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20 May 2010
Financial Management
CHECKLIST
Commanders and staffs participating in multinational operations should be able to answer the following questions with respect to financial management.
FINANCIAL MANAGEMENT
10-19. What are the arrangements to provide or receive multinational support to the local procurement process?
10-20. Who is providing check-cashing funding for finance elements of other nations?
10-21. What are the limitations on the amounts of cash payments (including check cashing) that Soldiers may receive in the AO? Who imposes the limitations?
10-22. How will the multinational force finance support provide currency exchange?
10-23. Will contracted subsistence support to the command affect entitlements to personnel?
10-24. What financial support weapon bounties and claims are needed?
G-8
10-25. Have support agreements been analyzed for financial management implications?
10-26. Has an executive agent been designated?
10-27. Has the financial management appendix to the OPLAN been prepared?
10-28. Have cost capturing mechanisms been established?
10-29. Will financial management support be required for other agencies (such as MWR, ICRC, NGOs, private volunteer organizations, and PA)?
10-30. If necessary, are unique reimbursement procedures through the UN required to capture incremental costs?
10-31. If required, have special appropriations been requested?
10-32. Have procedures been implemented to track multinational support costs and review billing procedures?
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Chapter 11
Health Service Support
HSS plays a key role in developing and maintaining combat power and can be a
major factor in achieving strategic goals. The health services mission is promoting
health, preventing casualties, and providing medical units capable of responding to
the challenging worldwide deployments in multinational operations. How HSS is
delivered in the field may be a factor in a particular nation’s decision to participate.
Differences in medical standards, customs, and training require careful coordination
and planning.
The multinational forces commander must ensure that forces deliver medical care
rapidly, effectively, and efficiently without interfering with the multinational forces mission. Health care is a national responsibility. The command must assess HSS
requirements and capabilities both quantitatively and qualitatively and provide
guidance to enhance the effectiveness of HSS through shared use of assets. Any
medical services that a nation can not provide must be covered by agreements
between national governments of the nations making up the multinational force. This
requires coordinating all HSS assets, providing a detailed health plan, and conducting effective liaison between the senior health service officers of each nation. The
multinational command surgeon plans, coordinates, and synchronizes the HSS plan
based on actual capabilities of contributing nations with standing health agreements
between the contributing nations. The concept of one nation’s forces being treated by another nation’s medical personnel or in another nation’s treatment facilities should be achievable.
PRINCIPLES
11-1. For effective and efficient multinational medical support, personnel must adhere to long established principles. The following principles should be the focus of each nation’s health service: z
Conformity with operations and administrative plans.
z
Proximity to forces being supported.
z
Flexibility to change with the tactical picture.
z
Mobility to maintain contact with supported units.
z
Continuity of treatment through the casualty management system.
z
Protection and prevention to minimize avoidable casualties.
z
C2 of health assets clearly defined at an appropriate level.
For an in-depth discussion of these principles, see FM 8-55 or ABCA Publication 256.
MEDICAL STAFF
11-2. It is necessary to identify a command surgeon early in the process to oversee and coordinate HSS
activities and to advise the multinational forces commander. This surgeon should be involved in all planning and provide a representative to the assessment team. (See Chapter 1.)
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Chapter 11
11-3. The multinational forces surgeon’s office, staffed with representatives from participating nations, must be established to facilitate the development of the HSS plan.
11-4. Specific responsibilities of the multinational forces surgeon during the force generation process include the following:
z
Identifying the HSS assets required to support the planned operation.
z
Determining the disease and nonbattle injury rate for planning purposes.
z
Obtaining the casualty rates from the operations officer.
z
Developing the multinational forces health plan.
z
Exploiting medical intelligence data and information derived from national and other service sources.
z
Advising the multinational forces commander on health risks relevant to the operation.
COMMAND SURGEON
11-5. The command surgeon is responsible to the commander for medical support in the AO. The surgeon should have direct access to the commander as chief medical advisor. He or she must understand the medical capacities and capabilities of all multinational nations. The surgeon should plan to deploy medical personnel early so they can establish, monitor, and evaluate HSS. The surgeon’s staff should have representatives from all nations.
