Department of Defense[DOD] - 4 of 6

Medical Resources for DSCA Operations

The Service medical units listed below have been identified for potential DSCA response.[15]

Army

  • Forward Surgical Team (FST): Provides a rapidly deployable, urgent initial surgical service capability including: Emergency treatment to receive, triage, and prepare incoming patients for surgery; provide the required surgery; and continued postoperative care for up to 30 critically wounded / injured patients over a period of 72 hours with its organic Medical Materiel Sets (MMS) as well as surgical team augmentation of other medical units / facilities. The FST is capable of continuous operations in conjunction with a supporting larger medical unit for up to 72 hours, providing urgent initial surgery for otherwise non-transportable patients. It also provides postoperative acute nursing care for up to eight patients simultaneously per team prior to further patient evacuations.

  • Combat Support Hospital (CSH): Provides hospitalization and outpatient services for all classes of patients, including hospitalization for up to 248 patients in four wards providing intensive nursing care for up to 48 patients and ten wards providing intermediate nursing care for up to 200 patients. In addition to emergency triage and treatment, the CSH contains a surgical capability, based on six operating room (OR) tables which are staffed for 96 operating table hours per day. It also provides consultation services for inpatients and outpatients to include area support for units without organic combat health support services as well as pharmacy, psychiatry, community health nursing, physical therapy, clinical laboratory, blood banking, radiology, and nutrition care services.

  • Early Entry Hospital element (EEHE [44-Bed]): A subordinate element of a CSH that provides hospitalization services for all classes of patients including hospitalization for up to 44 patients consisting of two wards providing intensive care nursing for up to 24 patients, and one ward providing intermediate care nursing for up to 20 patients. In addition to emergency treatment capability to receive, triage, and prepare incoming patients for surgery, the EEHE contains a surgical capability consisting of general and orthopedic surgery based on two OR tables staffed for 36 operating table hours per day. (This unit also provides OR space and time for operating table hours required by Hospital Augmentation Surgical Teams, if deployed.) It also provides pharmacy and clinical laboratory services to include limited basic microbiology screening, blood banking, and radiology service as well as unit-level FHP&R / HSS for organic personnel.

  • Hospital Augmentation Element ([HAE] 84-Bed): A subordinate element of a CSH that augments the EEHE (44-Bed) by providing outpatient specialty clinic services, and 40 intermediate care hospital beds. Its capabilities include: additional hospitalization for up to 40 patients consisting of two wards providing intermediate nursing care as well as consultation and outpatient specialty clinic services for outpatients referred from other medical treatment facilities. It also provides augmentation to company headquarters and supply and services section.

All CSH work areas and assemblages deploy with three days of supply on hand within identified MMS.

  • Area Support Medical Company (ASMC): Provides FHP&R to units located within its AOR by, among other capabilities, treating patients with disease and minor injuries, triage of mass casualties, initial resuscitation / stabilization, advanced trauma life support, and preparation for further evacuation of ill, injured, and wounded patients who are incapable of returning to duty within 72 hours. The ASMC is also able to provide patient holding for up to 40 patients as well as pharmacy services and multi-shift laboratory / radiological services. Additionally, the ASMC is capable of providing emergency medical supply / resupply to units operating within its AOR and fielding "Treatment Squads" which are capable of operating independently of the ASMC for limited periods of time.

Additionally, the Army can provide Specialized Medical Command (MEDCOM) Response Capabilities (SMRC) teams of personnel that support DSCA activities such as mental health, telemedicine, and disease response. (W. West, DoD [Office of the U.S. Army Surgeon General] personal communication through CDR W. Carroll [Joint Staff Surgeon], 2011 Sep 6)

Air Force

Expeditionary Medical Support (EMEDS) Basic: The EMEDS Basic force module is the first element of EMEDS capability. It provides force health protection, public health / preventive medicine, flight medicine, primary care, emergency medicine and surgery, perioperative care, critical care stabilization, dental care, AE coordination / communication, and patient preparation for transport. It can support a population at risk (PAR) of 1,500-3,000. The complete EMEDS Basic force package is capable of providing care for seven days in an austere environment without resupply. EMEDS Basic has no in-patient capability but is equipped to hold up to four patients for up to 24 hours. Patient evacuation within 24 hours is critical to mission success. Patients requiring priority / urgent AE will be scheduled for movement in accordance with theater AE policy. Blood storage, collection, and transfusion capability is limited. (Maj J. Langevin, DoD [U.S. Transportation Command {on behalf of U.S. Air Force Air Combat Command}], personal communication 2011 Aug 29)

  • EMEDS+10: When combined with EMEDS Basic, this increment provides prevention, acute intervention, primary care, and dental services to support a PAR of 3,000-5,000. The EMEDS+10 has ten inpatient beds and is capable of providing medical and dental care for seven days in an austere environment without medical re-supply. The ten beds provide complex medical / surgical inpatient capability consistent with the evacuation policydetermined by the supported COCOM. The core infrastructure provides additional ancillary support, medical equipment maintenance, and facility management. Blood storage, collection, and transfusion capability is limited.

  • EMEDS+25: When combined with EMEDS Basic and EMEDS +10, this increment provides prevention, acute intervention, dental services, and primary care to support a PAR of 5,000-6,500. The EMEDS+25 has 25 inpatient beds and is capable of providing medical and dental care for seven days in an austere environment without medical re-supply. The 25 beds provide complex medical / surgical inpatient capability consistent with the evacuation policy determined by the supported COCOM. EMEDS+25 provides the core infrastructure for specialty (i.e., critical care, gynecology, otorhinolaryngology, neurosurgery, oral surgery, ophthalmology, thoracic / vascular surgery, urology, mental health triage, and combat stress management).

