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Fleet Medicine

Pocket Reference

2008

Surface Warfare Medicine Institute,a component detachment of the

Naval Operational Medicine Institute

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CVN Aircraft Carrier

LHA Amphibious Assault Ship

LHD Amphibious Assault Ship

LPD Amphibious Transport Dock

LSD Dock Landing Ship

CG Cruiser

DDG Guided Missile Destroyer

FFG Frigate

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This booklet is designed to be a useful guide to medicaldepartment personnel assigned to operational medical billets tospecifically include Task Force/Expeditionary Strike Groups,Officers-in-Charge of Fleet Surgical Teams, and Carrier StrikeGroup Medical Officers. The information herein is derived fromprimary sources that are usually identified within the text. Non-referenced information is included in order to tap the experience ofprevious operational medical department personnel.

Thank you to the authors, reviewers and editors of this and allprevious editions, especially SURFOR, AIRFOR, Expeditionary

Health Services Pacific, NEPMU 5 and NMCSD personnel for theirongoing support.

Please send all correspondence concerning the content and styleof this reference to CDR Lou Gilleran, MC, USN, at the addressbelow. Feedback is always welcomed to keep our fellowoperational medical department personnel well informed andprepared.

Surface Warfare Medicine Institute

50 Rosecrans StreetBuilding 500Naval Submarine Base

San Diego CA 92106-4408(619) 553-0097

Email: [email protected]

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TABLE OF CONTENTS

Topic Page

Acronyms and Abbreviations 3Augmented Afloat Medical Assets 7Blood Program 12Communications 19

Credentials and PA&I 21Crisis Management 25Foreign Humanitarian/Disaster Relief 25Decedent Affairs 34HSS Naval Forces Afloat Capabilities 37HSS USMC 42Important Points of Contact 47International SOS 54Capability (Levels - Echelons) of Care 56Mass Casualty 58Medical Evacuation 60Medical Intelligence 65Medical Lessons Learned 72Naval Messages 73Port Visits 76Pre & Post Deployment Checklists 77Preventive Medicine 81

Shipboard Familiarization 87Special Circumstances 96SWMDO Warfare Designation 100Task Force Surgeon Duties 103Triage 106Glossary 111Prisoners of War 118Sailors Creed 119

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ACRONYMS and ABBREVIATIONS

AABB........... AmericanAssociation of BloodBanks

ACLS........... advanced cardiac lifesupport

ACU............. Assault Craft UnitADAL........... Authorized Dental

Allowance ListAFMIC.........Armed Forces

Medical IntelligenceCenter

AJBPO ........area joint blood

program officeALCC........... airlift control centerAMAL.......... Authorized Medical

Allowance ListAO............... area of operation;

Air Officer;Administrative Officer

AOR ............ area of responsibilityARG ............ Amphibious

Readiness GroupASBP........... Armed Services

Blood ProgramASBPO........ Armed Services

Blood Program OfficeASWBPL ..... Armed Services

Whole BloodProcessingLaboratory

ATF ............. Amphibious TaskForce

ATLS........... advanced trauma lifesupport

BAS............. battalion aid stationBES............. beach evacuation

stationBLS ............. basic life supportBPD.......... ... blood product depotBSU.......... ... Blood Supply UnitBTC.. ........... blood transshipment

centerC2................ command and

controlC2W............ command and

control warfareC4I............... command, control,

communication,computer &intelligence

CAS............. close air support

CAT..............Crisis Action TeamCATF............Commander, Amphibious

Task ForceCBR .............chemical, biological, and

radiologicalCBTZ............combat zoneCCO.............Combat Cargo OfficerCE................combat elementCECO...........Combat Evacuation Control

OfficerCI ............... ..counter-intelligenceCIA ...............Central Intelligence Agency

CIC...............Combat Information CenterCIFS.............close-in fire supportCLF ..............Co mmander, Landing ForceCLZ ..............LCAC landing zoneCLZA............LCAC landing zone support

areaCME. ............continuing medical

educationCNO.............Chief of Naval OperationsCOC. ............combat operations centerCOMMZ .......communications zoneCOMLANFLT Commander, U. S. Atlantic

FleetCOMPACFLT Commander, U. S. Pacific

FleetCONREP......connected replenishmentCOMSEC .....communications securityCONUS. .......continental United StatesCP................command postCPG .............Co mmander, Amphibious

Group (ONE, TWO, orTHREE)

CPR .............cardiopulmonaryresuscitation

CRRC...........combat rubber raiding craftCRTF ...........casualty receiving and

treatment facilityCRTS ...........casualty receiving and

treatment shipCSGCarrier Strike GroupCSAR. ..........combat search and rescueCSO .............Chief Staff Officer (of

amphibious squadron PHIBRON)

CSS..............combat service supportCSSD. ..........Combat Service Support

DetachmentCSSE ...........combat service support

element

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CTF............. Commander, TaskForce

DAS.......... ... deep air supportDASC.......... Direct Air Support

CenterDET............. detachmentDEW............ directed energy

weapon (usuallylaser)

DFAS........... Defense Finance &Accounting Service

DIA.............. Defense IntelligenceAgency

DNBI............disease andnonbattle injury

DOD............ Department of

DefenseDOS ............ Department of State(State Department)

DOWW........ disease occurrenceworldwide

DRAW......... demonstration, raid,assault, withdrawal(amphibious ops)

DTG............. date-time group(messages)

DZ ............... drop zoneEAF............. expeditionary airfieldEEI .............. essential elements of

informationELINT.. ........ electronic intelligenceEMB ............ embarkationEMCON....... emission controlEMFExpeditionary

Medical FacilityEMT............. emergency medical

technicianEPW............ enemy prisoner of

warESGExpeditionary Strike

GroupEW .............. electronic warfareFAC.. ........... forward air controllerFCC........ ..... Federal Coordinating

CenterFCSSA........ force combat service

support areaFDC........ ..... fire-direction centerFEBA........... forward edge of the

battle areaFEMA.......... Federal Emergency

Management AgencyFFA ............. free-fire areaFFP ............. fresh frozen plasma

FIC ...............F leet Intelligence CenterFISC.............Fleet and Industrial Supply

CenterFLTCINC......See COMPACFLTFMF..............Fleet Marine ForceFO................forward observerFOD .............f oreign object damageFORSCOM...Forces CommandFOS..............full operating statusFP .............. ..frozen platelets; or Family

PracticeFRBC ...........frozen red blood cellsFRSS.Forward Resuscitative

Surgery SystemFSCC ...........Fire-Support Coordination

Center

FSSG ...........Force Service SupportGroupFST ..............F leet Surgical TeamGCE .............ground combat element

(MAGTF)GPMRC........Global Patient Movement

Requirements CenterGPS .............gl obal positioning systemGQ ...............general quartersGYN .............gynecologyH&S..............Headquarters and Service

CompanyHANDSCO. ..Headquarters and Service

CompanyHCS .............Helicopter Coordination

SectionHDC .............Helicopter Direction CenterHE................high explosiveHHS .............health service supportHLSC ...........Helicopter Logistics Support

CenterHNS .............host-nation supportHSAP.Health Service

Augmentation ProgramFormerly (MAP)

HSS..............helicopter service supportHST..............Helicopter Support TeamHUMINT .......human intelligence (vs.

satellite imagery, radiosignal, etc.)

IADS.............Integrated Air DefenseSystem

IAW ..............i n accordance withIDC...............independent duty hospital

corpsmanIDTC.............inter-deployment training

cycleIFF................identification, friend or foe

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IMA.............. individualmobilizationaugmentee

IP................. initial pointIRR.............. Individual Ready

ReserveISO.............. International

StandardizationOrganization

ISIC............. immediate superior incommand

ITT............... Interrogator andTranslator Team

IV................. intravenousJBPO........... Joint Blood Program

Office

JCS ............. Joint Chiefs of StaffJDS ............. Joint DeploymentSystem

JIC............... Joint IntelligenceCenter

JMBO.......... Joint Military BloodOffice

JMRO..........Joint MedicalRegulating Office

JOPES ........Joint OperationsPlanning andExecution System

JTF.............. Joint Task ForceJULL......... ... Joint Unified Lessons

LearnedKIA .............. killed in actionLANTFLT..... See COMPACFLTLF................ Landing ForceLFOC...........Landing Force

Operations CenterLFSP........... landing force support

partyLOC............. line of

communicationLOD.......... ... line of departureLOI .............. letter of instructionLZ................ landing zoneLZCP........... landing zone control

partyLZSA........... landing zone support

areaMAGTF........ Marine Air-Ground

Task ForceMANMED .... Manual of the

Medical DepartmentMAA ............ master-at-armsMAO............ Medical

Administrative Officer

MAP .............medical augmentationprogram (HSAP)

MARDIV .......Marine divisionMARG ..........Marine Amphibious

Readiness GroupMASF. ..........Mobile Aeromedical Staging

FacilityMCLL ...........Marine Corps Lessons

LearnedM-Day ..........mobilization dayMEDCAPS ...medical capabilities studyMEDEVAC ...medical evacuationMEF .............Marine Expeditionary ForceMEF (FWD)..Marine Expeditionary Force

(forward)MEPES ........medical planning and

execution systemMEU. ............Marine Expeditionary UnitMIA...............missing in actionMLL.Medical Lessons LearnedMMART........Mobile Medical

Augmentation ReadinessTeam

MOOTW. Military Operations Otherthan War

MOPP ..........mission-oriented protectiveposture

MPF .............Maritime Pre-PositioningForce

MRCC ..........Medical Regulating ControlCenter

MRCO ..........Medical Regulating ControlOfficer

MRS. ............medical regulating systemMSC. ............Military Sealift Command; or

major subordinatecommand

MSOC ..........Medical Support OperationsCenter

MSR. ............main supply routeMTF..............Medical Treatment FacilityMWR............Morale, Welfare, and

RecreationNATO...........North Atlantic Treaty

OrganizationNATOPS ......naval air training and

operating proceduresNBC .............nucl ear, biological, and

chemicalNBG .............naval beach groupNCA .............Nati onal Command

AuthorityNDMS ..........National Disaster Medical

System

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NEO ............ non-combatantevacuation operation

