FM 8-55

CHAPTER 4

PATlENT EVACUATION AND MEDICAL REGULATING

Section I. EVACUATION POLICY

4-1. The Theater Evacuation Policy

a. Before plans can be made to providehospitalization and evacuation, there are certainproblems which must be resolved by commanddecision. One such decision is the evacuationpolicy. It is established by the Secretary ofDefense, with the advice of the JCS, and upon therecommendation of the theater commander. Thepolicy establishes, in number of days, the maxi-mum period of noneffectiveness (hospitalizationand convalescence) that patients may be heldwithin the theater for treatment.

b. This policy does not mean that apatient will be held in the theater for the entireperiod of noneffectiveness. A patient who is notexpected to be ready for RTD within the numberof days established in the theater evacuation pol-icy is evacuated to CONUS or some other safehaven. This is done providing that the treatingphysicians determine that such evacuation willnot aggravate the patient’s disabilities or medicalcondition. Field Manuals 8-10 and 8-10-6 discussthe theater evacuation policy and the intratheaterevacuation policy. Field Manual 8-10 also discussesthe acceptable percentage of fill for availablehospital beds.

c. The evacuation policy has differentmeanings for different personnel. For example:

(1) To the physicians and dentistsengaged in direct patient treatment and decisionsrelating to patient disposition, it means that thereis a maximum period within which clinical staffsmay complete the treatment needed to return thepatient to full duty within the theater. If thetheater policy is 60 days and full RTD can bepredicted within that time, the patient will beretained in the theater hospital system. If the

patient cannot be returned to full duty within 60days, the patient will be evacuated out-of-theateras early as clinically prudent. Once the clinicaljudgment has been made, the patient should beallowed to recover enough to endure the evacuation.

(2) To the HSS planner, it meansthat he can compute the beds required in thetheater if given the evacuation policy and otherplanning factors. (See Chapter 5.) This can betranslated into the type, mix, number, anddistribution of hospitals required in the theater.

(3) To the nonmedical logistician, itmeans, in part, that he can estimate his totalobligation to support this system.

(4) To the United States Air Force(USAF) planner, it means that he can plan ac-curately for USAF AE requirements for both intra-and intertheater patient movements.

(5) Finally, to the HSS operator, itmeans that he has a management tool, whichwhen properly adjusted and used, will provide thebalance between patient care and tactical supportrequirements. The HSS operator will be able totailor a HSS package specifically designed to handlepatient work loads, with maximum benefit to thepatients and with maximum economy of availableresources.

4-2. Factors Determining the EvacuationPolicy

The following factors are used in determining theevacuation policy:

a. Nature of Tactical Operations. Amajor factor is the nature of the combat operations.

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Will they be operations of short duration and smallmagnitude? Will they be operations of long dura-tion and heavy magnitude? Will NBC/DE weaponsbe employed? Will only conventional weapons beused? Is a static combat situation expected?

b. Number/Type of Patients. Anotherfactor is the number and types of patients anti-cipated and the rate of patient RTD. Admissionrates vary widely in different geographical areasof the world and in different types of militaryoperations. Chapter 5 discusses historical data onadmission rates under varying geographical,climatic, and organizational conditions.

c. Evacuation Means. An importantfactor is the means (volume and type of trans-portation) available for evacuation of patients fromthe TO to the CONUS.

d. Availability of Replacements. An-other important consideration is the capability ofCONUS to furnish replacements to the theater.For each patient who is evacuated from the theaterto CONUS, a fully trained and equipped replace-ment must be provided. During a small-scaleconflict overseas, CONUS replacement capabilitywould be much greater when compared to a large-scale conflict such as World War II.

e. Availability of In-Theater Resources.Limitations of all HSS resources such as insufficientnumbers and types of HSS units in the COMMZ tosupport the CZ and an insufficient amount ofhealth service logistics and nonmedical logisticswill have a definite impact on the evacuationpolicy. The amount and timing of engineering sup-port is also a consideration. The more limitations(or shortages), the shorter will be the theaterevacuation policy.

4-3. Impact of Evacuation Policy onHealth Service Support Requirements

a. A short theater evacuation policy—

• Results in fewer hospital bedsrequired in the theater and a greater number ofbeds required elsewhere.

