Army Health System Flashcards
Army Health System (AHS)
The AHS is a complex system of systems that is interdependent and interrelated and requires continual planning, coordination, and synchronization to effectively and efficiently clear the battlefield of casualties and to provide the highest standard of care to our wounded or ill Soldiers.
Medical Regulating
Medical regulating is designed to ensure the efficient and safe movement of patients. It is a system that entails identifying the patients waiting evacuation, locating the available beds, and coordinating the transportation means for movement.
Casualty Collection Point (CCP)
A location that may or may not be staffed, where casualties are assembled for evacuation to a medical treatment facility.
Ambulance Exchange Point (AXP)
A location where a patient is transferred from one ambulance to another en-route to a medical treatment facility. This may be an established point in an ambulance shuttle or it may be designated independently. Also called AXP.
Definitive treatment
refers to the final role of comprehensive care provided to return the patient to the highest degree of mental and physical health possible. It is not associated with a specific role or location in the continuum of care; it may occur in different roles depending upon the nature of the injury or illness. (FM 4-02)
As a general rule, no role of care will be bypassed except on grounds of medical urgency, efficiency, or expediency. The rationale for this rule is to ensure the stabilization/survivability of the patient through tactical combat casualty care (TCCC), and far forward resuscitative surgery is accomplished prior to movement between medical treatment facilities (MTFs) (Roles 1 through 3).
The Principles of Army Health System
Conformity, Proximity, Flexibility, Mobility, Continuity, Control
Conformity
Conformity with the operation order (OPORD) is the most basic element for effectively providing AHS support. In order to develop a comprehensive concept of operations, the medical commander must have direct access to the operational commander. AHS planners must be involved early in the planning process to ensure that we continue to provide AHS support in support of the Army’s strategic roles of shape, prevent, LSCO, and consolidate gains. Once the plan is established it must be rehearsed with the forces it supports. In operations with a preponderance of stability tasks, it is essential that AHS support operations are in consonance with the combatant commander’s (CCDR’s) area of responsibility (AOR) engagement strategy and have been thoroughly coordinated with the supporting assistant chief of staff, civil affairs (CA)
Proximity
Proximity is to provide AHS support to sick, injured, and wounded Soldiers at the right time and the right place and to keep morbidity and mortality to a minimum. AHS support assets are placed within supporting distance of the maneuver forces which they are supporting, but not close enough to impede ongoing operations. To support the operational commander’s plan, it is essential that AHS assets are positioned to rapidly locate, acquire, treat, stabilize, and evacuate combat casualties. Peak workloads for AHS resources occur during combat operations.
Flexibility
Flexibility is being prepared to, and empowered to, shift AHS resources to meet changing requirements. Changes in plans or operations make flexibility in AHS planning and execution essential. In addition to building flexibility into the OPLAN to support the commander’s scheme of maneuver, the medical commander must also ensure that he has the flexibility to rapidly transition from one level of violence to another across the range of military operations. As the current era is one characterized by persistent conflict, the medical commander may be supporting simultaneous actions characterized by different decisive actions, such as offensive, defensive, or stability tasks. The medical commander exercises his command authority to effectively manage his scarce medical resources so that they benefit the greatest number of Soldiers in the AO. For example, there are insufficient numbers of FSTs or FRSDs to permit the habitual assignment of these organizations to each BCT. Therefore, the medical commander, in conjunction with the command surgeon, closely monitors these valuable assets so that he can rapidly reallocate or recommend the reallocation of this lifesaving skill to the BCTs in contact with the enemy and where the highest number of Soldiers will potentially receive traumatic wounds and injuries.
Mobility
Mobility is the principle that ensures that AHS assets remain in supporting distance to support maneuvering forces. The mobility, survivability (such as armor plating), and sustainability of AHS units organic to maneuver elements must be equal to the forces being supported. Major AHS headquarters (HQs) in EAB continually assess and forecast unit movement and redeployment. AHS support must be continually responsive to shifting medical requirements in an OE. In noncontiguous operations, the use of ground ambulances may be limited depending on the security threat in unassigned areas and air ambulance use may be limited by environmental conditions and enemy air defense threat. Therefore, to facilitate a continuous evacuation flow, MEDEVAC must be a synchronized effort to ensure timely, responsive, and effective support is provided to the tactical commander. The only means available to increase the mobility of AHS units is to evacuate all patients they are holding. AHS units anticipating an influx of patients must medically evacuate patients they have on hand prior to the start of the engagement.
Continuity
Continuity in care and treatment is achieved by moving the patient through progressive, phased roles of care, extending from the POI or wounding to the CONUS-support base. Continuity of care refers to an attempt to maintain the role of care during movement at least equal to the care provided at the preceding facility. (FM 4-02) Each type of AHS unit contributes a measured, logical increment in care appropriate to its location and capabilities. In recent operations, lower casualty rates, availability of rotary-wing air ambulances, and other mission, enemy, terrain and weather, troops and support available, time available, and civil considerations (METT-TC) factors often enable a patient to be evacuated from the POI directly to the supporting CSH or hospital center. In more traditional operations, higher casualty rates, extended distances, and patient condition may necessitate that a patient receive care at each role of care to maintain his physiologic status and enhance his chances of survival. The medical commander, with his depth of medical knowledge, his ability to anticipate follow-on medical treatment requirements, and his assessment of the availability of his specialized medical resources can adjust the patient flow to ensure each Soldier receives the care required to optimize patient outcome. The medical commander can recommend changes in the theater evacuation policy to adjust patient flow within the deployed setting. A major consideration and an emerging concern in future conflicts is providing prolonged care within all roles of care when evacuation is delayed. The Army’s future OE is likely to be complex and challenging and widely differs from previous conflicts. Operational factors will require the provision of medical care to a wide range of combat and noncombat casualties for prolonged periods that exceed current evacuation planning factors
Control
Control is required to ensure that scarce AHS resources are efficiently employed and support the operational and strategic plan. It also ensures that the scope and quality of medical treatment meets professional standards, policies, and United States (U.S.) and international law. As the AHS is comprised of 10 medical functions which are interdependent and interrelated, control of AHS support operations requires synchronization to ensure the complex interrelationships and interoperability of all medical assets remain in balance to optimize the effective functioning of the entire system. Within the AO, the most qualified individual to orchestrate this complex support is the medical commander due to his training, professional knowledge, education, and experience. In a joint and multinational environment it is essential that coordination be accomplished across all Services and unified action partners to leverage all of the specialized skills within the AO. Due to specialization and the low density of some medical skills within the MHS force structure, the providers may only exist in one Service (for example, the United States Army has the only veterinary corps officers in the MHS).
MEDICAL FUNCTIONS
Medical command and control.
Medical treatment (organic and area support).
Hospitalization.
Medical Evacuation (to include medical regulating).
Dental services.
Preventive medicine services.
Combat and operational stress control (COSC).
Veterinary services.
Medical logistics (to include blood management).
Medical laboratory services (to include both clinical laboratories and environmental laboratories).
Medical command function
Medical command Communications and computers Task-organization Medical intelligence Technical supervision Regional focus
Medical treatment
First aid Tactical combat casualty care Forward resuscitative surgery Routine sick call Patient holding Casualty prevention measures Medical evacuation Physical therapy
Hospitalization function
Essential care Triage and emergency care Outpatient services Inpatient care Clinical Laboratory and blood banking Radiology Physical therapy Medical logistics Emergency and essential dental care General and specialty surgery Anesthesia service Pharmacy Nutrition care Behavioral health Patient administration services Consultation