1. MCWP 4-11.1 Health Service Support OperationsMCWP 4-11.1 Health Service Support Operations
Health Service SupportHealth Service Support
Operations Ch. 2 & 8Operations Ch. 2 & 8
A presentation by:A presentation by:

2. MCWP 4-11.1 Health Service Support Operations
PurposePurpose
To disseminate information on the mission,To disseminate information on the mission,
functions, structure, and concept of employmentfunctions, structure, and concept of employment
of HSS units.of HSS units.
To provide overarching doctrine and establishesTo provide overarching doctrine and establishes
a practical approach to HSS from thea practical approach to HSS from the
perspective of the commander or staff officerperspective of the commander or staff officer
This publication establishes general guidanceThis publication establishes general guidance
that requires judgment in application andthat requires judgment in application and
pertains equally to small-unit leaders and seniorpertains equally to small-unit leaders and senior
commanders.commanders.

3. MCWP 4-11.1 Health Service Support Operations
Chapter 2:Chapter 2:
IntelligenceIntelligence
Accurate and timely intelligence—Accurate and timely intelligence—
knowledge of the enemy and theknowledge of the enemy and the
surrounding environment that is needed tosurrounding environment that is needed to
support decision making—is a prerequisitesupport decision making—is a prerequisite
for military success.for military success.
Intelligence is a fundamental component ofIntelligence is a fundamental component of
command and control that aids thecommand and control that aids the
commander in applying combat power atcommander in applying combat power at
the decisive time and place.the decisive time and place.
Intelligence activity is mission-focused.Intelligence activity is mission-focused.

4. MCWP 4-11.1 Health Service Support Operations
Chapter 2:Chapter 2:
IntelligenceIntelligence
In MAGTF intelligence operations, intelligenceIn MAGTF intelligence operations, intelligence
operations are determined by the commander’soperations are determined by the commander’s
intelligence requirements.intelligence requirements.
The resulting intelligence effort provides criticalThe resulting intelligence effort provides critical
knowledge and understanding about the enemy andknowledge and understanding about the enemy and
the environment to help the commander plan andthe environment to help the commander plan and
make decisions.make decisions.
Medical intelligence includes more than justMedical intelligence includes more than just
information on disease or other environmentalinformation on disease or other environmental
hazards.hazards.

5. MCWP 4-11.1 Health Service Support Operations
Chapter 2:Chapter 2:
IntelligenceIntelligence
Raw data must be analyzed and properly actedRaw data must be analyzed and properly acted
on to prevent an adverse operational impact.on to prevent an adverse operational impact.
Medical intelligence from all sources—internalMedical intelligence from all sources—internal
and external to the MAGTF—must beand external to the MAGTF—must be
assimilated for the commander to have aassimilated for the commander to have a
complete picture of the medical threat.complete picture of the medical threat.

6. MCWP 4-11.1 Health Service Support Operations
Preventive Medicine SectionPreventive Medicine Section
Most preventive medicine assets organic to theMost preventive medicine assets organic to the
Marine expeditionary forceMarine expeditionary force ((MEF) are found inMEF) are found in
the preventive medicine section, headquartersthe preventive medicine section, headquarters
and service (H&S) company, medical battalion,and service (H&S) company, medical battalion,
force service support group (FSSG).force service support group (FSSG).
General support includes identifying informationGeneral support includes identifying information
on environmental health, demographics, livingon environmental health, demographics, living
conditions, water supply, waste disposal,conditions, water supply, waste disposal,
insects, diseases, and vector issues of militaryinsects, diseases, and vector issues of military
importance, as well as evaluating local foodimportance, as well as evaluating local food
sanitation and sight and hearing conservationsanitation and sight and hearing conservation
programs.programs.

7. MCWP 4-11.1 Health Service Support Operations
Local Command G-2 SectionsLocal Command G-2 Sections
Additional medical intelligence may beAdditional medical intelligence may be
requested through G-2 sections of therequested through G-2 sections of the
command element, ground combat elementcommand element, ground combat element
(GCE), aviation combat element (ACE), and(GCE), aviation combat element (ACE), and
combat service support element (CSSE).combat service support element (CSSE).
Additional information on intelligence support toAdditional information on intelligence support to
medical operations can be found in themedical operations can be found in the
intelligence series of the Marine Corpsintelligence series of the Marine Corps
warfighting publications (particularly MCWP 2-warfighting publications (particularly MCWP 2-
12,12, MAGTF Intelligence Production andMAGTF Intelligence Production and
Analysis)Analysis)..

