Document text
FM 8-10-6
MEDICAL EVACUATION
IN A THEATER OF
OPERATIONS
TACTICS, TECHNIQUES, AND PROCEDURES
HEADQUARTERS, DEPARTMENT OF THE ARMY
DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited.
*FM 8-10-6
FIELD MANUAL
No. 8-10-6
HEADQUARTERS
DEPARTMENT OF THE ARMY
WASHINGTON, DC, 14 APRIL 2000
MEDICAL EVACUATION IN A THEATER OF OPERATIONS
TACTICS, TECHNIQUES, AND PROCEDURES
TABLE OF CONTENTS
PREFACE
Page
XI
CHAPTER 1. INTRODUCTION TO THE COMBAT HEALTH SUPPORT
SYSTEM AND MEDICAL EVACUATION
1-1 . General
1-2. Threat
1-3. Medical Threat and Medical Intelligence
1 -4 . Medical Evacuation Versus Casualty Evacuation
1-5. Theater Evacuation Policy
1-6. Factors Determining the Evacuation Policy
1-7. Impact of Evacuation Policy on Combat Health Support Requirements .
1-8. Adjustments to the Evacuation Policy
1-9. Planning for Combat Health Support
1-10. Echelons of Medical Care
1-11. Principles of Combat Health Support Operations
1-12. Army Medical Department Battlefield Rules
1-13. Mandated Medical Evacuation Support
1-1
1-1
1
1
1
1
1
1-
1-
1-
1-8
1-10
1-11
1-12
CHAPTER 2. ECHELONS I AND II MEDICAL EVACUATION 2-1
2-1. General 2-1
2-2. Echelon I (Unit Level) Medical Evacuation 2-1
2-3. Echelon II Medical Evacuation in the Division 2-4
2-4. Echelons I and II Medical Evacuation in the Corps 2-5
CHAPTER 3. CORPS AND ECHELONS ABOVE CORPS MEDICAL
EVACUATION UNITS
Section I. Medical Evacuation Battalion
3-1 . General
3-2. Assignment 3-1
3-1
3-1
3-1
DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited.
*This publication supersedes EM 8-10-6, 31 October 1991.
FM 8-10-6
Page
Section
Section
CHAPTER
CHAPTER
3-3.
3-4.
II.
3-5.
3-6.
3-7.
3-8.
III.
3-9.
3-10.
3-11.
3-12.
4.
4-1.
4-2.
4-3.
4-4.
4-5.
4-6.
4-7.
4-8.
4-9.
4-10.
4-11.
4-12.
4-13.
Mission and Capabilities 3-1
Organization and Functions 3-2
Medical Company, Ground Ambulance 3-5
General 3-5
Assignment 3-5
Mission, Capabilities, and Limitations 3-5
Organization and Functions 3-6
Medical Company, Air Ambulance 3-8
General 3-8
Assignment 3-8
Mission and Capabilities 3-8
Organization and Functions 3-9
THE MEDICAL EVACUATION SYSTEM 4-1
General 4-1
Medical Evacuation 4-2
Basic Considerations in Medical Evacuation Operations 4-4
Property Exchange and Patient Movement Items 4-12
Medical Evacuation Tools 4-12
Medical Evacuation Support for Combat Forces in the Offense
and Defense 4-15
Medical Evacuation Support for Choices of Maneuver and Enabling
Operations 4-20
Medical Evacuation Support in Stability Operations 4-23
Medical Evacuation Support in Support Operations 4-25
Medical Evacuation of Enemy Prisoners of War 4-26
Evacuation and Disposition of Remains 4-27
Aeromedical Evacuation Operations 4-27
Evacuation of Military Working Dogs 4-29
MEDICAL EVACUATION IN SPECIFIC ENVIRONMENTS 5-1
General 5-1
Mountain Operations 5-1
Jungle Operations 5-5
Desert Operations 5-7
Extreme Cold Weather Operations 5-15
Medical Evacuation in a Nuclear, Biological, or Chemical
Environment 5-17
Naval Operations 5-19
Airborne and Air Assault Operations 5-21
Army Special Operations Forces 5-22
FM 8-10-6
Page
CHAPTER
CHAPTER
CHAPTER
5-10.
5-11.
5-12.
5-13.
6.
6-1.
6-2.
6-3.
6-4.
6-5.
6-6.
6-7.
6-8.
6-9.
6-10.
6-11.
6-12.
7.
7-1.
7-2.
7-3.
7-4.
7-5.
7-6.
7-7.
7-8.
7-9.
8.
-1.
-2.
-3.
-4.
-5.
-6.
-7.
Military Operations on Urbanized Terrain 5-22
Cross-Forward Line of Own Troops Operations 5-36
Combat Search and Rescue Operations 5-38
Minefield Operations 5-38
MEDICAL REGULATING
General 6-1
Purposes of Medical Regulating 6-1
Medical Regulating Terminology 6-1
Medical Regulating from the Division 6-4
Medical Regulating Within the Combat Zone 6-6
Medical Regulating from the Combat Zone to Echelons Above Corps ... 6-7
Medical Regulating Within Echelons Above Corps 6-8
Intertheater Medical Regulating 6-8
Mobile Aeromedical Staging Facility 6-9
Limitations of the United States Air Force Theater Aeromedical
Evacuation System 6-10
Originating Medical Facility's Responsibilities 6-10
Medical Regulating for Army Special Operations Forces 6-11
EVACUATION REQUEST PROCEDURES
General 7-1
Unit Evacuation Plan 7-1
Determination to Request Medical Evacuation and Assignment
of Medical Evacuation Precedence 7-1
Unit Responsibilities in Evacuation 7-2
Types of Medical Evacuation Request Formats and Procedures 7-3
Collection of Medical Evacuation Information 7-3
Preparation of the Medical Evacuation Request 7-4
Transmission of the Request 7-4
Relaying Requests 7-6
MANUAL EVACUATION
General 8-1
Casualty Handling 8-1
General Rules for Bearers 8-2
Manual Carries 8-2
Casualty Positioning 8-3
Categories of Manual Carries 8-4
Special Manual Evacuation Techniques 8-25
III
FM 8-10-6
Page
8-8 . Evacuation from the Bradley Infantry Fighting Vehicle 8-35
8-9. Minefield Extraction 8-39
8-10. Rules for Surviving Minefields and Acquiring Casualties 8-42
CHAPTER 9. LITTER EVACUATION 9-1
9-1. General 9-1
9-2. Types of Litters 9-1
9-3. Dressed Litter 9-9
9-4. Using Patient Securing Straps 9-12
9-5. General Rules for Litter Bearers 9-12
9-6 . Use of Spine Boards and the Kendricks Extrication Device 9-13
9-7. Travois 9-18
9-8. Packsaddle Litter 9-19
9-9. Litter Evacuation in Mountain Operations 9-20
9-10. Techniques for Litter Evacuation in Mountain Operations 9-20
9-1 1 . Types of Litters for Mountain Operations 9-20
9-12. Methods of Litter Evacuation in Mountain Operations 9-21
9-13. Horizontal Hauling Line 9-25
CHAPTER 10. EVACUATION PLATFORMS 10-1
Section I. Army Ground Ambulances 10-1
10-1. General 10-1
10-2. Ground Ambulances 10-1
10-3. Ambulance Driver 10-2
10-4. Medical Aidman 10-3
10-5. Ambulance Loading and Unloading 10-3
10-6. Truck, Ambulances, 4x4, Utility, M996 and M997 10-4
10-7. Truck, Ambulance, 1 1/4 Ton, 4x4, M 1010 10-15
10-8. Truck, Ambulance, 1 1/4 Ton, 6x6, M792 10-15
10-9. Buses (Ambulances) 10-17
10-10. Carrier, Personnel, Full Tracked, Armored, M113, T113E2 10-19
Section II. Nonmedical Vehicles Used for Casualty Evacuation or Medical
Evacuation 10-20
10-11. General 10-20
10-12. Casualty Transport and Patient Evacuation in a Mass Casualty
Situation 10-20
10-13. Truck, Cargo/Troop Carrier, VU, 4x4, M998 (Four-Man
Configuration) 10-24
10-14. Truck, Cargo/Troop Carrier, VU Ton, 4x4, M998 (Two-Man
Configuration) 10-25
IV
FM 8-10-6
Page
10-15. Truck, Cargo, 5 Ton, 6x6, Wide Bed, and Truck, Cargo, 2V2 Ton,
6x6, Wide Bed 10-26
10-16. Heavy Expanded, Mobility Tactical Truck, 8x8 , Cargo , M977 1 0-27
10-17. Semi-Trailer, Cargo, 22V2 Ton, M871 10-28
10-18. Truck, Cargo, Medium Tactical Vehicle, Long Wheelbase, 5 Ton,
M-1085 10-29
10-19. Truck, Cargo, Medium Tactical Vehicle, Light Vehicle Air Drop/
Air Delivery, 5 Ton, M-1093 10-30
10-20. Truck Cargo, Light Medium Tactical Vehicle, Light Vehicle Air
Drop/Air Delivery, 2V2 Ton, M-1081 10-32
Section III. Evacuation by Medical Air Ambulances 10-33
10-21. General 10-33
10-22. Advantages of Aeromedical Evacuation 10-33
10-23 . Responsibilities for Loading 10-34
10-24. Army Air Ambulances 10-34
10-25 . Helicopter Landing Sites 10-35
10-26. Loading Patients Aboard Rotary-Wing Aircraft 10-41
10-27. Loading Patients Aboard the UH-60A Blackhawk 10-41
10-28. Loading Patients Aboard the UH-IH/V Iroquois 10-49
Section IV. United States Army Nonmedical Aircraft 10-54
10-29. General 10-54
10-30. Army Fixed-Wing Aircraft 10-54
10-31. U-21/C- 12 Aircraft 10-55
10-32. Loading Patients Aboard Army Fixed-Wing Aircraft 10-55
10-33. The CH-47 (Chinook) 10-56
10-34. Loading Patients Aboard the CH-47 (Chinook) 10-56
Section V. United States Air Force Aircraft 10-58
10-35. General 10-58
10-36. Types of Air Force Transport Aircraft and Units 10-58
10-37. Aeromedical Evacuation Civil Reserve Air Fleet Aircraft 10-59
10-38. Preparing Aircraft to Receive Patients 10-60
10-39. Developing the Loading Plan 10-60
10-40. Documentation Required 10-61
10-41 . Patient Assessment Information 10-62
APPENDIX A. EFFECTS OF GENEVA CONVENTIONS ON MEDICAL
EVACUATION A-1
A-1 . General A-1
A-2. Distinctive Markings and Camouflage of Medical Facilities and
Evacuation Platforms A-1
A-3. Medical Aircraft A-2
A-4. Self-Defense and Defense of Patients A-2
FM 8-10-6
Page
A-5
A-6
APPENDIX
B
Section
I
B-1
B-2
Section
II,
B-3
B-4
APPENDIX
C
C-1
C-2
C-3
C-4
C-5
APPENDIX
D
D-1
D-2
D-3
D-4
APPENDIX
E,
Section
I,
E-1
E-2
Section
II
E-3
E-4
Section
III
E-5
E-6
Enemy Prisoners of War A-3
Compliance with the Geneva Conventions A-3
MEDICAL EVACUATION ESTIMATE AND PLAN B-1
Medical Evacuation Estimate B-1
General B-1
Sample Format for the Medical Evacuation Estimate of the Situation .... B-1
Medical Evacuation Annex to the Combat Health Support Plan B-1 2
General B-12
Sample Format for the Medical Evacuation Annex to the Combat
Health Support Plan B-12
USE OF DD FORM 1380, US FIELD MEDICAL CARD
SAMPLE FORMAT C-1
General C-1
Use of the US Field Medical Card C-1
Preparation of the Field Medical Card C-2
Disposition of Field Medical Cards C-3
Field Medical Record Jacket C-3
MEDICAL REENGINEERING INITIATIVE MEDICAL
EVACUATION UNITS D-1
General D-1
Headquarters and Headquarters Detachment, Medical Evacuation
Battalion D-1
Medical Company, Air Ambulance D-2
Medical Company, Ground Ambulance D-3
USE OF THE HIGH PERFORMANCE HOIST IN MEDICAL
EVACUATION OPERATIONS El
Crew Responsibilities E-1
General E-1
Primary Crew Responsibilities E-1
Intercrew Communications E-2
General E-2
Intercrew Communications E-2
Employment E-4
General E-4
Hoist Rescue Operational Phases E-4
VI
FM 8-10-6
Page
Section
IV,
E-7
E-8
E-9
E-10
Section
V
E-11
E-12
Section
VI,
E-13
E-14
E-15
E-16
E-17
Section
VII
E-18
E-19
E-20
E-21
Section
VIII
E-22
E-23
E-24
E-25,
Section
IX,
E-26
E-27
E-28
E-29
Section
X,
E-30
E-31
E-32
E-33
Section
XI,
E-34
E-35
E-36
E-37
Section
XII
E-38
E-39
E-40
Environmental Factors E-5
General E-5
Water Recovery Operations E-5
Land Operations E-7
Night Recovery Operations E-8
Inert Patient Recoveries E-9
General E-9
Procedural Guidance E-9
Meteorological and Terrain Factor E-10
General E-10
Performance Planning E-10
Mountain Operations E-10
Jungle Operations E-1 1
Extreme Cold Weather Operations E-12
Safety and Emergency Procedures for Hoist Missions E-14
General E-14
Safety Factors E-14
Emergency Procedures E-20
Tactical Considerations E-21
Forest Penetrator E-21
General E-21
Configuration of the Forest Penetrator E-22
Application E-22
Employment of the Forest Penetrator E-22
SKED Rescue System E-25
General E-25
Configuration E-25
Operation of the SKED Litter E-26
Maintenance of the SKED Litter E-30
Rescue (Stokes) Litter E-3 1
General E-3 1
Configuration E-3 1
Function E-3 1
Maintenance E-34
Poleless Semirigid Litter E-34
General E-34
Employment of the Poleless Semirigid Litter E-34
Function E-35
Maintenance E-36
Survivor's Sling (Horse Collar) and Cable Weight Cover E-36
General E-36
Configuration E-36
Function E-37
VII
FM 8-10-6
Page
E-41 . Maintenance E-37
E-42. Modifications E-38
Section XIII. Hoisting Vest E-38
E-43. General E-38
E-44. Configuration E-38
E-45. Employment of the Hoisting Vest E-39
E-46. Maintenance of the Hoisting Vest E-41
APPENDIX F. THE USE OF SMOKE AND OBSCURANTS IN MEDICAL
EVACUATION OPERATIONS F-1
F-1. General F-1
F-2. Employment of Smoke and Obscurants F-1
F-3. Geneva Conventions and the Use of Smoke and Obscurants in
Medical Evacuation Operations F-2
F-4. Use of Smoke in Aeromedical Evacuation and Hoist Rescue
Operations F-3
F-5 . Employment of Smoke in Ground Medical Evacuation Operations F-4
APPENDIX G. TACTICAL STANDING OPERATING PROCEDURE G- 1
G-1. General G-1
G-2 . Purpo se of the Tactical Standing Operating Procedure G-1
G-3 . Format for the Tactical Standing Operating Procedure G-1
G-4 . Sample Tactical Standing Operating Procedure (Sections) G-2
G-5 . Sample Tactical Standing Operating Procedure (Annexes) G-3
APPENDIX H. PATIENT REGULATING FORMS SAMPLE FORMAT HI
Section I. Use of DD Form 600, Patient's Baggage Tag HI
H-1. General H-1
H-2. Preparation of DD Form 600 H-1
H-3. Receipt for Checked Baggage H-1
H-4. Disposition of DD Form 600 H-1
Section 11. Use of DD Form 601 , Patient Evacuation Manifest H-3
H-5. General H-3
H-6. Preparation of DD Form 601 H-3
H-7. Disposition of DD Form 601 H-5
Section III. Use of DD Form 602, Patient Evacuation Tag H-5
H-8. General H-5
H-9. Preparation of DD Form 602 H-5
H-10. Continued Use of DD Form 602 H-6
H-U. Disposition of DD Form 602 H-6
VIII
FM 8-10-6
Page
APPENDIX I. SAMPLE FORMAT FOR MEDICAL EVACUATION MISSION
COMPLETION RECORD I-l
APPENDIX J. PROCEDURES FOR LITTER EVACUATION TRAINING J-1
J-1 . General J-1
J-2. Basic Guides for Training Litter Bearers J-1
J-3. Litter Commands J-1
J-4. Formation for Instruction J-2
J-5. Procedures to Procure, Ground, Open, Close, and Return the Litter J-2
J-6. Procedures for Loading a Patient onto a Litter J-6
J-7. Procedures for Carrying a Loaded Litter J-15
J-8. Procedures for Surmounting Obstacles J-21
APPENDIX
APPENDIX
APPENDIX
K.
K-1.
K-2.
K-3.
K-4.
K-5.
K-6.
K-7.
L.
L-1.
L-2.
L-3.
L-4.
L-5.
L-6.
L-7.
M.
M-1.
M-2.
M-3.
M-4.
SELECTION OF PATIENTS FOR AEROMEDICAL
EVACUATION AND PATIENT CLASSIFICATION
CODES AND PRECEDENCE K-1
General K-1
Selection of Patients for Aeromedical Evacuation K-1
Briefing of Patients Prior to Aeromedical Evacuation K-3
International Standardization Agreement Codes K-3
International Standardization Evacuation Precedence K-3
Patient Classification K-5
United States Air Force Evacuation Precedence K-5
RISK MANAGEMENT L-1
General L-1
Types of Risks L-1
Hazards L-1
Risk Management Steps L-1
Risk Management Principles L-3
Risk Assessment L-3
Factors to Consider in Risk Assessment L-6
MULTINATIONAL OPERATIONS Ml
General M-1
Alliances and Coalitions M-1
Command Structure of Multinational Forces M-1
Rationalization, Standardization, and Interoperability M-3
IX
FM 8-10-6
Page
M-5. Combat Health Support Issues M-5
M-6. Combat Health Support Considerations M-5
APPENDIX N. LEADER CHECKLISTS N-1
N- 1 . Sample Format of a Command Post Operations Checklist N-1
N-2. Site Selection and Establishing Unit Area Checklist N-3
N-3. Precombat Checklists N-4
APPENDIX O. COMBATTING TERRORISM AND FORCE PROTECTION 0-1
0-1. General 0-1
0-2. Combatting Terrorism 0-1
0-3. Terrorism Considerations 0-1
0-4. Antiterrorism Assessment 0-2
APPENDIX P. STRATEGIC DEPLOYABILITY DATA P-1
P-1. General P-1
P-2. Strategic Deployability Data P-1
APPENDIX Q. EVACUATION CAPABILITIES OF UNITED STATES
FORCES Q-1
Q-1. General Q-1
Q-2 . Evacuation Capabilities of United States Air Force Aircraft Q-1
Q-3 . Evacuation Capabilities of United States Army Vehicles and Aircraft .... Q-2
Q-4. Railway Car Capabilities Q-2
Q-5. Evacuation Capabilities of United States Navy Ships, Watercraft,
and Rotary-Wing Aircraft Q-2
GLOSSARY Glossary-1
REFERENCES References-1
INDEX Index-1
FM 8-10-6
PREFACE
This field manual (FM) provides the philosophy of and doctrine for medical evacuation in a theater of
operations (TO). Tactics, techniques, and procedures for accomplishing the medical evacuation of sick,
injured, or wounded soldiers are included. Medical evacuation, with the provision of en route medical
care, is a vital link in the continuum of care from the point of injury through the combat health support
(CHS) system to medical treatment facilities (MTFs) with the required definitive or restorative medical
treatment capabilities. This publication is intended for use by medical and nonmedical unit commanders
and their staffs. This publication also discusses the following:
• Coordination requirements for and use of nonmedical transportation assets to accomplish the
medical evacuation mission. These nonmedical assets may be used in a mass casualty situation or other
circumstances when the available medical evacuation assets are overwhelmed.
• Definitive guidance for the performance of hoist rescue missions.
• Techniques for evacuating casualties from minefields.
The information in this publication on manual and litter carries may be used to instruct personnel in the
proper methods of handling and moving casualties.
The use of the term continental United States (CONUS) includes the continental United States (US), Hawaii,
Alaska, and its territories and possessions.
The proponent of this publication is the US Army Medical Department Center and School (AMEDDC&S).
Send comments and recommendations on Department of the Army (DA) Form 2028 directly to the
Commander, AMEDDC&S, ATTN: MCCS-FCD-L, 1400 East Grayson Street, Fort Sam Houston,
Texas 78234-6175.
Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to men.
The staffing and organizational structure presented in this publication reflects those established in living
tables of organization and equipment (LTOEs) which were current at the time of publication of this manual.