• Creates a greater demand forintertheater Air Force evacuation resources. (Ashortened intratheater evacuation policy wouldlikewise increase the number of airframes requiredin the theater.)

• Increases the requirements forreplacements to meet the rapid personnel turnoverwhich could be expected, especially in combatunits. (The impact this would have on both intra-and intertheater transportation and other require-ments must also be considered.)

b. A longer theater evacuation policy—

Ž Results in a greater accumu-lation of patients and a demand for a largerHSS structure in the theater. It decreases bedrequirements elsewhere.

Ž Increases the requirements formedical materiel and maintenance (health servicelogistics) and nonmedical logistics support.

• Increases the requirements forhospitals, engineer support, and all aspects of basedevelopment for HSS. (It demands the estab-lishment of a larger number of hospitals in theCOMMZ. Regardless of the construction stipulated,the number of man-hours and materials requiredmust be considered.)

Ž Provides for a greater proportionof patients to be returned to duty within thetheater, and thus reduces the loss of experiencedmanpower.

4-4. Adjustments to the Evacuation Policy

When patients are received at a rather constantrate, the evacuation policy at a specific echelon

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may be adjusted to retain or RTD those patients of patients admitted in the CZ are evacuated to thewho do not require specialized treatment in COMMZ much earlier than under average condi-COMMZ general hospitals (GHs). However, when tions. The displacement of hospitals temporarilyincreased patient loads are anticipated, the reduces the number of beds available and mayintratheater evacuation policy must be adjusted to result in a greater number of patients beingmake additional beds available for current and evacuated out of the CZ during the period ofanticipated needs. As a result, a larger proportion relocation.

Section II. MEDICAL EVACUATION

4-5. Evacuation Tenets

a. Patient evacuation is the timely andefficient movement of wounded, injured, or illpersons from the battlefield and other locations tothe MTFs. Evacuation begins at the locationwhere the injury or illness occurs and continues asfar as the patient’s medical condition warrants orthe military situation requires. Medical personnelprovide en route medical care during patientevacuation.

b. Service component commanders areresponsible for evacuation of patients within theirAOR.

c. The unified commander is responsiblefor issuing procedures for evacuation of formerlycaptured or detained US military personnel.

d. The unified commander will issueprocedures for evacuation of EPW and civilianinternees, other detainees, and civilian patients.(See FM 8-10 for discussions on the GenevaConventions. The Conventions contain manyprovisions which are tied directly to the HSSmission. Also, see AR 190-8 for disposition of anEPW after hospital care.)

(1) Sick, injured, or wounded EPWare treated and evacuated through normal medicalchannels, but remain physically segregated fromUS and allied patients. Helmets, gas masks, and

like articles issued for personal protection willremain in the possession of each individual. Enemyprisoners of war are evacuated from the CZ as soonas possible. Only those sick, injured, or woundedprisoners who would suffer a great health risk bybeing evacuated immediately may be treatedtemporarily in the CZ.

(2) The MTF commander is re-sponsible for the treatment of sick, injured, orwounded EPW patients. The echelon commanderis responsible for the security of EPW patients.(See FM 19-40 for further information concerningEPW evacuation and control. Also, see FM 19-4 fora discussion on EPW operations.)

e. Procedures and policies for evacuationof injured and sick military working dogs (MWDs)will be issued by the unified commander.

f. Army aeromedical evacuation unitsmust be able to communicate with other Servicehospitals.

4-6. Planning for Patient Evacuation

a. Planning patient evacuation involvesconsidering all available forms of transportationand providing appropriate HSS personnel in theevacuation system to assure continuity of patientcare. It also involves planning the routing, con-trolling evacuation movements, and planning the

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location of evacuation facilities. Patient collectingpoints, ambulance exchange points, and anambulance shuttle system (ambulance loadingpoints, ambulance relay points, and ambulancecontrol points) must be planned. Thoroughinvestigation of all the available lines ofcommunications is an essential prerequisite tosuch planning. Field Manual 8-10-6 provides acomprehensive discussion on medical evacuationin support operations across the operationalcontinuum.

b. The AMEDD does not have dedicatedfixed-wing aircraft for evacuation of patients fromthe CZ to the COMMZ or from the COMMZ to theCONUS. (See paragraph 4-23a, b, and c.) Foradditional means of evacuation, coordination mustbe effected with—

Ž The particular Service control-ling aircraft and ships.