NGO............ non-governmentalorganization

NOFORN..... not releasable toforeign nationals

NOTAM....... notice to airmenNSA.......... ... National Security

AgencyNSN.............national stock

numberNWP............ Naval Warfare

PublicationsO&M............ operation and

maintenanceOAS............. offensive air support

OCONUS .... outside continentalUnited StatesOIC......... ..... Officer-In-ChargeOMFTS........ operational

maneuvers from thesea

OOTW.... ..... operations other thanwar

OPCON.... ... operational controlOPLAN........ operational planOPNAV........ Office of the Chief of

Naval OperationsOPNAVINST Naval Operations

InstructionOPLAN........ operations planOPORD....... operations orderOPSEC........ operations securityOPSUM.... ... operational summary

(a daily report)OPTEMPO.. intensity of

operations (e.g., low,high, extreme)

OSC ............ On-SceneCommander

OTC............. Officer in TacticalCommand

OTH............. over-the-horizonPACFLT ...... See COMPACFLTPAHO.......... Pan American Health

OrganizationPCO ............ primary control

officerPCRTS........primary casualty

receiving andtreatment ship

PCS.......... ... primary control shipPIM......... ..... position of intended

movement

PMI...............patient movement itemPOE .............projected operational

environmentPOL..............petroleum, oil, and

lubricantsPOM.............program objective

memorandumPOM.............pre-overseas movement (as

in POM period)POMI............Plans, Operations, and

Medical Intelligence OfficerPOTUS..President of the United

StatesRAS..............regimental aid stationRBC .............red blood cellsRCA .............ri ot-control agent

RFF.Request for ForcesRLT ..............Regimental Landing TeamROC. ............required operational

capabilityROE .............rules of engagementROPU...........reverse osmosis processing

unitRORO ..........roll on - roll offROS .............reduced operating statusSAM .............surface-to-air missileSAR..............search-and-rescueSATCOM......satellite communicationsSCM. ............ships cargo manifestSEAL............sea-air-landSERE ...........survival, evasion,

resistance, escapeSIGINT .........signal intelligenceSLOC ...........sea lines of communicationSOP .............s tandard operating

procedureSORM ..........Standard Organization and

Regulations Manual of theUS Navy (OPNAV 3120.32series)

SORTS.........status of readiness andtraining

SPLT.. ..........shore party liaison teamSPECAT.......special categorySTANAG ......standardization agreementSTP..............Shock-trauma PlatoonSURGCO .....Surgical CompanyT-AH.............hospital shipTAML ...........theater area (or Army)

medical labT/O...............table of organizationTAC..............Tactical Air CommanderTACAN.........tactical air navigation

systemTACC ...........Tactical Air Control Center

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TACLOG ..... Tactical-LogisticalGroup

TACRON..... Tactical Air ControlSquadron

TAD............. Tactical Air DirectorTADC .......... Tactical Air Direction

CenterTAO.......... ... Tactical Air ObserverTAOC.......... Tactical Air

Operations CenterTAR............. tactical air request

(net circuit)TEWA.......... threat evaluation and

weapons assignmentTF................ Task ForceTFMRS........ task force medical

regulating systemTOC............. Tactical OperationsCenter

TOW............ tube-launched,optically-tracked,wire-guided (missile)

TPFDD........ time-phased forceand deployment data

TPMRC ........Theater Patient MovementRequirements Center

TRAC2ES ....USTRANSCOM's regulatingcommand and controlevacuation system

TRANSCOM.Transportation CommandTRAP ...........tacti cal recovery of aircraft

and personnelTYCOM. .......Type Command

UDT..............Underwater DemolitionTeam

UNREP ........underway replenishmentUSAF ...........United States Air ForceVERTREP.. ..vertical replenishmentV/STOL ........vertical/short take-off and

landingWB ...............whole bloodWIA ..............wounded in actionWHO ............World Health OrganizationWMCCS .......worldwide military and

command control system

AUGMENTED AFLOAT MEDICAL ASSETS

FLEET SURGICAL TEAMS (FSTs)FSTs augment primary CRTS. They are distinct, freestanding,(non-BSO 18) assets of the Atlantic and Pacific Fleets operatingforces with their own UIC, and permanent OIC-coded billets. TheADCON ISIC is Expeditionary Health Servises (EHS) PAC or LANTand COMPHIBGRU3 and the OPCON ISIC is typicallyCOMPHIBRON, the CATF (Commodore). When not aboard theship, the FST members are ADDU to a regional MTF with the

Admin cell at PHIBGRU.

MISSIONProvide medical and surgical support, level II HSS capabilities, todesignated operating forces (CRTS) of the Atlantic and PacificFleets during Fleet and Fleet Marine Force (FMF) exercises androutine deployment of CATF/ESG.

LOCATION ISIC

FST # 1 San Diego EHSPACFST # 2 Norfolk EHSLANT

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FST # 3 San Diego EHSPACFST # 4 Norfolk EHSLANTFST # 5 San Diego EHSPACFST # 6 Norfolk EHSLANTFST # 7 Okinawa / Sasebo PHIBGRU 1FST # 8 Norfolk EHSLANTFST # 9 San Diego EHSPAC

TYPICAL FST CHAIN(S) OF COMMAND

Administrative (inport) Operational (at sea)FST FST

EHS/PHIBGRU PHIBRON / ESG/CSGCNSF NUMBERED FLEETCOMPAC/LANFLT NAVAL COMPONENT COMMAND

BILLET STRUCTURE AND GENERAL MEDICALCHARACTERISTICS:

Title Rank NOBC / NECOfficers OIC/ESG Surgeon 05 / 6 21XX

(7) FP / IM / ER / PED N/A 21XXGeneral Surgeon N/A 21XXAnesthesia N/A 21XX or 29XXCharge / CCRN N/A 29XXPerioperative RN N/A 29XXMRCO / MAO N/A 23XX

Enlisted LPO E6/7 0000/8404(9) General Duty (4) N/A 0000/8404

O.R. Tech (2) N/A 8483Adv Lab Tech N/A 8506Respiratory Tech N/A 8541

M+1 (WARTIME MANNING)

The current peacetime medical department of the CasualtyReceiving and Treatment Ship (CRTS), even with a Fleet SurgicalTeam, is inadequate to fulfill the wartime medical mission of theLHA/LHD; therefore 84 additional medical augmentation personnel

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are assigned to the CRTS upon request and approval of OPNAVN931and BUMED.

MISSION

Required Operational Capability (ROC) and Projected OperationalEnvironment (POE), for the LHA/LHD provides surgical capability offour ORs, 15 ICU/Recovery beds, 45 ward/holding beds, and ablood bank capacity of 500+ frozen blood units, FFP and a walkingblood bank. The M+1 mission is to meet the ROC/POErequirements of the medical department. Additionally, these assetsmay be used for humanitarian and disaster relief missions.

TRAININGAppropriate military training of medical personnel is the cornerstonefor effective force health protection. Military readiness training mustinclude any possible contingency from medical support in combatand homeland defense to humanitarian assistance (HA) anddisaster relief (DR). Medical personnel identified as M+1augmentees shall perform a minimum of 5 days of medicalreadiness training during each training cycle. Military Departmentsshall program for medical personnel to physically train at least onceevery other training cycle with their designated operational unit andequipment. Training for the M+1 Augmentees is coordinated bySurface Warfare Medicine Institute, EHSPAC/LANT, MTF(POMI/MMPO and senior leadership), SMO and medicaldepartment of identified LHA/LHD and FST.

BILLET STRUCTURE AND GENERAL MEDICAL

CHARACTERISTICSThe specific billets of the M+1 augmentation team are undercontinuing evaluation but presently consist of the following:

MC- 112 Internal Medicine; 1 Psychiatrist; 3 Anesthesiologist;3 General and 2 Orthopedic surgeons

DC-11 Oral Maxillo-Facial Surgeon

MSC-1HCA (unless specified)

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NC-221 Senior Nurse; 2 CRNAs; 5 Perioperative nurses;6 Critical care nurses; 2 ER nurses; 6 Med-Surg nurses

HM-48:24 General duty corpsman; 10 Surgical techs;2 medical admin; 2 Xray techs; 1 Lab tech; 1 BMET;1 Pharmacy tech; 2 Psych techs; 2 Ortho techs;3 Respiratory techsTEAMS LOCATIONS AND SOURCE

The CATF/ESG surgeon and SMO should work with the MMPO of

the MTF and senior leadership of the M+1 augmentees for effectivecontingency planning. Each CRTSs M+1 personnel come from aspecific MTF. There are 11 CRTS teams from MTF/ BudgetingSubmitting Office (BSO) 18:

Naval Medial Center San Diego: Teams 1, 3, 5

Naval Medical Center Portsmouth: Teams 2, 4, 6

National Naval Medical Center Bethesda: Teams 10, 11

Naval Health Clinic, Great Lakes: Teams 7, 9

Naval Hospital Jacksonville: Team 8

M+1 Platforms

USS TARAWA (LHA1) San Diego, CAUSS SAIPAN (LHA 2) Norfolk, VA

USS NASSAU (LHA 4) Norfolk, VAUSS PELELIU (LHA 5) San Diego, CAUSS WASP (LHD 1) Norfolk, VAUSS KEARSAGE (LHD3) Norfolk, VA

USS BOXER (LHD 4) San Diego, CAUSS BATAAN (LHD 5) Norfolk, VAUSS BONHOMME RICHARD (LHD 6) San Diego, CAUSS IWO JIMA (LHD 7) Norfolk, VA

SHIPBOARD SURGICAL SYSTEM (SSS / Triple S)

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The Shipboard Surgical System is the shipboard equivalent of aForward Resuscitative Surgical System (FRSS). It is designed tobe available on small combatants that do not have inherent surgicalcapabilities. In the Global War on Terror, this capability is ideal forMaritime Interdiction Operations (MIOs), shipboard seizures andother small scale operations.

SSS team is a six to eight member team of surgeons, ICU nursesand hospital corpsman from Shipboard Surgical Teams (SST)/FleetSurgical Teams (FST) who are able to rapidly set up and providecritical care for Sailors and Marines injured during MIO. It isdesigned to be extremely mobile, and clinically capable of providing

Level II minus emergency care, resuscitation and surgery for 5casualties, repeat interventions and a holding time of up to 72hours. Set up times may vary but it generally takes 45 minutes toset up on the mess deck. It is configured to use backup suppliesfrom the host ship but will not deplete the ships AMMAL below50%.