However, such staffing is subject to change to comply with manpower requirements criteria outiined in
Army Regulation (AR) 71-32 and can be subsequentiy changed by your modified table of organization and
equipment (MTOE).
This publications implements the following North Atiantic Treaty Organization (NATO) Standardization
Agreements (STAN AGs), American, British, Canadian, and Australian (ABC A) Quadripartite Standardi-
zation Agreements (QSTAGs), and Air Standardization Agreements (AIR STDs):
Title STANAG QSTAG AIR STD
Marking of Military Vehicles 512
xi
FM 8-10-6
Title STANAG
Stretchers, Bearing Brackets, and Attachment Supports 2040
Stretchers
Medical Employment of Air Transport in the Forward 2087
Area
Medical and Dental Supply Procedures 2128
Medical Materiel Management During Patient
Evacuation
Minimum Labelling Requirements for Medical Materiel
Documentation Relative to Medical Evacuation,
Treatment, and Cause of Death of Patients 2132
Morphia Dosage and Casualty Marking 2350
Regulations and Procedures for Road Movement and
Identification of Movement Control and Traffic
Control Personnel and Agencies 2454
Orders for the Camouflage of the Red Cross and the
Red Crescent on Land in Tactical Operations 293 1
Aeromedical Evacuation 3204
Aeromedical Evacuation by Helicopter
Selection, Priorities, and Classes of Conditions for
Aeromedical Evacuation
QSTAG
519
529
AIR STD
435
436
470
230
44/36A
61/71
When amendment, revision, or cancellation of this publication is proposed which will affect or violate the
international agreements concerned, the preparing agency will take appropriate reconciliatory action through
international standardization channels. These agreements are available from the Department of Defense
(DOD) Single Stock Point, Building 4, Section D, 700 Robbins Avenue, Philadelphia, Pennsylvania 19111-
5094.
The use of trade or brand names in this publication does not imply endorsement by the DOD, but is
intended only to assist in the identification of a specific product.
XII
FM 8-10-6
CHAPTER 1
INTRODUCTION TO THE COMBAT HEALTH SUPPORT
SYSTEM AND MEDICAL EVACUATION
1-1. General
a. The purpose of the CHS system is to conserve the fighting strength. This includes both the
deployed force and the sustaining base. Consistent with military and logistical operations, CHS operates in
a continuum across strategic, operational, and tactical levels. In a force projection army, the CHS system
supports a force which is rapidly deployable, lethal, versatile, and expandable. The Force XXI battle space
will be characterized by dispersion, lightning-quick military operations, increased mobility requirements,
rapid task organization, and lengthening lines of communication (LOC). The CHS system must be
strategically, operationally, and tactically agile in order to be responsible to the broad range of worldwide
requirements.
b. Medical commanders must effectively use their resources to treat, evacuate, and, when
possible, return to duty (RTD) sick, injured, and wounded soldiers.
1-2. Threat
a. The post-Cold War international environment presents the US with security challenges that are
unprecedented in ambiguity, diversity, risk, and opportunity. For many decades, nearly all US intelligence
analysis was directed toward one country. The Soviet strategic doctrine and tactics for conducting offensive
and defensive operations were well understood and confident estimates of Soviet weapons capabilities
existed. Further, during the Cold War, the US National Security Strategy carefully rationed the use of
military force to only those conflicts which promoted democracy over communism. The world was a
dangerous place, but the superpowers were held in check by the knowledge that each had the capability to
destroy the planet.
b. The end of the Cold War signaled the emergence of a "New World Order." Unfortunately,
reality has proven that this new order is neither new nor orderly. The old forces of adventurism, nationalism,
and separatism have reappeared, often with violent and unpredictable consequences. Coupled with this is a
new National Security Strategy, still in its infancy, which allows for US military involvement in complicated
scenarios such as peacemaking operations, nation assistance, and humanitarian assistance.
c. With the diminished threat of a large-scale military confrontation, military force size and
capabilities are being affected in countries throughout the world. Many of the major military powers are
moving toward smaller, better-equipped, and better-trained forces. Developed nations have also improved
military capabilities through greater access to military system technologies and the increased availability of
a wide range of advanced military equipment on the international market. How well these nations are able
to integrate advanced weapons systems for a high technology status may increase their leverage over
another regional power. While high technology weapons will be available, either through direct purchase
or through third party countries, many hostile forces, especially paramilitary or insurgent forces, will
maintain a low technology inventory. This low technology weapons environment does not translate into a
low threat environment for US forces. Small hostile forces often demonstrate a creativity and flexibility for
1-1
FM 8-10-6
use of low technology weapons that is unexpected, thereby compounding the problems associated with
assessing their capabilities. The implication for the US Army is clear. United States forces must be
continually prepared to face a variety of threat forces, many with credible military capabilities.
d. The Army Medical Department (AMEDD) views threat from two perspectives. Both
viewpoints are rooted in a potential adversary's capability to conduct combat operations. The first of these
viewpoints is similar to the way threat is viewed in the Army. This is a potential adversary's capability to
disrupt CHS operations on the battlefield. The second is the AMEDD's responsibility to anticipate and
prevent the degradation of soldiers' performance by diseases, environmental hazards, and military
capabilities. This second perspective is called the medical threat. Soldiers are the targets of these threats.
Weapons or environmental conditions that will generate casualties beyond the capability of the CHS system
are considered to be significant medical threats. (The medical threat is further discussed in paragraph 1-3.)
e.
FM 8-42.
For a discussion of CHS operations in stability operations and support operations, refer to
1-3. Medical Threat and Medical Intelligence
a. The medical threat is a composite of all ongoing or potential enemy actions and environmental
conditions that may render a soldier combat ineffective. The soldier's reduced effectiveness results from
sustained wounds, injuries, stress-induced performance deterioration, or diseases. The elements of the
medical threat include—
Diseases endemic to the area of operations (AO).
Environmental factors (heat, cold, humidity, and high altitude).
Battle injuries.
Biological warfare (BW) agents.
Chemical warfare (CW) agents.
Directed-energy (DE) sources.
Blast effect munitions.
Flame and incendiary weapons.
Nuclear weapons.
Toxic industrial materiel/chemicals (to include radioactive material).
Combat stress and continuous operations.
1-2
FM 8-10-6
• Level of compliance with the Law of Land Warfare and the Geneva Conventions
(Appendix A) requirements regarding respect and protection of medical personnel and their patients,
MTFs, and medical vehicles and aircraft.
b. In order to develop the CHS estimate and plan (Appendix B), the CHS planner obtains updated
medical intelligence through intelligence and other channels. Medical intelligence is the product resulting
from the collection, evaluation, and analysis, integration, and interpretation of all available general health
and bioscientific information. Medical intelligence is concerned with one or more aspects of foreign nations
or the AO. Until medical information is processed (ordinarily at the national level by the Armed Forces
Medical Intelligence Center [AFMIC]), it is not considered to be intelligence.
c. For additional information on medical intelligence, refer to FM 8-10-8.
1-4. Medical Evacuation Versus Casualty Evacuation
a. Medical evacuation is the timely, efficient movement and en route care by medical personnel
of the wounded, injured, or ill persons from the battlefield and/or other locations to MTFs. The provision
of en route care on medically equipped vehicles or aircraft enhances the patient's potential for recovery and
may reduce long-term disability by maintaining the patient's medical condition in a more stable manner.
(1) The gaining MTF is responsible for arranging for the evacuation of patients from the
lower echelon of care. For example. Echelon II medical units are responsible for evacuating patients from
Echelon I MTFs.
(2) Medical evacuation begins when medical personnel receive the wounded, injured, or ill
soldier and continues as far rearward as the patient's medical condition warrants or the military situation
requires.
b. Casualty evacuation (CASEVAC) is a term used by nonmedical units to refer to the movement
of casualties aboard nonmedical vehicles or aircraft.
CAUTION
Casualties transported in tiiis manner do not receive en route
medical care; if the casualty's medical condition deteriorates
during transport, an adverse impact on his prognosis and long-
term disability may result.
(1) If dedicated medical vehicles or aircraft are available, casualties should be evacuated on
these conveyances to ensure they receive en route medical care.
1-3
FM 8-10-6
(2) If available medical evacuation resources are overwhelmed (such as in a mass casualty
situation), some casualties (usually with minimal or nonlife-threatening injuries) may be required to be
transported on nonmedical vehicles. Medical personnel on-site will determine the priority for evacuation by
available medical vehicles and aircraft.
NOTE
When possible, nonmedical vehicles/aircraft transporting casualties
should be augmented with a combat medic or combat lifesaver. (On
nonmedical aircraft, sufficient space may not be available to permit a
caregiver to accompany the casualties.) The type of en route surveil-
lance and medical care/first aid provided is limited by the following
factors:
• Skill level of the individual providing care.
(The combat medic is military occupational specialty [MOS] -qualified
to provide emergency medical treatment [EMT]; the combat lifesaver
is trained to provide enhanced first aid.) The combat medic can
provide emergency medical intervention, whereas the combat lifesaver
can only monitor the casualty and ensure that the basic lifesaving first-
aid tasks are accomplished.
• Equipment available.
• Number of casualties being transported.
• Accessibility of the casualties. (If the nonmedical ground
vehicle is loaded with the maximum number of casualties, the combat
medic/combat lifesaver will not be able to attend to the casualties
while the vehicle is moving. At best, if the condition of a casualty
deteriorates and emergency measures are required, the vehicle will
have to be stopped to permit care to be given.)
1-5. Theater Evacuation Policy
a. The theater evacuation policy is established by the Secretary of Defense, with the advice of the
Joint Chiefs of Staff and upon the recommendation of the theater commander. The policy establishes, in
number of days, the maximum period of noneffectiveness (hospitalization and convalescence) that patients
may be held within the theater for treatment. This policy does not mean that a patient is held in the TO for
the entire period of noneffectiveness. A patient who is not expected to be ready for RTD within the number
of days established in the theater evacuation policy is evacuated to the CONUS or other safe haven. This is
done providing that the treating physician determines that such evacuation will not aggravate the patient's
1-4
FM 8-10-6
disabilities or medical condition. For example, a theater evacuation policy of 15 days does not mean that a
patient is held in the theater for 14 days and then evacuated. Instead, it means that a patient is evacuated as
soon as possible after the determination is made that he cannot be returned to duty within 15 days following
admission to an Echelon III or above hospital.
b. To the degree that unplanned for increases in patients occur (due perhaps to an epidemic or
heavy combat casualties), a temporary reduction in the policy may be necessary. This reduction is used to
adjust the volume of patients being held in the TO hospital system. A reduction in the evacuation policy
increases the number of patients requiring evacuation out-of-theater and increases the requirement for
evacuation assets. This action is necessary to relieve the congestion caused by the patient increases. A
decrease in the theater evacuation policy increases the evacuation asset requirements.
c. The time period established by the theater evacuation policy starts on the date the patient is
admitted to the first hospital (combat zone [CZ] or echelons above corps [EAC]). The total time a patient is
hospitalized in the theater (including transit time between MTFs) for a single, uninterrupted episode of
illness or injury should not exceed the number of days stated in the theater evacuation policy. Though
guided by the evacuation policy, the actual selection of a patient for evacuation is based on clinical
judgment as to the patient's ability to tolerate and survive the movement to the next echelon of
hospitalization. An exception to the theater evacuation policy may be required with respect to special
operations forces (SOF) personnel. This exception may be required to retain low density MOS skills within
the theater. Retaining these personnel within the theater for an extended period of time is possible if the
medical resources are available within the theater to treat their injuries and provide for convalescence and
rehabilitation. If retention within the theater would result in a deterioration of their medical condition or
would adversely impact on their prognosis for full recovery, they are evacuated from the theater for
definitive care.
d. The evacuation policy has different meanings for different personnel. For example, to the—
(1) Physicians and dentists engaged in direct patient treatment and decisions relating to
patient disposition, it means that there is a maximum period within which clinical staffs may complete the
necessary treatment needed to return the patient to full duty within the theater. If the theater policy is 15
days and full RTD can be predicted within that time, the patient is retained in the theater hospital system. If
the patient cannot be returned to fiill duty within 15 days, the patient is evacuated out-of-theater as early as
clinically prudent.
(2) Combat health support planner, it means that he can compute the beds required in
theater, if given the theater evacuation policy and other factors. This can be translated into the type, mix,
number, and distribution of hospital beds required in the theater.
(3) Nonmedical logistician, it means, in part, that he can estimate his total obligation to
support this system.
(4) United States Air Force (USAF) planner, it means that he can accurately plan the USAF
aeromedical evacuation (AE) requirements for both intra- and intertheater patient movements.
1-5
FM 8-10-6
(5) Combat health support operator, it means that he has a management tool which, when
properly adjusted and used, provides the balance between patient care and tactical support requirements.
The CHS operator is able to tailor a CHS package specifically designed to handle the patient workloads,
with maximum benefit to the patients and with maximum economy of available resources.
1-6. Factors Determining the Evacuation Policy
To fully understand how the theater evacuation policy affects CHS operations, the CHS operator should be
aware of the factors that influence the establishment of this policy. The following factors are used in
determining the evacuation policy:
a. Nature of Tactical Operations . A major factor is the nature of the combat operations. Will
they be operations of short duration and with a low potential for violence? Will they be operations of long
duration with significant combat operations? Will weapons of mass destruction (WMD) (to include nuclear,
biological, and chemical [NBC] or DE weapons) be employed? Will only conventional weapons be used?
Is a static combat situation expected? Is there a significant threat of terrorist activities? Are the majority
of patients anticipated to be disease and nonbattle injury (DNBI) patients or those with combat-related
trauma?
b. Number/Type of Patients. Another factor is the number and types of patients anticipated and
the rate of patient RTD. Admission rates vary widely in different geographical areas of the world and in
different types of military operations.
c. Evacuation Means. The means (quantity and type of transportation) available for evacuation
of patients from the TO to CONUS is an essential factor impacting on the evacuation policy.
d. Availability of Replacements . The capability of CONUS to furnish replacements to the theater
is another consideration. For each patient who is evacuated from the theater to CONUS, a fully trained and
equipped replacement must be provided. During a small-scale conflict overseas, the CONUS replacement
capability is much greater than when compared to a large-scale conflict such as World War II.
e. Availability of In-Theater Resources. Limitations of all CHS resources (such as insufficient
number and types of CHS units in EAC to support the CZ and an insufficient amount of combat health
logistics [CHL] and nonmedical logistics) will have an impact on the theater evacuation policy. The
availability, type, and timing of engineering support is also a consideration. The more limitations (or
shortages), the shorter the theater evacuation policy.
1-7. Impact of Evacuation Policy on Combat Health Support Requirements
a. A short theater evacuation policy—
• Results in fewer hospital beds required in the theater and a greater number of beds
required elsewhere.
1-6
FM 8-10-6
• Creates a greater demand for intertheater USAF evacuation resources. (A shortened
intratheater evacuation policy would likewise increase the number of airframes required in the theater.)
• Increases the requirements for replacements to meet the rapid personnel turnover which
could be expected, especially in combat units. (The impact this would have on both intra- and intertheater
transportation and other requirements must also be considered.)
b. A longer theater evacuation policy—
• Results in a greater accumulation of patients and a demand for a larger CHS infrastructure
in the theater. It decreases bed requirements elsewhere.
• Increases the requirements for CHL (medical supplies and equipment and medical
maintenance) and nonmedical logistics support.
• Increases the requirements for hospitals, engineer support, and all aspects of base
development for CHS. (It demands the establishment of a larger number of hospitals in EAC.)
• Provides for a greater proportion of patients to RTD within the theater, and thus reduces
the loss of experienced manpower.
c. The evacuation policy has no impact on the patient stabilization period for movement. This
period is known as the evacuation delay. It is the period of time planned for between the time of patient
reporting and the time of AE of the patient to the next echelon of care. Evacuation delays normally range
from 24 to 72 hours and are designated by the theater surgeon.
1-8. Adjustments to the Evacuation Policy
When patients are received at a rather constant rate, the evacuation policy at a specific echelon may be
adjusted to retain or RTD those patients who do not require specialized treatment in EAC hospitals.
However, when increased patient loads are anticipated, the intratheater evacuation policy must be adjusted
to make additional beds available for current and anticipated needs. As a result, a larger proportion of
patients admitted in the CZ are evacuated to EAC facilities much earlier than under normal conditions. The
displacement of hospitals temporarily reduces the number of beds available and may result in a greater
number of patients being evacuated out of the CZ during the period of relocation.
1-9. Planning for Combat Health Support
a. While the responsibility for what is or is not done is the tactical commander's alone, he must
rely on his staff and his subordinate commanders to execute his decisions. It is imperative that the CHS
planner be involved in the initial stages of the planning process. A thorough understanding of the tactical
commander's plan is necessary for CHS commanders to maintain CHS to sustain the tactical commander
during the absence of orders and communications. Combat health support planning is an intense and
demanding process. The planner must know—
1-7
FM 8-10-6
• What each supported element will do.
• When it will be done.
• How it will be done.
• What the organic medical capability is of the supported units.
b. The planner must foresee actions beforehand to be able to plan for positive and responsive
support to each element supported. He must be prepared to meet the requirements for all of the CHS
functional areas. The functional areas are— patient evacuation and medical regulating; hospitalization;
medical treatment (to include area medical support); preventive medicine (PVNTMED) services; CHL to
include blood management; medical laboratory services; dental services; veterinary services; combat stress
control (CSC); and command, control, communications, computers, and intelligence (C4I).
c. Planning must be proactive rather than reactive. Commanders must be able to allocate CHS
resources as tactical situations change.
d. On the integrated battlefield, medical units can anticipate situations in which large numbers of
patients are produced in a relatively short period of time. These mass casualty situations will exceed local
CHS capabilities. (Refer to FM 8-10-1 for an in-depth discussion on mass casualty operations.)
e. For additional information on CHS planning, refer to FMs 8-42, 8-55, and 101-5 and Appendix B
of this manual.
1-10. Echelons of Medical Care
Combat health support is arranged in echelons of care. Each echelon reflects an increase in medical
capabilities while retaining the capabilities found in the preceding echelon.
a. Echelon I. The first medical care a soldier receives is provided at Echelon I (also referred to
as unit-level medical care). This echelon of care includes—
Immediate lifesaving measures.
Disease and nonbattle injury prevention.
Combat stress control preventive measures.
Patient collection.
Medical evacuation from supported units to supporting MTFs.
Treatment provided by designated combat medics or treatment squads (battalion aid
stations [BASs]) in conventional forces. In Army special operations forces (ARSOF), Echelon I treatment
1-8
FM 8-10-6
is provided by special operations combat medics (SOCMs), special forces medical sergeants (SFMSs), or
physicians or physician assistants (PAs) at forward operating bases (FOBs), special forces (SF) operating
bases (SFOBs), or in joint special operations task force (JSOTF) areas of responsibility (AOR). (Major
emphasis is placed on those measures necessary for the patient to RTD, or to stabilize him and allow for his
evacuation to the next echelon of care. These measures include maintaining the airway, stopping bleeding,
preventing shock, protecting wounds, immobilizing fractures, and performing other emergency measures,
as indicated.)
(1) The combat medic is assisted in his duties by nonmedical personnel performing first-aid
procedures. First aid is administered by an individual (self-aid, buddy aid) and by the combat lifesaver.
(a) Self-aid and buddy aid. Each individual soldier is trained to be proficient in a
variety of specific first-aid procedures. These procedures include aid for chemical casualties with particular
emphasis on lifesaving tasks. This training enables the soldier or a buddy to apply first aid to alleviate a
life-threatening situation.
(b) Combat lifesaver. The combat lifesaver is a member of a nonmedical unit selected
by the unit commander for additional training beyond basic first-aid procedures. A minimum of one
individual per squad, crew, team, or equivalent-sized element should be trained. The primary duty of this
individual does not change. The additional duty of the combat lifesaver is to provide enhanced first aid for
injuries (based on his training) before the combat medic arrives. The combat lifesaver' s training is
normally provided by medical personnel assigned, attached, or in direct support (DS) of the unit. The
training program is managed by the senior medical person designated by the commander. Members of SF
operational detachment A (ODA) teams receive enhanced first-aid training at the combat lifesaver level.
(2) Echelon I medical treatment is provided by the combat medic or by the physician, PA, or
medical specialist in the HAS.
(a) Emergency medical treatment (immediate far forward care) consists of those
lifesaving steps that do not require the knowledge and skill of a physician. The combat medic is the first
individual in the CHS chain who makes medically substantiated decisions based on medical MOS-specific
training. (The SFMS receives more advanced training than the conventional force combat medic, as the
SFMS may be required to maintain patients for longer periods of time under austere conditions.)
(b) The physician and the PA in a treatment squad are trained and equipped to provide
advanced trauma management (ATM) to the battlefield casualty. This element also conducts routine sick
call when the tactical situation permits. Like elements provide this echelon of medical care to division,
corps, and EAC units.