11-6. The surgeon prepares the HSS plan and medical annex to the OPLAN or OPORD. This plan should–
z
Define the scope of medical care to be delivered in detail.
z
Allocate resources.
z
Determine the number of medical personnel required to staff the multinational surgeon’s office.
z
Detail the medical resources required to support the operation.
11-7. The surgeon coordinates HSS provided to or received from multinational forces and the appropriate reimbursements. The surgeon also advises the commander on the following:
z
HSS to the operation.
z
Intratheater rest, rotation, and reconstitution.
z
Preventive medicine.
z
Dental and veterinary medicine requirements.
z
Other medical factors that could affect operations.
11-8. In addition, the surgeon performs the following:
z
Informs the commander on the status of HSS units and assistance required by and provided to the civilian populace and multinational nationals.
z
Reviews health programs of civilian agencies in the AO to determine the feasibility for emergency usage. Advises on humanitarian and civic assistance activities within the AO.
z
Establishes and coordinates a comprehensive medical logistics system for medical materiel, blood, and fluids.
z
Supervises the activities of any medical cells, boards, and centers established by the multinational. For example, he or she would supervise a patient movement center to identify bed space requirements and the movement of patients within and out of the AO.
z
Coordinates medical intelligence support for HSS organizations.
z
Develops a preventive medicine program that–
Includes pre- and post-surveillance programs.
Evaluates infectious disease risks.
Determines the requirements for an entomologist for vector control.
z
Provides technical assistance and advice to the CMOC.
z
Ensures liaison is established with each nation’s surgeon.
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FM 3-16
20 May 2010
Health Service Support
z
Resolves the multinational medical equipment and supply requirement because medical items frequently require long lead-times and special handling.
z
Identifies and coordinates appropriate medical facility accreditation and medical professional certification requirements.
COMMAND AND CONTROL
11-9. As a multinational force matures, the members will centralize their efforts by establishing a lead nation command structure. Subordinate national commands will maintain national integrity. The lead nation command establishes integrated staff sections with the composition determined by the leadership. A national commander commands all elements including the supporting combat HSS system. For command purposes, the commanders normally delegate command of their assigned HSS resources to their senior HSS officer, located in the national support element. At each level of command, the senior HSS officer must possess the right of direct access to the commander on matters affecting the health of the command.
11-10. The command relationships of the HSS components must be clearly defined when the multinational forces are organized. These relationships must be embodied in the command directives issued to each national component commander by the authority creating the multinational force. Operational (technical) control of national HSS resources may be delegated to the senior HSS officer to facilitate overall coordination of resources in the theater of operations. It may not be possible to establish C2 over all participants. Some nations may have specific requirements that limit how much command authority the multinational or national commanders can exercise over their forces. Command in its formal sense may not exist and a system of cooperation may exist in its place.
11-11. During operations, the responsibilities of the senior HSS officer at each level include the following:
z
Advising the commander on the health of the command.
z
Informing the commander and staff on matters affecting the delivery of health care.
z
Developing, preparing, coordinating, and monitoring HSS policy and procedures with
commanders of National Health Service units.
z
Exploiting medical intelligence data and information derived from national and other Service sources.
z
Monitoring the activities of HSS assets assigned to their command.
11-12. The commander and the senior medical officer of each nation must understand the legal limits concerning the use of nonnational medical treatment facilities and supplies, especially blood, by their nations’ forces. Exchanging blood between nations is a sensitive issue and must be coordinated as early as possible. Mutual medical support must be in accordance with existing legal directives. Coordination for any lead nation, role specialization, or ACSA authority must be addressed during the multinational planning process. Casualty evacuation, especially outside the AO, and the use of nonnational medical facilities requires careful planning and an agreement.
PLANNING
11-13. HSS planning is done at all levels. The process aims at developing a system that provides for the best possible use of HSS resources in a given situation. Details of the HSS planning process are contained in ABCA Publication 256. Considerations include the operational situation (commander’s overall mission) and basic medical threat information including endemic diseases and climate appropriate to the theater of operations. Issues specific to the operation also should be identified and considered in planning.
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Chapter 11
11-14. The following factors are normally critical aspects of HSS planning:
z
Mission and type of operation.
z
Operation concept or plan.
z
Anticipated duration of the operation.
z
Evacuation policy from the combat zone to the theater of operations.
z
Selection and consideration of the HSS aim.
z
Health threat assessment, including medical countermeasures.
z
Health surveillance.
z
Provision of casualty estimate by the staff and effects on health care delivery.
z
Availability of and restrictions on resources.
z
Availability and access to HN facilities.
z
C2 requirements and limitations.