The Triple S team and equipment offer an opportunity to expandresuscitative or trauma care in nontraditional settings in support ofMIOs or significant trauma risk from small scaleoperations/missions. Two units have been constructed anddelivered to the U.S. Seventh Fleet. A total of 6 SSS units will beassembled and maintained for rapid deployment, but may bereplaced with ERSS (below).

Expeditionary Resuscitative Surgical System

(ERSS)At the time of this publication, ERSS has not been fullyimplemented. A highly responsive, mobile and flexible system oftrained personnel and equipment to provide tailored, missionspecific medical capability, close to the point of injury, that supportsthe range of military operations afloat and ashore. Focus is onhaving immediate life and limb saving surgery, trauma care, medicalevacuation and en-route care, at or near combat operations. Thiswill be an expansion of the SSS initiative and existing FST, able tosupport split operations, special operations, etc.

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The ERSS will be made up of 4 interacting components based uponthe Fleet Surgical Team (FST) with Health Service AugmentationProgram (HSAP) personnel, as noted below:

1. Shipboard Surgical Team (SST):Fleet Surgical Team (FST) and Ships company to provide modularresuscitative surgery on a LHA/LHD.

2. Expeditionary Surgical Team (EST):Provides forward initial emergency (damage control) surgery;capable of functioning from a small platform or from a shore basedposition. 1 GS, 1 Anesthesia provider, 1 CCN, 1 OR Tech.

Provides Level II minus to a Level I platform.

3. Expeditionary Trauma Team (ETT):Provides initial emergency life and limb saving actions, capable offunctioning from a small platform or shore based position. 1 EMphysician, 1 PA, 1 IDC

4. En-Route Care Team (ERCT):Provides treatment of patients during movement betweencapabilities in the continuum of care. 1 CCN and 1 Flight Medic(HM)

Referencesa. CINCPACFLT/CINCLANTFLTINST 5450.5B dtd 14 FEB 00 Fleet Surgical

Teamsb. DOD Directive 1322.24 dtd 12 JUL 2002 Medical Readiness Trainingc. BUMED 6440.5C dtd 24 Jan 2007 Health Service Augmentation Program

BLOOD PROGRAMCONCEPT OF OPERATIONS: Fluid and blood product availabilityat different levels of care.

Echelon I: Ringers Lactate and human albumin Echelon II: Ringers Lactate, human albumin, Group O red

blood cells, liquid Echelon III: Ringers Lactate, albumin (25 percent), red blood

cells (liquid and frozen), fresh frozen plasma, plateletconcentrate

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Echelon IV: Ringers Lactate, albumin (25 percent), red bloodcells (liquid and frozen), fresh frozen plasma, plateletconcentrate

Echelon V: Fullrange of resuscitation fluid and bloodproducts

Frozen Blood Capabilities:

Disclaimer: Blood and blood products capabilities are dependent onprojected operational environment, type of deployment, availability of

products, equipment capacity aboard ships, and medical personnelmanning (FST, M+1).

* We are not licensed by the FDA for frozen platelets, therefore referencesto platelets should include if available since the five-day shelf life means

providing them may be impossible. The ASBPO will probably not meet

theater needs until platelets with longer shelf life are available or frozenplatelets become licensed.

PLANNING FACTORS AND ISSUES: Four units of red blood cells per initial admission of each WIA

and DNBI. One technician and four cell washers can deglycerolize 96

units of frozen blood cells in 24 hours. Assign staff for 12-hourshifts and 7-day work weeks.

Ship Deployment RBCs FFP Platelets*

LHA Contingency 400-450 20 50

Mobilization 400-450 40 TBD

LHD Contingency 400-450 20 50

Mobilization 400-450 40 TBD

T-AH Contingency 1400 100 25

Mobilization 1400 110 TBD

FleetHospital

(no frozenblood)

- - -

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There is NO FROZEN BLOOD RESUPPLY TO SHIPS. Oncefrozen red cells are used by the LHDs, LHAs, and T-AHs,expect no additional frozen blood from the blood productdepots (BPDs). Frozen blood is a transition into liquid blood;count on it for the first few days until the liquid blood pipeline isestablished. Hence, the early establishment of the pipeline ofBSUs, BTCs, AJBPO, and JBPO is imperative. Frozen redblood cells should be incorporated into the routine inventory sothat the medical staff is familiar with its use.

Walking Blood Bank: This is a tertiary source of blood (i.e., tobe used only after liquid and frozen blood sources have been

depleted (CNSF 6000.1 series). However, walking blood bankresponse should be checked frequently. Activate the WalkingBlood Bank (or parts of it) during mass-casualty drills.Activating the walking blood donor program requires follow upof recipients by BUMED and the medical treatment facilitywhere the ship is home ported. All transfusion records shouldbe turned over to the medical treatment facility responsible forsupporting the ship in homeport.

EXTREMELY IMPORTANT: Meet OPNAV 6530.4Arequirements: Save the donor card, a frozen plasma sample,and the correct donor / unit numbers. Report transfusions onships to BUMED Navy Blood Program Office and the medicaltreatment facility where the ship is home ported for subsequenttracking in the future. This is a BIG ISSUE now, especiallywith HIV, HTLV, and hepatitis C.

Prior to deployment, acquire all message go-bys for bringingblood to the ship if needed (a task for the senior advanced labtech).

BLOOD SUPPORT ACTIVITIES

Blood Resources Management and SupportJoint Blood Program Office - Each unified command has beenrequested by the Armed Services Blood Program Office todesignate a joint health office to implement DOD blood programpolicies and coordinate the blood programs of the unified commandcomponents. The JBPO will be the single interface with the ArmedServices Blood Program Office in CONUS. Normally, the JBPO will

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collocate with the Theater Patient Movement Requirement Center(TPMRC). The JBPO will redistribute blood among regions in thetheater and will request blood supply from CONUS. The JPBO willsubmit a daily blood situation report to the Armed Services BloodProgram Office during the contingency using the appropriate format(Annex A). Information copies will be provided to each AJBPO andother agencies as required.

Area Joint Blood Program Office - Unified commands have beenrequested by the Armed Services Blood Program Office to establishAJPBOs as required. They will implement the unified commandblood program policies, coordinate the blood programs of the

unified command components within their area, and manage bloodproducts in the assigned BTC. Normally, the AJPBO will collocatewith the Area TPMRC. The AJPBO will redistribute blood amongcomponents in the theater or request blood supply from the JBPO.The AJBPO will submit a daily blood situation report to the JPBOusing the appropriate format (Annex A). Information copies will beprovided to each component blood products depot unit and otheragencies as appropriate.

Blood Transshipment Centers - The USAF operates the BTCs.The USAF is planning to staff and equip these centers to store andissue up to 3,600 units each of liquid and frozen blood products ona daily basis. Determining the numbers and locations of the centersis a responsibility of the unified command and will be adequate tosupport each unified command components blood requirements onan area basis. Normally, the Navy or Marine Corps will arrangetransportation to obtain blood from the BTC for Navy or Marine

Corps units. Blood issue to the Navy and Marine Corps will bebased on a daily allocation system established by the theaterJMBO. The allocations will be modified as required.

Frozen Blood Depots - The Navy operates one frozen blood depotin Sigonella, Sicily, and one in Okinawa, Japan. These depots havethe capability to store 40,000 and 10,000 units of frozen blood,respectively. Each depot has one Medical Service Corps officer,Naval Officer Billet Code 0866; one enlisted technician, NavyEnlisted Classification 8506; and four civilian technicians, GS-644-04/05. These depots will provide frozen blood products toappropriate medical platforms upon direction by the AJBPO. The

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Army is also planning to establish frozen blood depots to store atotal of 75,000 units of frozen blood products. The USAF isplanning to store 50,000 units of frozen blood in Armed ServicesWhole Blood Processing Laboratories in CONUS.

Blood Supply Units - The Navy and Marine Corps will establishBSUs as recommended by the JBPOs. Personnel at these supplypoints will, upon direction by the AJBPO, arrange or providetransportation for blood products from the BTCs to the BSUs andthen coordinate shipment to Navy or Marine Corps field medicalunits, Fleet Hospitals, and ships. The following units are likely tofunction as BSUs:

Frozen blood depots. USMC units where medical personnel are responsible for

coordinating blood and clinical fluids support. FSSG detachments in the theater of operations. Blood processing centers at Naples, Italy; Rota, Spain; and in

the United Kingdom.

Medical Field Refrigerator - A lightweight, refrigerated blood box(NSN 410-01-287-7111) operating from direct or alternating current,containing 30 to 50 units of red blood cells. It has been shipped tothe field medical supply activities by the Defense Personnel SupportCenter.

Frozen Blood Container - The USAF developed a shipping andstorage container for frozen blood products to transport themwithout dry ice. It can be ordered through the local medical stock.The stock number is 814013571551 on the Management DataListing.

Blood Box Management - Whenever possible, blood will betransported from blood supply points in boxes provided by theintended recipient. When the recipient has no box, attempt will bemade to return boxes used to ship blood to the blood supply point orto exchange empty for full boxes.

Frozen Blood Management - Assure that Standard OperatingProcedure (SOP) is clear on the new USAF frozen blood containerand explains the proper handling of the eutectic solutions. To reuse

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the solutions, they must be COMPLETELY thawed to roomtemperature and then refrozen at 65C or lower.

Communications - All blood reports and blood shipment reportsare sent using standard Armed Services Blood Program Officevoice, message, and/or computer-generated blood report formats.The US Message Text Format is the basis for voice and messageblood reports. The Armed Services Blood Program Office plans tohave the Defense Systems Support Command automate the ASBPblood banks by developing the Defense Blood Standard System.The Theater Army Medical Management Information System hasbeen designated to automate Army activities in the theater and

modernized to support the Navy Fleet Hospitals as the FleetHospital blood bank module. Any computer systems purchased forCONUS blood collection stations will be compatible with theDefense Blood Standard System, and computer systems purchasedfor OCONUS MTFs shall be compatible with the Theater ArmyMedical Management Information System. The Armed ServicesBlood Program Office requires that the Theater Army MedicalManagement Information System and the Defense Blood StandardSystem also be compatible.

Walking Blood Bank - SOP will be clear that blood from walkingdonors is collected properly. OPNAV instruction require completionof donor cards, saving of frozen blood samples, and correct donor /unit numbers to identify the donor card, donor frozen sample, andunit number. This allows the donated units to be tested for HIV,HCV, etc., to be accurately accomplished.