These units require base operating support for such things as electricity, water, and many other considerations

The Air Force is also currently developing an EMEDS Health Response Team (EMEDS-HRT) to provide rapid deployable modular patient care for humanitarian assistance and disaster relief. (Maj J. Foltz, DoD [Office of the U.S. Air Force Surgeon General], personal communication, 2011 Aug 29)

  • Critical Care Air Transport Team (CCATT): Assists in carrying out the AE mission, which includes air transport of patients under medical supervision while delivering optimal care. CCATTs serve as a distributive MTF. They provide medical care after the patient has received essential, stabilizing care by other medical entities such as civilian hospitals or Army field hospitals. CCATTs are able to continuously monitor and maintain stabilization of critically ill / injured / burned patients during transport of the patient in flight. Prior to transport, the role of the CCATT is to prepare the critically ill patient for the flight. The CCATT will normally accompany the patient from the originating medical facility to the aircraft and continue to monitor and intervene during in-flight operations as required. This team does not routinely provide primary stabilization and does not replace forward surgical or ground medical support team capabilities.

  • Contingency Aeromedical Staging Facility (CASF): One of the ground expeditionary components of the AE mission, the CASF provides personnel and equipment necessary to care for, transport to aircraft, and administratively process patients transiting the AE system. They provide a patient holding and transfer capability. The CASF coordinates and communicates with medical and AE elements to accomplish patient care, staging, and patient movement, including ground transportation of patients in the AE system. The CASF personnel package is customized depending on nature and size of mission requirement. CASFs are built in modular and, if necessary, incremental fashion to form Staging Facilities of 25-, 50-, 100- and 250-bed configurations. The CASF provides an initial rapid-response capability to operate a staging facility for 24-hour 7-day / week operations. Critically ill patients will be cared for at either the nearest MTF facility with required capability or on a short-term basis by CCATTs at the CASF location for patients awaiting airlift. CASF personnel provide nursing care and administration processing for all patients traveling in the AE system during emergency conditions or contingency operations.

  • Mobile Aeromedical Staging Facility (MASF): A smaller and more temporary patient holding and transfer capability compared to the CASF, the MASF is designed to provide forward support with the smallest footprint and contains sleeping tents to provide some operating support for deployed personnel. The MASF includes a capability to receive patients, provide supportive patient care, and meet administrative requirements on the ground while awaiting AE. CCATTs can be assigned to forward-based MASFs to enhance rapid evacuation. The MASF is equipped and staffed for routine processing of 40 patients every 24 hours, usually holding patients up to ten hours. Because it has no beds, patients remain on the litters provided by the originating facility.

Disaster Aeromedical Staging Facility (DASF): Created by adding a CASF nursing personnel package to a MASF, the DASF is a 43-person, temporary AE staging facility that supports rapid response patient staging, limited holding and supports civil disaster response operations and will optimally operate out of existing buildings of opportunity. The DASF is equipped and staffed with patient care and support personnel for a throughput planning factor of 140 patients in a 24- hour period with a maximum 1-2 hour patient hold time. (Maj J. Langevin, DoD [U.S. Transportation Command {on behalf of U.S. Air Force Air Combat Command}], personal communication 2011 Aug 29) Navy

  • Mercy-Class Hospital Ship (T-AH): Operated by MSC, these two CONUS-based ships are primarily intended to provide emergency afloat or pier-side hospital level care, including advance inpatient critical and surgical care. They each contain 12 fully-equipped ORs, over 500 hospital beds (almost half the beds are top bunks), digital radiological services, a medical laboratory, a pharmacy, an optometry lab, a Computerized Axial Tomography (CAT)-scan capability, and two oxygen producing plants. Each ship is equipped with a helicopter deck capable of landing large military helicopters. The ships also have side ports to take on patients at sea. These ships conform to the Geneva Convention as hospitals.

  • Amphibious Assault Ship (Tarawa-Class [LHA] and Wasp-Class [LHD]): Primarily intended to land and sustain Marines once ashore, these nine CONUS-based ships (two LHA / seven LHD) can be tasked as part of a DSCA response force. Their Medical Departments provide primary health care and emergency capabilities to the ship's crew and embarked personnel. Medical elevators rapidly transfer casualties from the flight deck and hangar bay to the medical facilities.

    • The LHA provides four ORs, ten ward beds, three intensive care unit (ICU) beds, a 1,000-unit blood bank, and x-ray capabilities in addition to full dental facilities. With augmentation it can provide 15 ICU and 45 ward beds.

    • The LHD provides a surgical capability of six (four main and two emergency) ORs, along with 15 ICU / recovery beds, 45 ward / holding beds, laboratories, and a blood bank.

Each ship is capable of providing medical assistance to 60 patients per day for one day, 40 patients per day for four days, and 30 patients, on a sustained basis, based on patient evacuation policy of 24 hours.

  • Expeditionary Medical Facility (EMF [10-116 Bed]): Intended to support a COCOM, the EMF is a scalable facility, capable of providing two ORs (2-4 operating tables), 4-20 ICU beds, and 6-96 acute care beds, as well as laboratory, X-ray, and pharmacy services.

Marine Corps (Medical and dental support is provided by the Navy)

  • Medical Battalion (MedBn): Assigned to the Marine Logistics Group, the three AC and one RC MedBns are the primary source of HSS above the battalion / squadron and regiment / group-level aid station; it provides resuscitative care and temporary holding of casualties. It is composed of a Headquarters & Service Company which includes eight Shock and Trauma Platoons, and three Surgical Companies, each of which is capable of establishing three ORs and a 60-bed ward, along with laboratory, X-ray, and pharmacy services.[16]

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