8. MCWP 4-11.1 Health Service Support Operations
Health Service SupportHealth Service Support
ElementElement
The health service support element (HSSE) isThe health service support element (HSSE) is
often the first to receive medical intelligenceoften the first to receive medical intelligence
from on-site care providers due to multiplefrom on-site care providers due to multiple
communications and information links availablecommunications and information links available
to sections within the FSSG combat serviceto sections within the FSSG combat service
support operations center (CSSOC).support operations center (CSSOC).

9. MCWP 4-11.1 Health Service Support Operations
The Armed ForcesThe Armed Forces
Medical Intelligence CenterMedical Intelligence Center
The Armed Forces Medical Intelligence Center (AFMIC) is aThe Armed Forces Medical Intelligence Center (AFMIC) is a
field production activity of the Defense Intelligence Agency. It isfield production activity of the Defense Intelligence Agency. It is
the sole producer of medical intelligence in the Department ofthe sole producer of medical intelligence in the Department of
Defense (DOD).Defense (DOD).
AFMIC provides all-source intelligence on—AFMIC provides all-source intelligence on—
– Worldwide infectious disease and environmental healthWorldwide infectious disease and environmental health
risks.risks.
– Foreign military and civilian health care systems andForeign military and civilian health care systems and
infrastructure.infrastructure.
– Foreign biomedical developments and life scienceForeign biomedical developments and life science
technologies of military medical significance.technologies of military medical significance.

10. MCWP 4-11.1 Health Service Support Operations
The Armed ForcesThe Armed Forces
Medical Intelligence CenterMedical Intelligence Center
AFMIC maintains extensive data bases; monitors foreignAFMIC maintains extensive data bases; monitors foreign
research, development, production, and transitional flowresearch, development, production, and transitional flow
of medical materiel for military interest; and providesof medical materiel for military interest; and provides
intelligence liaison services to key customers.intelligence liaison services to key customers.
It also conducts in-house and mobile training, includingIt also conducts in-house and mobile training, including
a medical intelligence fellowship program; serves ona medical intelligence fellowship program; serves on
numerous intelligence committees and working groups;numerous intelligence committees and working groups;
and trains military reservists for mobilizationand trains military reservists for mobilization
assignments.assignments.
AFMIC’s intelligence products provide direct support toAFMIC’s intelligence products provide direct support to
U.S. military customers for operational planning;U.S. military customers for operational planning;
development of policy, doctrine, and training priorities;development of policy, doctrine, and training priorities;
and medical research and development.and medical research and development.

11. MCWP 4-11.1 Health Service Support Operations
The Armed ForcesThe Armed Forces
Medical Intelligence CenterMedical Intelligence Center
Queries for medical intelligence support areQueries for medical intelligence support are
addressed via the HSS chain or direct fromaddressed via the HSS chain or direct from
deploying units to—deploying units to—
Defense Intelligence Agency Armed ForcesDefense Intelligence Agency Armed Forces
Medical Intelligence Center Fort DetrickMedical Intelligence Center Fort Detrick
Frederick, MD 21701-5004Frederick, MD 21701-5004
Via message to— DIRAFMIC FTDETRICKMD.Via message to— DIRAFMIC FTDETRICKMD.

12. MCWP 4-11.1 Health Service Support Operations
Chapter 8: Patient MovementChapter 8: Patient Movement
Patient movement is a casualty management system.Patient movement is a casualty management system.
It is designed to coordinate the movement ofIt is designed to coordinate the movement of
casualties from site of injury or onset of diseasecasualties from site of injury or onset of disease
through successive levels of care to a facility that canthrough successive levels of care to a facility that can
provide the appropriate level of treatment.provide the appropriate level of treatment.
Prompt movement of casualties through thePrompt movement of casualties through the
evacuation system to treatment facilities is essential toevacuation system to treatment facilities is essential to
decrease morbidity and mortality of battlefielddecrease morbidity and mortality of battlefield
casualties.casualties.

13. MCWP 4-11.1 Health Service Support Operations
Chapter 8: Patient MovementChapter 8: Patient Movement
If casualties occurred at regular intervals, in constantIf casualties occurred at regular intervals, in constant
numbers, at predetermined locations, and withnumbers, at predetermined locations, and with
predictable injuries, their movement would require littlepredictable injuries, their movement would require little
or no coordination.or no coordination.
Patient movement is a vital support factor that must bePatient movement is a vital support factor that must be
planned.planned.
Personnel must be trained on equipment andPersonnel must be trained on equipment and
procedures in advance of operations in the field.procedures in advance of operations in the field.

14. MCWP 4-11.1 Health Service Support Operations
PhasesPhases
Coordination of casualty movement is especiallyCoordination of casualty movement is especially
critical during operations when casualties must becritical during operations when casualties must be
moved from shore to task force ships.moved from shore to task force ships.
When properly followed, the medical regulatingWhen properly followed, the medical regulating
process ensures that patients move only as farprocess ensures that patients move only as far
rearward in the continuum of care as their healthrearward in the continuum of care as their health
needs dictate which, in turn, assures the efficient andneeds dictate which, in turn, assures the efficient and
effective use of the limited HSS assets available to theeffective use of the limited HSS assets available to the
MAGTF.MAGTF.

