a. Combat health support (CHS) is provided for the Army in the field in war and peace by the utilization of a variety of medical modules and echelons of care. The medical system is functionally designed to prevent, collect, assess, treat, evacuate, and rehabilitate sick or injured soldiers. The combat health support system is designed to project, sustain, and protect the health of the soldier in war and operations other than war (OOTW). Consistent with strategic and tactical operations, CHS operates across all operational levels, from the forward line of own troops (FLOT) to the continental United States (CONUS) sustaining base. It is a system that provides continuous medical management throughout all echelons of care.

(1) The goals of the Army's CHS system in support of warfighting are to:

(a) Reduce the incidence of disease and nonbattle injuries (DNBI) through sound preventive medicine programs.

(b) Provide medical and surgical treatment for acute illnesses, injuries, or wounds.

(c) Evacuate patients through the echelons of care to the appropriate medical treatment facility (MTF) commensurate with requisite care.

(d) Maintain soldiers on duty or promptly return to duty (RTD) those who have recovered.

(e) Maintain a robust and aggressive science and technology base to enhance all capabilities related to health and the delivery of health care.

(2) These goals are the embodiment of the CHS battle field rules:

(a) Maintain medical presence with the soldier (be there).

(b) Maintain the health of the command.

(c) Save lives.

(d) Clear the battlefield.

(e) Provide state-of-the-art care.

(f) Ensure early return to duty.

b. Combat health support is arranged in levels or echelons of care. Each level of care reflects an increase in capability, yet the functions of each lower level of support are contained within the capabilities of all higher levels. The basic levels of health service support are the unit level, the division level, the corps level, the communication zone (COMMZ) level, and the CONUS support base.

c. The health service support system represents a continuum of care, beginning at the FLOT (forward line of own troops) and ending in the CONUS base. Each soldier is evacuated rearward only to that level of health service support having the medical treatment capabilities necessary to treat that patient's injuries. The objective of health service support in the field is to treat the soldier as far forward as possible and to return him to duty as soon as he is able.

d. Unit and division level medical care organizations are based on a modular design. In the future, modular components will even be employed at the corps and COMMZ level. The system used at the division level and forward is comprised of six basic models as listed below:

(1) Combat medic. This module consists of one medic with a prescribed load of medical supplies and equipment. Combat medics are assigned to the medical platoon or section of the combat support battalions and are attached to the companies of the battalions as required.

(2) Treatment squad. The treatment squad consists of a primary care physician, a physician assistant (PA), and six medical specialists. The squad is trained and equipped to provide advanced trauma management (ATM) to the battlefield casualties. Advanced trauma management is physician or physician assistant directed care. It is designed to resuscitate and stabilize the patient for evacuation to the next echelon of medical care or to treat and return him to duty. Advanced trauma management provides maximum benefit if received within 60 minutes of injury. To maintain contact with the combat maneuver elements, each squad has two emergency treatment vehicles. Each squad can split into two treatment teams. These squads are organic to medical platoons or sections in maneuver battalions and designated combat support units. This module is the building block of the medical company.

(3) Ambulance squad. The ambulance squad module is comprised of four medical specialists and two ambulances. This squad operates in conjunction with the treatment squad. The squad provides patient evacuation throughout the operational continuum and care in route. Each ambulance carries a medical equipment set (MES) that includes intravenous fluids, oxygen, bandages, and splints, as well as other medical supplies and equipment to enable patient monitoring. In conjunction with the treatment squad, there is the capability to acquire a patient within 30 minutes of wounding, treat the patient, and coordinate for the rapid evacuation to the next level of care. Ambulance squads are organic to medical platoons and sections of maneuver battalions and squadrons, selected combat support units, divisional and nondivisional medical treatment companies, and ground ambulance companies of the medical evacuation battalion.

(4) Area support squad. This module is composed of a dental officer, a dental specialist, an x-ray specialist, a laboratory specialist, and associated medical equipment set (MES). The dentist is trained in advanced trauma management to augment the capabilities of the physician and/or physician assistant during periods of increased treatment requirements. The area support squad is organic to medical companies within the brigade support area, division support area, corps support area, or the COMMZ.

(5) Patient holding squad. This module is composed of practical nurses, medical specialists, and a medical equipment set (MES) specifically designed for the mission of the squad. Each squad is capable of providing limited medical support for minimal care patients who are expected to return to duty within 72 hours. Patient holding squads are assigned to a treatment platoon of the medical company.

(6) Forward surgical team. This module is staffed with two surgeons, two nurse anesthetists, a medical/surgical nurse, two operating room specialists, and two practical nurses. The forward surgical team is organized to provide early resuscitative surgery for seriously wounded or injured patients, to save life, and to preserve physical function. Early surgery is performed whenever a likely delay in the evacuation of a patient threatens life or the quality of recovery. This team collocates with the patient holding squad where postsurgical patients awaiting evacuation are held. The forward surgical team provides the required nursing care. Forward surgical teams are organic to the airborne and air assault divisions. All other surgical modules are called detachments and are not organic to these divisions. Forward surgical team members and their equipment can be transported by helicopter or air dropped, allowing for the provision of emergency surgical care.

e. Modular medical support characterizes Echelons I and II. The system standardizes medical subelements within these units. The modular design of the subelements enables the medical resource manager to rapidly tailor, augment, reinforce, or reconstitute the battlefield in areas of most critical need.

(1) The system is designed to provide emergency medical treatment and dental care, advanced trauma management, and routine sick call for soldiers of supported units. The modular medical support system is built around the six modules organic to division and nondivisional CHS units.

(2) It is oriented toward casualty assessment, collection, evacuation, treatment, and initial surgical resuscitation. When effectively employed, it provides assured flexibility, mobility, and patient care capabilities.