(c) Echelon I care is provided by—
• Medical platoons/sections of combat and combat support (CS) battalions/
squadrons.
• Divisional medical companies.
1-9
FM 8-10-6
• Corps and EAC area support medical companies (ASMCs).
• Special forces medical sergeants, PAs, and physicians assigned to special
forces groups (SFGs), special operations support battalions (SOSBs), and SOCMs, PAs, and physicians
assigned to Ranger regiments.
b. Echelon II. At this echelon, care is rendered at the clearing stations (division or corps) which
are operated by the treatment platoon of the medical company. Here the casualty is examined and his
wounds and general status evaluated to determine his treatment and evacuation precedence, as a single
casualty among other casualties. Emergency medical treatment, including beginning resuscitation is
continued and, if necessary, additional emergency measures are instituted, but they do not go beyond the
measures dictated by immediate necessities. The clearing station has a whole blood capability and limited
x-ray, laboratory, and dental support. Echelon II CHS also includes PVNTMED and CSC assets in the
division (main support medical company [MSMC]) and in the corps (area support medical battalion
[ASMB]). Those patients who can RTD within 1 to 3 days are held for treatment. These functions are
performed typically by company-sized medical units organic to brigades, divisions, and ASMBs. Patients
who are nontransportable due to their medical condition may receive immediate surgical care from a
forward surgical team (EST) collocated with a division or corps medical company. (A discussion of the EST
is contained in EM 8-10-25.) (Army special operations forces units do not have organic Echelon II
resources and are dependent upon theater assets for this echelon of care. Support is provided on an area
support basis by the ASMB.)
c. Echelon III. At this echelon, the patient is treated in an MTE staffed and equipped to provide
resuscitation, initial wound surgery, and postoperative treatment. Those patients who are expected to RTD
within the theater evacuation policy are regulated to a facility that has the capability for reconditioning and
rehabilitation.
d. Echelon IV. At Echelon IV, the patient is treated in a hospital staffed and equipped for general
and specialized medical and surgical care to stabilize the patient for further evacuation out of the theater, or
for reconditioning and rehabilitation prior to RTD.
e. Echelon V. Echelon V medical care is found in support-base hospitals. Mobilization requires
expansion of military hospital capacities and the inclusion of Department of Veterans Affairs (VA) and
civilian hospital beds in the CHS system to meet the increased demands created by the evacuation of patients
from the TO. The support-base hospitals represent the most definitive medical care available within the
CHS system.
1-11. Principles of Combat Health Support Operations
a. Conformity. Conformity with the tactical plan is the most fundamental element for effectively
providing CHS. Only by participating in the development of the operation plan (OPLAN) can the CHS
planner ensure adequate CHS on the battlefield at the right time and place.
b. Continuity. Combat health support must be continuous since the interruption of treatment may
cause an increase in morbidity and mortality. Procedures are standardized at each organizational level to
1-10
FM 8-10-6
ensure that all required medical treatment at that echelon is accomplished. No patient is evacuated any
farther to the rear than his physical condition or the military situation requires.
c. Control. Control of CHS resources must rest with the medical commander. Combat health
support staff officers must be proactive and keep their commanders apprised of the impact of future
operations on CHS assets. The CHS system must be responsive to a rapidly changing battlefield and must
support the tactical plan in an effective manner. The medical commander must be able to tailor medical
organizations and direct them to focal points of demand throughout his AO. For this reason, CHS units
normally maintain unit integrity for command and control (C2). Treatment performed at each echelon of
the CHS system must be commensurate with available CHS resources. Since these resources are limited, it
is essential that their control be retained at the highest CHS echelon consistent with the tactical situation.
d. Proximity. The location of CHS assets in support of combat operations is dictated by the
tactical situation (mission, enemy, terrain, troops, time available, and civilian considerations [METT-TC])
factors, the time and distance factor, and the availability of evacuation resources. The speed with which
medical treatment is initiated is extremely important in reducing morbidity and mortality. Medical
evacuation time must be minimized by the efficient allocation of resources and the judicious location of
MTFs. The MTF cannot be located so far forward that it interferes with the conduct of combat operations
or is subjected to enemy interference. Conversely, it must not be located so far to the rear that medical
treatment is delayed due to the lengthened evacuation time.
e. Flexibility. Since a change in tactical plans or operations may require redistribution or
relocation of medical resources, the CHS plan must be flexible. The medical commander must be able to
shift CHS resources to meet the changing requirements. No more medical resources should be committed
nor MTFs established than are required to support expected patient densities. When the patient load
exceeds the means available for treatment, it may be necessary to give priority to those patients who can
RTD the soonest rather than those who are more seriously injured. This ensures the manning of the tactical
commander's weapons systems.
/. Mobility. Since contact with supported units must be maintained, CHS elements must have
mobility comparable to that of the units they support. Mobility is measured by the extent to which a unit
can move its personnel and equipment with organic transportation. When totally committed to patient care,
a CHS unit can regain its mobility only by immediate patient evacuation. When the mobility of the unit is
jeopardized by the accumulation of patients, it may be necessary to leave a small holding element with the
patient.
1-12. Army Medical Department Battlefield Rules
The AMEDD has developed CHS battlefield rules to aid in establishing priorities and in resolving conflicts
between competing priorities within CHS activities.
a. These battiefield rules are (in order of their priority) to—
• Maintain a medical presence with the soldier.
1-11
FM 8-10-6
Maintain the health of the command.
Save lives.
Clear the battlefield.
Provide state-of-the-art care.
Return soldiers to duty as early as possible.
b. These rules are intended to guide the CHS planner to resolve system conflicts encountered in
designing and coordinating CHS operations. Although medical personnel seek always to provide the full
scope of CHS in the best possible manner, during every combat operation there are inherent possibilities of
conflicting support requirements. The planner or operator applies these rules to ensure that the conflicts
are resolved appropriately.
c. The rationale for the battlefield rules is based on the prevention of disease and injury and the
evolving clinical concept which demonstrates that with good medical care the trauma victim will probably
survive the injury.
(1) Good medical care means that the injured soldier receives prompt medical attention; he
is adequately resuscitated and stabilized; and stabilization is maintained during evacuation.
(2) The goal of resuscitation and stabilization is the restoration of vascular volume with
adequate oxygen delivery to the cells. This means that the patient's bodily systems have available the
amount of oxygen demanded to ensure viability. The patient can then be evacuated over a greater distance
to a rearward MTF with time being less of a major concern to save life and limb.
(3) Good medical care and stabilization prior to evacuation are major aspects in determining
whether the patient survives, provided stabilization is sustained during evacuation. Early medical care with
the ability to adequately stabilize the patient must be available with less delay from the time of injury than it
has ever been in the past. An enhanced capability to sustain stabilization during evacuation must also be
provided.
1-13. Mandated Medical Evacuation Support
When an aircraft is reported down and has sustained damage, a medical evacuation platform (either ground
or air) is required to pick up the crew of the aircraft. Initial EMT is provided, if required, and en route
medical care sustains the injured crew members during the evacuation.
1-12
FM 8-10-6
CHAPTER 2
ECHELONS I AND II MEDICAL EVACUATION
2-1. General
a. The ground ambulance squad is the basic module for evacuation at the unit and division levels.
This squad provides patient evacuation throughout the division, corps, and EAC and ensures the continuity
of care en route. Ambulance squads are organic to the medical platoon or section in combat and CS units
and to the division support command (DISCOM) medical companies. This squad is also a part of the
ASMCs in corps and EAC.
b. Area medical support is provided to those units (which do not have organic medical evacuation
resources) operating in the division, corps, or EAC AO. To ensure that adequate medical evacuation
support is provided, prior planning and coordination must be accomplished. Medical evacuation support is
coordinated with supported units to ensure the timely response to evacuation requests.
2-2. Echelon I (Unit Level) Medical Evacuation
a. The medical platoon organic to the headquarters and headquarters company (HHC) of the
combat maneuver battalion provides medical evacuation support for the battalion. Their mission is to
provide this support for the subordinate elements of the battalion. They also provide support to other
elements (which do not have organic medical evacuation resources) in the sector providing CS to their unit.
The medical platoon leader is a physician and also serves as the battalion surgeon. He is assisted by the
medical operations officer (field medical assistant) in the operational, administrative, and logistical support
aspects of the platoon. The ambulance section of the medical platoon is organized into ambulance squads
and is supervised by the platoon sergeant. Each squad contains a noncommissioned officer (NCO) squad
leader, three medical specialists/ambulance drivers, and two ambulances (Figure 2-1).
b. The number of ambulance squads in a section varies and is based on the type of parent
organization. The infantry, airborne, and air assault battalions' ambulance sections have two ambulance
squads equipped with high mobility multipurpose wheeled vehicle (HMMWV) ambulances. The mechanized
infantry and armor combat maneuver battalions' ambulance sections have four ambulance squads equipped
with M-113 truck ambulances.
c. Each ambulance team consists of one vehicle and two medics (aide/evacuation NCO and
medical aidman). Specific duties of the ambulance team are to—
Operate the vehicle and maintain contact with supported elements.
Find and collect the wounded.
Perform triage when necessary.
Administer EMT as required.
Initiate or complete the Department of Defense (DD) Form 1380, US Field Medical
Card (EMC) (Appendix C).
2-1
FM 8-10-6
BNHQ
HQ SECTION
HHC
HQCO
1
• • •
\/
MEDICAL
PLATOON
COMBAT
MEDIC
SECTION
TREATMENT
SQUAD
AMBULANCE
SECTION
AMBULANCE
SQUAD
**
u
NOTE:
* MECHANIZED INFANTRY AND ARMOR UNITS HAVE 4 AMBULANCE SQUADS.
** TWO AMBULANCE TEAMS.
*** AIRBORNE AND AIR ASSAULT UNITS HAVE 12, LIGHT INFANTRY UNITS HAVE 9, ARMOR UNITS HAVE 5,
AND MECHANIZED INFANTRY UNITS HAVE 13.
Figure 2-1. Medical platoon.
2-2
FM 8-10-6
d.
• Evacuate litter patients to the BAS.
• Direct or guide ambulatory patients to the BAS.
• Resupply combat medics with Class VIII supplies.
• Serve as messengers within CHS channels.
NOTE
In track ambulances, three medics are required to provide en route
medical care.
The ambulance squad consists of two ambulance teams.
(1) The aide/evacuation NCO—
Collects casualties.
Performs triage and EMT procedures in the care and management of trauma
Assists in the care and management of combat stress patients.
Prepares patients for movement.
Provides en route patient care or acts as vehicle commander and navigator.
Maintains contact with supported units.
Performs NBC detection procedures.
Assists the platoon leader and platoon sergeant in selecting medical evacuation
Regulates the backhaul of medical supplies for his squad.
(2) The medical specialist/ambulance driver is trained in EMT procedures. He operates and
maintains the ambulance and all of its on-board equipment. He also assists the aide/evacuation NCO in the
care and handling of patients.
e. The ambulance team is essentially a mobile combat medic team. Its principal function is to
collect and treat the sick, injured, and wounded on the battlefield and to rapidly evacuate them. The
patients.
routes.
2-3
FM 8-10-6
patients may be evacuated to the nearest patient collecting point (PCP), ambulance exchange point (AXP),
or to the BAS. For communications, the ambulance team employs vehicular-mounted tactical radios on its
assigned ambulance. The ambulances are equipped with navigational aids (NAVAIDS) and, when available,
the Global Positioning System (GPS). The GPS has the capability of instantly providing ambulance crews
with their location by eight-digit grid coordinates. It also provides correct route selection for traveling to a
designated point. The team normally operates in the same net as the BASs.
2-3. Echelon II Medical Evacuation in the Division
a. The ambulance platoons of the medical companies organic to the division (Figure 2-2 [Page
2-6] and Figure 2-3 [Page 2-7]) provide—
• Unit-level evacuation support on an area support basis for all units without organic
evacuation assets operating within the division AO.
• Division-level medical evacuation support for the entire division.
b. The mission of the ambulance platoon is to—
• Provide ground evacuation and en route medical care for patients from the BAS, from
the supported units in the brigade support area (BSA) and division rear, and, when necessary, from the
forward support medical company (FSMC) in the BSA to the MSMC in the division rear.
• Reinforce and reconstitute ambulance support forward.
• Provide medical resupply through the backhaul method using returning ground ambu-
lances.
c. The ambulance platoon consists of a platoon headquarters module and multiple ambulance
squad modules.
(1) Platoon leader. This officer directs, coordinates, and supervises the platoon and plans
for its employment. Further, he-
Establishes and maintains contact with supported treatment squads.
Makes route reconnaissances.
Develops and issues strip maps.
Allocates mission requirements based on priority.
Designates PCPs and AXPs and develops medical-specific situational overlays.
2-4
FM 8-10-6
(2) Platoon sergeant. This NCO assists the platoon leader in planning the employment
of platoon assets. He provides direct supervision and training of enlisted personnel to include opera-
tor maintenance. He assists the platoon leader in conducting route reconnaissance and developing
strip maps.
(3) Aide /evacuation noncommissioned officers. These NCOs supervise ambulance squads
and serve as ambulance team leaders. They perform triage, provide EMT, and assist in evacuating patients.
(4) Aide /ambulance drivers. They provide EMT necessary to prepare patients for movement
and operate ambulances. They also perform preventive maintenance on their assigned ambulances and
associated equipment.
d. The ambulance platoon headquarters normally collocates with the treatment platoon head-
quarters for mutual support and area support taskings. The ambulance platoon may be totally deployed
at one time. The platoon of the MSMC normally places one ambulance team in support of each FSMC
and in support of units in the division rear. The remaining teams are used for task force (TF) opera-
tions, augmentation, or establishment of an AXP or ambulance shuttle. The FSMC ambulance platoon
establishes contact and may locate one or more ambulance teams with the medical platoon of each maneuver
battalion.
e. For communications, the ambulance platoon employs vehicular-mounted tactical radios in the
platoon headquarters vehicle and each ground ambulance. The platoon operates on the medical evacuation
frequency and monitors the company's operations net.
2-4. Echelons I and II Medical Evacuation in the Corps
a. Units located in the corps with organic medical evacuation assets use these assets for Echelon I
medical evacuation support.
b. The ASMC (Figure 2-4 [page 2-8]) provide Echelons I and II medical evacuation support to
those units (without organic resources) located in the corps. The ASMC is structured like the division
medical companies with its ambulance platoon providing evacuation support on an area basis to all corps
units in the corps rear.
c. The mission of the ambulance platoon is to—
• Provide ground evacuation and en route medical care for patients from the site of injury
to an ASMC.
• Provide medical resupply through the backhaul method using returning ambulances.
• Act as a carrier of medical records and resupply requests.
• Provide transportation of medical personnel and equipment.
2-5
FM 8-10-6
d. The organization and staffing of the ASMC ambulance platoon is similar to the ambulance
platoon in the division-level medical companies. The platoon has four ambulance squads equipped with
HMMWV ambulances. The ambulance platoon collocates with the clearing station. The ambulance teams
are collocated with MTFs and hospitals, as required.
HSC
FSMC
AMBULANCE PLATOON
• • •
PLTHQ
AMBSQD*
1
* AIR ASSAULT HAS THREE SQUADS
Figure 2-2. Ambulance platoon (airborne, air assault, and light infantry divisions).
2-6
FM 8-10-6
FSMC
MSMC
AMBULANCE PLATOON
• • •
PLTHQ
AMB SQD '
MAIN SUPPORT BATTALION (MSB) HAS FIVE AMBULANCE SQUADS WITH WHEELED VEHICLES.
FORWARD SUPPORT BATTALION (FSB) HAS FIVE AMBULANCE SQUADS WITH TWO SQUADS OF
WHEELED VEHICLES AND THREE SQUADS OF TRACK VEHICLES.
Figure 2-3. Ambulance platoon (mechanized infantry and armor divisions).
2-7
FM 8-10-6
COHQ
TRMTPLT
PLTHQ
AMB PLT
PLTHQ
AMBSQD
AREA SPT
SEC
AREA SPT
SQO
TRMTSQD
TRMTSQD
PNT HLDG
SOD
Figure 2-4. Area support medical company.
2-8
FM 8-10-6
CHAPTER 3
CORPS AND ECHELONS ABOVE CORPS MEDICAL
EVACUATION UNITS
This chapter discusses Medical Force 2000 (MF2K) units. Organizations designed and/or changed under
the Medical Reengineering Initiative (MRI) are discussed in Appendix D.
Section I. MEDICAL EVACUATION BATTALION
3-1. General
The headquarters and headquarters detachment (HHD), medical evacuation battalion, serves as the central
manager of ground and air evacuation assets within the corps and EAC.
3-2. Assignment
a. The medical evacuation battalion is assigned to the medical command (MEDCOM) in the EAC
or to the medical brigade in the corps. It is normally further assigned to a medical group for C2.
NOTE
Under the MRI design, the medical group is replaced by the medical
brigade.
b. Air and ground ambulance companies assigned to the MEDCOM or medical brigade are
attached to the medical evacuation battalion for C2.
c. The basis of allocation is one medical evacuation battalion per a combination of three to seven
of the following units:
• Medical companies, air ambulance.
• Medical companies, ground ambulance.
3-3. Mission and Capabilities
a. The mission of the medical evacuation battalion is to provide C2 of air and ground medical
evacuation units within the TO. It tactically locates in the area where it can best control subordinate air and
ground ambulance companies.
3-1
FM 8-10-6
b. The medical evacuation battalion is designed to focus on C2, planning, patient evacuation,
subordinate unit support, and vehicle management. Specific capabilities are—
• Command and control, planning and supervision of operations and training, and
administration of a combination of air and ground ambulance companies.
• Staff and technical supervision of aviation operations, safety, standardization, and aviation
unit maintenance (AVUM)-level maintenance within the attached air ambulance companies.
• Coordination of medical evacuation operations and communications functions.
• Coordination of logistics and service support to attached units.
• Aviation medicine and unit-level CHS.
c. This unit is dependent upon appropriate elements of the corps or Army Service Component
Command (ASCC) for—
• Personnel service support (PSS).
• Combat health support, to include hospitalization.
• Mortuary affairs (MA) support.
• Laundry, shower, and clothing repair.
• Communications security (COMSEC) equipment maintenance.
• Military police support.
3-4. Organization and Functions
a. Medical Evacuation Battalion {Figure 3-1, Page 3-4). The HHD, medical evacuation battalion,
is organized into a—
• Battalion headquarters section.
• SI (Adjutant [US Army]) section.
• S2/S3 (Intelligence Officer [US Army] and Operations and Training Officer [US Army])
section.
• S4 (Supply Officer [US Army]) section.
3-2
FM 8-10-6
• Detachment headquarters.
• Treatment team.
b. Battalion Headquarters Section. This section provides C2 of the assigned and attached air and
ground ambulance companies. It also assists the commander on all military intelligence matters (to include
the medical threat), organization, training, operations, planning, PSS, and logistics support. Further, it
provides information on the health of the command and aviation medicine expertise, as well as providing
supervision over technical and flight aspects of administration, training, and safety within subordinate
aviation units.
c. SI Section. This section, under the direction of the SI, is responsible for the operational and
technical supervision of personnel and administrative duties to include—
Strength accounting, casualty reporting, and replacement operations.
Personnel actions.
Forms management.
Other personnel and administrative service functions.
Legal support (preparation of required documents for nonjudicial, judicial, and adminis-
trative procedures).
d. S2IS3 Section. This section assists the S2/S3 officer in the execution of his duties and is
capable of sustained 24-hour operations. This section remains abreast of the tactical situation and determines
future medical evacuation requirements. It plans for ground and air evacuation operations, coordinates
command post (CP) operations, and maintains the status of the air ambulance units and plans for their
employment. Further, this section maintains communications systems and nets, determines intelligence
requirements, coordinates with movement control elements, and prepares orders and overlays.
e. S4 Section. The S4 section assists the S4 officer in the execution of his duties. This section
plans, coordinates, and supervises the requisitioning, receipt, storage, issue, and accounting for all classes
of supply. Further, it monitors and keeps the commander informed on all matters pertaining to maintenance
on assigned aircraft, ground vehicles, and medical equipment. This section also serves as the interface with
the supporting medical battalion, logistics (forward/rear) for medical nonexpendable and durable item
supply transactions.
/. Detachment Headquarters Section. The detachment headquarters section provides, C2,
administration, and logistics support for assigned personnel. It is also responsible for company supply and
armament functions, food service operations, maintenance operations, and unit administration.
g. Treatment Team. The treatment team provides unit-level CHS to assigned and attached
elements collocated with the detachment headquarters and to adjacent units on an area support basis.
3-3
FM 8-10-6
The physician is a flight surgeon and provides staff assistance to the battalion commander on all matters
pertaining to aviation medicine. The flight surgeon provides care and treatment for all assigned and
attached aircrew members. This physician is dual -hatted as the battalion surgeon.
