Health service support units must plan, train, and routinely practice mass casualty management. The NBC attack or TIM event will likely be in conjunction with enemy conventional operations. But, the TIM event may be caused by terrorist or belligerent action. There will likely be increased conventional casualties in addition to the NBC/TIM related casualties. The supply and transportation units will be using the MSR in support of the combat commander's requirements; thus, impacting on patient MEDEVAC and HSS unit resupply. Communications will be disrupted. Therefore, HSS C2 must plan and prepare for conducting operations with limited or no communications with other HSS organizations.
Figure 2-1. Sample triage and emergency medical treatment decision matrix.
2-5. Movement/Management of Contaminated Facilities
Operations in a contaminated area require the HSS commander/leader to operate with contaminated or potentially contaminated assets. The following provides guidance in determining how to operate with contaminated facilities:
a. Fulfill Health Service Support Principles. In making his decision to move or continue to operate with contaminated facilities, the commander/leader must apply the principles of conformity, proximity, flexibility, mobility, continuity, and control. The unit's operation must conform to the tactical commander's operation plan (OPLAN). Health service support must be provided to the tactical unit as far forward as possible; this ensures prompt, timely care. Additionally, the HSS commander/leader must be flexible; his support must be tailored to meet the supported commander's OPLAN requirements. Therefore, HSS assets must be as mobile as the unit they support. Finally, the HSS commander/leader must control his assets. Dispersion on the integrated battlefield may enhance unit survivability; but the HSS commander/leader may not be able to maintain control of his assets, they may become compromised.
b. Decision to Move. The HSS commander/leader (when deciding to move his unit to an uncontaminated area or in support of the tactical commander's plan) must base his decision to move on several factors.
(1) Protection available. What type of protection is available in the new area? Will he need to establish the units' collective protection shelter (CPS) systems, or are indigenous shelters available (for example, buildings, tunnels, caves)? Does the unit have sufficient individual protective equipment for unit personnel?
(2) Persistency. If his unit has been in a contaminated area, is the contamination persistent or nonpersistent? Is the area he will move to contaminated or clean? Persistency determines the MOPP level; the degree of threat; and performance decrement caused by the protective measures used. The level of contamination will determine whether employment of CPS is viable. The MTF may be able to continue to operate at the location by employing CPS. Personnel and patient decontamination must be accomplished before processing into the CPS.
(3) Patients. Before moving the entire facility, the HSS commander/leader must consider the number and types of patients at the MTF; his ability to redirect en route patients to the new MTF location; and his ability to evacuate the patients currently on hand. All patients should be stabilized before movement; but, MEDEVAC must be continued.