THREAT ASSESSMENT
11-15. The medical threat assessment is a composite of ongoing or potential enemy actions and environmental conditions that might reduce the effectiveness of the multinational forces through wounds, injuries, diseases, or psychological stressors.
11-16. The medical threat is a composite of–
z
Infectious disease.
z
Environmental conditions.
z
Occupational health threats.
z
Conventional and irregular warfare.
z
Biological warfare.
z
Chemical warfare agents.
z
Directed-energy weapons.
z
Blast effect weapons.
z
Combat operational stress.
z
Flame and incendiary weapons.
z
Nuclear warfare.
z
Radiological agents.
z
Accidents.
POLICIES AND ISSUES
11-17. Force HSS policies must be established to cover the many facets of HSS in multinational operations. The multinational forces surgeon establishes policies with senior health services officers of contributing nations.
11-18. Subject areas for force policy and coordination include the following:
z
Eligibility for medical care including noncombatants, contractors, displaced persons, refugees, and HN civilians plus appropriate reimbursement for nations.
z
Coordinating HSS provided to or received from the multinational forces or other friendly nations to include using HN facilities.
z
Mass casualty response plan.
z
Establishing liaison with each nation’s surgeon.
z
Medical regulating, to include evacuating casualties to nonnational medical facilities.
z
Policies on medical countermeasures and vaccinations.
z
Policies on the exchange of medical equipment accompanying patients.
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Health Service Support
z
Policies on transferring a patient from one nation’s evacuation system to another.
z
Mechanism for returning patients to their parent nations after medical treatment in another nation’s medical facility.
z
Medical support to detainee/enemy POWs operations and facilities.
z
Establishing an evacuation system for the theater of operations, to include defining the theater’s holding and evacuation policy, mission responsibility, and evacuation control system.
z
Determining HSS reports and returns required, including format, content, and frequency.
z
Clinical documentation, policy format, and the exchange of clinical records that should include the following:
Medical records of the clinical condition with treatment of each patient so that continuing treatment may be related to past events and post-deployment actions.
Information to notify the patient’s next-of-kin.
Information to units for preparing personnel strength returns.
Statistical data for planning purposes and historical records.
Materials for medical research.
Information to track patients whose whereabouts is unknown.
z
Policies on blood supply source, screening standards, storage, and use.
z
Policies on pharmaceutical source, acceptance standards, storage, and use.
z
Policies on sharing and exchange of occupational and environmental health surveillance data.
Data could include:
Air, soil, and water sampling.
Individual or group exposure results.
Any other environmental sampling.
COUNTERMEASURES
11-19. Historically, disease and nonbattle injuries have rendered more Soldiers combat ineffective than actual battle casualties. Countermeasures must be taken to reduce disease and nonbattle injuries. The capability to assess the Soldier’s health continuously and improve Soldier sustainability is required to protect the force.
11-20. The following countermeasures ensure effective force medical protection:
z
A comprehensive medical intelligence system.
z
Continuous health surveillance.
z
Countermeasures, prophylaxis, and immunization policies approved by the multinational forces commander and implemented by all contributing nations.
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Chapter 11
STANDARDS OF CARE
11-21. The multinational HSS must ensure continuity of patient management at a standard acceptable to all nations. Achieving the desired degree of patient management depends on the successful interoperability of treatment principles and clinical policies. As a national responsibility executed under national standards or care and practice, each nation sets medical policy for its Soldiers. As such the multinational commander can not direct a sovereign nation’s armed forces to adopt a different standard for sake of uniformity across his or her command. Patient management is a continuous process of medical care, increasing in complexity by roles (levels) of capability to deal with the clinical needs of the patient. While optimal patient management is never compromised unless dictated by the combat situation, it is also a balance between many conflicting factors. These factors include the following:
z
Treatment.
z
Evacuation.
z
Resources.
z
Environmental and operational conditions.
11-22. Dental support is arranged in levels, reflecting an increase in capability at each succeeding level.