Pre-qualifying walking donors in CONUS military blood banks justprior to deployment is a method used by some deploying units.However, regardless of pre-qualification, SOP must be followed foreach donated unit.

BLOOD ISSUES ASHORE LANDING FORCEEchelon I, Unit Corpsman and Battalion Aid Station

Resuscitation fluids: Ringers Lactate, human albumin.Blood / blood products: None.

Echelon II, Shock-trauma PlatoonsResuscitation fluids: Ringers Lactate, human albumin.Blood / blood products: Frozen blood, Group O liquid blood

Echelon II, Surgical Company

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Resuscitation fluids: Ringers Lactate, human albumin.Blood / blood products: Liquid / frozen blood, fresh frozenplasma, platelet concentrate.

Operational Aspects - The CATF/CLF Surgeon will assess bloodresources / requirements daily and report to the AJBPO. The CATFSurgeon will coordinate blood and fluid support for the medicalbattalion from the CRTS, using medical field refrigerators andstandard blood boxes. When the CRTSs leave the amphibious opsarea, the medical battalion must rely on the medical logisticscompany or the AJBPO for blood. If no liquid blood is available,blood may be harvested from LF personnel or from the ships crew

(before leaving the amphibious ops area).

Shock-Trauma Platoon - Each STP can draw 240 units of bloodand can process and crossmatch 1,000 units. Each STP can store120 units in field refrigerators. Occasionally, a STP may beaugmented with a surgical support platoon, which has a blood bankcapacity equivalent to that of a STP.

Amphibious Assault - Personnel responsible for management ofclinical fluids and blood products will report to the CATF Surgeon orLF Surgeon daily. Consider locating a clinical fluids squad with theSurgical Company and a clinical fluids platoon with the MedicalLogistics Company. These squads can thaw and wash frozenblood and receive and distribute liquid blood. Submit daily bloodreports to the AJBPO. The CRTS will supply thawed and washedusing standard blood boxes and medical field refrigerators. Frozenblood will be transported in the new shipping and storage containers

for frozen blood. Prior to the CRTS leaving the amphibious opsarea, or the blood supply aboard the CRTS being depleted, the CLFSurgeon will request more blood / blood products from the AJBPO.

Surgical Company - If liquid or frozen blood is unavailable orunobtainable, each Surgical Company has the capability to draw720 units and process and cross-match 3,000 units. Storagecapability in current field refrigerators is 360 units.

Organizational Aspects - Resuscitation fluids and blood productstransported ashore will be handled by the STP, the evacuationplatoon at the Beach Evacuation Station, the helicopter support

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team evacuation station, and medical personnel charged withcoordinating blood / clinical fluids for the Surgical or MedicalLogistics Company. The CLF Surgeon or representative willmanage blood resources and requirements. If frozen blood isneeded on the beachhead, deglycerolize it on the LHA / LHD andthen ship it ashore.

Transportation - Resuscitation fluids and blood products will betransported ashore primarily by helicopters dispatched to evacuatecasualties. A secondary means is ground vehicle landing craft oramphibious landing craft. Transport of resuscitation fluids forwardto regimental and BAS will be by any means available, depending

heavily on vehicles used for medical evacuation. Additional deliverymethods - Navy emergency air cargo delivery systems, low-altitudeparachute extraction systems, and high-speed low-altitude - havebeen successfully tested and may be available. Blood productsrequested from and assigned by the AJBPO can be picked up ordelivered by helicopter from the nearest BSU or BTC assigned bythe AJBPO.

Referencesa. DOD Inst 6480.A dtd 5 August 1996, Armed Services Blood Program (ASBP)

Operational Procedures

COMMUNICATIONS

DISCUSSIONAs the CATF/ESG Surgeon/SMO/SMDR you will need tocommunicate with other providers in your task group regarding

patients, patient transfers, and to ask or provide advice to otherproviders and or commanding officers therefore you need to havesome understanding of what type of communications are availableto you (your ship). Establish a good rapport with PHIBRON, MEUand ships communication officers. Ask for a brief tour of thecommunications capabilities that are available prior to you actuallyneeding the services. These people are professional and they findcreative solutions to help Medical get in touch with the outside worldor other units.

PATIENT CONFIDENTIALITYA communication net is not private. Everyone from the Commodoreto the sailor or marine on watch is listening. When conducting

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consultation or patient transfers on the radio, KEEP PATIENTPRIVACY IN MIND.

Nets used for normal deployment on a day to day basis:

SATHICOM: The SATellite HIgh-level COMmunication circuit isused to pass essential information to and from an echeloncommander. SATHICOM is guarded (monitored) by all underwayunits and shore stations and is one of the most essential andreliable of voice circuits.

NAVY RED: a UHF net, using l ine-of-sight voice, used for shortrange (within 30 miles) communication. Navy Red is a high-priority

circuit for ships traveling in close range to pass specific informationsuch as operational maneuvers, exercises, and emergencies. Allships must guard this circuit while underway. This is the mostfrequently used net while deployed. Most of the medicalemergencies from other ships will be heard on this net.

ESG/CSG Command Net: a satellite voice circuit for long-rangecommunications for ships traveling within a specific group(ESG/CSG). Only ships in the group are assigned satellite accesswill maintain a guard for this circuit. This circuit allows ships in thegroup to separate and still maintain reliable communications.

SIPRNET CHAT: a secured form of instant messaging that isguarded by all underway units and shore stations and is one of themost essential and reliable means of communication. SIPR CHATcan be used at a set time as a means of group discussion ofmedical issues afloat. Due to SIPR CHAT being located on the HI-SIDE a secret clearance is required.

Nets used for wartime or contingency purposes:

Medical Regulating Net Afloat (HF)MED-REG-NET provides communication between the task forcemedical regulating control officer (ESG MRCO) in the medicalregulating center (MRC) and the medical regulating teams (MRT)afloat and ashore regarding current information on the capabilitiesof the different medical facilities. Priorities of patient evacuation andpatient tracking occur in this net. The quality of the Med Reg Nethas been a difficult recurrent issue for the task force medicaldepartment. This net does not just happen. Close interaction and

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attention by the CATF Surgeon with all the communication officersis required.

Marine Air-Ground Task Force (MAGTF) Alert/Broadcast Net(HF)For alert warnings or general traffic pertaining to all units assignedto the net. It is also used for passing Nuclear-Biological-Chemical(NBC) warnings.

Color Beach Administrative Net (HF)The CBAN is for passing administrative information, requestingsupplies and equipment, coordinating supply and equipmentdeliveries to specific beaches, and evacuating casualties from

landing beaches.Tactical Air Request - Helicopter Request [TAR-HR], (HF, VHF)For forward ground combat units to request immediate air supportfrom the tactical air control center (TACC) or the direct air supportcenter (DASC). Intermediate ground combat echelons monitor thisnet and may modify, disapprove, or approve a specific request. TheTACC / DASC use this net to brief the requesting unit on the detailsof the mission and may pass along target damage assessmentsand emergency helicopter requests. In the initial stages of anamphibious operation or any Marine Expeditionary Force (SpecialOperations Capable) [MEU(SOC)] operation, this may be the onlynet the unit can use.Helicopter Direction Net [HD], (UHF, VHF, HF): used by theHelicopter Direction Center (HDC) for positive control of inboundhelicopters in the amphibious objective area (AOA). This is whereinbound casualty details can be found; it is monitored in the flagshipHDC.

Miscellaneous:The following networks are also available.Local area network (LAN)Wide area networks (WANs)World Wide Web, (NIPRNET, SIPRNET).Saltgrams (a supply Email network)OPREP-5 Feeder (ships daily message, with a medical sectioncovering the previous days medical events)

CREDENTIALS AND PERFORMANCEASSESMENT AND IMPROVEMENT (PA & I)

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PURPOSEThe purpose of the Process Assessment and Improvement (PA & I)Program is to ensure that all Sailors and Marines receive thehighest quality of care available. The Credentials Program ensuresthat all our health care professionals are properly trained andqualified to carry out their medical duties.

DISCUSSIONThe TYCOMs rely on shipboard medical officers to carry out theprovisions of references (a) through (h) and the management of theShipboard PA & I Program. The Shipboard PA & I Program

consists of the following areas: medical readiness provider care: physician and non-physician inpatient nursing and provider care performance appraisal reports (PARS) AMMAL change proposals quarterly PA & I meeting platform capability monitoring

RESPONSIBILITYThe overall responsibility for the Shipboard PA & I Program resideswith the COMNAVSURFOR Medical Officer. When underway, theCATF Surgeon is responsible for implementing the PA & I Programfor the ships assigned to the Expeditionary Strike Group. As such,the CATF Surgeon is responsible for:

Holding quarterly PA & I meetings while deployed. Thesemeetings should be scheduled in port whenever possible toallow the fullest participation of all medical officers and SeniorMedical Department Representatives (SMDRs).

Preparing and submitting Performance Appraisal Reports(PAR) on all embarked credentialed medical personnelpracticing on Ships in the ESG. NOTE: this includesMARFOR Medical Officers. PARs can be completed duringthe return to CONUS or homeport so the information is readyfor the members parent command. After completing PARs,forward them to the TYCOM via ISIC Medical Officer.

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Performing medical records review on IDCs assigned to theESG on a monthly basis. IDCs require a 10% chart review,during which the physician preceptor will hold medical trainingfor the IDC. Quarterly, submit a summary of the IDC chartreviews to TYCOM Medical via ISIC.

Performing Monthly Medical record reviews of medical officersassigned to the ESG. A quarterly summary of these reviewsmust be completed and forwarded to TYCOM medical via ISIC(Enclosure (2). A carbon copy (cc) should be forwarded to theMedical ISIC for inclusion in the IDC file.

During the quarterly PA & I meetings, conduct medical trainingfor embarked medical officers and non-physician health careproviders.

Ensuring that all clinical notes on patients seen by non-IDCHMs in a clinical area are reviewed and signed by adesignated provider (MO, IDC, PA, NP, etc.) before the patientdeparts the clinical area.

Ensuring that Inpatient Nursing Care and Surgical Casereviews are completed. Identified discrepancies will beaddressed and resolutions documented during the QuarterlyPA & I meetings.

