Transcript Forward Medical Service Support System

Philippines
Conduct of written survey to selected ground troops in the
Army Brigades and Battalions of the First Infantry Division in
Zamboanga Del Sur and the Marine Brigade and Battalions in
Basilan, both located in Mindanao, Southern Philippines.
The Project Management Team (PjMT) conducted an
assessment, and concluded that the absence of an
established doctrine is the most significant factor in the
actual and perceived flaw for a responsive and efficient
delivery of Forward Medical Service Support (FMSS). The
lack of doctrine caused several other shortfalls in the forward
delivery system including: Organization, Training, Materiel,
Personnel, and Facilities.
1. Policies on the Career Development of Field Medical Service Personnel
a. Basic Medical Aidman Course/Advanced Medical Aidman Course
accreditation as career course
b. Medical Service (MS) Military Occupational Specialty
2. Support System through upgrading of Forward Support Medical Units
a. TO&E of Forward Support Medical Company
b. TO&E of Medical Platoon, Infantry Battalion
3. Standardized POI for First Aid Skills (Self-Aid/Buddy-Aid and Combat
Lifesaver) of individual soldiers and Field Medical Service Personnel;
Accreditation System for MS EP Trainers
4. Develop and expand medical support system through MOA/MOU with local
hospitals and other healthcare providers
5. Forward Medical Support Doctrine
a. FMSSS Manual
b. Brigade and Battalion Medical Equipment and Supplies Template
c. SOP (Medical Records and Utilization of Field Line Ambulance)
 Basic Medical Service Support (MSS) Doctrine
 Major Tenets of MSS
 MSS Challenges including planning,
prevention, far forward care, and medical
evacuation (MEDEVAC)
 Concept of MSS System
 Principles of MSS
Echelons (Levels) of Care
 Applicability of the system in war and in
Operations-Other-Than-War (OOTW)
MEDICAL SUPPORT SYSTEM
(MSS)
 Continuum
of successive echelons
(levels) of care, beginning at the
point of injury up to an appropriate
Medical Treatment Facility (MTF),
both military and civilian.
Basic Doctrine of Medical Service Support
The objective of the MSS system is to conserve the fighting strength
of tactical units by:
• Reducing the incidence of Disease and Non-Battle Injury
(DNBI) and Battle Fatigue (BF) through sound preventive
medicine and Combat and Operational Stress Control
(COSC) programs;
•Providing care and treatment of acute illnesses, injuries, or
wounds; and
• RTD as many soldiers as possible at each echelon.
• Far forward medical treatment including, but not limited
to, Advanced Trauma Management (ATM);
• Patient evacuation that is timely and efficient.
MAJOR TENETS OF THIS DOCTRINE:
• Selectivity of Return to Duty (RTD) and Non-
Return to Duty (NRTD) patients at lowest
possible echelon;
• Standardized Echelons I and II MSS units;
and
• A medical system that provides continuous
medical management throughout all echelons
(levels) of care and evacuation.
MEDICAL SERVICE SUPPORT CHALLENGES
Prevention
 Most
effective and least expensive method of
providing the commander with sustained combat
power.
 Enhanced by the application of training programs
on Self- Aid/Buddy-Aid (SA/BA) and Combat
Lifesaver (CLS); continuous interface with Unit and
Division level medical aidmen; Division-wide
preventive medicine programs; COSC programs; and
leadership emphasis at all levels of Command.
Ultimately, whether it is individual or collective,
prevention is the unit commander’s responsibility.
Far Forward Care
 Self-Aid/Buddy-Aid (SA/BA), Combat Lifesaver (CLS), and
Unit level Forward Medical Service Support (FMSS).
 Combat Lifesavers are equipped with a higher degree of skill
than SA/BA but their primary role is the performance of their
duties as members of the Squad, Section, or Team, and their
first-aid duties are performed as the mission permits.
 Far forward care is provided to the frontline soldier by the
combat medic and field medical evacuation personnel attached
to the Maneuver Company.