• The transportation commandcontrolling the locomotive power for trains andother forms of transportation.

c. Coordination with other Services andcommands is usually accomplished through medicalregulating (MEDREG). The surgeon, however,must forecast the requirements for air and surfaceevacuation so that coordination for its procurementmay be done in advance of the need. Aircraft arerequested on the basis of anticipated needs and tomeet emergencies such as those occurring innuclear warfare where CZ hospitals are suddenlyfilled to capacity.

4-7. Evacuation Means

a. The USAF Airlift System is primarilyresponsible for moving patients from the CZ to theCOMMZ, within COMMZ, and from COMMZ toCONUS. (See paragraph 4-24.) If movementrequirements exceed the capability of the USAFAE system, the MEDCOM medical regulating

officer (MRO) may have to seek alternative modesof transportation. (See paragraph 4-17h.) He maytask the MEDCOM's medical battalion (evacuation)(see paragraph 4-20) for movement of patients byArmy aircraft or ground ambulances.

b. In addition to using ground evac-uation when the USAF AE system cannot supportthe number of patients requiring air evacuation,there are other factors that may require the use ofground evacuation from the CZ to the COMMZ.Some reasons for evacuating patients by groundtransportation are the following:

(1) Tactical considerations that pre-vent the use of aircraft for patient evacuationduring certain periods.

(2) Patients who cannot be evac-uated by air.

(3) Weather conditions.

(4) Lack of adequate or properly lo-cated airfields.

(5) Insufficient numbers of aircraftavailable.

c. When patient evacuation by air fromthe CZ to the COMMZ is not possible or appropriate,field or bus ambulances from medical ambulancecompanies assigned to the medical battalion (evac-uation) of the COMMZ medical brigade, MEDCOM,may be used.

d. If air or ground ambulances must beused to transport large numbers of patients to orwithin the COMMZ, the MEDCOM MRO mustobtain clearance through the TA movement controlcenter (MCC), which is an agency of the TAtransportation command. This agency coordinatesand controls the movement of Army aircraft andground transportation within the theater. Whencapabilities are exceeded, the MCC coordinatesrequests for additional air and ground resources.

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It also obtains the necessary clearances to supportthe mission from the CZ.

e. Modern warfare is likely to generatemore casualties than the airlift system can handle.Surface evacuation is then a possibility. It ispossible that, under certain circumstances, patientsmay be returned to CONUS by surface vesselrather than by air. Such transportation is theresponsibility of the Military Sealift Command(MSC) (paragraph 4-23b). Deliberate plannersshould strive to make requirements estimatesknown so that MSC planners are able to providemedical evacuation. The MEDCOM MRO would

be responsible for coordinating the evacuationrequirements. After coordination is complete, theMEDCOM establishes patient-holding facilities atCOMMZ ports. Patients would be delivered tothese facilities and held until loaded aboarddesignated ships. Once in CONUS, patients wouldnormally be taken to the nearest Air MobilityCommand (AMC) terminal for further airlift todestination hospitals.

f. Table 4-1 lists the types of trans-portation usually available to the AMEDD for theevacuation of patients within a TO and shows theirpatient-transporting capacity.

Table 4-1. Evacuation Capabilities (United States Forces)

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Table 4-1. Evacuation Capabilities (United States Forces) (Continued)

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Table 4-1. Evacuation Capabilities (United States Forces) (Continued)

Section Ill. CALCULATION OF PATlENT EVACUATION REQUIREMENTS

4-8. Methodology 4-9. Time Factors

This section presents a methodology for calculating The following are time factors for evacuation ofthe time and the number of units of transport patients (including loading and unloading):required to evacuate a given number of patients, orto support a specific operation. a. Litter Squads.

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(1) Average terrain, four-personsquad—900 meters and return in 1 hour.

(2) Mountainous terrain, six-personsquad—350 meters and return in 1 hour.

b. Ambulance (wheel and track vehicle).During combat in the division area—eight kilo-meters and return in 1 hour (optimal weather andterrain).

c. Aircraft.

(1) Helicopter—150 kilometers one-way in 1 hour (based on the operational capabilityand patient-loading ease of UH-1V/H helicopter).