15. MCWP 4-11.1 Health Service Support Operations
Patient Movement May OccurPatient Movement May Occur
In Two PhasesIn Two Phases::
Evacuation—the movement of patients betweenEvacuation—the movement of patients between
point of injury or onset of disease to a facility thatpoint of injury or onset of disease to a facility that
can provide the necessary treatment capability.can provide the necessary treatment capability.
Medical regulating—the process of selectingMedical regulating—the process of selecting
destination MTFs with the necessary HSSdestination MTFs with the necessary HSS
capabilities for patients being medicallycapabilities for patients being medically
evacuated in, between, into, and out of differentevacuated in, between, into, and out of different
theaters of geographic combatant commandstheaters of geographic combatant commands
and CONUS.and CONUS.

16. MCWP 4-11.1 Health Service Support Operations
Decision-makingDecision-making
Degree of care for the sick and wounded in any areaDegree of care for the sick and wounded in any area
of combat is greatly influenced by prevailing tacticalof combat is greatly influenced by prevailing tactical
situations.situations.
Conditions are seldom static, and success in combatConditions are seldom static, and success in combat
must remain the primary goal of combat, combatmust remain the primary goal of combat, combat
support, and combat service support units.support, and combat service support units.
This environment requires a dynamic casualtyThis environment requires a dynamic casualty
management decision making process which must bemanagement decision making process which must be
applied at all HSS units and in the patient movementapplied at all HSS units and in the patient movement
system.system.

17. MCWP 4-11.1 Health Service Support Operations
Casualty Sorting (Triage)Casualty Sorting (Triage)
An effective process of casualty sorting, alsoAn effective process of casualty sorting, also
referred to as triage, is basic to the successfulreferred to as triage, is basic to the successful
operation of a patient movement system.operation of a patient movement system.
Rapid evaluations must be made to identifyRapid evaluations must be made to identify
which patients need immediate resuscitationwhich patients need immediate resuscitation
and which patients can tolerate delay inand which patients can tolerate delay in
treatment.treatment.
Deciding which patients should be moved afterDeciding which patients should be moved after
initial treatment to other medical facilities is ofinitial treatment to other medical facilities is of
equal importance.equal importance.

18. MCWP 4-11.1 Health Service Support Operations
Medical ManagementMedical Management
Under combat conditions, the flow of sick andUnder combat conditions, the flow of sick and
wounded puts variable pressure on capabilities ofwounded puts variable pressure on capabilities of
medical facilities.medical facilities.
Incoming casualties necessitate the movement ofIncoming casualties necessitate the movement of
stable casualties who can be evacuated.stable casualties who can be evacuated.
Close coordination between clinical andClose coordination between clinical and
administrative services must be maintained toadministrative services must be maintained to
achieve effective management of individualachieve effective management of individual
casualties.casualties.
Medical officers who are responsible for decisions onMedical officers who are responsible for decisions on
movement of individual casualties must work closelymovement of individual casualties must work closely
with administrative officers charged withwith administrative officers charged with
implementing patient movement for evacuation.implementing patient movement for evacuation.
Underlying all considerations is the basic objective ofUnderlying all considerations is the basic objective of
preserving life and limb.preserving life and limb.

19. MCWP 4-11.1 Health Service Support Operations
Medical Evacuation AssetsMedical Evacuation Assets
The assigned mission dictates the number and types of aircraftThe assigned mission dictates the number and types of aircraft
assigned to accomplish all assault support tasks.assigned to accomplish all assault support tasks.
This mission, along with the limited number of aircraft in theThis mission, along with the limited number of aircraft in the
Marine Corps inventory, precludes the assignment of dedicatedMarine Corps inventory, precludes the assignment of dedicated
aeromedical evacuation (AE) aircraft in most cases.aeromedical evacuation (AE) aircraft in most cases.
All Marine Corps rotary wing transport and utility aircraft haveAll Marine Corps rotary wing transport and utility aircraft have
the capability to perform an AE mission.the capability to perform an AE mission.
Allocation of aircraft to perform the AE mission would be at theAllocation of aircraft to perform the AE mission would be at the
discretion of the MAGTF commander.discretion of the MAGTF commander.
Assets are designated to perform AE through implied missionAssets are designated to perform AE through implied mission
tasking or by assuming a standby posture.tasking or by assuming a standby posture.