 More comprehensive care at a physician-directed treatment
at Battalion Aid Station (BAS), Brigade Treatment Facility (BTF),
Forward Mobile Emergency Deployable Intermediate Care
System (Forward M.E.D.I.C.S.), or civilian treatment facilities
with initial resuscitation and stabilization, and advanced trauma
management capabilities.
Medical Evacuation (MEDEVAC)
 En
Route Care
 Ground ambulances are used in the Division
for slightly wounded, ill, or injured soldiers who
are expected to RTD.
 Air evacuation is used, when feasible, for
seriously wounded, sick or injured soldiers who
are NRTD patients. In a combat situation, air
evacuation assets will fly as far forward as the
Mission, Enemy, Time, Terrain & Troops
available (METT-T) permit.
 Responsibility for MEDEVAC rests with the next
higher echelon of MSS. For example, the Medical
Platoon is responsible for the evacuation of patients
out of the Forward Maneuver Company to the BAS.
The Forward Support Medical Platoon (FSMP)
attached to the Infantry Brigade is responsible for
evacuation from the BAS to the BTF, and the Forward
Support Medical Company (FSMC) from the BTF to
the Division Station Hospital or to pre-established
civilian hospitals in the locality throughout the
evacuation chain may be done, if and when the
condition of the patients so warrants.Use of nonmedical vehicles should be established and
supplemented when casualties exceed the capability
of MEDEVAC assets.
Concept of Medical Service Support
It is organized into five (5) separate Echelons of Care which extend
rearward from the area of operation to those located in the Division level.
Legend: Self-Aid/Buddy-Aid (SA/BA); Individual First Aid Kit (IFAK); Combat Lifesaver (CLS);Basic
Medical Aidman Bag (BMAB); Mobile Medical Transport Kit (MMTTK); Emergency Lifesaving (ELS)
Medical Service Support Principles
CONFORMITY with the Tactical Plan
 Most fundamental element using medical intelligence data.
 MSS planner must participate in the development of the commander’s
Operations Plan (OPLAN) to ensure adequate MSS at the right time and place and
for rapid reinforcement or replacement of forward echelons of the MSS.
CONTINUITY
 Chain of medical units/elements from the combat zone (Echelon I) to the rear
terminus (Echelon V) of medical care which may involve preventive medicine,
COSC, treatment, evacuation, hospitalization, and rehabilitation.
The medical goods and services are provided without break until the soldier is in
RTD status or separated due to disability.
CONTROL
 Medical units are under the control of a single medical manager to ensure that
scarce MSS resources are efficiently employed and support the tactical plan.
 Centralized control with decentralized execution permits the medical commander
and his staff to rapidly tailor and adjust MSS assets.
PROXIMITY
 Location of medical assets is as far forward as practicable and as the
combat situation permits. Medical intervention is critical during the golden
period of a traumatic injury.
FLEXIBILITY
 Ability to rapidly shift MSS resources to areas of greatest need in
response to major shifts in the location and volume of casualties; changes
in the supported unit composition and mission; and changes in the intensity
of conflict.
MOBILITY
 Mobility of MSS units organic to maneuver elements must equate to the
forces being supported. Medical commanders must continually assess and
forecast echelonment of medical units, through collective use of all
transportation resources.
ANTICIPATION
Ability to foresee future operations and health support requirements by
identifying, accumulating, and maintaining information required for MSS
planning.
RESPONSIVENESS
Providing the right support in the right place at the right time and the ability to
meet changing requirements on short notice.
SIMPLICITY
MSS units and personnel usually operate with resource constraints and under
severe battlefield conditions as such, planning and executing MSS operations
must be understood easily with utmost practicality and economy.
IMPROVISATION
The talent to create, enhance, arrange, or fabricate what is needed from what is
on hand in order to provide sustained and responsive support. Innovative
solutions to problems must be sought since not every eventuality can be
anticipated.
Echelons of Medical Service Support
Each echelon of care reflects an increase in medical capabilities
while retaining capabilities found in preceding echelon of care.
Echelon I Care - frontline medical care thru SA/BA, CLS, emergency
first aid, initial wound surgery, relief of pain and discomfort, and
prioritization for MEDEVAC. It also provides psychological SA/BA;
support and/or referral; and CLS and combat medic cursory
assessment and prescribed actions.