(2) Transport—360 kilometers one-way in 2 hours (based on 1 1/2 hour mission forC-130E aircraft and 30 minutes patient-loadingtime).

(3) Army airplane—200 kilometersone-way in 1 hour (based on the operational cap-ability of U-21 aircraft, including patient-loadingtime).

4-10. Computations

a. The following formulas may be usedto calculate the time and the number of units oftransport required to evacuate a given number ofpatients:

(1) Time required:

T = N X tU X n

(2) Units required:

U = N X tT X n

Nto be evacuated.

nported in one load.

T

tround-trip.

U

= Total number of patients

= Number that can be trans-

= Total time.

= Time required for one

= Number of units of trans-port (litters, ambulances, and aircraft).

b. The amount of evacuation resourcesrequired to support a specific operation may becalculated by using the following formula for eitherWIA or DNBI patients: (See paragraphs 4-11 and4-12 for example problems and solutions. )

(A X B) X E = ambulance require-C ments by type per day.D

where:

A = The total patients (WIA orDNBI) generated for a specific operation per day.This figure may be calculated using projectedfigures for the specific AO. Admission ratescontained in Chapter 5 reflect experience factorsderived from past wars. These figures may be usedas bottom-line planning factors only.

B = The percentage of those pa-tients in A, above, requiring evacuation. Normally,this figure will exceed 100 percent as a recognitionof the fact that many patients will need to be movedmore than once. The number of times a patient willbe moved will depend on many factors. In assigninga specific percentage as a planning factor, the HSSplanner must consider—

Ž Terrain.

• Force structure.

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• Enemy weapons systems.

• Weather.

• Airfield or seaport loca-tions.

• Other factors affectingpatient flow.

C = The average number of patientsmoved by a means of evacuation. The figure willvary depending on the type of ambulance (groundor air), or the specific model of vehicle.

D = The average number of mis-sions a particular evacuation vehicle can completeper day.

E = The dispersion allowance forthe specific types of evacuation vehicles in theformula. The dispersion allowance is a recognitionthat a specific percentage of vehicles in the forcewill be unavailable for missions due to maintenance,crew rest, combat loss, or replacement lag time.The HSS planner will determine the specificpercentage used by reviewing maintenance his-torical data and considering the threat in terms ofthe enemy, terrain, and weather. To convert thedispersion allowance into a factor, see Table 5-1,Chapter 5.

4-11. Example Problems

To determine the requirements for air or groundevacuation resources to support a specific operation,you, as the HSS planner, have determined in-formation necessary to compute this problem.Complete the calculations for air or groundevacuation vehicles by using formulas provided inparagraph 4-10B. Compare the answers to thesolutions provided in paragraph 4-12.

a. Using the information below, cal-culate air ambulance requirements. (See paragraph4-10B for formula application.)

(1) Type of patients:

• DNBI 413.

• WIA 588.

(2) Patients by type requiring airevacuation:

• DNBI 120 percent.

Ž WIA 180 percent.

(3) Average number of patientsper mission: 3.

(4) Average number of missionsper helicopter per day: 11.

(5) Dispersion allowance: 30 per-cent.

b. Using the following information,calculate ground ambulance requirements:

(1) Type of patients:

Ž DNBI 413.

Ž WIA 588.

(2) Patients by type requiringground evacuation:

Ž DNBI 130 percent.

Ž WIA 70 percent.

(3) Averageper trip: 2.

(4) Averageday per ambulance: 6.

number of patients

number of trips per

(5) Dispersion allowance: 35 per-cent.

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4-12. Example Solutions

a. Calculate air ambulance requirements:

(1) Type of patients:

• DNBI 413X 1.20

496 Patients re-quiring air evacuation.

• WIA 588X 1.801,058 Patients re-

quiring air evacuation.

• DNBI 496WIA + 1,058

1,554 Total pa-tients requiring air evacuation.

(2) 1,554 / 3 patients per mission =518 missions.

(3) 518 / 11 missions per day = 47helicopters.