Documenting suggested changes to the Ships AMMAL in thequarterly PA & I minutes. AMMAL change requests (ACRs)

should also be submitted via ISIC to the TYCOM. Completing and reviewing all Occurrence Screens, forwardingthem to ISIC for review and appropriate action. Forward allLevel III/IV occurrences to the TYCOM Medical Officer forreview and action.

Include the Platform Capabilities Monitoring in the monthlyQA/QI Report after discussion in the monthly QI meeting.Areas of particular interest are changes or deletions of medicalequipment and changes to the physical plant of the medicaldepartments (i. e. SHIPALTS) that alter the departmentscapabilities.

CREDENTIALING

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The TYCOM Medical Officer is responsible for professionaloversight of Shipboard Credentialing and privileging Program.When embarked on the ESG, the ESG Surgeon is responsible forreviewing the credentials of all embarked medical personnel andcompleting their PARs. Upon mobilization to a deploying platform,the members parent activity is responsible for forwarding aCredential Transfer Brief to COMLANTFLT Professional AffairsCoordinator (LANTFLT) or COMNAVSURFOR for approval ofprimary and special privileges before arrival. COMLANTFLT /SURFOR will forward approval of credentials to the ship andPHIBGRU.

REPORTSExamples maybe found in the below references. IDC Chart Review IDC Quarterly Review Form Physician Chart Review Form Physician Quarterly Review Form Inpatient Nursing Evaluation Form Guidelines for Inpatient Nursing Eval Form Utilization Inpatient Provider Evaluation Form Performance Appraisal Report (PAR) Nurse Corps Performance Appraisal Report Quality Improvement Meeting Minutes Format Checklist and

Worksheet Occurrence Screen Report Non-inclusive List of Special Occurrences

Referencesa. COMNAVSURFORINST 6000.1 seriesb. COMNAVSURFORINST 6000.2 seriesc. COMNAVSURFORINST 6320.1 seriesd. CINCLANTFLT 6320.2 seriese. CINCLANTFLT 6320.4 seriesf. OPNAVINST 6400.1 seriesg. BUMEDINST 6230.66 seriesh. BUMEDINST 6010.13 series

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CRISIS MANAGEMENT BASICS

WHAT HAS HAPPENED? WHAT IS HAPPENING?WHAT IS LIKELY TO HAPPEN NEXT?WHAT IS THE WORST THAT COULD HAPPEN NEXT?WHO IS IN CHARGE?WHAT IS THE CHAIN OF COMMAND?

WHAT HAS BEEN DONE? WHAT IS BEING DONE?WHAT SHOULD BE DONE NEXT?WHAT SHOULD NOT BE DONE?

WHO HAS BEEN INFORMED? WHO SHOULD BE INFORMED?WHO SHOULD NOT BE INFORMED?

INTERNAL EXTERNALWHAT DO WE NEED?WHO ARE THEY?WHAT ARE THEY?WHERE ARE THEY?

FOREIGN HUMANITARIAN ASSISTANCE (FHA)AND DISASTER RELIEF OPERATIONS

Support must be requested by Host Nation. When directed byPresident of the United States (POTUS) or SECDEF, COCOMconducts Foreign HA / Disaster Relief Operations in order toalleviate human suffering.

END STATES Efficient provision of immediate life-saving supplies and

services Successful transition of support efforts to other responsible

authorities Creation of a stable, secure environment for the restoration of

peace Enhanced U.S. prestige and influence in the affected region

PHASES Phase I Crisis assessment and preparation

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Phase II Deployment Phase III Mission Operations Phase IV Transition Phase V Redeployment

COMMAND AND CONTROL

DOS (usually USAID) is lead USG agency working closely withhost nations

COCOM will designate a CJTF or JTF commander

MILITARY SUPPORT REQUESTS Mission dictates priority order:

- Medical support and casualty evacuation- Delivery/distribution of food, water, clothing, blankets,

medicine- Construction of temporary roads, bridges and shelters- Repair of local critical infrastructure- Clearing of debris- Emergency power- Bathing facilities- Traffic control

CONSIDERATIONS

Balance between thorough planning and timely life-savingsupport

Assessment plan needs to be well coordinated with:- Country Teams (DOS, DOD)- Foreign Disaster Assistance Response Teams (DOS)

DOS provides early direction on likely U.S. DODrole/responsibilities to allow focused crisis action planning

SAMPLE FHA/DR MISSIONProvide humanitarian assistance in the form of resuscitative orrestorative medical/surgical care to affected residents.

Deploy a task organized FHA/DR medical team with security IOTprovide medical care to the citizens while maintaining a solid forceprotection posture throughout.

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Endstate: FHA/DR medical/surgical care provided, medical suppliesdistributed, FHA/DR readiness skills improved and team safelyredeployed to ship or Forward Operating Base.

CONCEPT OF OPERATIONSPhase I - Receive guidance from JTF Commander and conductmission planning.

Phase II - Conduct medical & security recon of medical treatment orclinic site. Draw medical supplies from ship or FOB. Confirminterpreters, and security plan. Conduct convoy & securityrehearsal.

Endstate- Medical team prepared to conduct FHA/DR

Phase III - Conduct mission pre-brief (Security/ROE, convoy ops,COMMS). Load COMMS, personnel, supplies/equipment intovehicles. Assemble convoy and count (personnel and vehicles).Depart FOB, arrive FHA/DR site, COMMS and security set-up.Conduct FHA/DR mission.

Endstate - FHA/DR medical care safely provided

Phase IV - Prepare for FHA/DR mission transition to IOs, NGOs orHN.Phase V - FHA/DR Team redeploysEndstate - All personnel and equipment accounted and secure.

PLANNING CONSIDERATIONS DELIVERY SITE AND PROPOSED RECIPIENTS

- Clinic site: Are there fixed structures with water andelectricity?

- Medical Personnel: Are there doctors and nurses(veterinarians) etc?

- Approximate Population: Men, women, children, disabledpopulation, and language %s.

- Local POCs to coordinate with (medical professionals /Village Elder)

- Translators (knowledge of medical terminology andappropriate gender)

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SECURITY AND DESCRIPTION OF THE AREA- Security threat in the area?- Types and number of US / Coalition medical personnel

required?- Medical Class items required, example Class VIII- Forces available to provide security?

INTEGRATION WITH IO / NGOsAre there any medical NGOs / IOs in the area? POCsWhat services have they or are they providing?

VILLAGE HEALTH ASSESSMENT Village

- Location / Grid- Security Threat- Local Security. HN promised 10. Accept no fewer than 5- Population- Clinic Site- Local Leader- Women / Men- Medical Personnel- Vaccinations Programs- IOS / NGOS- Interpreter (Women Needed). 6 Planned. Accept no fewer

than 3

FP Plan: HN or US security forces for FP. Weaponsrequirements, Rules for use of forces (RUF)/ Rules ofEngagement (ROE) BRIEF

Priority of work:

- Make liaison with local authorities- Set-up exam areas with med consumables- Begin FHA/DR operations- End FHA/DR operations- Roll-up security- Retrograde

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Develop Communication Plan: Establish emergencyCOMMS via SATCOM or Cell Phone. Contact FOB/ship,AT/FP security force. Motorola Radios for convoy & on siteinternal comm. No Commo Plan: If no contact in one hour, re-deploy to FOB or ship.

Develop a casualty plan: COMMS, evacuation means,location and routes. Identify nearest possible LZ (i.e. soccerfield). Provide Grid coordinates.

CONDUCT FHA/DR ORM (Sample)

HAZARD RISK CONTROL AFTERCNTRLS

Kidnapping MED US personnel armed guards.Local populace friendly.Local officials have personal interest i n ensuringTeams security.Team is alert and avoids crowding.

LOW

Assassination LOW Travel w/vehicle windows open & Team alert topersonnel and terrain out side of vehicle 360visibility.On Site: HN Security outside clinic.US security inside clinic area.

LOW

IED LOW Eyes on vehicles while parked at clinic.Visually inspect vehicles prior to movement.MPs inspect upon return to FOB.

LOW

Mines In Road LOW Do not announce which route we are taking toFHA/DR treatment or clinic site or which routewe will return by.Avoid water, loose surfaces.

Local Population uses road.Avoid anything they avoid.

LOW

Veh Accident MED Tasks planned with adequate time for completionwithout rushing.Small unit supervision.Experienced personnel.

LOW

FP / AsymmetricAttack

LOW JTF and AT/FP personnel conscious of currentthreat reporting.Local populace friendly.Locals will identify outsiders.Limited population.Good 360 visibility.Security posture.

LOW

Heat Illness LOW Personnel Acclimatized.Proper hydration supervised by leaders.

LOW

Malaria MED All on antimalarial prophylaxis. LOW

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No stagnant water, mosquito breeding in vicinityof village.

Rodents, Insects,Animals, Snakes,etc

LOW Personnel briefed on poisonous varieties andinstructed to leave wildlife alone.

LOW

Personnel gettinglost

MED FHA/DR Team unfamiliar w/area. Othersmaintain close proximity.Use of strip maps & front/rear guides for convoy.

LOW

Disease contractedfrom localpersonnel

MED Medical Providers take appropriate precautions. LOW

DEFENSE SUPPORT CIVIL AUTHORITIES (DSCA)

DSCA: Refers to Department of Defense support provided byFederal military forces, DOD Civilians and contract personnel, andDOD agencies and components, in response to requests forassistance during domestic incidents to include terrorist threats orattacks, major disasters, and other emergencies. NationalResponse Plan December 2005

Two circumstances exist for DOD providing Defense Support toCivil Authorities:

In emergency circumstances, such as managing theconsequences of a terrorist attack, major disaster, or otheremergency, DOD could be asked to act quickly to providecapabilities that other agencies do not possess or that havebeen exhausted or overwhelmed.

In non-emergency circumstances of limited scope or plannedduration, DOD could be tasked to plan for and support civilauthorities where other Federal agencies have the lead forexample, providing security at a special event such as theOlympics, or assisting other Federal agencies to developcapabilities to detect chemical, biological, nuclear, andradiological threats.