Echelon II Care - medical care provided to the rear of the battlefield
by a team of medical personnel supported by a level of facilities;
medical supplies; and equipment, either to stabilize casualties for
further evacuation for a more definitive care or to treat them for
RTD. For stress-related cases, this echelon provides outpatient
counselling or the individual is held 1 to 3 days for rest and
restorative activities.
Echelon III Care - medical care provided in the combat zone at
facilities staffed and equipped to provide resuscitation, initial
and final wound surgery, and definitive and post operative
treatment. For stress casualties, it provides hospital diagnostic
capabilities and the individual is held 1 to 2 weeks for
reconditioning treatment.
Echelon IV Care - medical care provided at General Hospitals
staffed and equipped for definitive care, with a mission to
rehabilitate casualties to duty status.
Echelon V Care - medical care provided at the AFP Medical
Center, civilian Medical Centers, or Specialty Hospitals for
definitive, specialized, and rehabilitative care.
Division Level Forward Medical Service Support
The Forward Support Medical Company (FSMC) provides Echelon II
forward medical support for units operating in the division and brigade area
of operation (AO). Each company consists of headquarters section and
three (3) Forward Support Medical Platoons (FSMP) that will provide direct
support (DS) to the infantry brigades.
Capabilities
• Patient holding for up to ten (10) patients per brigade and able to RTD within
seventy two (72) hours.
• Limited reinforcement and augmentation to supported maneuver battalion
medical platoons.
• Provide combat medic to the reconnaissance companies of the division and
security platoons of the brigade
Assignment
Organic to the Service Support Battalion (SSBn), Infantry Division.
Allocation
One (1) FSMC per infantry division.
Concept of Appointment
Deploy one (1) FSMP to provide direct medical support to each Infantry
Brigade.
Battalion Level Medical Service Support
Medical Platoon, HHC, Infantry Battalion
Medical Platoon Organizational Structure
• Mission
To provide Echelon I medical support to elements of an Infantry Battalion
to include EMT, evacuation, prevention of DNBI, and COSC
• Capabilities
 Treatment and Outpatient consultation services
 Ground evacuation for patients from company aid posts (CAPs)
and designated CCPs to BAS.
 Conduct of SA/BA and CLS refresher training.
 COSC program implementation in the AOR.
 Field Sanitation and Hygiene activities.
 Coordination of field blood support requirements.
• Assignment
 Headquarters and Headquarters company.
• Allocation
 One (1) per infantry battalion.
• Concept of Employment
Provides Direct Support to an infantry battalion by operating a BAS;
deploying combat medics to establish, man, and operate CAPs as needed;
employ medical evacuation personnel to evacuate patients to the CAPs/CCPs,
and ambulance team to evacuate patients from the CAPs/CCPs to the BAS.
Unit Level Medical Service Support
• Combat Lifesaver
A minimum of two (2) non-medical personnel per squad, team, or
equivalent-sized unit are selected by the unit commander to undergo
the CLS training program, which is normally provided by medical
personnel assigned, attached, or in DS of the unit and managed by a
designated senior medical person. Aside from his primary duty, the CLS
is equipped with a kit to provide enhanced first-aid for injuries before
the combat medic arrives.
• Self-Aid/Buddy-Aid (SA/BA)
SA/BA is the initial care applied by the individual soldier to himself or to
other squad members if and when he gets sick or wounded in the field,
using his knowledge and skills and individual first aid kit (IFAK) which is
part of his individual clothing and individual equipment (ICIE). Most
injured or ill soldiers are able to return to their units to fight and/or
support primarily because they are given appropriate and timely first aid
followed by the best medical care possible.
Augmentation Medical Service Support
• AFP Affiliate and Reserve Units (AFPARUs)
Certain government and private entities, corporations,
establishments, and organizations at the national,
provincial, and municipal levels which provide essential
medical services and are considered vital and strategic in
providing FMSS will be organized as medical affiliate and
reserve units in coordination with the AFP Reserve
Command (AFPRESCOM) to support the implementation of
national defense plans or to meet an emergency.