(4) 47 X 1.43 dispersion factor =67 helicopters.

b. Calculate ground ambulance require-ments:

(1) Type of patients:

• DNBI 413X 1.30

537 Patients re-quiring ground evacuation.

• WIA 588X .70

412 Patients re-quiring ground evacuation.

Ž DNBI 537WIA + 412

949 Total pa-tients requiring ground evacuation.

(2) 949 / 2 patients per trip =475 trips.

(3) 475 / 6 trips per day = 79ambulances.

(4) 79 X 1.54 dispersion factor =122 ambulances.

Section IV.

4-13. Casualty Management System

MEDICAL REGULATING

to avoid increased morbidity and mortality. Seediscussions in FMs 8-10, 8-10-3, and 8-10-6.

Medical regulating is a casualty managementsystem designed to coordinate the movement ofpatients from site of injury or onset of disease 4-14. Planning for Medical Regulatingthrough successive echelons of medical care to anMTF that can provide the appropriate medical a. If patients occurred at regular inter-care and treatment. Prompt movement of patients vals, in constant numbers, at predeterminedto the required level of professional care is necessary locations, and with predictable injuries, their

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evacuation would require little or no MEDREG.Since these circumstances never occur, MEDREGis a vital support factor which must be employed inthe most effective manner possible.

(1) Coordination. The MEDREGsystem operates worldwide to regulate themovement of patients from the US Army, USNavy, and USAF to appropriate MTFs or medicaltreatment elements (MTEs). While the concept ofMEDREG is simple, its execution becomes quitecomplex for the following reasons:

(a) It involves all three mil-itary services, thus requiring careful and detailedcoordination.

(b) Patients require contin-uous medical care during all phases of evacuation.

(c) The AMEDD does not haveits own long-range evacuation means; therefore,close coordination with the Services providingtransportation is required.

(2) Control. The MEDREG systemis under the technical control and supervision ofMROs assigned to all medical command and controlheadquarters above battalion throughout the TA.These officers plan and coordinate with the variousorganizations and agencies who participate in theMEDREG system. Many factors must be consideredin controlling the movement of patients. Theprimary factor is the tactical situation. Conditionsare seldom static, and success in achieving thecombat mission must remain the primary goal ofboth combat and CS units. Tactical MEDREG iscontrolled by Service MROs; theater MEDREG iscontrolled by the theater JMRO or AJMROs; andCONUS MEDREG is controlled by the ASMRO.

b. Patient management, therefore, is adynamic decision-making process which must beapplied throughout all echelons of medical care. Itdoes little good to move a patient from one point to

another if the receiving point is not prepared tohandle him. Effective patient regulating mayprove to be as big a problem as medical evacuation.For example, patients may not be regulated to a296-bed combat support hospital (CSH) with 150empty beds. Why? There may be many factorsthat may impede this regulating. Other factors, inaddition to the tactical situation, which influencethe scheduling of patient evacuation include—

(1) Availability of transportation.

(2) On-hand patient mix, specialtycapabilities, Class VIII status, medical equipmentstatus, staffing status, associated supply items ofother equipment status, pending displacement ofMTFs, or locations of MTFs.

(3) The current bed status of MTFs(beds occupied/not occupied).

(4) Surgical backlog of each facility.

(5) Number and location of patientsby diagnostic category.

(6) Location of airfields or seaports.

(7) Condition of each patient. (Is thepatient sufficiently stabilized to withstand travel?)

(8) Communications capabilities.

4-15. Wartime Regulating

a. The wartime regulating and/orevacuation of patients between the second andthird echelons of care MTFs are the responsibilityof the Service component (Army, Navy, or AirForce) commander. In the CZ, the Service com-ponents are responsible for evacuation of patientsfrom an injury site to the nearest MTF.

b. In the CZ where patients are trans-ferring between facilities of the same Service and

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these facilities do not support other Services, theJMRO is not assigned regulating responsibility.(Component Service MTFs may be required tosupport patients from other Services in the CZ.Service MROS must, therefore, ensure there issecure communication and coordination betweenService MROS in the CZ.) The regulating ofcasualties from the third to fourth echelon and thesubsequent regulating from the theater to CONUSis accomplished jointly by JMRO and the ASMRO(paragraph 4-19).