Under the provisions of the Stafford Act, DOD support for disasterrelief must be requested. (The other principal statute under whichDOD provides emergency support is the Economy Act, under whichany Federal agency can request support on a reimbursable basisfrom DOD.) Requests for Defense Support are made through DOD

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Executive Secretary and a Defense Coordinating Officer (DCO) isassigned

DSCA: What it is notHomeland DefensePrograms under separate mandate (Counter-Drug Operations,some Intelligence support, Community Affairs or IRT Programs)Foreign DisastersSensitive support per DODD 5210.36US Army Corps of Engineers (USACE) as a primary agency IAWESF #3 of the NRPMutual Assistance

DSCA: What it isResponse to a SECDEF approved Request for Federal Assistancebefore, during, or after domestic incidents (includes CBRNE CM)Approved support to other Federal Departments or Agencies(NSSE, special events, WFF)Civil Strike/Augmentation (Postal, FAA, Federal Prisons)Civil Disturbance Operations

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Defense Coordinating Officer (DCO)

Act as the designated DOD on-scene representative at JFO.

Act as the DOD single point of contact (POC) at the incidentmanagement location for coordinating and processing requests formilitary support assistance by DOD.

Coordinate request for assistance [Assistance Request Form ARF]and mission assignments with the FCO or designated Federalrepresentative.

Operate as DCO/DCE within the Joint Field Office (JFO).

Direct on-scene support of Defense Coordinating Element (DCE),comprised of administrative staff and liaison personnel, includingEmergency Preparedness Liaison Officers (EPLO).

Forward mission assignments to appropriate military organizationsthrough DOD-designated channels.

Assign military liaisons, as appropriate, to activated EmergencySupport Functions (ESF).

Figure IV-1. Defense Coordinating Officer(Source: National Response Plan, Dec 2005, 37and 42, and JHM)

PURPOSE OF ESF 8:Emergency Support Function (ESF) #8 Public Health and MedicalServices, provides the mechanism for coordinated Federalassistance to supplement State, local, and tribal resources inresponse to public health and medical care needs (includingveterinary and/or animal health issues when appropriate) forpotential or actual domestic incidents and/or during a developingpotential health and medical situation. ESF #8 is coordinated by theSecretary of the Department of Health and Human Services (HHS)principally through the Assistant Secretary for Public HealthEmergency Preparedness (ASPHEP). ESF #8 resources can beactivated through the Robert T. Stafford Act or the Public HealthService Act (pending the availability of funds) for the purposes ofFederal-to-Federal support or in accordance with the memorandumfor Federal mutual aid included in the National Response Plan(NAP) Financial Management Support Annex.

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SCOPE:ESF #8 provides supplemental assistance to State, local, and tribalgovernments in identifying and meeting the public health andmedical needs of victims of a domestic incident. This support iscategorized in the following core functional areas: Assessment ofpublic health/medical needs (including behavioral health); publichealth surveillance; Medical care personnel; and Medical equipmentand supplies. As the primary agency for ESF #8, HHS coordinatesthe provision of Federal health and medical assistance to fulfill therequirements identified by the affected State, local, and tribalauthorities. ESF #8 uses resources primarily available from: HHS,including the Operating Divisions and Regional Offices; The

Department of Homeland Security (DHS); and Other ESF #8support agencies and organizations.

ANTICIPATED MISSION ASSIGNMENT:Consider utilizing Local, State, and National Guard capabilities toperform this mission. Rotary Wing Medical Evacuation / Casualty Evacuation

Temporary Medical Treatment Facilities

Referencesa. National Response Plan December 2005

Overview of initial Federal involvement under the Stafford Act

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DECEDENT AFFAIRS

INTRODUCTIONThe Navys Decedent Affairs Program encompasses the search,recovery, identification, care, and disposition of remains of allpersonnel for whom the Department of the Navy is responsible. Themanagement of the program onboard naval vessels is theresponsibility of the commanding officer and the senior medicalrepresentative. The decedent affairs procedures are outlined in theDecedent Affairs Manual, NAVMEDCOMINST 5360.1.

MEDICAL DEPARTMENT RESPONSIBILITIES

Decedent Affairs Officer (DAO): The medical administrationofficer onboard the LHA/LHD and CV/CVN is often designatedthe decedent affairs officer. The DAO is responsible forcoordinating with the personnel and supply departments,MMSO (Military Medical Support Organization), and thenearest mortuary facility to carry out the procedures outlined inthe Decedent Affairs Manual. The DAO will ensure allnecessary forms, body pouches, and transfer cases areavailable onboard prior to getting underway. He/She is alsoresponsible for the decedent affairs programs on the smallerships within the battle group.

Initial Report: Immediately after a death occurs within thecommand, the SMO or senior medical representative submitsan initial memorandum report to the commanding officer

according to MILPERSMAN 4210-100 andNAVMEDCOMINST 5360.1. An entry is also made in themedical department journal with all available informationregarding the death.

Death Certificate: The DD Form 2064, Certificate of Death(Overseas) must be completed for all deaths occurringonboard naval vessels or OCONUS. This form needs to besigned by the medical officer or another American medicaldoctor, either civilian or military. Three copies of the completedDD Form 2064 must accompany the remains. MANMED,Chapter 17, provides further information concerning deathcertificates.

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Medical Record Entries: After documenting the detailssurrounding the death and enclosing the completed DD Form2064 in the medical record, the health record is closed andsent with the remains inside the transfer case.

Disposition of Remains: As soon as possible, the remainsshould be transferred to the nearest military medical facility forpreservation and further disposition. The Decedent AffairsManual lists the available overseas military mortuary facilities.Also refer to Annex D of the Fleet AOR OPORD. TheAmerican Embassy and MMSO may be able to assist inlocating an appropriate mortuary facility when overseas. If a

foreign facility is used, a DD2062, Record of Preparation andDisposition of Remains (OCONUS) must be completed.

- To prepare the body for temporary storage, refer toNAVMED P-5083. Affix waterproof body ID tags, markedwith waterproof ink, with wire ties to the right great toeand to each end of the body bag. The body can betemporarily refrigerated at 36-40 degrees Fahrenheit untiltransfer is possible.

- The following items must accompany the remains: Medical and Dental Records, Dental X-rays Three copies of DD 2064 Certificate of Death

(overseas), signed by an American physician. Two completed DD Form 565, Statement of

Recognition. The form must be signed by twodifferent shipmates who knew the deceased, ifremains are recognizable.

Escort

PERSONNEL DEPARTMENT RESPONSIBILITIES

Personnel Casualty Report (PCR): A personnel casualtyreport should be submitted as soon as possible after a deathoccurs. Such reports are required on all members of theArmed Forces, civilians serving with or attached to Navycommands, and retired members whose deaths occur onnaval reservations or aboard ships. The report should be sentby priority message within 4 hours to COMNAVPERSCOM inaccordance with MILPERSMAN 1770-030. The report can also

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be scanned and sent unclassified via e-mail [email protected]. Once submitted toCOMNAVPERSCOM, the report will automatically be routed tothe remaining action and information addressees. Refer toMILPERSMAN 1770-030 for a complete list of addressees andthe proper format and required information for the PCR. If aCRTS receives another units deceased, the CRTS will draftand submit the initial PCR. The deceaseds unit will then benotified to draft/submit a more complete PCR to supplementthe initial report.

- Page 2/SGLI: The personnel department will verify and

immediately submit the deceaseds page 2 and SGLIinformation to PERS-62.- Escort: Assigns a mature person of the same rank, job,

and unit as the deceased, preferably a friend, to be theescort. The escort ensures effective transportation of theremains from place of death to place of final disposition.MMSO will pay TAD for 1 escort; members ship/unit canpay for additional escorts. Escort will hand carrymembers personal effects after inventoried (see SupplyDept responsibilities).

- Uniform Items: Prepares the members service dressblue uniform with authorized insignia, devices, badges,and decorations for burial. If the appropriate items are notavailable in the members personal effects, they must bepurchased.

- CO Condolence Letter: Prepared by the CO to the NOKwithin 48 hours of casualty with sufficient facts relating to

the incident. Copy is sent to CHNAVPERS and JAGInvestigations Division.

SUPPLY DEPARTMENT RESPONSIBILITIES

Temporary Storage: Remains are stored in the morgue orfreezer at 36-40 degrees Fahrenheit. The space must containno other items and be cleaned and disinfected before reuse.

Inventory: For enlisted personnel, the division officer (or otherofficer if DIVO not present) and the master-at-arms willinventory the deceaseds personal effects, using NAVSUP

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Form 29. For officers, two officers are required. The effects areturned over to the Supply Officer and either transported withescort/remains or forwarded to NOK.

Referencesa. NAVMEDCOMINST 5360.1 Navy Decedent Affairs Manualb. COMNAVSURFORINST 6000.1 Shipboard Medical Procedures (Ch 4-1-

13), and (Ch 5-20)c. MILPERSMAN 1770-030 Military Personnel Manual Personnel Casualty

Reportsd. NAVMED P-5083 Storing of Remainse. NAVPERS 15955-F Manual for Escorts

HEALTH SERVICES SUPPORT AFLOATCAPABILITIES

Amphibious Task Force CRTSsAfter troops debark for ship-to-shore movement, specific ships ofthe ESG/ATF are designated as primary CRTSs to provide EchelonII HSS to the LF during amphibious operations. Primary CRTSs(LHA/LHD) have laboratory (including blood) and radiologycapability to support surgical suites. During amphibious ops,primary CRTSs are staffed as necessary to provide extensivetrauma support. The CATF/ESG may designate amphibious shipsas secondary CRTSs. These may include any class ship with thecapability to receive and treat casualties, if appropriate medicalmateriel and personnel are available to provide resuscitative care.Ships normally designated as secondary CRTSs include LPD, LSD,and LCC class ships.

LHA [Amphibious Assault Ship (General Purpose)]The LHA can transport approximately 1,900 troops along with thehelicopters, boats, and amphibious vehicles required for landingthem. LHAs are capable of receiving casualties from helicopter andwaterborne craft and are designed to function as primary CRTSs inamphibious operations. The LHA(R) is expected to replace the LHAin the future.

LHD [Amphibious Assault Ship (Multi-Purpose)]The LHD is the newest, largest, and most versatile amphibiousassault ship. Externally, it resembles an aircraft carrier. The LHD iscapable of transporting approximately 1,800 troops along with thehelicopters, boats, and amphibious vehicles required for landing

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them. LHDs have the largest medical capability of any amphibiousship currently in use. LHDs are capable of receiving casualties fromhelicopter and waterborne craft and are designed to function asprimary CRTSs in amphibious operations.