20. MCWP 4-11.1 Health Service Support Operations
Medical Evacuation AssetsMedical Evacuation Assets
Prior planning is essential to ensure proper allocation ofPrior planning is essential to ensure proper allocation of
aircraft to support AE missions. Within the MEF, theaircraft to support AE missions. Within the MEF, the
FSSG HSSE, in conjunction with the FSSG logisticsFSSG HSSE, in conjunction with the FSSG logistics
movement coordination center (LMCC), plans formovement coordination center (LMCC), plans for
medical evacuation aircraft.medical evacuation aircraft.
The LMCC air liaison officer is the direct link to the MAWThe LMCC air liaison officer is the direct link to the MAW
for identification of medical evacuation missions in the airfor identification of medical evacuation missions in the air
tasking order.tasking order.
In the absence of an AE capability, casualty evacuationIn the absence of an AE capability, casualty evacuation
is accomplished using any surface (water or ground)is accomplished using any surface (water or ground)
transportation available (ground ambulance, five-tontransportation available (ground ambulance, five-ton
truck, smalltruck, small boat, landing craft air cushion).boat, landing craft air cushion).

21. MCWP 4-11.1 Health Service Support Operations
Evacuation Concepts UsedEvacuation Concepts Used
By The Marine CorpsBy The Marine Corps
Dedicated medical evacuation assets are patientDedicated medical evacuation assets are patient
movement assets configured for medical evacuation,movement assets configured for medical evacuation,
externally marked with a red cross, and specificallyexternally marked with a red cross, and specifically
reserved to support the medical evacuation mission.reserved to support the medical evacuation mission.
Dedicated medical evacuation assets are authorizedDedicated medical evacuation assets are authorized
protection under the Geneva Conventions.protection under the Geneva Conventions.
Designated medical evacuation assets are non-medicalDesignated medical evacuation assets are non-medical
patient movement assets, not externally marked with apatient movement assets, not externally marked with a
red cross, but configured and allocated for patientred cross, but configured and allocated for patient
movement. Designated medical evacuation assets aremovement. Designated medical evacuation assets are
not afforded protection under the Geneva Conventions.not afforded protection under the Geneva Conventions.

22. MCWP 4-11.1 Health Service Support Operations
Aeromedical EvacuationAeromedical Evacuation
Request ProceduresRequest Procedures
Normally, when control is seabased, units request AENormally, when control is seabased, units request AE
by radio to the helicopter direction center using theby radio to the helicopter direction center using the
helicopter direction net.helicopter direction net.
When command and/or net control has been passedWhen command and/or net control has been passed
ashore, units request AE from the direct air supportashore, units request AE from the direct air support
center using the tactical air request/helicopter requestcenter using the tactical air request/helicopter request
net.net.
The air officer will then consult with either the ATFThe air officer will then consult with either the ATF
medical regulating control officer when seabased ormedical regulating control officer when seabased or
the LF patient evacuation officer when ashore for athe LF patient evacuation officer when ashore for a
recommendation of the best medical facility to care forrecommendation of the best medical facility to care for
the patient.the patient.

23. MCWP 4-11.1 Health Service Support Operations
Aeromedical EvacuationAeromedical Evacuation
Request ProceduresRequest Procedures
In operations where dedicated AE assets are assigned,In operations where dedicated AE assets are assigned,
the direct air support center will make liaison with thethe direct air support center will make liaison with the
units responsible to provide AE.units responsible to provide AE.
AE missions are classified as preplanned or immediate.AE missions are classified as preplanned or immediate.
Both types of support are delivered in response toBoth types of support are delivered in response to
specific requests via the assault support request.specific requests via the assault support request.
AE missions from Marine Corps MTFs to theaterAE missions from Marine Corps MTFs to theater
hospitals will be coordinated by the patienthospitals will be coordinated by the patient
evacuation/patient movement section, FSSG, inevacuation/patient movement section, FSSG, in
coordination with the HSSE, the CSSOC, LMCC, and thecoordination with the HSSE, the CSSOC, LMCC, and the
theater patient movement requirements center.theater patient movement requirements center.

24. MCWP 4-11.1 Health Service Support Operations
Further GuidanceFurther Guidance
NWP 4-02.2 Vol. 1,NWP 4-02.2 Vol. 1, Patient MovementPatient Movement,,
provides a general summary of the HSSprovides a general summary of the HSS
system and the specific tactic, techniques, andsystem and the specific tactic, techniques, and
procedures (TTP) for naval expeditionary forceprocedures (TTP) for naval expeditionary force
medical regulating.medical regulating.
For joint operations, refer to Joint Pub 4-02.2,For joint operations, refer to Joint Pub 4-02.2,
Joint Tactics, Techniques, and Procedures forJoint Tactics, Techniques, and Procedures for
Patient Movement in Joint OperationsPatient Movement in Joint Operations..

25. MCWP 4-11.1 Health Service Support Operations
Any questions?Any questions?