4-16. Intratheater Medical Regulating

a. The medical brigade and group com-manders assign missions to their subordinatehospitals and evacuation units in support of thecommitted divisions. This establishes an antici-pated flow of patients from the division medicalcompanies to the CSHs or mobile army surgicalhospitals (MASHs) at the corps. Through periodicand “spot” reports, the medical brigade MRO,assisted by medical group MROs, further controlsthe movement of patients to prevent the overloadingof individual hospitals.

b. The patient disposition and reportsbranch, division medical operations center(DMOC), division support command coordinateswith the medical group MRO who regulates thepatients from the division’s AO. The divisiontracks patients rather than regulates them. Theexception to this is when the DMOC, in coordinationwith the medical group and medical brigade MROs,regulates patients directly to the MASH, but thisis not a routine procedure.

c. The formal joint MEDREG systembegins in the hospitals assigned to the corps.

(1) On a daily basis, physiciansidentify those patients who cannot be returned toduty within the established evacuation policy andare sufficiently stabilized to withstand movementto a COMMZ hospital.

(2) This information is reported byeach patient care unit (ward) to the patient ad-ministrator (PAD).

(3) The PAD in each hospitalnormally performs the MEDREG function.

(a) He assembles all pertinentinformation from the patient-care units (wards)and transmits a consolidated report to the MRO ofthe medical group/brigade headquarters to whichthe hospital is attached. This report is, in effect, anevacuation request. It should contain, as a min-imum, the following information.

• Number of patientsby clinical service such as surgical, medical, andneuropsychiatric.

Ž Number of patientsby transportability categories: litter and ambu-latory.

• Patient status suchas active duty (AD) military, US civilian, EPW, ornoncombatant evacuees.

This required information identifies hospital bedrequirements, clinical specialty requirements,loading configuration for transportation, specialhandling requirements of patients, and requestedevacuation date and time.

(b) The PAD is also respon-sible for keeping his next higher MRO apprised ofcurrent beds available and clinical service status.

(4) Thequarters—

(a)the attached hospitals.

(b)

MRO at group head-

Receives the reports from

Consolidates the reports.

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(c) Designates patients to sub-ordinate hospitals and tasks subordinate medicalevacuation units for assets to transfer patients.

(d) Forwards a consolidatedrequirements report to the medical brigade MROfor coordination of MEDREG for patient evacua-tion from the medical group facilities to thesupporting MTFs in the COMMZ.

(e) Indicates desired MASFfor patients being evacuated via air transportation.

(f) Keeps the brigade MROinformed of current beds available and clinicalservice status.

(g) Monitors bed status re-ports from hospitals under his span of control.

(5) The MRO at the medical brigadeheadquarters in the CZ–

(a) Provides medical regula-tion of patient movement to and between assignedand attached MTFs, designates receiving hospitals,and notifies subordinate MROs who disseminatethe information to the hospital PADs, or coordinatethe evacuation resources for the transfer. If patientswithin the CZ are being regulated to other ServiceMTFs, an AJMRO will be established who willregulate patients between Service MROs.

(b) Consolidates the reportsfrom all groups within the corps and transmits(submits) a consolidated report on the remainingrequirements (those patients requiring regulatingto COMMZ hospitals) to the MRO at the MEDCOMheadquarters.

(c) Keeps the MEDCOM MROinformed of current beds available and clinicalservice status.

d. Medical regulating within the COMMZis similar to the system described within the CZ.Attending physicians in field hospitals (FHs)identify patients to be evacuated to GHs, andPADs consolidate requests within their hospitalsfor submission to the medical brigade MRO. (ThePAD is also responsible for keeping his next higherMRO informed of current beds and clinical servicestatus.) Brigade MROs further consolidate therequests of patients requiring evacuation fromsubordinate hospitals and forward them to theMEDCOM MRO.

e. The MEDCOM MRO consolidates allreports of patients requiring evacuation fromsubordinate MROs and submits them to the JMRO.The JMRO consolidates the patient evacuationrequests from all Services—Army, Navy, and AirForce—within the theater. He then compares therequests to the current bed status reports fromCOMMZ hospitals to identify receiving hospitals.(This comparison enables the JMRO to assureavailability of adequate beds for current andanticipated needs, route patients requiring spe-cialized treatment to the proper MTFs, and effectan even distribution of patients in COMMZhospitals.) The JMRO designates MTFs in theCOMMZ to receive the patients identified forintratheater evacuation. The JMRO will then no-tify the CZ medical brigade MRO and the COMMZMEDCOM MRO of the regulating decision. TheJMRO, therefore, regulates the flow of patientsregardless of Service throughout the theater,assuring the efficient use of theater hospital beds.

