ROLES OF MEDICAL CARE (ARMY) Flashcards
ROLES OF MEDICAL CARE
A basic characteristic of organizing modern AHS support is the distribution of medical resources and capabilities to facilities at various levels of command, diverse locations, and progressive capabilities, which are referred to as roles of care
Definitive care
refers to (1) that care which returns an ill or injured Soldier to full function, or the best possible function after a debilitating illness or injury. Definitive care can range from self-aid when a Soldier applies a dressing to a grazing bullet wound that heals without further intervention, to two weeks bed rest in theater for Dengue fever, to multiple surgeries and full rehabilitation with a prosthesis at a continental United States (CONUS) medical center or Department of Veteran’s Affairs hospital after a traumatic amputation. (2) That treatment required to return the Service member to health from a state of injury or illness. The Service member’s disposition may range from return to duty to medical discharge from the military. It can be provided at any role depending on the extent of the Service member’s injury or illness. It embraces those endeavors which complete the recovery of the patient.
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.
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).
Nonmedical Personnel
Nonmedical personnel performing first aid procedures assist the combat medic in their duties. First aid is administered by an individual (self-aid or buddy aid) and enhanced first aid is provided by the combat lifesavers. A combat lifesaver is a nonmedical Soldier of a unit trained to provide enhanced first aid as a secondary mission
Self-Aid and Buddy Aid
Each individual Soldier is trained in a variety of specific first aid procedures. These procedures include aid for chemical casualties with particular emphasis on lifesaving tasks. This training enables the Soldier or a buddy to apply first aid to alleviate potential life-threatening situations. Each Soldier is issued an individual first aid kit to accomplish first aid tasks. First aid refers to urgent and immediate lifesaving and other measures which can be performed for casualties (or performed by the victim himself) by nonmedical personnel when medical personnel are not immediately available
Combat Lifesaver
The combat lifesaver is a nonmedical Soldier selected by his unit commander for additional training beyond basic first aid procedures. A minimum of one individual per squad, crew, team, or equivalent-sized unit should be trained. The primary duty of this individual does not change. The additional duty of the combat lifesaver is to provide enhanced first aid for injuries, based on his training, before the combat medic arrives. Combat lifesaver training is normally provided by medical personnel during direct support of the unit. The training program is managed by the senior medical person designated by the commander. Members of Special Forces operational detachment teams receive first aid training at the combat lifesaver level.
Role 1
The first medical care a Soldier receives is provided at Role 1 (also referred to as unit-level medical care). This role of care includes—
Immediate lifesaving measures.
Disease and nonbattle injury (DNBI) prevention.
Combat and operational stress preventive measures.
Patient location and acquisition (collection).
Medical evacuation (MEDEVAC) from supported units (point of injury [POI] or wounding, company aid posts, or casualty/patient collection points) to supporting MTFs.
Treatment provided by designated combat medics or treatment squads. (Major emphasis is placed on those measures necessary for the patient to return to duty or to stabilize him and allow for his evacuation to the next role of care. Return to duty refers to a patient disposition which, after medical evaluation and treatment when necessary, returns a Soldier for duty in his unit. (FM 4-02) These measures include maintaining the airway, stopping bleeding, preventing shock, protecting wounds, immobilizing fractures, and other emergency measures, as indicated.)
Role 2
At this role, care is rendered at the Role 2 MTF which is operated by the area support squad, medical treatment platoon of medical companies. Here, the patient is examined and his wounds and general medical condition are evaluated to determine his treatment and evacuation precedence, as a single patient among other patients. Tactical combat casualty care including beginning resuscitation is continued, and if necessary, additional emergency measures are instituted, but they do not go beyond the measures dictated by immediate necessities. The Role 2 MTF has the capability to provide packed red blood cells (liquid), limited x-ray, clinical laboratory, operational dental support, combat and operations stress control (COSC), preventive medicine, and when augmented, physical therapy and optometry services. The Role 2 MTF provides a greater capability to resuscitate trauma patients than is available at Role 1. Those patients who can return to duty within 72 hours (1 to 3 days) are held for treatment. This role of care provides MEDEVAC from Role 1 MTFs and also provides Role 1 medical treatment on an area support basis for units without organic Role 1 resources.
Role 3
At Role 3, the patient is treated in an MTF staffed and equipped to provide care to all categories of patients, to include resuscitation, initial wound surgery, damage control surgery, and postoperative treatment. This role of care expands the support provided at Role 2. Patients who are unable to tolerate and survive movement over long distances receive surgical care in a hospital as close to the supported unit as the tactical situation allows. This role includes provisions for—
Coordination of patient evacuation through medical regulating.
Providing care for all categories of patients in an MTF with the proper staff and equipment.
Providing support on an area basis to units without organic medical assets
Role 4
Role 4 medical care is found in CONUS-based hospitals and other safe havens. If mobilization requires expansion of military hospital capacities, then the Department of Veteran’s Affairs and civilian hospital beds in the National Disaster Medical System are added to meet the increased demands created by the evacuation of patients from the area of operations (AO). The support-based hospitals represent the most definitive medical care available within the AHS.
Point of Injury/Battalion Aid Station ∧ Below
Nonmedical Personnel
Self-Aid and Buddy Aid
Role 1 Immediate lifesaving measures EMT / ATM Medic, Physician, Physician Assistant Medical Evacuation Combat Lifesaver Immediate lifesaving measures AWT / CLS Trained Individual Soldier / Battle Buddy
Medical Company BSMC or MCAS / Role 2
X-ray, laboratory, and dental support Preventive medicine Patient Hold Advanced Trauma Management MEDLOG Medical Evacuation
Hospital Center / Field Hospital/Role 3
Resuscitation, initial wound surgery, and postoperative treatment Hospitalization Medical regulating Clinical services Pharmacy
Army Health Clinic,Community Hospital,Medical Center ,/Role 4
Full spectrum of definitive medical care
CONUS or OCONUS safe havens