Key and technical personnel of the utility shall be
commissioned/enlisted and included in the roster of
personnel to cover all the activities of the management and
operation necessary to function effectively in time of
emergency.
• Field Surgical Hospital (Forward Medical Emergency Deployable
Intermediate Care System Forward M.E.D.I.C.S.)
 Nature:
 Modularized deployable medical support system which may
initially be attached to an ill-equipped, undermanned Station
Hospital at Division level, or attached to an FSMC at Brigade level,
or area FMSS to a Task Force conducting joint operations as a
joint use facility, where the Major Services and Armed Forces of the
Philippines Wide Service Support Units (AFPWSSUs) will
contribute and rotate personnel requirements to augment its
resuscitative surgical/trauma care capability.
 Miniature mix of a clearing platoon and mobile surgical
hospital.
 One of the major operating units of the AFP Medical Center
(AFPMC).
 Mission:
To receive, sort, and provide emergency or
resuscitative treatment for patients until
evacuated.
 Functions:
 Admits, sorts, and temporarily hospitalizes
injured and wounded soldiers.
 Addresses life-threatening conditions of
combat casualties which are beyond the
capabilities of combat medics.
 Provides emergency surgical care to
stabilize casualties who might otherwise die
or lose a limb before reaching definitive care.
 Command Relationships:
The Chief of Staff, AFP (CSAFP) provides direction in the
management and operation of the Forward MEDICS through the
Commander, AFPMC. It shall be under the functional supervision of the
Deputy Chief of Staff for Personnel, J1 through The Surgeon General,
AFP. The Commander, AFPMC shall exercise command, control, and
supervision to the Forward MEDICS unit. It shall be placed under
operational control (OPCON) to the Unified Command to which it shall
be deployed and placed under tactical control (TACON) to the joint task
force or the operating command in the area of deployment.
The Forward MEDICS unit commander shall be authorized to
coordinate with the MTFs in the adjacent area under its OPCON
Unified Command on matters affecting the operation of the Forward
MEDICS unit as in case of personnel augmentation during intense
offensive operations when the probability of incurring trauma cases are
high (surge casualties).
FORWARD MEDICAL
TRAINING FACILITIES
Brigade Treatment Facilities (BTFs)
 Echelon II semi-fixed facility to stabilize and prepare casualties for
further evacuation to an appropriate MTF for more definitive care. It also
has the capability to treat minor injuries and sick call cases, and return
the patients to duty.
 Participates in the management of mass casualties through triaging,
airway and breathing management, hemorrhage control, advance
trauma management, casualty immobilization, minor surgical
procedures, and as evacuation platform.
 Provided with portable field equipment; instrument set; supply sets;
furniture and office equipment to be able to attend to a wide variety of
cases including observation cases. Figure 5-1.1 shows the basic
medical equipment set found in the BTF.
Brigade Treatment Facilities
BTF Medical Equipment Set (Echelon II)
Battalion Aid Station (BAS)
 Echelon I primary medical care beyond the level
of a combat medic.
 Resuscitative treatment to prevent unnecessary
evacuation and prepare the casualty for further
evacuation to the appropriate level of care as
necessary.
 It is mobile that allows maximum movement
when the battalion is engaged in combat.
 Provides scheduled appointments, unscheduled
drop-ins or traditional sick call in
garrison/base/camp during lull periods or when
situation allows.
Battalion Aid Station (BAS)
BAS Medical Equipment Set (Echelon I)
Mobile Medical Treatment and Transport Kit
(for Echelon I & II)
Mobile Medical Treatment and Transport Kit Inserts
Individual and Organizational Medical Kits
for Field Personnel
Individual First Aid Kit (IFAK)
 Issued to every personnel upon entry into the
military service. Common medicines (antimotility, antipyretic, anti-bacterial, and
analgesic drugs ), dressings, band-aid strips.
water purifying tablets and insect repellants
and combat application tourniquet are
contained in a canvass pouch which is carried
by the individual soldier for easy access and
use.
Individual First Aid Kit (Echelon I)
Combat Lifesavers Kit (CLS Kit)
 A rifle squad organizational equipment used by
non-medical service personnel who have undergone
CLS training.