SI SEC
S2/S3 SEC
S4SEC
DETHQ
TRMT TM
Figure 3-1. Medical evacuation battalion.
3-4
FM 8-10-6
Section II. MEDICAL COMPANY, GROUND AMBULANCE
3-5. General
The CHS system to sustain the US Army in war is a continuum of increasing echelons of care extending
from the forward line of own troops (PLOT) through the CONUS base. Patients must be moved through
the system quickly to maintain their physiology and prevent needless loss of life or function. Ground
ambulances serve as one of the primary means of evacuating patients from the battlefield.
3-6. Assignment
a. The medical company, ground ambulance, is normally assigned or attached to a medical
evacuation battalion, HHD, for C2.
b. The basis of allocation within the CZ is one per division supported, and within the EAC, one
per two divisions within the theater.
3-7. Mission, Capabilities, and Limitations
a. The mission of the medical company, ground ambulance, is to provide ground evacuation
within the TO. The medical company, ground ambulance, is employed in both the corps and EAC. It is
tactically located where it can best control its assets and execute its patient evacuation mission.
b. The unit is capable of providing—
• A single-lift capability for evacuation of 160 litter patients, or 320 ambulatory patients.
• Medical evacuation from division medical companies to CZ hospitals.
• Medical evacuation from the ASMC to supporting hospitals.
• Augmentation of division medical company evacuation assets.
• Augmentation of covering force and deep operations medical evacuation assets.
• Movement of patients between hospitals or aeromedical staging facilities/aeromedical
staging squadrons (ASFs/ASTS), mobile aeromedical staging facilities (MASFs), railheads, seaports, and
hospitals in both the corps and EAC.
• Area evacuation support beyond the capabilities of the ASMB.
• Emergency movement of medical personnel and supplies.
3-5
FM 8-10-6
c. Effective operation of this unit is dependent upon viable communications systems for C2 and
adequate road networks.
NOTE
Employment in severe arctic or primitive jungle conditions seriously
impairs the capabilities of the ground ambulance company.
d. This unit is dependent upon the appropriate elements of the corps, EAC, or ASCC for—
• Religious, financial, legal, personnel, and administrative services.
• Laundry, shower, and clothing repair.
• Generator equipment maintenance.
• Combat health support to include hospitalization.
3-8. Organization and Functions
a. Medical Company, Ground Ambulance. The medical company, ground ambulance, is
organized into a company headquarters section and four ambulance platoons. Each ambulance platoon
consists of a platoon headquarters and five ambulance squads of two ambulances each (Figure 3-2).
b. Company Headquarters. This element provides C2, communications, administration, food
service, and logistical support (to include maintenance) for the subordinate ambulance platoons. It also
advises the commander on NBC defensive measures and maintains communications capabilities and
equipment.
c. Ambulance Platoon Headquarters. Each of the four ambulance platoon headquarters provides
C2 for five subordinate ambulance squads (10 ambulances).
d. Ambulance Squad. Each ambulance squad consists of two ambulances with a two-man crew.
The members of the squad operate the ambulances and provide en route medical care for patients entrusted
to their care. Further, they maintain the level of expendable Class VIII supplies in the ambulance medical
equipment set (MES) by reconstituting supplies from medical companies or hospitals when they pick up or
drop off patients. They are also responsible for performing operator maintenance on assigned vehicles.
When employed in the CZ—
• Two ambulance platoons are stationed forward in the division to provide medical
evacuation support from the division to the corps and to act as augmentation.
3-6
FM 8-10-6
• Two ambulance platoons may be employed in the corps to provide medical evacuation
support for interhospital and hospital to MASF (or other embarkation points) transfers.
AMB
AMB PLT
AMB PLT
PLTHQ
AMBSQD
AMB SQD
Figure 3-2. Medical company, ground ambulance.
3-7
FM 8-10-6
Section III. MEDICAL COMPANY, AIR AMBULANCE
3-9. General
The medical company, air ambulance, provides aeromedical evacuation for all categories of patients
consistent with evacuation precedences and other operational considerations. Medical evacuation is effected
from as far forward as possible in the tactical AO to division- and corps-level MTFs.
3-10. Assignment
a. The medical company, air ambulance, is normally assigned to the MEDCOM or medical
brigade and attached to the medical evacuation battalion for C2.
b. The basis of allocation is one unit in support of each division or equivalent force supported.
Further, one unit is in general support (GS) in the corps per two division or fraction thereof; or .333 units
per separate brigades or armored cavalry regiments (ACRs).
3-11. Mission and Capabilities
a. The mission of the medical company, air ambulance, is to provide—
• Aeromedical evacuation support within the TO, either DS to the divisions or GS to the
corps.
• Emergency movement of medical personnel, equipment, and supplies including whole
blood, blood products, and biologicals.
b. Specific capabilities of this unit are to—
• Operate on a 24-hour-a-day basis.
• Evacuate patients based on operational capability (dependent on type of aircraft).
• Operate fifteen air ambulances (UH-60A). These ambulances are each capable of
carrying six litter patients and one ambulatory patient, or seven ambulatory patients, or some combination
thereof. Single patient lift capability is 90 litter patients, or 105 ambulatory patients, or some combination
thereof. In-flight medical treatment and surveillance of patients is provided by a flight medic. OR
• Operate fifieen air ambulances (UH-IH/V). These ambulances are capable of
carrying six litter, or nine ambulatory patients, or some combination thereof. Single patient lift capability is
90 litter, 135 ambulatory, or some combination thereof. In-flight medical treatment and patient surveillance
are provided by a flight medic.
3-8
FM 8-10-6
Provide internal/external load capability for the movement of medical personnel and
equipment.
• Perform AVUM on all organic aircraft and organizational maintenance on all organic
avionics equipment. It also performs unit-level maintenance on all organic equipment less medical.
• Provide air crash rescue support, less fire suppression.
• Provide rescue of downed aircrews. (Refer to paragraph 1-13 for additional information.)
• Operate as an area support medical evacuation (MEDEVAC) section and three forward
support MEDEVAC teams (FSMTs) to provide flexibility in supporting division, brigade, or brigade TF
equivalent operations.
c. This unit is dependent upon—
(1) Support elements of corps or ASCC for—
• Finance, legal, and religious support.
• Personnel services.
• Logistics.
• Combat health support, to include medical supply and equipment.
• Food service support.
• Communications security equipment maintenance.
• Mortuary affairs support.
• Military police support.
• Laundry, shower, and clothing repair.
• Engineer support for heliport/landing strip construction and maintenance.
(2) The supporting aviation intermediate maintenance (AVIM) organization for AVIM
support.
3-12. Organization and Functions
a. The medical company, air ambulance (Figure 3-3), is organized into a/an—
3-9
FM 8-10-6
• Company headquarters.
• Flight operations platoon consisting of a platoon headquarters, a flight operations section,
and an airfield service section.
• Aircraft maintenance platoon consisting of a platoon headquarters, a component repair
section, and a maintenance section.
• Air ambulance platoon consisting of a platoon headquarters, an area support MEDEVAC
section, and three FSMTs.
b. For additional information on the organization and functions of the medical company, air
ambulance, refer to FM 8-10-26.
COHQ
PLTHQ
OPS SEC
AFSVC
SEC
FLTOPS
PLT
AVUM PLT
PLTHQ
ACFT
COMP REP
SEC
ACFT
MAINT
SEC
AIRAMB
PLT
PLTHQ
AREA SPT
MEDEVAC
SEC
FWDSPT
MEDEVAC
TM
Figure 3-3. Medical company, air ambulance.
3-10
FM 8-10-6
CHAPTER 4
THE MEDICAL EVACUATION SYSTEM
4-1.
General
a. The current medical evacuation doctrine and organizations are the result of an evolutionary
process. This process includes both trial and error and the assimilation of lessons learned on the battlefield
and in training environments.
b. Medical evacuation encompasses—
Collecting the wounded.
Sorting (triage) and prioritizing.
Providing an evacuation mode (transportation).
Providing medical care en route.
Anticipating complications and being ready to perform emergency medical intervention.
c. The increase in the speed and lethality of combat formations has served to increase the
importance of medical evacuation as the key link in the continuum of care. The air and ground evacuation
assets currentiy used to perform battiefield evacuation have both strengths and limitations. To be effective
they must be employed in a synchronized system, each complementing the capabilities of the other.
This paragraph implements STANAG 3204 and AIR STD 44/36A.
d. The initial decision of treatment echelon required is made by the treatment element (squad,
team, or treatment platoon). Soldiers are evacuated by the most expeditious means of evacuation dependent
on their medical condition and assigned evacuation precedence. (Refer to Chapter 7 for an in-depth discus-
sion of the evacuation precedences.)
Priority I, URGENT.
Priority lA, URGENT-SURG.
Priority II, PRIORITY.
Priority III, ROUTINE.
Priority IV, CONVENIENCE.
4-1
FM 8-10-6
NOTE
The NATO STAN AG 3204 has deleted the category of Priority IV,
CONVENIENCE; however, it will still be included in the US Army
evacuation priorities as there is a requirement for it on the battlefield.
(1) The medical evacuation battalion maximizes the effectiveness of corps ground and air
ambulance resources. This unit exercises C2 over assigned and attached ground or air ambulance
companies. It also provides the required evacuation out of division areas, between hospitals in the corps
and EAC, and from ASMBs in the corps and EAC. The medical evacuation battalion provides the
flexibility and capability for task organizing to support close, deep, and rear operations. It can be modified
to support all aspects of the operational continuum. The ASMB ambulance platoon and the ambulance
squad in the division medical company provide evacuation within their assigned AO. To ensure that
patients are evacuated to the appropriate treatment elements, medical regulating officers (MROs) are
organic to the medical group and medical brigade.
(2) The patient's medical condition is the overriding factor in determining the evacuation
platform and destination facility. The air ambulance operates wherever needed on the battlefield, dependent
on risk and METT-TC factors. The crew of the air ambulance, assisted by on-board patient monitoring and
diagnostic equipment, is trained in aeromedical procedures to provide optimum en route patient care. It is
the platform of choice for most categories of patients. However, insufficient numbers of air ambulances are
available to evacuate all patients expected in a corps. To conserve these valuable resources, CHS planners
should plan to use air ambulances to primarily move Priority I, URGENT and Priority lA, URGENT-
SURG patients with other categories on a space available basis.
e. On the integrated battlefield, commanders must employ their available evacuation resources to
accomplish the mission while maximizing survivability. The enemy's ability to fire on exposed elements
may be inhibited by the clever use of cover, concealment, and available defilade. It is essential to minimize
our vulnerabilities while exploiting those of the enemy. It is also important to be as well trained and
knowledgeable of US, allied, coalition, and threat forces capabilities and operational doctrine as possible.
(Refer to paragraph 5-6 for additional information.)
/. In stability operations and support operations, the force composition and availability of
evacuation resources will be determined by the mission, the anticipated duration of the operation, and the
potential for violence. (Refer to paragraphs 4-8 and 4-9 for additional information on these types of
operations.)
4-2. Medical Evacuation
An efficient medical evacuation system—
• Minimizes mortality by rapidly and efficiently moving the sick, injured, and wounded to an
MTF.
4-2
FM 8-10-6
wounded.
Clears the battlefield enabling the tactical commander to continue his mission.
Builds the morale of the soldiers by demonstrating that care is quickly available if they are
• Provides en route medical care that is essential for improving the prognosis and reducing
disability of wounded, injured, or ill soldiers.
a. Evacuation is performed by the higher echelon of medical care going forward and evacuating
from the lower echelon.
b. Evacuation assets must have equal or greater mobility as the troops supported.
c. The CHS commander responsible for the medical evacuation mission is the primary manager
of the medical evacuation assets. A single, dedicated medical command authority must manage all evacuation
assets. The medical manager ensures that the optimum evacuation mode is used based upon the patient's
medical condition and the—
• Availability of resources.
• Destination MTF.
• Tactical situation.
d. The evacuation of patients in nonmedical ground and air assets must be considered in mass
casualty situations. Nonmedical assets will be augmented, whenever possible, with medical personnel to
provide en route medical care. With prior coordination, augmentation medical personnel may be obtained
from within the division medical company or the ASMB. When augmentation of medical personnel is not
possible, the transportation of casualties can still be accomplished using nonmedical vehicles and aircraft;
when possible, combat lifesavers should accompany the casualties. The planning for this requirement is the
responsibility of the division medical operations center (DMOC) or battalion S3. (Refer to paragraph 1-4
for a discussion of CASE VAC.)
e. Routinely bypassing echelons of care is detrimental to the wounded soldier and the CHS
system. Bypassing echelons of care—
• Negates the effectiveness of medical resources.
• Risks further injury to the patient.
• Removes soldiers unnecessarily from forward locations on the battlefield.
• Causes overevacuation of less critically injured soldiers; thereby, resulting in a delay of
potential RTD soldiers.
4-3
FM 8-10-6
• Unnecessarily removes the evacuation asset from its supporting position for longer
periods of time.
4-3. Basic Considerations in Medical Evacuation Operations
a. General. As METT-TC factors affect the employment of all units, the medical evacuation
commander must consider the basic tenets that influence the employment of medical evacuation assets.
These factors include the patient's medical condition and the—
• Tactical commander's plan for employment of combat forces.
• Enemy's most likely course of action.
• Anticipated patient load.
• Expected areas of patient density.
• Availability of medical evacuation resources.
• Availability, location, and type of supporting MTFs.
• Protection afforded medical personnel, patients, and medical units, vehicles, and aircraft
under the provisions of the Geneva Conventions.
• Army airspace command and control (A2C2) plan.
• Engineer obstacle plans.
• Fire support plan (to ensure medical evacuation assets are not dispatched onto routes and
at the times affected by the fire support mission.)
• Road network/dedicated medical evacuation routes (contaminated and clean).
• Weather conditions.
b. Patient Acquisition.
(1) Units with organic medical evacuation assets have the primary responsibility for patient
acquisition. Methods of employment and evacuation techniques differ depending upon the nature of the
operation.
(2) Units without organic ambulance assets are provided medical evacuation support on an
area basis. Units must develop techniques which facilitate the effective employment of their combat
medics, enhance the ability to acquire patients in forward areas, and rapidly request medical evacuation
4-4
FM 8-10-6
support. The techniques developed should be included in the unit tactical standing operating procedure
(TSOP). As a minimum, the TSOP should include the—
• Vehicle assignment for the combat medic.
• Vehicles designated to be used for casualty transport and/or patient evacuation.
•
Procedures for requesting medical evacuation support (during routine operations or
during mass casualty situations).
• Role of the first sergeant, platoon sergeants, and combat lifesavers in medical
evacuation.
c. Medical Platoon, Treatment Squad Forward.
(1) The medical platoon leader (a physician) should be included in all battalion tactical
planning. He must keep himself knowledgeable of the concept of operations, commander's intent, and the
anticipated CHS requirements. He develops his CHS plan (FM 8-55 and FM 8-42) and provides CHS
overlays with preplanned evacuation routes, PCPs, and AXPs to the ambulance squads or teams (Figure
4-1) for inclusion in the battalion OPLAN. He ensures that his squad leaders provide strip maps or other
navigational tools to the ambulance drivers, if needed. He requests augmentation support from the
supporting medical company in advance of the operation, if required. When elements of a maneuver
battalion are attached to a TF, the medical platoon leader ensures that adequate medical elements are
included in the support package. He further ensures that orientation and support are provided for his
medical personnel. This precludes taxing the medical elements of the receiving unit. These responsibilities
are normally delegated to the medical operations officer (field medical assistant).
(2) The ambulance section NCO ensures that his squad leaders have a working knowledge of
the terrain features in the AO. Whenever possible, he familiarizes himself with primary and secondary
medical evacuation routes through route reconnaissance conducted by his squad leaders. This NCO
manages the employment of the ambulance teams and monitors the communications net to remain abreast of
the tactical situation.
(3) The following factors should be considered when selecting ambulance routes:
• Tactical mission.
• Coordinating evacuation plans and operations with the unit movement officer.
• Security of routes.
• Availability of routes.
• Physical characteristics of roads and cross-country routes (to include natural
obstacles).
4-5
FM 8-10-6
UMITOF
ADVANCE
•
B
^
1
1
UHLC
GEORGE
SAM LOA
Figure 4-1. Typical evacuation overlay.
4-6
FM 8-10-6
Requirements to traverse roads in built-up areas and potential obstructions from
rubble and debris.
Traffic density.
Time and distance factors.
Proximity of possible routes to areas that may be subject to enemy fire.
Lines of patient drift.
Cover, concealment, and available defilade for moving and stationary vehicles.
Engineer obstacle plans.
Fire support plan (to ensure medical evacuation assets are not dispatched onto
routes and at the times affected by the fire support mission).
(4) Depending upon the combat situation, the modes of evacuation may include walking
soldiers who are wounded, manual and litter carries, nonmedical transportation assets, or dedicated medical
evacuation platforms. Evacuation in the battalion area normally depends on the organic ambulances
assigned. Evacuation by air ambulance is dependent upon the patient's medical condition, availability of air
assets, tactical situation, and weather conditions.
(a) The ambulance team or squad routinely deploys with the company trains (combat
trains). It operates, however, as far forward as the tactical situation permits. This team, when operating in
a maneuver company AO, is normally under the tactical control of the maneuver company executive officer
or first sergeant. The team, however, remains under the technical and operational control (OPCON) of the
medical platoon.
(b) The medical operations officer ensures that the ambulances are located close to the
anticipated patient workload. An ambulance team consists of one ambulance and two medical specialists
(on track vehicles, a third medic is required to permit en route medical care). One or two of these teams
serve in DS of a maneuver company. To become familiar with the specific terrain and battiefield situation,
the team maintains contact with the company during most combat operations. The remaining ambulance
assets are positioned strategically throughout the battalion area or are sited at the BAS to—
• Evacuate patients from the company aid posts, PCPs, or AXPs to the BAS.
• Reinforce the forward teams.
• Support the combat forces held in reserve and/or scout and mortar platoons.
(c) Another employment option is to forward site the additional ambulance teams at
company aid posts or PCPs, as well as at the BASs.
4-7
FM 8-10-6
{d) Many times the ambulance team finds battlefield casualties who have not been seen
by a combat medic. In these cases, the team members dismount and then find, treat, and evacuate the
patients.
{e) Ambulance teams not specifically dedicated to support combat elements can be
used as messengers in medical channels and to provide transport of emergency medical personnel,
equipment, and supplies.
(5) During static situations where the maneuver company is not in enemy contact or is in
reserve, the ambulance team returns to the BAS to serve as reinforcement to other elements in contact.
However, during movement to contact, the ambulance team immediately deploys with its supported unit.
In moving patients back to the PCPs point, the team may be assisted by nonmedical personnel. Specific
duties of the ambulance team are to—
Maintain contact with supported elements.
Find and collect the wounded.
Administer EMT.
Initiate or complete the FMC (Appendix C).
Evacuate patients to the BAS.
Direct or guide ambulatory patients to the BAS.
Resupply combat medics.
Serve as messengers in medical channels.
(6) During the offense, PCPs may be used to avoid hampering the movement of the maneuver
elements. In fast-moving situations, preplanned PCPs are included in the CHS plan and activated based on
the crossing of phase lines, upon the occurrence of predetermined events, or on the execution of other
control measures. It may be necessary to set up multiple PCPs for each phase of an operation. Rotating the
use of these points precludes the enemy from using them to pinpoint maneuver elements or from attracting
enemy fires. When the situation permits, patient evacuation from PCPs or AXPs may be accomplished by
air ambulances.
(7) Ambulance teams move using available terrain features for cover and concealment.
They avoid prominent terrain features and likely targets. When stationary, the ambulance crew should
conceal the vehicle as much as possible.
(8) When a casualty occurs in a tank or a Bradley infantry fighting vehicle (BIFV), the
ambulance team moves as close to the armored vehicle as possible. Assisted by the armored crew, if
possible, the casualty is extracted Irom the vehicle and then administered EMT. The ambulance team
4-8
FM 8-10-6
moves the patient to the BAS, or to a PCP point to await further evacuation. The combat medic normally
remains with the company combat trains, but may be used anywhere in the company area, even assisting the
ambulance teams in some situations. He may be used to direct ambulance teams to locations where vehicle
crews need assistance, or where injured or wounded crew members have been left. In some situations,
crew members may have to rely on self-aid or buddy aid until the combat lifesaver or the combat medic
arrives.
(9) Medical evacuation on an area basis is required at all echelons in the CHS system.
Divisional units, without organic evacuation resources such as combat engineers, will require evacuation
support on an area basis. To ensure that these elements receive adequate support, the CHS planner must
include their requirements into the OPLAN. Prior coordination is essential to ensure that the locations of
PCPs, AXPs, and BASs are disseminated to these elements and that any unique support requirements are
included.
d. Medical Platoon Treatment Squad or Team to Forward Support Medical Company.