The functions of each lower level of dental support are contained within the capabilities of each higher level. A preventive dentistry program can be provided in the theater of operations.
REQUIRED CAPABILITIES
11-23. The health support plan will address the following HSS functional areas, as described in the ABCA Publication 256:
z
Preventive medicine.
z
Combat casualty care.
z
Hospital, surgical, and dental services.
z
Ground and air evacuation.
z
Stress management.
z
Outpatient services.
z
Veterinary services.
z
Medical nuclear, biological, and chemical considerations.
z
Health surveillance.
z
Medical logistics.
z
Blood.
11-6
FM 3-16
20 May 2010
Health Service Support
CHECKLIST
Commanders and staffs participating in multinational operations should be able to answer the following questions with respect to the HSS portion of the operation.
MEDICAL STAFF
11-24. Has a command surgeon been appointed?
11-25. Are there health services representatives on the assessment team?
11-26. Have contributing nations provided staff or liaison to the multinational forces surgeon?
COMMAND AND CONTROL
11-27. Have national elements appointed senior health service officers?
11-28. Are the C2 relationships of health service assets clearly defined?
11-29. Are there adequate arrangements for coordination and liaison between health service elements?
SUPPORT PLAN
11-30. Does the HSS plan conform to the operation and administrative plans?
11-31. Are all forces in reasonable proximity to HSS?
11-32. What flexibility is there in the HSS plan? Are there health assets available for surge situations?
11-33. Are the HSS assets sufficiently mobile to provide support to the force?
11-34. Will a casualty receive continuous treatment while in the health care system?
11-35. Have the following medical protection issues been addressed:
z
Health threat assessment?
z
Medical countermeasures and vaccination?
z
Health surveillance system?
11-36. Who is entitled to treatment? Are cross-servicing provisions in place?
11-37. What responsibilities do the multinational forces HSS assets have to noncombatants?
11-38. What is the response to a mass casualty?
11-39. How will casualty evacuation be coordinated?
11-40. Are there sufficient evacuation assets?
11-41. How will medical regulations, both in and out of theater, be affected?
11-42. What are the multinational forces obligations and responsibilities under the Geneva conventions?
11-43. What HSS reports and returns will be available to the commander multinational forces?
11-44. What are the arrangements for preventive medicine measures?
11-45. Are there adequate dental services available?
11-46. What provisions are there for combat stress management?
11-47. Who will inspect foodstuffs from a health perspective?
11-48. How will units obtain class VIII supplies?
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Chapter 11
11-49. How will medical equipment get repaired?
11-50. What is the blood supply system?
11-51. Does the support plan include provision of, or access to, limited critical medical equipment such as magnetic resonance imagery?
11-52. Does the support plan identify any unusual Soldier physical screening standards necessary for this operation?
11-53. What are the medical support requirements for detainee operations and facilities?
MEDICAL
11-54. What does the SOFA with the HN state in regards to the use of HN medical facilities for the treatment of U.S. personnel? What is U.S. policy on using HN medical facilities for this specific operational period?
11-55. Are medical facilities identified to support the operation?
11-56. Are chemical weapon threats known? Are troops and medical facilities prepared to cope with their possible use?
11-57. Are procedures in place to service multinational casualties to include recognizing cultural differences in dealing with casualties and procedures and policies for local civilians? Have procedures been coordinated with national commands.
11-58. What are the other multinational element capabilities and procedures for medical evacuation? Do they include air and ground capabilities, both intra- and inter-theater, that multinational forces will be supported by or required to support?
11-59. What are the sources of medical supply and payment options?
11-60. What are the procedures for tracking patients?
11-61. What are the coordination requirements for return-to-duty transportation?
11-62. What forces have organic level I, II, or III combat health support? For those that do not have this support, what level will other multinational forces provide?
11-63. What are the policies and procedures for medical personnel to use on level II through V medical treatment facilities to provide medical treatment for multinational forces?
11-64. Who is eligible for medical care, both routine and emergency, and under what conditions? This must be coordinated with other staff sections.
11-65. What is the blood policy and distribution system? What is U.S. policy for emergency use of blood from other than U.S. sources, such as host nation, for this operational period?
11-66. What is the mass casualty response plan?
11-67. Is there a medical surveillance program to follow disease trends and detect disease outbreaks?
11-68. What is the public health policy?