LHD/LHACAPABILITY

STAFFING

Ship's Company/FST Ship's Company / FST / MAPOperating Rooms 1 4Intensive Care Unit Beds 3 15Ward Beds 12 45Ancillary Capabilities Laboratory, x-ray, pharmacy, preventive medicine,

biomedical repair, aviation physical examination.Complement Ship's Company FST MAP

Medical Corps 2 3 11Dental Corps 1 1

Nurse Corps 3 22

Medical Service Corps 1 1 1

Hospital Corpsmen 19 9 49

LPD (Amphibious Transport Dock)The mission of the (LPD) is to transport and land Marines, theirequipment and supplies by embarked landing craft or amphibiousvehicles augmented by helicopters. The LPD San Antonio classcontains enhanced command and control features and a robustcommunications suite that improves its ability to support embarkedlanding forces, joint and friendly forces. They could be used asemergency or overflow CRTSs if augmented with medical personneland supplies.

LPD 17 San Antonio Class

The primary mission is amphibious warfare and will be thereplacement class of LPD 4, LSD 36. It is designed to executeOperational Maneuvers from the Sea (OMFTS) and Ship toObjective maneuvers.

OR 2Ward beds 24Dental .2 OR rooms

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LSD (Dock Landing Ship)The mission of the dock landing ship (LSD) is to transport and landMarines, their equipment and supplies either by embarked landingcraft or amphibious vehicles augmented by helicopters and tosupport amphibious operations including landings via landing craftair cushion (LCAC). Although called a 'landing ship,' the LSD doesnot beach. These ships are similar to LPDs with larger well decksbut limited troop and cargo carrying capacities. LSDs offer limiteduse as CRTSs if augmented with medical personnel and supplies.

LSD CAPABILITY STAFFINGOperating Rooms

Intensive Care Beds

Ward Beds 8 (2 isolation beds)

Ancillary Capabilities Laboratory and x-ray

ComplementMedical Corps 1

Dental Corps 1

Hospital Corpsmen 9

LCC (Amphibious Command Ship)LCCs serve as command centers for amphibious operations.These ships are equipped with sophisticated electronic andcommunications equipment and normally serve as the flagship ofboth the CATF/ESG and CLF. LCCs have adequate medicalfacilities to care for embarked personnel but their limitationspreclude use as CRTSs.

LCCMEDICAL FACILITIESOR (minor surgery)...............1

ICU Beds..............................0Ward Beds .........................20Overflow Beds......................0Quiet / Isolation Beds ...........4

AncillaryLab and X-ray................... yes

LCCMEDICAL MANNINGMedical Corps.......................1

Dental Corps ........................0Nurse Corps .........................0Anesthesia Provider..............0Medical Service Corps..........0Hospital Corpsmen .............12Dental Technicians ...............0

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CVN and CV (Aircraft Carriers)The mission of the CV / CVN is to operate offensively in a highdensity, multi-threat environment as an integral member of a CarrierStrike Group (CSG) or expeditionary strike group (ESG); and toprovide credible, sustained forward presence, conventionaldeterrence, and support aircraft attacks in sustained operations inwar. Supportive missions, including medical support of the crewmembers aboard, are facilitated by a self-sufficient carrier hospital,which is a 52-bed, level "2-plus" facility.

CVN CAPABILITY STAFFINGOperating Rooms 1

Intensive Care Unit Beds 3

Ward Beds 52

Ancillary Capabilities Laboratory, x-ray, pharmacy, preventivemedicine, biomedical repair, aviationphysical examinations, radiation health,spectacle fabrication

Complement (Ship's Company and Air Wing)Medical Corps 6* - * Includes embarked physicians

Dental Corps 5

Nurse Corps 2** - **Includes certified registered nurseanesthetist if anesthesiologist is not on board

Medical Service Corps 5

Hospital Corpsmen 47

The carrier's medical department also serves as a consultative andprimary MEDEVAC facility for the other vessels within CSG/ESG,which may consist of another six ships and some 2,000crewmembers.

The CSG/ESG is a tactical organization of surface and subsurfacecombatants, maritime aviation, assault and transport troops andtheir equipment for expeditionary operations. The notional ESGelements are:

Amphibious assault ship Amphibious transport docks Surface combatants (guided missile cruisers, destroyers or

frigates) Attack submarine.

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T-AH (Hospital Ships)T-AH Capability STAFFING

Operating Rooms 12

Intensive Care UnitBeds

100 (includes 20 post-surgical recoverybeds)

Intermediate Care Beds 400

Minimal Care Beds 500

Ancillary Capabilities Laboratory, x-ray, pharmacy, CT scanner,blood storage (3,000 frozen/2,000 fresh)

Complement (staffing for 1000 beds)Medical Corps 66

Medical Service Corps 20

Nurse Corps 168

Hospital Corpsmen 698

Non-Medical Officer 14Non-Medical Enlisted 244

Dental Corps 4

Hospital ships (T-AH) are operated by a Military Sealift Command(MSC) and are designed to provide emergency, on site care,Echelon III, for U.S. combatant forces deployed in war and otheroperations. The mission of the T-AH is to provide a mobile, flexible,rapidly responsive afloat medical capability to provide acute medicaland surgical care in support of CSG/ESG/ATF and Navy/joint forceselements. Functioning under the provisions set forth in the GenevaConvention, they have capabilities equivalent to a CONUS generalhospital. The T-AHs secondary mission is to provide full mobile-hospital services by designated Government agencies HA/DR orlimited humanitarian care to these missions worldwide or peacetimemilitary operations.

(AS) Submarine TenderThe mission of the submarine tender (AS) provides at-sea supportcapability.

CAPABILITIES STAFFINGOperating Rooms 1

Intensive Care Unit Beds

Ward Beds 12

Ancillary Capabilities Laboratory, x-ray, and pharmacy

ComplementMC / MSC/ IDC 2 / 1 (RadHlth) / 2

Hospital Corpsmen 10

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Surface CombatantsThe surface combatant ships, cruiser (CG), destroyer (DD/G), andfrigate (FF) have limited HSS capabilities (Echelon I) and staffing.Their ancillary capability consists of basic laboratory. They aremanned by at least one Independent Hospital Corpsman (NEC8425) and one general duty junior HM.

Cruiser (CG) Destroyer (DD/G) Frigate (FF) Littoral Combat Ship (LCS)

Littoral Combat Ship (LCS)The LCS will transform naval operations in the littorals and performSpecial Operations Forces (SOF) support, high speed MIO,Intelligence, Surveillance and Reconnaissance (ISR), and Anti-Terrorism/Force Protection. As the LCSs are being built and orplanned as of this publication, (USS FREEDOM and USSINDEPENDENCE) the core crew is expected to be approximately40 personnel and the medical support for the various missions maychange.

Referencesa U.S. Navy NTTP 4-02.2 Navy Tactics, Techniques, and Procedures.

(draft) dtd Nov 2006) Section 2b BUMED 2006 Contingency Fact Book, Current Operations

HEALTH SERVICES SUPPORT (USMC)

THE MARINE CORPS MISSIONNaval expeditionary force, that while deployed unobtrusively ininternational waters, is instantly ready to help any friend, defeat anyfoe, and convince any potential enemy of the wisdom of keeping thepeace. Source: Operational Maneuver from the Sea

ORGANIZATIONMarines are organized as a "force-in-readiness to support nationalneeds. They are divided into 3 broad categories:Operating Forces // Reserves // Supporting Establishment Operating Forces

- MARFORPAC: I MEF & III MEF- MARFORCOM: II MEF

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Marine Reserves- MARFORRES: IV MEF

Supporting Establishments- MCB, MCAS, MCRD, MCCDC, MARCORSYSCOM, etc.

Marine Air Ground Task Force (MAGTF)- Marine Expeditionary Force (MEF)- Marine Expeditionary Brigade (MEB)- Marine Expeditionary Unit (MEU)- Special Purpose MAGTF (SPMAGTF)

The MAGTF: Combined Arms ForceScaleable, Flexible, Expeditionary

MEFMEF(HQ, DIV,(HQ, DIV,

WING, MLG)WING, MLG)

MEBMEB(HQ , RLT(HQ , RLT

GROUP, BSSG)GROUP, BSSG)

RefugeeRefugee

ManagementManagementConsequenceConsequence

ManagementManagement

HumanitarianHumanitarian

AssistanceAssistanceDisasterDisaster

ReliefRelief

NonNon--combatantcombatantEvacuation OpsEvacuation Ops

PeacekeepingPeacekeeping PeacePeace

EnforcementEnforcement

Forcible EntryForcible Entry

andand

Sustained Ops AshoreSustained Ops Ashore

6 Hours

14 Days

30 DaysAir

ContingencyF

orc

e

Air

ContingencyF

orc

e

6to

48

Hours

6t

o4

8Hours

50,000

2,000Response times

Maritim

e

Maritim

ePrep

o

Prep

oForce(M

PF)

Force(M

PF)

5to14Days

5to

14Days

MEUMEU(HQ, BLT(HQ, BLT

SQDN, MSSG)SQDN, MSSG)

Size

Core Elements to the Marine Air Ground Task Force (MAGTF):

MAGTAFHeadquarter

(HQ)

GroundCombat

Element (GCE)

Air CombatElement

(ACE)

LogisticCommandElement

(LCE)

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Core Elements to the Marine Expeditionary Force (MEF):

A large percentage of USMC medical assets are Med AugmentationProgram (MAP)/Hlth Service Augmentation Program (HSAP)personnel, assigned during deployments - work in MTFs when unitsare in garrison.