(1) Evacuation fi-om the treatment squad or team is normally provided by the FSMC ambu-
lance platoon and the FSMT of the DS air ambulance company. Further, these ambulance assets provide
evacuation support on an area basis to other units in the brigade rear.
(2) The elements of the ambulance platoon are normally collocated with the FSMC treatment
platoon for mutual support. They establish contact and locate one ambulance team with the medical platoon
of each maneuver battalion. The remaining ambulances are used for brigade TF operations and area
support. The ambulances are pre-positioned at AXPs or PCPs, or are field-sited at the FSMC.
(3) An air ambulance team of the corps air ambulance company can be forward deployed to
the BSA and collocated with the FSMC depending upon METT-TC. The team may be attached in DS or
under the OPCON of the FSMC. (The FSMT may also be attached to the aviation brigade for support less
OPCON.) The OPCON relationship provides authority to the FSMC to direct the integrated air and ground
evacuation system. Administrative and logistics responsibilities, along with discipline, internal organization,
and training, remain the responsibility of the parent unit. The section leader of the FSMT should be
included in the brigade tactical planning process. The air ambulance team evacuates Priority I, URGENT
patients from as far forward as possible to the FSMC. Further, when a EST is collocated with a division
medical company (FSMC or MSMC), air ambulances evacuate Priority lA, URGENT-SURG to this
facility. External lift capabilities of aeromedical evacuation helicopters add an important dimension to its
role on the battlefield. It provides the FSMC commander flexibility and agility in the movement of
treatment teams and equipment to the forward battle area. It also provides the capability to rapidly resupply
Class VIII supplies to combat units.
{a) Corps air evacuation elements may operate from the division rear and BSAs
providing around-the-clock, immediate response, evacuation aircraft. To accomplish this, elements must
maintain a close tie with the division A2C2 system.
{b) The FSB support operations can provide planning and coordination between air
ambulance elements in the BSA and the maneuver brigade S3. Since the support operations section is not
4-9
FM 8-10-6
staffed for this mission, the FSMT should plan to provide the FSB support operations cell with a flight
operation specialist to assist in A2C2 planning and coordination. Forward support MEDEVAC teams,
through the FSB support operations, provide the necessary information to the maneuver brigade S3.
(4) In the FSMC, the executive officer is the principal assistant to the commander for the
tactical employment of the company assets. He should be included in all brigade tactical planning. He
needs to be prepared to reinforce or reconstitute forward CHS elements and to request augmentation
through the DMOC, if required. The FSMT leader keeps the FSMC executive officer appraised of his
operational capability. This enables the executive officer to effect timely reinforcement or augmentation.
The FSMC executive officer must be familiar with the specific terrain and battlefield situation. Further, he
should have a thorough understanding of the division and brigade commanders' ground tactical plan.
e. Forward Support Medical Company to the Medical Company in the Division Rear Area.
(1) In Vietnam, with the virtually unrestricted availability of aeromedical evacuation, it
became a common practice to overfly echelons of CHS. Patients were evacuated directly to a corps-level
hospital. A return to a more systematic approach to patient evacuation is dictated by the—
Potentially greater distances involved.
Necessity of integration into the various levels of A2C2.
Requirement to treat as far forward as possible.
Requirement to limit the overevacuation of patients to reduce congestion at corps
MTFs.
Threat.
(2) The FSMC commander is responsible for the brigade medical evacuation plan, to include
the use of both ground and air assets. The commander should include the medical company executive
officer, brigade SI, brigade executive officer, medical platoon leaders, FSMT leader, and the forward
support battalion (FSB) CHS officer in the planning process. Evacuation from the FSMC is normally
provided by ground and air assets from the corps medical evacuation battalion. The ambulance platoon of
the MSMC does not possess sufficient assets to move the anticipated number of patients from the FSMCs.
It usually moves only those patients who will RTD within 72 hours (and are held in the MSMC holding
squad) or clear the FSMC prior to the relocation of the unit.
(3) The MSMC ambulance platoon normally collocates with the treatment platoon for mutual
support and area taskings. It performs ground evacuation and en route patient care for supported units in
the division rear. It may also evacuate patients from the FSMC in the BSA, as necessary. The ambulance
platoon is mobile in operations as its assets may be totally deployed at one time. The platoon normally
forward stations a portion of its teams in support of those units in the division rear. The remaining teams
are used for TF operations, reinforcing support, or ambulance shuttles. Platoons or squads from the corps
ground ambulance company will be in DS, or OPCON to, and collocated with the medical company in the
division rear or BSA. These assets evacuate patients from the forward medical treatment elements.
4-10
FM 8-10-6
(4) A corps air ambulance company designated to support a division may be deployed as
OPCON, attached, or in DS of the division. For aeromedical evacuation when OPCON or attached, the air
ambulance company is normally under the control of the DISCOM. The air ambulance company may
collocate with the MSMC or aviation brigade and forward deploys air ambulance teams or crews to the
FSMCs depending upon METT-TC. Air ambulance teams deployed to the FSMC will have the minimum
number of aircraft required to accomplish the mission. The remaining aircraft are located with the company
headquarters for reinforcement of the FSMC and an area support mission in the division rear.
/. Evacuation from Main Support Medical Company to Echelons 111 and IV Hospitals .
(1) The mission of the hospital system is twofold. First, it is designed to maximize the RTD
of patients. Secondly, it provides the necessary treatment to stabilize patients for further evacuation.
Patients are further evacuated when they are not expected to RTD within the limits of the theater evacuation
policy.
(2) Hospitalization in the theater is provided at Echelons III and IV of the CHS system.
{a) The EST collocates with division medical companies to provide resuscitative
surgery. (In some scenarios the EST may be collocated with an ASMC.) Patients are further stabilized and
evacuated to Echelons III hospitals. (Field Manual 8-10-25 discusses the operation and employment of
ESTs. Although the EST is not an Echelon III resource, its parent unit is the combat support hospital
[CSH].)
{b) Forward-oriented CSHs (FM 8-10-14) are capable of treating all classes of patients;
however, their primary mission is that of providing—
• Resuscitative surgery and trauma treatment.
• Returning patients to duty within prescribed CZ policies.
(c) Field hospitals (EHs) (EM 8-10-15) are designed to focus on RTD patients and
specialize in reconditioning and rehabilitation. These hospitals are normally located in either EAC, but may
be employed in the corps area, if required.
{d) General hospitals (GHs) (EM 8-10-15) are oriented toward the trauma patient but
have sufficient balance to fulfill their area support role for all classes of patients. They are normally located
in the EAC.
NOTE
Under MRI, there is only one basic type of hospital in the theater.
(3) Elements of the medical evacuation battalion are also tasked with corps interhospital
transfer responsibilities and the movement of patients to US AF M ASEs (this may be accomplished by air or
4-11
FM 8-10-6
ground ambulances as determined by the commander). Corps area ground evacuation support is provided
by the ASMB with its organic ambulance assets. This allows the medical evacuation battalion to focus its
entire ground effort forward on the supported divisions and the movement of patients between corps
hospitals.
(4) The organic ground evacuation assets of the MSMC provide evacuation support on an
area basis.
4-4. Property Exchange and Patient Movement Items
a. United States Army Medical Evacuation Operations. Whenever a patient is evacuated from
one MTF to another or is transferred from one ambulance to another, medical items of equipment (casualty
evacuation bags [cold weather-type bags], blankets, litters, and splints) remain with the patient. To prevent
rapid and unnecessary depletion of supplies and equipment, the receiving Army element exchanges
like property with the transferring element. This reciprocal procedure will be practiced to the fullest extent
possible through all phases of evacuation from the most forward element through the most rearward
hospital.
b. United States Air Force Aeromedical Evacuation Operations. A major factor in the evacuation
of patients is that specific medical equipment and durable supplies designated as patient movement items
(PMI) must be available to support the patient during the evacuation. Examples of PMI include ventilators,
litters, patient monitors, and pulse oximeters. These items will be available for exchange at the supporting
ASFs and MASFs. Refer to Joint Pub 4-02.2 for additional information on PMI.
c. Medical Property of Allied Nations (NATO and ABCA armies). Medical property accom-
panying patients of allied nations will be returned to the parent nation at once, if possible. If it is not
possible, like items will be exchanged as in paragraph a above.
d. Medical Property of Coalition Forces or Allied Nations Without Ratified Standardization
Agreements. Absent a formal agreement, such as an Acquisition and Cross-Servicing Agreement, medical
property accompanying patients of coalition and allied forces without ratified STANAGs will be returned to
the parent nation as soon as practicable. Commanders should consult with their Staff Judge Advocate early
in the planning process to ensure appropriate policy and procedures are developed and disseminated.
4-5. Medical Evacuation Tools
It is essential that the evacuation plan for all combat operations be well conceived, planned, coordinated,
and disseminated. In designing the medical evacuation plan, the CHS planner uses the following tools:
4-12
FM 8-10-6
a. Patient Collecting Points. In fast-moving situations, PCPs normally are predesignated along
the axis of advance or evacuation routes. Forward of the BAS, combat medics, combat lifesavers, and
combat troops take casualties to the PCPs. These points facilitate acquisition by supporting ambulance
teams and reduce evacuation time. When used by the BAS, PCPs help preserve BAS mobility, preclude
carrying casualties forward, and reduce evacuation time to the rear. Patient collecting points designated by
the division level of CHS concentrate patients along evacuation routes, increasing the efficiency of each
ambulance mission to the treatment station. They also provide those units lacking organic medical support
with a forward area for patient disposition. When designating a PCP, the designating authority makes a
decision whether or not to provide medical staff at the location. This decision is based upon the assessment
of risk versus the availability of personnel. Normally, the echelon of CHS designating the point is
responsible for staffing. Combat health support personnel may not be available to staff these points, and
combat lifesavers and ambulatory patients may be required to perform self-aid, buddy aid, or enhanced first
aid. Patient collecting points should be identified on operational overlays (Figure 4-1).
NOTE
A PCP staffed by a trauma treatment team is designated as a BAS
(minus) rather than as a PCP.
b. Ambulance Exchange Points. A position where patients are exchanged from one evacuation
platform to another is designated as an AXP.
(1) These points are normally preplanned and are a part of the CHS annex to the OPLAN.
In the forward area, the threat of enemy ground activities, large concentrations of lethal weapons systems,
and effective use of antiaircraft weapons may dictate that the AXP be a predetermined rendezvous point for
the rapid transfer of patients from one evacuation platform to another. The location of AXPs should be
frequently changed to preclude attracting enemy fires.
(2) Ambulance exchange points are established for many different reasons. For example,
the ambulance platoon of the heavy FSMCs now possesses a mixture of wheel and track ambulances. The
track vehicles are provided so that they may keep up with maneuver elements. These vehicles carry the
patients from the BAS to an AXP where the divisional wheel ambulances take over for the relatively longer
trip to the rear. Ambulance exchange points are not limited to ground evacuation assets. Another example
is a situation where the threat air defense artillery capability is such that air ambulances cannot fly as far
forward as the BASs. However, an AXP could be established a few kilometers to the rear, still well
forward of the BSA. The divisional track or wheel ambulances could then transfer the patients to the air
assets, thereby facilitating the rapid evacuation of patients and realizing a significant timesavings.
(3) By using AXPs, evacuation assets are returned to their supporting positions faster. This
facilitates evacuation as the returning crews are familiar with the road network and the supported unit's
tactical situation. In the case of air ambulance assets, it is important because of the requirements for
integration into the A2C2 system at each level and the enhancement to survivability provided by current
threat and friendly air defense information.
4-13
FM 8-10-6
c. Ambulance Shuttle System. The ambulance shuttle system (Figure 4-2) is an effective and
flexible method of employing ambulances during combat. It consists of one or more ambulance loading
points, relay points, and when necessary, ambulance control points, all echeloned forward from the principal
group of ambulances, the company location, or basic relay points as tactically required.
(1) Ambulance loading point. This is a point in the shuttle system where one or more
ambulances are stationed ready to receive patients for evacuation.
(2) Ambulance relay point. This is a point in the shuttle system where one or more empty
ambulances are stationed. They are ready to advance to a loading point or to the next relay post to replace
an ambulance that has moved from it. As a control measure, relay points are generally numbered from
front to rear.
V
A2C2 INFORMATION FLOW
DENOTES REQUISITE COORDINATION BY THE
DMOC AND OTHERS TO ENSURE ALL PARTIES
HAVE CURRENT A2C2 INFORMATION.
MAY OR MAY NOT BE DEPLOYED FORWARD.
Figure 4-2. Ambulance shuttle system.
4-14
FM 8-10-6
(3) Ambulance control point. The ambulance control point consists of a soldier (from the
ambulance company or platoon) stationed at a crossroad or road junction where ambulances may take one of
two or more directions to reach loading points. The soldier, knowing from which location each loaded
ambulance has come, directs empty ambulances returning from the rear. The need for control points is
dictated by the situation. Generally, they are more necessary in forward areas.
(4) Establishment of the ambulance shuttle. Once the relay points are designated, the
required number of ambulances are stationed at each point. If the tactical situation permits, the ambulances
may be delivered to the relay points by convoy.
(5) Staffing of relay, loading, and ambulance control points. Important points may be
manned to supervise the blanket, litter, and splint exchange (paragraph 4-4) and to ensure that messages and
medical supplies to be forwarded are expedited.
(6) Advantages of the ambulance shuttle system. This system—
• Places ambulances at PCPs and BASs as needed.
• Permits a steady flow of patients through the system to MTFs.
• Avoids unnecessary massing of transport in forward areas.
• Minimizes the danger of damage to ambulances by the enemy.
• Permits the commander or platoon leader to control his elements and enables him to
extend their activities without advancing the headquarters.
• Facilitates administration and maintenance.
• Maximizes the use of small C2 elements (sections or platoons) to operate the
ambulance shuttle without employing the entire parent unit.
• Provides for flexible use of other ambulance assets for specific situations.
d. Obstacles Marking. Ambulance crews must know and recognize the standard land/gap marking
patterns. Unit TSOPs on the types of materials used should be available to ambulance crews. Refer to FM
90-13-1 for additional information.
4-6. Medical Evacuation Support for Combat Forces in the Offense and Defense
a. Support to the Offense.
(1) The offense is the decisive form of war, the commander's only means of attaining a
positive goal or of completely destroying an enemy force (FM 100-5). The offense is characterized by rapid
4-15
FM 8-10-6
movement, deep penetrations, aggressive action, and the ability to sustain momentum regardless of
counterfires and countermeasures.
(2) When considering the evacuation plans to support an offensive action, the CHS planner
must consider many factors (FM 8-55). The forms of maneuver, as well as the enemy's capabilities,
influence the character of the patient workload and its time and space distribution. The analysis of this
workload determines the allocation of CHS resources and the location or relocation of MTFs.
(3) Evacuation support of offensive operations must be responsive to several essential
characteristics. As operations achieve success, the areas of casualty density move away from the supporting
facilities. This causes the routes of medical evacuation to lengthen. Heaviest patient workloads occur
during disruption of enemy main defenses, at terrain or tactical barriers, during the assault on final
objectives, and during enemy counterattacks. The accurate prediction of these workload points by the CHS
planner is essential if medical evacuation operations are to be successful.
(4) In traditional combat operations, the major casualty area of the division is normally the
zone of the main attack. As the main attack accomplishes the primary task of the division, it receives first
priority in the allocation of combat power. The allocation of combat forces dictates roughly the areas which
are likely to have the greatest casualty density. As a general rule, all division MTFs are located initially as
far forward as combat operations permit. This allows the maximum use of these facilities before lengthening
evacuation lines force their displacement forward.
(5) In operations that feature deep battles with WMD targeted at supporting logistical bases,
mass casualty operations may be conducted in rear areas.
(6) As advancing combat formations extend control of the battle area forward, supporting
medical elements overtake patients. This facilitates the acquisition of the battie wounded and reduces the
vital time elapsed between wounding and treatment. In offensive operations, two basic problems confront
the supporting evacuation units. First, contact with the supported unit must be maintained. Responsibility
for the contact follows the normal CHS pattern— rear to front. The contact is maintained by forward
deployed air and ground evacuation resources. Secondly, the mobility of the MTFs supporting the combat
formations must be maintained. Periodically, division medical companies, FSTs, and CSHs are cleared so
that they may move forward. This requirement for prompt evacuation of patients from forward MTFs
requires available ambulances to be echeloned well forward from the outset. The requirement for periodic
movement of large numbers of patients from divisional and corps facilities further stresses the evacuation
system.
(7) Types of operations in the offense include—
{a) Movement to contact. Medical evacuation support in movement to contact is keyed
to the tactical plan. Prior deployment of evacuation resources with parent and supported units permits
uninterrupted and effective evacuation support. (Refer also to paragraph 4-3 c[5].)
{b) Exploitation and pursuit. Evacuation support of exploitation and pursuit operations
resembles those discussed for the envelopment (paragraph 4-la[2]). Since exploitation and pursuit operations
4-16
FM 8-10-6
can rarely be planned in detail, evacuation operations must adhere to TSOPs and innovative C2. These
actions are often characterized by—
• Decentralized operations.
• Unsecured ground evacuation routes.
• Exceptionally long distances for evacuation.
• Increased reliance on convoys and air ambulances.
(c) Attack. Refer to paragraph 4-6a(4) above. A sample overlay of a brigade attack is
depicted in Figure 4-3.
b. Support to the Defense. There are three forms of the defense: area defense, mobile defense,
and retrograde. The area defense concentrates on denying enemy access to designated terrain for a specific
period of time, rather than on the outright destruction of the enemy. The mobile defense focuses on denying
the enemy force by allowing him to advance to a point where he is exposed to a decisive counterattack by
the striking force. The primary defeat mechanism, the counterattack, is supplemented by the fires of the
fixing force. The third form of defense is the retrograde. The retrograde is an organized movement to the
rear and away from the enemy. The enemy may force these operations or a commander may execute them
voluntarily. Within the retrograde operation there are three forms: delay, withdrawal, and retirement.
(1) Support is generally more difficult to provide in the defense. The patient load reflects
lower casualty rates, but forward area patient acquisition is complicated by enemy actions and the maneuver
of combat forces. Medical personnel are permitted much less time to reach the patient, complete vital
EMT, and remove him from the battle site. Increased casualties among exposed medical personnel further
reduce the medical treatment and evacuation capabilities. Heaviest patient workloads, including those
produced by enemy artillery and NBC weapons, may be expected during the preparation or initial phase of
the enemy attack and in the counterattack phase. The enemy attack may disrupt ground and air routes and
delay evacuation of patients to and from treatment elements. The depth and dispersion of the defense create
significant time and distance problems for evacuation assets. Combat elements may be forced to withdraw
while carrying their remaining patients to the rear. The enemy exercises the initiative early in the operation
which may preclude accurate prediction of initial areas of casualty density. This makes the effective
integration of air assets into the evacuation plan essential. The use of air ambulances must not only be
integrated into the CHS annex to the operation order (OPORD), but also into the A2C2 annex. A medical
overlay for a defensive operation is depicted in Figure 4-4.
(2) The support requirements for retrogrades may vary widely depending upon the tactical
plan, the enemy reaction, and the METT-TC factors. Firm rules that apply equally to all types of
retrograde operations are not feasible, but considerations include—
• Requirement for maximum security and secrecy in movement.
4-17
FM 8-10-6
COMBAT TRAINS
COMPANY TRAINS
.
,
BAS (-)
TRMT TM A
.
,
BAS (-)
tD
■i)
XXX CORPS AMBULANCES "'"'"^"'" "'"'^ ^
XX DIV AMBULANCES
II BN AMBULANCES
AXP AMBULANCE EXCHANGE POINT
BAS (-) BATTALION AID STATION OPERATING IN SPLIT MODE
Figure 4-3. Medical overlay to brigade attack.
4-18
PL BOB 081800
(8) —
PL BILL 081600
I
CO
-TTTT-*^
PL BETTY 081000
I. i J081600
TRMT TM B
/ rfTi [^ rTT!
\ RTE I 1 / L I :08i600 ^r+T+l
I y L_i_j X''(j
i / __ trmttma "
¥ \ Iaxp
PL BOB 081800
PL BILL 081600
PL BETTY 081000
NOTE 1: FOR SIMPLIFICATION, ONLY ONE TASK FORCE (TF 2-10) IS DETAILED.
NOTE 2: AXPs ARE TIME SEQUENCED TO SUPPORT BRIGADE DELAY OPERATIONS.
Figure 4-4. Medical overlay to brigade delay.
00
p
FM 8-10-6
• Influence of refugee movement that may impede medical evacuation missions
conducted in friendly territory.
• Integration of evacuation routes and obstacle plans should be accomplished.
• Difflculties in controlling and coordinating movements of the force which may
produce lucrative targets for the enemy.
