1

JOINTWARFARE

JOINT PUB 0-2

UNAAF

JP 4-02.1 JTTP for Healt Service Logistics Support in ...97).pdf · Health Service Logistics...

Documents

Transcript of JP 4-02.1 JTTP for Healt Service Logistics Support in ...97).pdf · Health Service Logistics...