MEF ORGANIC HSS ELEMENTS

MARDIV

TANKBATTALION

HEADQUARTERSBATTALION

ARTILLERYREGIMENT

ASSAULT

AMPHIBIOUSBATTALION

LIGHT ARMORED

RECONNAISSANCEBATTALION

COMBAT

ENGINEERBATTALION

INFANTRY

REGIMENTS

Medical

Platoon

(GCE)

MAW

MARINE AIRCONTROL GROUP

MARINE WINGSUPPORT GROUP

MARINE WINGHEADQUARTERS

SQUADRON

MARINEAIRCRAFT

GROUP

- MWS Squadron Aid Station per MAG

(ACE)

MLG

HEADQUARTERS& SERVICEBATTALION

MOTORTRANSPORTBATTALION

ENGINEERINGSUPPORT

BATTALION

LANDINGSUPPORT

BATTALION

MEDICAL

BATTALION

MAINTENANCEBATTALION

SUPPLYBATTALION

DENTALBATTALION

SHOCK/TRAUMAPLATOONS (6-8)

H & S

COMPANYSurgical Co

(LCE)

*Surgical Co, akaHealth Service

Support Company

2 MO/65 HM

BttnAid Stat

Marine Wing

Support Squadron

MarineExpeditionaryForces (MEF)

Marine Division(MARDIV)

Marine AircraftWing (MAW)

MarineLogistics

Group (MLG)

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Division/GCE Medical Assets:

HQ:- Division Surgeon, Medical Administrative Officer,

Environmental Health Officer, Division Psychiatrist,Enlisted Personnel

Battalion Surgeon Battalion Aid Station {Level I-First Responder} 1-2 MO (GMO) = Battalion Aid Station (BAS) 21 HM's = Battalion Aid Station 11 HM's = Weapons Company 33 HM's = Rifle Companies (3)

MLG/LCE Medical Assets:

HQ:- Group Surgeon, Medical Admin Officer-Planner, Enlisted

Personnel Assistants

Surgical Co. 1-3/Med Battalion of MLG {Level II-FwdResuscitation}:- Triage/Evacuation Platoon -Holding Platoon- Surgical Platoon -Combat Stress Platoon- Ancillary Service Platoon -FRSS- Dental Detachment- Assets

- 17 MC, 7 MSC, 23 NC, 127 HM, 19 USMC- 3 ORs, 60 BEDS

FRSS 1/Health Service Support Company, Med Battalion ofMLG {Level II-Fwd Resuscitation}

Definition/Purpose:A rapidly deployable, highly mobile, small footprint for variousmissions/operations

Characteristics:- 8-10 Personnel (2 Surgeons, 1 Anesthesiologist, CC NC,

3 OR Techs, 1 IDC)

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- Less than 500 cubic feet // Less than 5,000 lbs- Approx 1400 lbs of med equip and consumables- Treat 18 casualties without re-supply for 48 hours of

continuous operation- Provide pre-, peri-, and post operative care. Administer

local and general anesthesia.

Shock Trauma Platoon 8/Hlth Service Support Company, MedBattalion of MLG {Level 1(+) - First Responder}

Stabilization Section:- 2 MO (EM), 1 IDC, 1 PA, 6 - HM's

Collecting/Evacuation Section:- 1 NC, 7 HM, 7 USMC- 0 ORs; 10 COTS

WING/ACE MEDICAL ASSETS: HQ:

- Wing Surgeon (MC), Med Admin Officer-Planner,Environmental Health Officer, Industrial Hygiene Officer,Enlisted Personnel Assistants

Wing Aid Station 1/Marine Air Group {Level I}:- 5 MO's and 34 HM's: routine sick call, aviation medicine,

preventive medicine, and laboratory, x-ray, pharmacyservices.

- 0-ORs. May include satellites, i.e. Flight Line Aid Stationwith FSs

Squadron:- Flight Surgeon and 2-3 HMs/squadron

USMC INITIATIVES

En Route Care (ERC):Manpower and Equipment for transporting patients from Level 2 toLevel 2+ - Fwd Resuscitation/Theater Hospitalization utilizingdesignated, primarily USMC CH46 or USA Air Ambulance H60s.

Medical attendant(s) NC and/or HM

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Equipment and supplies for two critical patients Medical supervision/protocols Rapid cabin re-configuration Move critical & post-op patients from FRSS/STP to Shore and

Sea Level II+ -Fwd Resuscitation.

CASEVAC:Manpower and Equipment for transporting patients from Point ofInjury (POI) or Casualty Collection Point (CCP) utilizing Lift ofOpportunity or Designated aircraft to Level 2+ - Fwd Resuscitation.

Medical attendant HM Equipment and supplies at PHTLS/TCCC level Rapid Cabin Reconfiguration Move injured patients from combat zone or Level 1 to Level 2+

IMPORTANT POCs

The Internet is a massive information resource; therefore, siteslisted below are only a beginning guide to numerous Navy andmedical sites. Routinely, everyone will have their own favorite sitesand preferences for information searching.

MILITARY SITESNaval Operational Medicine Institute

TEL: (850) 452-4554 DSN: 922- 4554http://www.nomi.med.navy.mil/

Commander, U. S. Central Command

Tel: (813) 827-5895 DSN: 651-5895http://www.centcom.mil/sites/uscentcom1/default.aspx

Commander, U. S. Pacific Command (USPACOM)Tel: (808) 477-1341 D-477-1341

http://www.pacom.mil/

Commander, Fleet Forces CommandTEL: (757) 836-3644

http://www.cffc.navy.mil/

Commander, U. S. Pacific FleetTEL: (808) 471-3769 DSN: 471-3769

http://www.cpf.navy.mil/

Commander, Marine Forces Pacifichttp://www.mfp.usmc.mil/

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Commander, Seventh FleetTEL: 011-81-46-816-7220 DSN: (315) 243-7220

http://www.c7f.navy.mil/

Navy Knowledge OnlineToll Free: (877) 253-7122 DSN: 922-1001,

https://wwwa.nko.navy.mil/portal/splash/index.jsp

Navy.milhttp://www.navy.mil/

Navy Medicine Onlinehttp://navymedicine.med.navy.mil/

Navy Medicine Locator

http://ldap.med.navy.mil/

Naval Personnel CommandTEL: (866)-U-ASK-NPC DSN 882-5672

http://www.npc.navy.mil/channels

My Payhttps://mypay.dfas.mil/mypay.aspx

Marine Corps LocatorTEL: (703) 784-3941

http://www.usmc.mil/marinelink/ind.nsf/locator

OTHER USEFUL SITESNational Library of Medicine

http://www.ncbi.nlm.nih.gov/PubMed/

Hardin Meta Directory of Internet Health Sourceshttp://www.lib.uiowa.edu/hardin/md/idx.html

The Centers for Disease Control and PreventionTEL: 800-CDC-INFOhttp://www.cdc.gov/

Center for Excellence in Disaster Management and Humanitarian AssistanceTEL: 808-433-7035http://coe-dmha.org/

Physicians Online, a free membership service with a number of useful featureshttp://www.po.com

Surface Warfare Officer School CommandTEL: (401) 841-4957/4958http://www.swos.navy.mil/

American Medical AssociationTEL: (800) 621-8335

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http://www.ama-assn.org/

National Institute of Mental HealthTEL: (866) 615-6464 (toll-free)

http://www.nimh.nih.gov/

International Society for Infectious Diseaseshttp://www.promedmail.org/pls/promed/f?p=2400:1000

New York Times Health Navigatorhttp://www.nytimes.com/library/national/science/health/health-navigator.html

http://www.pbg.mcgraw-hill.com/McGraw-Hill Professional Bookstore

MTFsNaval Medical Center San DiegoTEL: (619) 532-6400

http://www-nmcsd.med.navy.mil/

National Naval Medical Center Bethesda

TEL: (301) 295-4611 OR 1-800-526-7101 (toll free)http://www.bethesda.med.navy.mil/Naval Medical Center Portsmouth

TEL: (757) 953-5000http://www-nmcp.mar.med.navy.mil/

US Naval Hospital YokosukaTEL: from US: 81-468-16-7144

http://www.nhyoko.med.navy.mil/

US Naval Hospital, Guantanamo Bayhttp://imcenter.med.navy.mil/gitmo/

Naval Hospital Camp PendletonTEL: (760) 725-1211

http://www.cpen.med.navy.mil/

Naval Hospital LemooreTEL: (559) 998-4481

https://lemoore.med.navy.mil/

Naval Hospital Twentynine PalmsTEL: (760) 830-2978

http://www.nhtp.med.navy.mil/

US Naval Hospital RotaTEL: 011 (34) 956-82-3305 DSN: (94)-314-727-3305

https://navymedicine.med.navy.mil/rota/

Naval Hospital JacksonvilleTEL: (904) 542-7300

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http://navalhospitaljax.com/

Naval Hospital PensacolaTEL: 850-505-6601

http://psaweb.pcola.med.navy.mil/

US Naval Hospital GuamTEL: (671) 344-9340

http://www.usnhguam.med.navy.mil/home.htm

Naval Health Clinic, Great LakesTEL: (847) 688-5328 X3110 DSN: 792-5328 X3110

http://greatlakes.med.navy.mil/

Naval Hospital Camp LejeuneTEL: (910) 451-3079

http://lej-www.med.navy.mil/

Naval Hospital Cherry PointTEL: (252) 466-0266

http://cpoint-www.med.navy.mil/

US Naval Hospital OkinawaTEL: 011(81) 611-743-7555 DSN 315-643-7555

http://www.oki.med.navy.mil/

Naval Hospital BeaufortTEL: (843) 228-5600 DSN: 335-5600http://www.nhbeaufort.med.navy.mil//

Naval Hospital CharlestonTEL: (843) 743-7000 DSN: 563-7000

http://www.nhchasn.med.navy.mil/

Naval Hospital BremertonTEL: (800)422-1383 (360) 475-4000http://nh_bremerton.med.navy.mil/

Naval Hospital Oak HarborTEL: (360) 257-9500 or DSN: 820-9500

http://nhoh.med.navy.mil/

US Naval Hospital KeflavikTEL: From U.S.: 011-354-425-3300

http://northstar.med.navy.mil/

US Naval Hospital Napleshttp://www-usnhnaples.med.navy.mil/

US Naval Hospital Sigonellahttp://www.sig.med.navy.mil/

TEL: 011-39-095-56-3842 DSN: 314-624-3842

Naval Health Clinic Hawaiihttp://www.nmclph.med.navy.mil/

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TEL: 808.473.2444x501

OTHER MILITARY RESOURCESArmed Forces Institute of Pathology

TEL: (202) 782-2100http://www.afip.org/

FLEET MEDICINE TELEPHONE LISTNUMBERS VERIFIED APRIL 2006

Location ............... ................ ................ ................ ............... ................ ......... VoiceACU-4 (Little Creek LCACs)............. ............... ................ ............... (757) 462-7004ACU-5 (Camp Pendleton LCACs). ................ ............... ................ .. (760) 725-0653AFMIC Operations...................... ................ ................ ................ .... (301) 619-7574Armed Forces Institute of Pathology ............... ................ ............... (202) 782-2100Armed Services Blood Program (Policy) ............... ........