• Movements at night or during periods of limited visibility.
• Time and means available to remove patients from the battiefield. In stable
situations and in the advance, time is important only as it affects the physical well-being of the wounded. In
retrograde operations, time is more important. As available time decreases, CHS managers at all echelons
closely evaluate the capability to collect, treat, and evacuate all patients.
• Medical evacuation routes will also be required for the movement of troops and
materiel. This causes patient evacuation in retrograde movements to be more difficult than in any other type
of operation. Command, control, and communications may be disrupted by the enemy. Successful medical
evacuation requires including ambulances on the priority list for movement; providing for the transportation
of the slightiy wounded in cargo vehicles; and providing guidance to subordinate commanders defining their
responsibilities in collecting and evacuating patients. Special emphasis must be placed on the triage of
patients and consideration given to the type of transportation assets available for evacuation.
• When the patient load exceeds the means to move them, the tactical commander
must make the decision as to whether patients are to be left behind. The medical staff officer keeps the
tactical commander informed in order that he may make a timely decision. Medical personnel and supplies
must be left with patients who cannot be evacuated. (Refer to FM 8-10 for additional information.)
4-7. Medical Evacuation Support for Choices of Maneuver and Enabling Operations
a. Choices of Maneuver.
(1) Penetration. In this tactic, the attack passes through the enemy's principal defensive
position, ruptures it, and neutralizes or destroys the enemy forces. Of all forms of offensive maneuver, the
penetration of main enemy defenses normally produces the heaviest medical evacuation workload. Patient
acquisition starts slowly, but becomes more rapid as the attack progresses. The evacuation routes lengthen
as the operation progresses. The penetration maneuver is often preceded by heavy preparatory fires which
may evoke heavy return fire. These enemy fires may modify the decision to place evacuation assets as far
forward as possible. Patient evacuation may be slow and difficult due to damage to roads or the
inaccessibility of patients. Evacuation support problems multiply when some combat units remain near the
point of original penetration. This is done to hold or widen the gap in enemy defenses while the bulk of
division forces exploit or pursue the enemy. Treatment elements are placed near each shoulder of the
penetration; ground evacuation cannot take place across an avenue of heavy combat traffic. Besides the
heavy traffic, the area of the penetration is normally a target for both conventional and NBC weapons.
4-20
FM 8-10-6
(2) Envelopment. In the envelopment, the main or enveloping attack passes around or over
the enemy's principal defensive positions. The purpose is to seize objectives which cut his escape routes
and subject him to destruction in place from flank to rear. Since the envelopment maneuver involves no
direct breach of the enemy's principal defensive positions, the medical evacuation system is not confronted
with a heavy workload in the opening phase. Ambulances are echeloned well forward in all echelons of
CHS to quickly evacuate the patients generated by suddenly occurring contact. Medical treatment facilities
moving with their respective formations overtake patients during evacuation and reduce delays in treatment.
After triage and treatment, the patients are evacuated to corps-level facilities by accompanying corps assets.
When the isolated nature of the envelopment maneuver precludes prompt evacuation, the patients are
carried forward with the treatment element. Again, nonmedical vehicles may be pressed into emergency
use for this purpose. When patients must be carried forward with the enveloping forces, CHS commanders
use halts at assembly areas and phase lines to arrange combat protection for ground ambulance convoys
through unsecured areas. Further, the commander may take advantage of friendly fires and suppression of
enemy air defenses to call for prearranged air ambulance support missions, or emergency use of medium-
lift helicopter backhaul capabilities.
(3) Infiltration.
(a) Infiltration is a choice of maneuver used during offensive operations. The division
can attack after infiltration or use it as a means of obtaining intelligence and harassing the enemy. Though it
is not restricted to small units or dismounted actions, the division employs these techniques with a portion of
its units, in conjunction with offensive operations conducted by the remainder of its units.
(b) Combat health support of infiltration is restricted by the amount of medical equip-
ment, supplies, and transportation assets that can be introduced into the attack area. No deployment of
division-level medical units without their organic transportation should be attempted. Elements of unit-level
CHS should be accompanied by their organic vehicles, and ambulances should receive priority for deploy-
ment. It may be necessary to man-carry enough BAS equipment into the attack area to provide EMT and
ATM; however, this results in degrading mobility. When the element is committed without its ambulances,
patients are evacuated to the BAS by litter bearer teams. This requires reinforcement of the medical platoon
by division or corps medical personnel or improvisation of litter teams using combat troops (if available and
approved by the tactical commander). Patient evacuation Irom the BAS and medical resupply of the force
may be provided by litter bearers, depending upon distances and degree of secrecy required.
(c) When airborne and air assault forces are used, infiltrating elements may land at
various points within the enemy's rear area and proceed on foot to designated attack positions. As in
surface movement, the amount of medical equipment taken may be limited. In airborne operations, the
evacuation of patients will be by litter bearers or Irontiine ambulances to PCPs or the BAS and then by
division-level ambulances to the clearing station. In air assault operations, the evacuation is by litter bearers
to PCPs or to the BAS and then by air ambulances to a clearing station. Once the combat element begins the
assault on the objective, secrecy is no longer important and its isolated location requires CHS characteristic
to airborne and air assault operations until ground linkup.
(4) Turning movement. The turning movement is a variant to the envelopment in which the
attacker attempts to avoid the defense entirely; rather, the attacker seeks to secure key terrain deep in the
4-21
FM 8-10-6
enemy's rear and along his LOCs. Faced with a major threat to his rear, the enemy is thus "turned" out of
his defensive positions and forced to attack rearward at a disadvantage.
• General MacArthur's invasion at Inchon during the Korean War is an example of a
classic turning movement. Casualties were initially light as the main defenses were avoided; however, as
the invasion developed, resistance stiffened and higher casualty rates were experienced. Further, as
fighting occurred in a populated area (Seoul), significant civilian casualties resulted. The lack of Korean
health care providers caused many of these civilians to seek medical aid from US field medical units.
• Medical evacuation support to the turning movement is provided basically in the
same manner as to the envelopment. As the operation is conducted in the enemy's rear area, LOCs and
evacuation routes may be unsecured resulting in delays in resupply and evacuation. In the Inchon example,
a hospital ship was located off the coast to accept patients evacuated from the fighting. However, due to the
precarious tides, evacuation and resupply were often delayed for hours and sometimes days since the harbor
could not be navigated by small vessels. It was not until Kimpo Airfield fell that timely evacuation could
occur. The deployed CHS units must be able to quickly clear the battlefield of patients, evacuate them fi-om
the forward areas, and sustain the patients in rear areas until evacuation routes are established.
b. Enabling Operations.
(1) Passage of lines . This situation presents a challenge for the CHS planner. There will be
a number of medical evacuation units using the same air and road networks. Coordination and
synchronization are essential if confusion and overevacuation are to be avoided. The information required
to operate in the division AO includes—
Radio Irequencies and call signs.
Operations plans and TSOPs.
Location of MTFs.
Location of PCPs and AXPs.
Main supply route, forward arming and refueling points (FARP), and A2C2 data.
(2) Security operations. The covering forces are dependent upon organic resources found in
the maneuver battalion medical platoon for initial support. The level of command for the covering force
(division or corps) determines the responsibility for the subsequent evacuation plan. In a corps covering
force, for example, the corps CHS structure has the responsibility for establishing and operating the medical
evacuation system to support the forward deployed corps forces. This is done to prevent the divisions
following the covering forces from becoming overloaded with patients prior to the hand off and passage of
lines. The use of PCPs, AXPs, and nonmedical transportation assets (CASE VAC) to move the wounded is
essential. The covering force battie may be extremely violent. Patient loads will be high and the distance to
MTFs may be much longer than usual. The effectiveness of the medical evacuation system depends upon
the forward positioning of a number of ground ambulances and the effective integration of corps air
ambulances into the evacuation plan.
4-22
FM 8-10-6
(3) Advance, flank and rear guards. These forces normally receive medical evacuation
support through the attachment of evacuation teams. The teams evacuate patients to predesignated PCPs
along a main axis of advance or to the nearest treatment element providing area support. Employment of air
ambulances provides a measure of agility and flexibility.
(4) River crossing operations. The river barrier itself exerts decisive influence on the use of
divisional medical units. Attack across a river line creates a CHS delivery problem comparable to that of
the amphibious assault. Combat health support elements cross as soon as combat operations permit. Early
crossing of treatment elements reduces turnaround time for all crossing equipment that is used to load
patients on the far shore. Maximum use of air ambulance assets is made to prevent excessive patient
buildup in far shore treatment facilities. Near shore MTFs are placed as far forward as assault operations
and protective considerations permit to reduce ambulance shuttle distances from off-loading points. For
detailed information on river crossing operations, refer to FM 90-13.
(5) Reconnaissance operations. The reconnaissance in force is an attack to discover and test
the enemy's position and strength or to develop other intelligence. The division usually probes with
multiple combat units of limited size, retaining sufficient reserves to quickly exploit known enemy
weaknesses. Combat health support techniques follow those discussed for a movement to contact (paragraph
4-6a). Ambulances are positioned well forward at both unit and division levels. Ambulances are moved at
night to enhance secrecy. The echeloning of ambulances is an indication to the enemy that an attack is
imminent due to the forward placement of CHS. Clearing stations are not established until a significant
patient workload develops. Patients received at BASs of reconnoitering units are evacuated to clearing
stations as early as practical, or are carried forward with the force until a suitable opportunity for evacuation
presents itself. Maximum possible use of air ambulance assets is made to cover extended distances and to
overcome potentially unsecured ground evacuation routes.
(6) Unifled action. The majority of operations occurring at the present time are joint,
interagency, or multinational operations. The CHS planner must determine in the initial planning stages of
these operations whose responsibility it is to provide medical evacuation support to the force. The CHS
planner must also ensure that duplications in support do not exist, guidelines are established as to eligible
beneficiaries and when individuals are to be returned to their own nation's health care delivery system, and
what mechanisms exist for reimbursement of services. For additional information, refer to FM 8-42.
(7) Integrated warfare operations. Medical evacuation in an NBC environment is discussed
in paragraph 5-6.
4-8. Medical Evacuation Support in Stability Operations
a. Overview of Stability Operations.
(1) Stability operations apply military power to influence the political environment, facilitate
diplomacy, and interrupt specified illegal activities. They include both developmental and coercive actions.
Developmental actions enhance a government's willingness and ability to care for its people. Coercive
actions apply carefully prescribed limited force and the threat of force to achieve objectives. The types of
activities conducted in stability operations include—
4-23
FM 8-10-6
Peace operations.
Operations in support of diplomatic efforts.
Combatting terrorism operations.
Counterdrug operations.
Noncombatant evacuation operations (NEO).
Arms control.
Nation assistance and foreign internal defense.
Support to insurgencies.
Support to counterinsurgencies.
Shows of force.
Civil disturbance operations.
(2) While each operation in this environment is unique, there are seven broad
imperatives which enhance the deployed forces' ability to develop concepts and schemes for executing
stability operations. These imperatives are to—
Stress force protection.
Emphasize information operations.
Maximize interagency, joint, and multinational cooperation.
Display the capability to apply force without threatening.
Understand the potential for disproportionate consequences to individual and small
unit actions.
Apply force selectively and discriminantly.
Act decisively to prevent escalation.
b. Medical Evacuation Support.
(1) Medical evacuation support to forces deployed in stability operations is dependent upon
the specific type of operation, anticipated duration of the operation, number of forces deployed, theater
4-24
FM 8-10-6
evacuation policy, medical troop ceiling, and anticipated level of violence. In most situations, medical
evacuation support follows the traditional support provided to combat forces. If there is a shortened theater
evacuation policy, a limited medical troop ceiling, and limited hospitalization assets within the AO, organic
and DS ambulance support is provided from the point of injury to the supporting Echelons I or II MTF and,
once the patient is stabilized for further evacuation, from the treatment element to an airfield for evacuation
out of the theater.
(2) During NEO, those persons who are injured, wounded, or ill are treated and stabilized
by the medical element accompanying the NEO force. Once stabilized, they are evacuated by the NEO
force. In NEO conducted in a permissive environment (no apparent physical threat to the evacuees), sick,
injured, or wounded persons should be evacuated on dedicated medical evacuation platforms, if at all
possible. In an uncertain or hostile environment, the transportation assets used to insert and extract the
NEO force are normally used to evacuate the patients. The medical personnel accompanying the force
provide en route medical care until the NEO force reaches an intermediate staging base (ISB) or safe haven.
Those evacuees requiring medical care are then transferred to dedicated medical evacuation platforms for
further evacuation to MTFs capable of providing the required care.
(3) During combatting terrorism operations, planning considerations for medical evacuation
support include—
• Using medical and nonmedical transportation assets to evacuate casualties in mass
casualty situations. If nonmedical assets are used, planning should include augmenting these assets with
medical personnel to provide en route medical care.
• Applying techniques for acquiring and evacuating patients under hostile fire or on
adverse terrain (from rubble or from above or below ground level. (Refer to paragraph 5-10 for additional
information.)
• Ensuring security measures (such as establishing checkpoints, screening personnel
and vehicles, and limiting access to the MTF area) are implemented.
(4) In nation assistance, support to insurgencies, and support to counter insurgencies, medical
evacuation personnel may be called upon to assist in the development of a medical evacuation system for the
supported nation/group; teach civilian, military, or paramilitary personnel basic evacuation techniques and
the treatment protocols for providing provision of en route medical care; or provide the more traditional
support from the point of injury to the supporting treatment element.
(5) For additional information, refer to FM 8-42.
4-9. Medical Evacuation Support in Support Operations
a. Support operations provide essential supplies and services to assist designated groups. They
are conducted mainly to relieve suffering and help civil authorities respond to crises. In most cases. Army
forces achieve success by overcoming conditions created by man-made or natural disasters. The ultimate
4-25
FM 8-10-6
goal of support operations is to meet the immediate needs of designated groups and transfer responsibility
quickly and efficiently to appropriate civilian authorities. Support operations, which consist of humanitarian
assistance and environmental assistance accomplish one or more of the following: save lives; reduce
suffering; recover essential infrastructure; improve quality of life; and restore situations to normal. The
seven broad support imperatives are to-
Secure the force.
Provide essential support to the largest number of people.
Coordinate actions with other agencies.
Hand over to civilian agencies as soon as feasible.
Establish measures of success.
Conduct robust information operations.
Ensure operations conform to legal requirements.
b. Humanitarian assistance operations can include a number of activities such as disaster relief,
domestic support, refugee assistance, the provision of medical care to isolated populations, and refeeding
programs resulting from famines or natural disasters. Medical evacuation assets may be used to evacuate
the injured from disaster sites, to provide the emergency transport of critically needed medical supplies and
personnel to remote locations, or to perform emergency rescues during times of flooding, wild fires, or
other natural disasters.
c. Further, medical evacuation assets may perform community assistance missions such as the
Military Assistance to Safety and Traffic (MAST) program, where an air ambulance unit provides evacuation
support to the nearby civilian community. (For additional information, refer to Army Regulation AR 500-4
and FM 8-10-26.)
4-10. Medical Evacuation of Enemy Prisoners of War
Sick, injured, and wounded enemy prisoners of war (EPWs) are treated and evacuated in military police
(MP) channels when possible. They must be physically segregated from US, allied, and coalition patients.
Guards for these prisoners are provided in accordance with the division or corps TSOP and are from other
than medical resources. The echelon commander is normally responsible for this support.
a. United States medical personnel decide if EPWs are healthy enough to be escorted within MP
channels or if they need to be medically evacuated. Generally, ambulatory prisoners remain within the MP
channels and litter patients are evacuated through medical channels.
b. The US provides the same standard of medical care for wounded, sick, and injured EPWs as
that given to US, allied, and coalition soldiers. Wounded, sick, or injured EPWs in the CZ may be treated
4-26
FM 8-10-6
and returned to MP channels for evacuation; or the EPWs may be stabilized and moved through medical
channels to the rear as far and as quickly as possible. Enemy prisoners of war are moved to corps or EAC
hospitals for treatment.
c. When EPWs are evacuated through medical channels, medical personnel—
• Report this action through medical channels to the next higher headquarters.
• Request disposition instructions from the corps MRO.
d. The corps MRO is responsible for—
• Coordinating the transportation means.
• Identifying the MTF to which the EPWs will be taken.
• Coordinating, in conjunction with the hospital commander, with the branch Prisoner of
War Information Center (PWIC) to account for EPWs within medical channels.
4-11. Evacuation and Disposition of Remains
a. The transportation and disposition of remains is a Quartermaster function. Air and ground
ambulance personnel do not clear the battlefield of remains nor do they carry remains in their dedicated
medical vehicles or aircraft. Medical units do not accept remains or provide temporary morgues in which
to hold remains for other units until they can be transferred to MA sites/personnel.
b. The only remains that a medical unit handles are those of its own unit members or of patients
who are dead on arrival (DO A) or who died of wounds (DOW) while in their care. Whenever a medical
unit must establish a temporary morgue, it should be established out of sight of the triage and treatment
areas. This area can be established behind a natural barrier, such as a stand of trees or it can be set off by
using tentage and tarpaulins. This is not an actual morgue, as it has neither the required equipment nor is it
staffed; it is only a temporary holding area.
c. For additional information, refer to FMs 8-10 and 8-10-1.
4-12. Aeromedical Evacuation Operations
a. The effectiveness and efficiency of the AMEDD is enhanced by the air ambulance's capabilities
to—
Remove patients from otherwise inaccessible areas.
Circumvent fixed defenses and natural obstacles.
4-27
FM 8-10-6
•
Deliver medical supplies and blood products.
Provide a rapid evacuation means.
Provide emergency airlift of medical personnel, equipment, and supplies.
b. Individual medical evacuation mission requests are processed through communications channels
designated in the CHS annex of the OPLAN or OPORD. Mission control is retained by the appropriate
CHS headquarters commander.
c. Medical evacuation missions are based upon requests from units within the CZ requiring CHS.
Requests for augmentation or reinforcement of aeromedical evacuation capabilities are made by the
controlling CHS headquarters. Since the majority of requests for medical evacuation originate in the
division, the basic concept of mission control is oriented on this requirement. Mission requests are processed
through the fastest and most reliable means available. A sole-user channel is desirable for the expedient
transmission of medical evacuation requests. Within their area of responsibility, surgeons at various levels
of command may monitor requests and recommend priorities for patient evacuation.
d. Direct aeromedical evacuation support is normally provided to each division (from the corps)
by one air ambulance company. It is the mission of this company to—
Evacuate selected patients within the division.
Transport medical elements to areas where they are critically needed.
Ensure the uninterrupted delivery of blood, blood products, biologicals, and medical
supplies.
Provide for air crash rescue (less fire suppression).
Rescue downed aircrews (refer to paragraph 1-13 for additional information).
e. In addition to the air ambulance company (DS) operating in the division area, aeromedical
evacuation support is provided by one or more air ambulance companies (GS) in the corps. Their primary
mission is to augment and reinforce forward deployed air ambulances units. To accomplish this mission,
they—
• Evacuate patients from FSMC, MSMC, and EST to corps hospitals.
• Evacuate patients from combat, CS, and combat service support (CSS) units operating
between division rear and corps rear boundaries.
• Evacuate patients between corps-level hospitals and intermediate staging points (MASFs,
railheads, and seaports).
4-28
FM 8-10-6
• Transport medical teams and squads, as required.
• Deliver blood and blood products, medical supplies, and biologicals.
• Rescue downed aircrews.
/. The aeromedical evacuation mission requests are referred to the air ambulance unit or team
supporting the particular echelon of health care. Proper flight clearance is obtained as the mission is
accepted. If the mission cannot be accepted, the commander will coordinate with either lateral or rear
supporting air ambulance units.
g. Aeromedical evacuation support, which exceeds the capabilities of the assets available at
division, becomes the responsibility of the medical evacuation battalion commander. He adjusts evacuation
capabilities between supported divisions through his unit commanders based on the tactical situation and
patient densities. The air evacuation unit commanders coordinate and receive flight missions, as appropriate.
The requesting unit is notified, if possible, as to the estimated time of arrival for the support. If evacuation
requirements overwhelm available medical evacuation battalion assets, the medical evacuation battalion
coordinates for additional corps-level assets. When nonmedical aircraft are used to meet the requirements
for peak periods of patient evacuation, every attempt should be made to furnish medical personnel and
equipment for en route medical care. The use of nonmedical assets requires intensive preplanning to ensure
availability of assets when needed. One source of personnel and equipment may be from the additional
treatment teams of the MSMC. In instances when the evacuation system becomes overwhelmed, every
available space on general purpose aircraft may be used to transport those less severely injured without
provisions for en route medical care. Regardless of the method used, control of nonmedical assets is
maintained through medical channels regarding the designation of the point of origin, the casualties to be
carried, and the destination.
h. Medical regulating remains the responsibility of the corps medical brigade or group. However,
coordination for the medical evacuation of patients to the FST or CSH from the FSMC or MSMC is
accomplished by the DMOC. Medical regulating out of the division is accomplished procedurally and must
be preplanned to ensure proper pre-mission planning by both ground and air units.
i. For additional information on the medical company, air ambulance, refer to Chapter 3,
Section III of this manual and FM 8-10-26.