It is a folding canvass bag packed with critical life
saving medical supplies in a handy carrying bag with
strap for immediate emergency care of battle
casualties.
It has three separate compartments that contain
supplies for airway and breathing management,
hemorrhage control, trauma management and
casualty immobilization.
Combat Lifesaver Bag
(Echelon I)
The Basic Medical Aidman Bag (BMAB)
an organizational equipment issued to every
designated combat medic of the rifle squad,
medical aidman, and medical evacuation
personnel. It is a canvass bag containing
medicines, medical supplies, and medical
instruments needed for immediate
resuscitative and initial trauma management of
combat casualties on site or en route to MTF.
The Basic Medical Aidman Bag (BMAB)
Medical Aidman Bag (Echelons I & II)
The Basic Medical Aidman Bag (BMAB)
The Basic Medical Aidman Bag (BMAB)
Medical Aidman Bag (Echelons I & II)
The Basic Medical Aidman Bag (BMAB)
FORWARD MEDICAL
TRAINING FACILITIES
Evacuation Chain
MTFs are so organized, and so located, as to provide the type and
quality of medical care required with maximum internal efficiency
and minimum interference with combat operations. The location of
these facilities usually demands that large or complex MTFs be
located at sites remote from active combat.
Evacuation and Hospitalization
Evacuation is generally a staged process, not a continuous flow.
Evacuation and treatment are interdependent. Evacuation flow is
channeled through selected MTF along the evacuation route in order to
provide necessary treatment. Response or non response to treatment at
each facility dictates the need for, or urgency of, further evacuation.
Care and Treatment En Route
Medical personnel are assigned to all types of medical evacuation
(MEDEVAC) vehicles in order to provide medical care en route. Before
evacuating a patient, the MTF should note his condition and list special
care requirements on the Field Medical Card or other medical record. The
responsible medical officer will instruct medical personnel in the
evacuation vehicle on any special attention that the patient may need en
route. Evacuation personnel are responsible for the safety and comfort of
all patients.
Principles which Guides Evacuation
 Evacuation is medical support, not transportation.
 Patients are evacuated no further to the rear than their condition
requires and the military situation permits.
 Evacuation of patients is normally, but not invariably, accomplished by
the next higher level of medical support.
 An ambulance must have tactical and terrain mobility that is at least
equivalent to that of the unit it supports. Field ambulances of maneuver
units have capability for terrain mobility, and armor protection, to follow the
supported units as close as possible in the front lines to substitute
vehicles for man-carry.
Evacuation of patients is normally, but not invariably, accomplished by
the next higher level of medical support.
 Any means of transportation – medical or non-medical – may be utilized
for the evacuation of patients.
Rear higher echelon medical units are responsible in evacuating
patients from supported units. Lower echelon supported and supporting
units must ensure evacuation support plans are complete and current by
close, direct coordination.
Ground Evacuation
Guidelines in the Use of Field of Ambulances
The safety and protection of the patient as well as the medical care
providers shall be the primary consideration in the use of the field
ambulances.
 It shall be used to transport patients especially the critically ill/serious
and/or injured.
 It is preferred for the evacuation of neuropsychiatric (NP) and battle fatigue
(BF) casualties requiring restraints and or medications. However, a nonambulance ground vehicle for evacuation is preferred for NP and BF
casualties who can manage without medications and physical restraints.
 It shall also be used to transport medical care providers and blood and
emergency supplies.
 It shall not be used to transport cadavers, transport able-bodied
combatants, shelter of able-bodied combatants, as an arms and ammunition
transport, or as military observation post.
Guidelines in the Use of Field of Ambulances
 The field ambulance shall be properly marked and identified.
 The field ambulance must:
Have appropriately trained and competent personnel.
Have the prescribed equipment and supplies.
Be regularly maintained.
The field ambulance must:
Be always properly cleaned, sanitized, and decontaminated, before and
after patient and medical care provider transport.
 Medical personnel assigned to the ambulances that are positioned with
the supported medical element will not be required to perform duties as
kitchen police, perform as perimeter guards, and perform driver duties for
other than their assigned vehicle.
Adherence to Geneva Convention requirements for protection must be
ensured.