4-13. Evacuation of Military Working Dogs
Military working dogs (MWDs) when injured or ill may be evacuated on any transportation means available.
The using unit is responsible for the evacuation of the animal. Use of dedicated medical evacuation assets
(air or ground ambulances) is authorized based on mission priority and availability. When possible, the
handler should accompany the animal during the evacuation. Using units should include the location of
veterinary support units on operational overlays.
4-29
FM 8-10-6
CHAPTER 5
MEDICAL EVACUATION IN SPECIFIC ENVIRONMENTS
5-1. General
This chapter addresses medical evacuation in specific environments or under special circumstances. The
medical evacuation effort must be well planned and its execution synchronized to be effective. Further,
medical evacuation personnel must be flexible and ready to improvise, if needed, to meet the demands of
unique situations.
5-2. Mountain Operations
a. In the past, armies have experienced great difficulty in evacuating patients from mountainous
areas. Mountain environments are extremely diverse in nature. Some mountains are dry and barren with
temperatures ranging from extreme heat in the summer to extreme cold in the winter. In tropical regions,
mountains are frequently covered by lush jungles and heavy seasonal rains occur. Many areas display high
rocky crags with glaciated peaks and year-round snow cover. Elevations can also vary from as little as
1,000 feet to over 16,000 feet with drastic and rapidly occurring weather changes.
b. Operations in mountainous terrain require some procedure modifications. This is due to the
environmental impact on personnel and equipment. Important physical characteristics and considerations
that influence medical evacuation are-
Rugged peaks, steep ridges, and deep valleys.
Limited number of trafficable roads.
Reduced communications ranges.
Unpredictability of and severe changes in weather.
Decreased partial pressure of oxygen.
Limited availability of landing zones (LZs).
c. In order to effectively support the tactical plan, the CHS plan must provide maximum
flexibility. The CHS planner should consider using all means of evacuation. Due to the length of
evacuation times and the limited means of ground evacuation, it is important to triage and prioritize patients
prior to movement.
(1) The availability of improved, hard-surfaced roads is extremely limited, if they exist at
all. Usually, improved roads are only found in valley corridors. Such roads are often dependent upon a
system of narrow bridges spanning mountain streams and ravines. They may also twist along ridgelines and
cling to steep shoulders.
5-1
FM 8-10-6
(2) Secondary roads and trails may be primitive and scarce. However, they may provide the
only routes capable of vehicular traffic. Cross-compartment travel between adjacent valleys may be
impossible by ground vehicle. Off-road travel requires detailed planning, even for short distances.
(3) Because of rough terrain, the FSMC may not be able to reach the BAS by ground
vehicle. An ambulance shuttle system is established with an AXP for air and ground evacuation vehicles to
meet litter bearers. Litter bearers and beasts of burden may be the only means of evacuation available. Any
available personnel may be used as litter bearers (nonmedical personnel from supported units may be
required to augment the litter bearer teams). Close coordination between FSMC and BASs in establishing
PCPs or AXPs is necessary to—
• Reduce distance traveled by litter bearers.
• Reduce evacuation time.
• Conserve personnel.
• Locate the best potential LZs for air ambulances.
(4) In mountainous areas, evacuation of patients by air is the preferred means. Air
ambulances permit the rapid movement of patients over rugged terrain. For example, to travel a distance of
only 6 kilometers on foot could take up to 2 hours, while flying time could be less than 2 minutes.
(5) Frequency-modulated (FM) radios are the principal means of communication in this
environment. The ability to transmit is hampered by the limitations of line of sight transmissions.
(6) The briefing of ambulance drivers needs to be extensive, including detailed strip maps
and overlays. Further, specific instructions on what to do in various situations should be covered (such as if
the vehicle breaks down or the unit moves).
d. The mountain environment, with its severe and rapidly changing weather, impacts on aircraft
performance capabilities; accelerates crew fatigue; and requires special flying techniques. Having to rely on
continuous aviation support for a successful mountain operation is risky.
(1) Flying in mountainous areas requires special training. Both the terrain and the weather
influence basic flying techniques and operational planning. Rugged, mountainous terrain complicates flight
route selection. Direct routes can seldom be flown without exposing the aircraft to detection and destruction
by the enemy.
(2) Important considerations for aeromedical operations in mountainous areas are—
{a) Density altitude. Density altitude is the most important factor affecting aircraft
performance. Density altitude combines temperature, humidity, and pressure altitude, and provides the
basis for lift capability. Density altitude can vary signiflcantiy between the pickup point and the LZ because
of the time of day and changes in elevation. Frequent performance planning updates are essential.
5-2
FM 8-10-6
(b) Wind. Unpredictable winds can produce significant turbulence, wind sheers,
updrafts, and downdrafts. This further increases the risk of a catastrophe in a seemingly routine mission.
Adverse winds along with high density altitude demand current and accurate performance planning. Pilots
must plan for greater margins of safety.
(c) Icing. Ice can clog intake ports, thus starving the engine of air, or it can collect on
rotor blades resulting in a significant loss of lift. Asymmetrical shedding can cause severe out-of-balance
rotor conditions.
(d) Visibility. Low clouds or fog greatly decrease the ability to navigate or to avoid
obstacles.
(e) Lack of landing zones. The characteristics of mountain terrain do not usually afford
adequate LZs. The terrain may only allow the aircraft to hover while loading patients on board.
(f) Hoist operations. Use of the internal or external rescue hoist (Appendix E) can be
expected in mountainous terrain. Mounting the rescue hoist on the aircraft as standard equipment in
mountain operations may be required. When possible, orientation and training sessions with supported
troops should be conducted to help minimize the difficulty of such missions. Depending on the terrain, the
forest penetrator may also be needed to accomplish the mission.
(g) Enemy air defenses. When enemy air defense capabilities preclude using air
ambulances in forward areas, they should be used to evacuate patients from AXPs or from division clearing
stations.
(h) Ambulatory patients . Some ambulatory patients may be reported as litter patients in
mountainous terrain. These patients may be unable to move unassisted over the rugged terrain. Once
placed on the air ambulance, their status may be upgraded.
(0 Crew training. Ground and air evacuation crews should receive additional training
and orientation in mountaineering skills, handling patients, and survival skills; for example-
Cold weather survival training, including cold injury prevention.
Mountain (rock) climbing.
Use of ropes and vertical rescue techniques (paragraphs 9-12 through 9-13).
Individual and unit movement at high altitudes.
Care and treatment of patients suffering high altitude illnesses and cold weather
injuries.
Techniques of patient evacuation by litter, emphasizing the use of pack animals
(if available from the host country), and the improvised travois (paragraph 9-7) litter.
5-3
FM 8-10-6
(j) Patient loading. Care must be taken when loading patients where there is a great
deal of slope to the LZ. Emphasis on approaching and loading the aircraft from the down-slope side of the
aircraft must be reinforced.
CAUTION
Approaching the aircraft from the up-slope side is hazardous.
e. Troops operating in mountainous areas are exposed to other injuries and illnesses that
frequently occur in this environment. These conditions include—
• An increased rate of fracture, sprain, and dislocation injuries.
• Incidents of acute mountain sickness, high-altitude pulmonary edema, and cerebral edema
caused by rapid ascent to heights over 7,500 feet.
• Cold weather injuries.
• Dehydration and heat exhaustion.
• Sunburns and snow blindness.
•
Aggravated sickle cell anemia. Although this condition is not considered a mountain
illness, personnel with the sickle cell trait can be seriously affected by the decrease in barometric pressure
and lower oxygen levels found at higher altitudes.
/. The proportion of litter cases to ambulatory cases is increased in mountainous terrain, for even
the slightly wounded may be unable to move unassisted over rough terrain. Litter relay stations may be
required along the evacuation route to conserve the energy of litter bearers and to speed evacuation.
g. It is important to be able to predict the number of patients that can be evacuated with available
personnel. When the average terrain grade exceeds 20 degrees, the four-man litter team is no longer
efficient and should be replaced by a six-man team. The average mountain litter team should be capable of
climbing 120 to 150 vertical meters of average mountain terrain and return with a patient in approximately
1 hour.
h. Mountain operations may require medical personnel to carry additional equipment. Items
such as ropes, pulleys, pitons, piton hammers, and snap links are all necessary for evacuating patients and
establishing BASs. All unnecessary items of equipment including those for which substitutes or
improvisations can be made should be left behind. Heavy tentage, bulky chests, extra splint sets, excess
litters, and nice-to-have medical supplies should be stored. Such medical supplies, if stored, should be
5-4
FM 8-10-6
readily available for airdrop or other means of transport. Medical items that are subject to freezing should
be safeguarded; they should not be exposed to the low temperatures experienced in mountainous areas.
i. Evacuation times may be extended when using litter teams with AXPs. Therefore, shelter for
patients must be improvised if tentage is not available to prevent undue exposure. In the summer or in
warm climates, improvisation may not be necessary; however, since there is a close relationship between
extreme cold and shock, medical personnel must be conscious of the need to provide adequate shelter for
patients. Satisfactory shelter may be found in caves, under overhanging cliffs, behind clumps of thick
bushes, and in ruins. Shelters may be built using a few saplings, evergreen boughs, shelter halves, or
similar items. The time a patient is to be held influences the type of shelter used. When patients are to be
kept overnight, a weatherproofed shelter should be constructed.
j. For further information on mountain operations, refer to FM 90-6 and Training Circular (TC)
90-6-1. For aviation-specific information, refer to FMs 1-202 and 1-400.
5-3. Jungle Operations
a. Combat health support elements in a jungle environment retain the same basic capabilities as
in other environments. Jungle operations, however, subject personnel and equipment to effects not found in
other environments. The jungle environment degrades the ability to maneuver. Security problems are also
increased and affect medical evacuation operations as much as they do the combat forces.
b. In jungle operations a combination of air and ground evacuation units are used to maximize the
patient evacuation potential. Using this dual system of evacuation ensures that the inherent limitations of
one system can be compensated for by the other. Jungle variations affect the organizing, positioning, and
securing of CHS. Due to the terrain, aerial resupply is usually a common practice. The responsiveness
provided by aerial resupply requires fewer supplies to be stockpiled in the combat trains.
c. Jungle combat operations are characterized by ambushes and other guerrilla-type operations.
The security threat caused by infiltrators requires that LOCs be patrolled often and that convoys be
escorted. It is, therefore, essential that CHS be performed as far forward as the tactical situation permits.
Positioning assets forward—
• Improves response time.
• Reduces road movement.
• Allows the CHS elements to take advantage of the security offered by combat units.
d. The thick foliage often makes evacuation by ground more difficult than in other types of
terrain. Factors such as the threat, limited road network, and reliance on nonmedical personnel for convoy
security make air evacuation the preferred means. By using the ambulance shuttle system, patients can be
transferred from forward operating ground ambulances to either ground or air ambulances operating further
to the rear. In situations where evacuation assets are delayed by various factors (weather or terrain),
5-5
FM 8-10-6
patients are held for longer periods of time at forward locations. This will dictate the need for additional
medical supplies. Combat health support planners must try to anticipate these delays whenever possible.
The increased disease and infection incidences associated with the jungle environment may worsen the
patient's condition; therefore, timely evacuation is essential.
e. In some remote and densely foliaged jungles, the only means of evacuation may be by litter.
Ambulances may not be practical on trails, unimproved muddy roads, or in swamps. As in mountain
operations, there is a higher proportion of litter cases than usual. In the jungle even a slightly wounded
soldier may find it impossible to walk through dense undergrowth. At best, litter teams can carry patients
only a few hundred meters over rough jungle terrain before needing rest or relief. Litter carries should be
kept as short as possible and medical elements pre-positioned and retained forward.
/. Other special planning considerations in jungle operations include—
(1) 'Water. Water is vital in the jungle and is plentiful. Water from natural sources,
however, should be considered contaminated. 'Water purification procedures must be taught to all soldiers.
(Refer to FMs 21-10 and 21-10-1 for additional information.)
(2) Clothing. Due to the tropical climate, units should pack hot weather clothing when
deploying to jungle areas. Jungle fatigues and boots are recommended. Insect (mosquito) nets, insect
repellent, and sunscreen should be issued to all soldiers operating in this environment.
(3) Disease and nonbattle injuries. The jungle environment is ideal for the transmission of a
large number of diseases. The rate of DNBI casualties is potentially the highest in this climate. The heat,
humidity, and terrain places the troops at high risk for dehydration, heat injury, skin diseases, endemic
diseases, and immersion foot. Small wounds can rapidly become infected and lead to loss of effectiveness
and possibly require evacuation. High standards of personal hygiene must be taught, encouraged, and
maintained by the command. Mosquitoes and other arthropods that carry disease flourish under jungle
conditions. Use of all possible personal protective measures must be ensured. Food- and waterborne
diseases leading to diarrhea or other symptoms will abound. Food service sanitation measures must be
strictly followed. The potential for contamination of food and water increases with each time they are
handled, stored, or transported. Soldiers must be encouraged to consume adequate amounts of water that
has been purified and to eat only approved foods. In the jungle it is necessary for the commander to pay
meticulous attention to the details of PVNTMED measures to maintain an effective fighting force. For
additional information on PVNTMED measures, refer to FM 21-10 and FM 21-10-1.
(4) Training. Combat health support personnel should be trained in survival and support
techniques in jungle environments. For example, training should be conducted in—
• Hot weather acclimatization and survival.
• Prevention, early detection, and treatment of arthropod-, food-, and waterborne
diseases.
5-6
Land navigation in a jungle environment.
FM 8-10-6
• Field sanitation and other PVNTMED measures.
• Care and maintenance of equipment and supplies.
(5) Equipment. Due to the increased heat and humidity, vehicles and equipment require
additional maintenance. Equipment tends to rust quickly and must be cleaned and oiled more frequently.
Canvas items rot and rubber deteriorates much faster than in more temperate climates.
(6) Communications. The range of FM communications in the jungle is significantly reduced
due to the dense undergrowth, heavy rains, and hilly terrain. The range of a radio set operated in the jungle
may be reduced by 10 to 25 percent. The heavy rain and high humidity of the tropics also reduce the range
(about 20 percent) and reliability of wire communications. The transmission range can be extended by
using additional radio relays and field expedient antennas.
(7) Aircraft performance . Utility helicopters are not able to lift the same size loads that can
be lifted in more temperate areas. This results in a reduced patient load in some evacuation aircraft. Again,
fi-equent and accurate performance planning is essential for mission accomplishment.
(8) Landing zones . Theremay be few suitable LZs. Many LZs will only be large enough to
support one or two helicopters at a time.
(9) Hoist operations. Hoist operations may be required more frequently in the thick jungle
vegetation where LZs are not available. The forest penetrator should be carried on all operations.
g. For aviation-specific information, refer to FMs 1-202 and 1-400.
5-4. Desert Operations
a. The Environment.
(1) Deserts are arid, barren regions of the earth incapable of supporting normal life due to a
lack of fresh water. Although deserts are often thought of as hot climates, it is important to note that
temperatures range fi^om over 136 degrees Fahrenheit (F) in some deserts, to bitter cold in others. Day to
night fluctuations in temperature can exceed 70° F. Desert terrain can have mountains, rocky plateaus, or
sandy dunes; some desert areas may contain all of these characteristics. Rain, when it falls, often causes
flooding in low-lying areas. Winds can have a devastating effect upon CHS operations by destroying
equipment and supplies and causing dust storms. Dust storms make navigation and patient treatment
difficult. Since deserts vary considerably in the type of terrain and temperature, and in their cultural
makeup, current medical intelligence should be obtained prior to deployment on operations conducted on
desert terrain.
(2) People have lived and fought in desert areas for thousands of years. However, the
environmental effects on personnel can be extreme, especially for soldiers not prepared for these operations.
5-7
FM 8-10-6
• Acclimatization. To be effective, soldiers must be properly acclimatized to the
desert. Two weeks are usually required to satisfactorily acclimatize troops to hot environments, using
progressive degrees of heat exposure and physical exertion. Other potential acclimatization problems that
may be encountered are the effects of dry air and altitude on the respiratory system. Since many desert
areas are located in mountainous terrain, soldiers must be acclimatized for both the altitude and the
temperature. In some areas of the world, such as the Gobi Desert in East Asia, people must be acclimatized
to the cold, in addition to the dryness. (For additional information, refer to FM 21-10, FM 8-250, and TB
MED 507.)
• Discipline. Units deployed in desert areas typically have long LOCs and are widely
dispersed. As unit elements become more dispersed, commanders must rely more heavily on junior officers
to ensure that C2 is maintained and that discipline and PVNTMED programs are enforced. For a unit to be
effective, a high level of discipline must exist at all levels of the organization.
• Water. Water is the most basic need in a desert. Without it, soldiers cannot
function effectively for more than a few hours.
• Thirst is not an adequate indicator of the need for water. It is necessary for
each commander to establish and enforce a supervised drinking program. Experience has shown many
times that soldiers do not drink enough fluids unless forced to do so. It is important to cool the water, if at
all possible, to make it more appealing. Water supplies should be carefully guarded against accidental loss,
sabotage, or contamination.
• Extra water must be carried by CHS vehicles for patients to drink and to cool
heat casualties.
• Endemic disease and environmental injuries. Soldiers deployed in the desert are
susceptible to endemic diseases and environmental injuries.
• Proper water discipline, vaccines, prophylactic measures, field sanitation
measures, personal hygiene, and other PVNTMED measures can reduce these risks.
• Cold weather injuries, heat injuries, and respiratory disease can also be
prevalent. Proper clothing, equipment, and a water discipline program must have command emphasis in
desert operations.
• Winds. Winds may very easily damage materiel such as aircraft, antennas, and
tents. Equipment is protected by using covers, tie-downs, and shelters. Terrain helps shield equipment
from the wind if site selection is done carefully. In some cases, special tools, such as extra long metal tent
stakes, are necessary.
• Wind and sand. The effects of wind and sand are interrelated. Desert sand starts to
become airborne when the wind reaches about 20 knots. Sandstorms—
• Restrict visibility.
5-8
FM 8-10-6
• Pose a hazard to eyes (especially for soldiers wearing contact lenses).
• Can contaminate water supplies (if they are not protected).
• Make navigation difficult.
• Sun. The sun may cause sunburn of the skin and eyes (if protection is not used).
(3) Eight characteristics of the desert environment that may adversely effect equipment
are—
• Terrain. Trafficability varies with the type of terrain covered. Open, flat, and
rocky terrain affords higher trafficability than do mountainous areas, lava beds, or salt marshes. Drivers
must be well trained in judging the terrain over which they are driving to select the best alternative
routes.
• Tracked vehicles are best suited for desert operations. However, they can
throw tracks when traversing a rocky area. Their use is also limited in rough terrain with steep slopes.
• Wheeled vehicles may be used in desert operations; however, they normally
have a lower average speed than tracked vehicles and a higher incidence of damage and malfunction.
Wheeled vehicles often bog down in sandy areas and cannot traverse many of the rougher areas.
• In planning for desert operations, vehicles should carry extra repair parts (fan
belts, tires, and other items apt to malfunction).
• Heat.
• Excessive heat causes vehicles to overheat, leading to greater than normal
wear. The frequency of leaks on vehicles and aircraft is greater than in some other environments. Engine
and transmission seals tend to dry out and crack; fuel lines wear out quickly; and water requirements for
cooling vehicle engines are greater. Loss of water, through evaporation, must be included in logistical
planning. Aircraft temperature limitations may be reached quickly, resulting in limited use during the
hotter parts of the day. Aircraft performance is greatiy reduced by the heat when combined with the effects
of ground elevation. This may result in the limited use of some LZs, reduced patient carrying capacity, and
reduced fuel load. There may not be sufficient out-of-ground-effect hover power available for landing in
confined areas or on pinnacles, for using the hoist, or for nap-of-the-earth (NOE) flights. Using vehicle and
aircraft covers reduce the effects of heat while vehicles and aircraft are not in use.
• Batteries do not hold their charge efficientiy in intense heat. Dry battery
supplies should be increased to compensate for a higher usage rate.
• Communications equipment must be protected from the heat in the desert.
Dust covers are used on this type of equipment. If the equipment has ventilating ports, these should be
cleaned regularly to avoid clogging.
5-9
FM 8-10-6
• Medical supplies must be protected from the heat to prevent deterioration.
The shelf life of some medical supplies decreases when stored in hot climates.
• Medical equipment must be protected from the effects of heat. It may be
protected using the same techniques as those used to protect communications equipment.
• Radiant light.
• The sun burns unprotected skin and it may damage unprotected eyes. Soldiers
should dress in loosely fitting clothing, use sunburn cream or oils to protect exposed skin, and wear
sunglasses or goggles to protect their eyes. Soldiers should remain fully clothed. Removing clothing
increases direct exposure of the skin to the sun and eliminates the beneficial cooling effects of the moisture
trapped in clothing.
• Radiant light or its heat effects may be detrimental to plastics, lubricants,
pressurized gasses, rubber, and other fluids. All vehicles and aircraft should be kept well ventilated, and
windshields should be covered to reduce heat buildup inside. Supplies of all types should be stored in a well
ventilated, shady area. Placing supplies in covered holes in the ground may reduce adverse heat effects.
• Dust and sand.
• Dust and sand present one of the greatest dangers to the proper functioning of
equipment. Sand mixed with lubricants forms an abrasive paste. Lubrication fittings, bearings, and filters
should be inspected frequently and changed when required.
• Aircraft should not be exposed to dust and sand any more than is absolutely
necessary. Ground handling instead of hovering reduces sand ingestion. Dust and sand increase failure of
microphone switches, signal distribution panels, and circuit breakers, and cause electrical motors and
generators to burn out. Wheel and fiight control bearings require more frequent cleaning; engines should
be flushed frequentiy.
• Medical and communications equipment may be adversely affected by dust
and sand. Over a period of time, electrical insulation is damaged by windblown sand. When combined
with the effects of lubricants on the insulation, dust and sand can become a major communications problem.
Special care should be taken to brush dust off radio equipment and to keep ventilating ports and channels
clear.
• Sand can accumulate in airframes, on the bottom of armored vehicles, and in
bearings on all types of equipment. This accumulation, combined with oil and condensation, adds extra
weight to aircraft and vehicles as well as jamming their control linkages. Sand and grease buildups must be
removed from bearings to ensure safe operation and control of aircraft and vehicles.
• Dust trails created by hovering aircraft or ground vehicles can be seen in
excess of 10 miles on a relatively flat desert. This exposes these assets to direct and indirect enemy fires.
Ground vehicles should reduce their speed to the point that they do not create a dust signature.
5-10
FM 8-10-6
• Humidity. Humidity is a factor in some desert areas of the world, especially in the
Middle East. Humidity can become a problem for short periods of time in other desert areas. Light coats of
lubrication can help prevent rust; however, these benefits should be weighed against the dust-gathering
qualities of oil. Demisting equipment is used on optics and night vision equipment to combat the effects of
humidity.
• Temperature variation. Temperature variation can cause condensation in humid
desert areas affecting optics, fuel lines, air tanks, and weapons. Expansion and contraction of air and fluids
cause tires to over inflate during the day and under inflate at night. Fuel tanks may overflow during the day
causing a fire hazard. Oil fluid levels become overfull and cause leaks during the day, or insufficient
lubrication occurs when the oil cools. Vehicle operators and crew chiefs must ensure that the effects of
temperature variations do not become a significant problem.
• Static electricity. Static electricity is prevalent in the desert. This is important to
remember during refueling operations and when oxygen is being used on board vehicles or aircraft. Proper
refueling procedures must be followed. Static electricity also causes severe shock to ground personnel in
sling load and hoist operations.
NOTE
The load must touch the ground before the ground crew can handle it.
b . Preparation for Desert Operations .
(1) To ensure success in desert operations, detailed planning is required. Factors to consider
include—
• Water. Additional quantities of water are required for CHS operations for the
survival of both medical personnel and their patients. Load plans for all vehicles and aircraft must include
water. Water is as mission essential as any piece of unit equipment. It should be a priority item when
loading plans are developed.
• Prescribed load lists. These lists are expanded to carry sufficient quantities of
repair parts easily degraded by the environmental factors. For example, rubber and plastic fittings and
tubes, or spare parts for communications equipment.
• Wind, sand, and sun. Plan for the effects of wind, sand, and sun. All plastic and
glass surfaces on vehicles, aircraft, and other equipment should be covered when not in use. Covers should
be ordered or made prior to deployment.
• Fuel. Fuel planning is critical due to power limitations, extended range require-
ments, and increased vulnerability of refueling sites in the relatively open desert terrain. Careful planning
of FARPs is essential for mission accomplishment.
5-11
FM 8-10-6
• Clothing. Units should plan to pack both hot and cold weather clothing when
deploying.
• Petroleum, oils, and lubricants. Petroleum, oils, and lubricants (POL) products
should be of the proper viscosity for desert operations. Maintenance services are also performed more
frequently on ground vehicles and aircraft, thus requiring a larger amount of POL than normal.
• Filters. Extra filters of all types are planned for due to a higher consumption rate.
(2) Training for desert operations is not significantly different than training for operations in
other areas except for the following:
• Mountain training. Because many desert areas are in mountainous terrain and
because high temperatures increase density altitude, aeromedical evacuation units should conduct mountain
training to prepare for contingencies in desert areas. Further, procedures and techniques for evacuation in
mountainous terrain must be practiced by all CHS personnel. Special equipment requirements (paragraph
5-2/z) must also be considered.
• Navigation. Navigation in desert terrain varies from simple to extremely difficult.
Factors affecting navigation are the type of desert and the scale and quality of the available navigational
charts. At times, aircraft may have to use dead-reckoning navigational techniques (time, distance, and
heading). Ground vehicles must have compasses available, as they have to rely on compass headings and
odometer readings to navigate. Ground and air ambulance crews should be able to interpret navigational
charts and maps of all types and scales. Use of convoys is a viable technique to improve security and to
ensure that ground vehicles do not get lost. Aircraft may be used to assist in navigation by convoys in those
areas in which there are poor road networks and the terrain offers no distinctive features by which to
navigate.
c. Medical Evacuation Operations in the Desert. In principle, medical evacuation operations in
the desert do not differ greatly from these operations in other environments. However, techniques exist
which may increase the effective use of medical resources.
(1) Helicopter landing sites should be chosen with care. Common mistakes made by many
units when establishing the LZ are—
• Locating the pad relative to the patient and tents, vehicles, and other obstacles. A
common tendency is to locate the helipad downwind of MTFs so that approaches may be made into the wind
towards the facility. In high winds, the helicopter must make its take-off over the facility or go around it.
This not only endangers personnel on the ground, but also the crew of the aircraft. It forces the pilot to take
off with a strong crosswind or tailwind if he does not have the power to clear the obstacles in front of him.
At times, crosswind take-offs are not possible because of higher terrain on either side of the landing area.
In mountainous deserts, winds normally channel down the valleys and are more predictable along valley
floors. A better site selection for a LZ is with the MTF along side the approach and take off zone. Thus,
the landing direction is up or down the valley, depending on the airflow, and the MTF is not overflown.
5-12
FM 8-10-6
• Situating landing sites in washes, small confined areas between large rocks, or
close to moving tracked vehicles. Map coordinates are rarely accurate unless the site is beside a major
terrain feature. Therefore, LZs should be located next to major terrain features or on higher ground where
they can be seen from the air at a distance of 2 to 3 kilometers, if possible. Lack of distinctive features in
the open desert and on large-scale maps makes pinpoint navigation difficult, especially at night.
• Marking of helicopter LZs is done so that the pad can be seen from the air, but the
markings should not be a hazard in themselves. If engineer tape is used, it should be firmly secured to
prevent it from blowing loose. Panel markers are not a good tool to use as they are difficult to see. If panel
markers are used, they need to be secured. If used, flares or marker smoke should not be deployed on or
directly upwind from the pad. Smoke grenades or flares should not be thrown under the aircraft as it lands.
Avoid using white smoke to mark the LZ. Colored smoke is probably the best daylight marking method. It
is difficult to detect a smoke grenade more than 2 to 3 kilometers away, but an aircraft in the general
vicinity can normally see it. Radios are used to guide aircraft to the LZs, but this creates an electronic
signature. Units requesting medical evacuation must be prepared to signal the evacuation aircraft upon its
arrival. Normally, map coordinates will guide the aircraft to within 2 to 3 kilometers of the LZ. Even from
NOE altitudes, the aircrew may be able to see several units in the area. The requesting unit must signal the
aircraft to ensure the designated LZ is used.
(2) Considerations for night flight include the following:
(a) Moonlight aids the medical evacuation pilot by providing him with the light to see
with either unaided vision or night vision goggles (NVG). When adequate ambient light exists, medical
evacuation crews function almost as effectively at night as they do during daylight. The small arms threat is
somewhat reduced at night, although it still exists from radar-guided weapons, infrared-sited weapons, and
passive night vision device-equipped weapons systems. Flying into a bright moon with NVG on can be
compared to flying into the sun during the day. The goggles darken and visibility becomes extremely poor.
Flight routes should not be planned to fly directly into a bright moon if NVG are to be used.
(b) The lack of visual cues over sand is similar to that over water. It is very easy for
pilots to become disoriented and fly into the ground. Reliance on radar altimeters is a must over flat sandy
areas of the desert.
(c) Frequently, desert areas do not have sufficient ambient light to allow adequate night
vision, even with the aid of NVG. A pilot wearing NVG is often unable to see the ground at an altitude of
100 feet using a landing light equipped with a pink light filter. Under these conditions, dead reckoning is
the only effective navigation method unless Doppler equipment or NAVAIDS are available. Unfiltered
light can be used with or without NVG; however, this increases the risk of exposing the aircraft's position to
the enemy.
(3) Desert warfare is usually characterized by extended battle zones which increase
evacuation distance and time. Combat health support units are located further to the rear in the desert.
Establishing an ambulance shuttle system or PCPs is useful. Combat health support units require a greater
number of vehicles for operating in deserts than in other environments. Air evacuation by fixed- and
rotary-wing aircraft is the preferred method due to their speed and range. Further, using aircraft reduces
5-13
FM 8-10-6
the load on ground vehicles. Augmentation from higher echelon CHS may also be required to meet the
extended evacuation needs.
(4) Smoke is used extensively on the modern battlefield by both sides. It can be effectively
used to mask friendly actions to include medical evacuation. (Refer to Appendix F for further information.)
• Smoke can be a major hazard, especially to medical evacuation helicopters. Smoke
reduces visibility and forces an aircraft higher where it can be acquired by threat weapons systems. The
phenomenon of inversion occurs often in the desert. When this happens, medical evacuation vehicles and
aircraft may be able to work underneath the smoke using the smoke layer for overhead concealment.
• Medical units must coordinate closely with supported organizations on smoke
operations. Smoke can either help or hinder the evacuation mission, depending upon how it is used.
(5) Communications in the desert are affected by a number of factors. Atmospheric
interference and the skip of signals occur frequently. Mineral deposits in the desert may unexpectedly
disrupt communications. Many of these problems can be overcome by using additional radio relays,
preestablished control measures, and visual signals.
(6) Artificial lights may be used at times in the desert. They are very easily detected. Even
with blackout lights, vehicles using lights can be detected for miles with NVG. Serious consideration
should be given to driving without using lights when the tactical situation dictates. Ground guides are used
to help vehicles navigate through areas that are not clearly marked or through area where troops are
present.
(7) Wind is one of the most significant environmental factors affecting medical evacuation in
the desert. Wind can be destructive to both structures and equipment; tents, antennas, and aircraft can be
easily damaged. Wind direction and speed vary greatly within the space of a few miles. Velocity is
substantially increased when wind channels between hills and direction changes due to interference of
terrain features. The wind frequently makes aeromedical evacuation impossible by exceeding the operating
limitations of the aircraft. At other times, it may limit the use of some potential LZs. Blowing sand and
dust can slow down the evacuation system by making navigation by either ground or air ambulance difficult,
if not impossible. High winds are predictable to a certain extent. For example, at certain times of the year
in the Mojave Desert high winds occur every day at dusk and last for 3 to 4 hours. At other times, high
winds, based on frontal weather patterns, can remain for several days at a time. These factors should be
considered by CHS planners, and medical evacuation assets should be massed or relocated accordingly.
(8) The desert provides little or no protection from enemy air defenses except in mountainous
terrain. Aircraft may have to be flown above NOE altitudes to prevent a dust signature. These factors cause
increased exposure and vulnerability of air ambulances to enemy air defenses and may limit their
employment.
d. Further Information. Refer to FM 90-3 for additional information on desert operations. For
aviation-specific information, refer to FMs 1-202 and 1-400.
5-14
FM 8-10-6
5-5. Extreme Cold Weather Operations
a. Operations in the extreme cold have many of the limiting factors found in desert operations.
The tundra and glacial areas are harsh, arid, and barren. Temperatures may reach lows of -80° F to -100° F
which, combined with gale force winds, make exposure unsurvivable.
b. The greatest environmental detriment to operations is blowing snow. This results in a loss of
depth perception from total white conditions. Blowing snow is caused by the wind or by the rotorwash of
helicopters; its effect reduces visibility to zero.
c. Other environmental considerations are as extreme but easier to circumvent. Solid footing is
suspect in both the dead of winter and in the summer. Snow and ice cover crevasses, holes, and otherwise
unstable ground. In traversing suspect ground situations, consider linking soldiers by rope. During the
summer, ground transportation is more restricted than in any other environment due to the marsh and
muskeg composition of the arctic tundra. Patients must be sustained for a longer duration due to terrain
delays and the lack of direct lines of evacuation.
d. Greater responsibility has to be placed on each soldier, especially for maintenance of nutrition
and water consumption. It is imperative to stress that leadership and training are important in the prevention
of cold weather injury. Strict adherence to the guidelines found in FMs 21-10 and 31-70 assures an
effective fighting force. Water conservation is essential; however, adequate consumption by the individual
should be enforced.
e. Factors to consider for conducting evacuation in arctic operations include the following:
• Arctic warfare is usually characterized by extended battle zones that increase evacuation
distance and time. Establishing an ambulance shuttle system or PCPs is useful. Augmentation from higher
echelon CHS may also be required to meet the extended evacuation needs.
• Additional supplies of water should be carried by ambulances and maintained at PCPs, if
possible.
• Due to the decreased temperature and frozen environment, ambulance maintenance
requirements are increased. Lubricants must be of the correct viscosity for the temperature. In extreme
cold, batteries perform less efficiently. Consult the specific aircraft maintenance manual for the recom-
mended battery and procedures for extreme cold weather operations.
NOTE
All ambulances are considered deadlined without a functional heater
for the patient compartment.
• The proper storage of medical supplies is essential to prevent loss from freezing.
5-15
FM 8-10-6
• There are few terrain features or road networks; therefore, evacuation routes must be
surveyed and marked over open terrain. At extreme latitudes, operations during the winter months are
conducted in extended hours of darkness. The use of NVG may be required. Compass accuracy is
inconsistent due to a geomagnetic phenomenon. Beacons and homing devices are essential for air navigation.
• Weather is extremely unpredictable. There are too few observers to allow for accurate
assessment of weather patterns. Unfavorable weather conditions cause unexpected delays; therefore, medical
personnel must be prepared to provide survival measures for their patients and themselves.
• Landing zones must be chosen with extreme care in both winter and summer. Blowing
snow mandates instrument-assisted takeoffs and running landings. Landing areas must be correspondingly
larger. The full weight of the aircraft cannot be allowed to settle on the skis until after firm ground
conditions are established. Movement of patients to and from the aircraft is difficult. Where an aircraft
lands is where it stays. A rocking motion, to free the skis prior to lift off, is performed using the cyclic and
antitorque controls.
/. Thorough planning and strict preparation are the keys to survival. Factors to consider include
the following:
• Mud obstacles at noon may become an avenue of approach at midnight.
• Snow complicates all work. Snow-covered terrain hampers reinforcements, muffles
noise, makes cross-country driving hazardous, and creates different camouflage requirements.
• Because of thermal sights, a complete reappraisal of concealment is required.
• Tracks in the snow destroy concealment.
• No soldier is assigned to any job alone. The buddy system is used at all times.
• Anticipate that all maintenance tasks will take twice as long.
• Bare metal can stick to skin or wet garments in subfreezing temperatures.
• Fuel spilled on skin or garments increases the freezing factor; it is one of the greatest
causes of injury in winter operations.
• When operating in the cold, anticipate increased POL needs. Fuel consumption can rise
as much as 25 percent for vehicles operating in deep snow, slush, or mud.
• The recommended fuel for Yukon stoves is diesel.
• Make every effort to warm gearboxes and engines before starting.
• A higher paraffin content is contained in jet petroleum (JP)-5 fuel. At extremely cold
temperatures, the aircraft fuel controls are likely not to work even with preheating.
5-16
FM 8-10-6
• The first consideration in the AO is heat; followed by shelter for sustained work.
• Soldiers need to stand clear of taut cables; steel tends to be brittle and breaks in extremely
cold temperature.
• Fire extinguishers are winterized by adding 15 percent nitrogen to the carbon dioxide.
• Degradation of battery life requires changes as much as six times more frequently than in
a more temperate environment.
• Radio sets are warmed up prior to transmission. The sets may be turned on but should
not transmit for at least one-half hour.
NOTE
Single-channel ground and airborne radio system (SINCGARS) radios
do not require a warm up period.
• Frost shields (such as using the plastic bag in which the batteries are packed) should be
placed over microphones.
• Grounding rods have to be buried horizontally instead of pounded in vertically. Recovery
of stakes and rods placed in the ground is significantly more difficult.
• Flooring is needed in heated areas because of the thawing of the tundra.
• Soldiers must take breaks for water and warmth.
• Static electricity presents a serious safety hazard especially around flammable materials.
g. For additional information, refer to FM 31-70. For aviation-specific information, refer to
FMs 1-202 and 1-400.
5-6. Medical Evacuation in a Nuclear, Biological, or Chemical Environment
a. Medical evacuation and treatment operations are conducted continuously throughout operations
conducted in an NBC environment. The CHS commander must have a comprehensive plan which is
rehearsed on a periodic basis to ensure the timely evacuation and treatment of casualties in an NBC
environment. Techniques and procedures which are essential for operating in a contaminated environment
should be contained in the unit TSOP. The number of casualties and their medical condition, type of
contaminant, the size of the land area contaminated, the expected duration of operation, risk assessment and
acceptable level of risk, and the number of CHS assets (medical personnel, medical units, and evacuation
5-17
FM 8-10-6
vehicles and aircraft) initially contaminated will determine the quantity and type of uncontaminated CHS
resources, if any, which will be introduced into the contaminated environment to ensure timely medical
treatment and evacuation occur.
b. Evacuation of patients in an NBC environment forces the commander to consider to what
extent he will commit evacuation assets to actually enter the contaminated area. Since the combinations of
evacuation methods are nearly endless, the commander has greater flexibility in tailoring an evacuation
system to meet his particular tactical situation and to deal with the NBC environment.
c. On the modern battlefield there are three basic modes of evacuating patients (personnel,
ground vehicles, and aircraft).
(1) In using personnel to physically carry the casualties, the commander must realize the
inherent stress involved. Cumbersome mission-oriented protective posture (MOPP) gear needed in a
contaminated environment (added to climate, increased workloads, and the fatigue of battle) greatly reduces
the effectiveness of unit personnel.
(2) If the commander must send evacuation personnel into a radiologically contaminated
area, he must establish operational exposure guidance (OEG) for the medical evacuation operation.
Radiation exposure records are maintained by the unit NBC NCO and are made available to the commander,
staff, and surgeon. Based on OEG, the commander decides which medical evacuation assets to send into the
contaminated environment.
d. Commanders should make every effort to limit the number of evacuation assets which are
contaminated while still maintaining a timely and effective medical treatment and evacuation operation.
(1) It is expected that a certain number of both ground and air ambulances will become
contaminated in the course of battle. The commander can, therefore, segregate the contaminated ones.
This results in the smallest impact on his available assets and the greatest possibility for continuing the
patient evacuation mission. Optimize the use of resources, medical or nonmedical, which are already
contaminated before employing uncontaminated resources.
(2) Once a vehicle or aircraft has entered a contaminated area, it is highly unlikely that it
will be able to be spared long enough to undergo a complete decontamination. This depends upon the
contaminant, the tempo of the battle, and the resources available. Normally, contaminated vehicles (air and
ground) have restricted use and are confined to dirty environments.
(3) Introducing uncontaminated aircraft into a contaminated area should be avoided,
whenever possible. Ground ambulances should be used instead of air ambulances as long as their use does
not adversely affect the patient's medical condition. Ground ambulances are more plentiful and are easier
to decontaminate. This does not, however, preclude using aircraft in a contaminated environment or in the
evacuation of contaminated patients.
(4) The relative positions of the contaminated area, FLOT, and threat air defense systems
determine if and where helicopters are to be used. The commander may choose to restrict one or more
5-18
FM 8-10-6
helicopters to the contaminated areas and use ground vehicles to cross the line separating contaminated and
clean areas. The ground ambulance can proceed to the receiving MTF with a
…[truncated]