f. Depending upon the distance betweenhospitals, patients may be evacuated by Armyevacuation means, or by Air Force aircraft. TheMEDCOM MRO coordinates through the AELT(paragraph 4-24b) to the AECC (paragraph 4-24a)for USAF evacuation flights from the CZ to theCOMMZ. (See subparagraph 4-17 f through l. Hecoordinates Army medical evacuation by taskingsubordinate evacuation units. Large groundmovements must be coordinated through the MCC.

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4-17. Intertheater Medical Regulating

a. Many of the patients treated atCOMMZ hospitals are returned to duty within thetheater. Others, however, cannot be returned toduty within the theater evacuation policy andmust be evacuated to the CONUS. The reportingof these patients for evacuation is as previouslydescribed—from attending physician to patientadministration officer, through the COMMZ bri-gade MRO to MEDCOM MRO, consolidated ateach headquarters. The MEDCOM MRO submitsthe consolidated request for CONUS evacuationfrom the COMMZ hospitals to the JMRO.

b. The JMRO coordinates the evacuationrequirements for CONUS beds with the ASMROwho is located in CONUS. Paragraph 4-19 discussesthe ASMRO.

c. The ASMRO consists of represen-tatives from the Army, Navy, and Air Force. TheASMRO will direct the distribution of patients intoCONUS hospitals.

d. In the event no JMRO has been estab-lished because multiple services are not providingEchelon IVHSS, the MEDCOM MRO assumes thefunctions of the JMRO.

e. When the ASMRO provides theJMRO with CONUS hospital designations, theJMRO disseminates this information to theMEDCOM MRO (and to the MROs of other Servicecomponents).

f. The MEDCOM MRO requests airtransportation through the AELT to the AECC forevacuation flights from the CZ to the COMMZ andfrom the COMMZ to the CONUS.

g. The AECC coordinates the AE re-quirements with aerial resupply missions into theCZ. To the maximum extent possible, retrograde

tactical aircraft are used for AE missions. Whenrequired, special mission aircraft may be allocatedto accomplish the mission. After coordination iscomplete, the AECC furnishes detailed flightschedules to the MEDCOM through the AELT,indicating on-load and destination airfields,number of patients to be moved, and the Air Forcemission numbers of the aircraft.

h. When the MEDCOM MRO receivesthe information from the AECC through the AELT,he, in turn, disseminates the information to sub-ordinate MROs. If movement requirements exceedthe capability of the AE system, the MEDCOMMRO may have to seek alternative modes oftransportation.

i. Communications zone medical bri-gade and CZ medical brigade/group MROs informtheir MTFs of the number of patients to beevacuated from each departure airfield, the missionnumbers of the evacuation aircraft, and the arrivaland departure time of the aircraft. They alsodesignate ambulance units to support each hospitalin moving the patients.

j. Each facility, supported by designatedambulance units, then moves its patients to theappropriate departure airfield(s). At designatedcorps airfields, the USAF AE squadron operates aMASF (subparagraph 4-24d) to hold patientspending loading on aircraft. These holding facilitiesare limited so the time frame during which patientsmust arrive at the MASF is generally limited to noearlier than 3 hours prior to the aircraft’s arrivalor no later than 1 hour prior to departure.

k. Once patients are delivered to theMASF (subparagraph 4-24d), the Air Force assumescontrol of them until they are off-loaded at thedestination airfield. If for some unforeseen reason,AE aircraft is not available, the originating MTFwill pick up the patient and provide medical careuntil the next scheduled flight. At the COMMZairfield, the patients are off-loaded from the C-130

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aircraft, placed on Army vehicles, and transportedto the destination GH.

l. In the COMMZ, the Air Force operatesan ASF (subparagraph 4-24e) at each AMC terminalused for AE. If for some unforeseen reason, AEaircraft is not available, the originating MTF willpick up the patient and provide medical care untilthe next scheduled flight. When the patients aredelivered to the ASF, AMC assumes responsibilityfor their care.

m. On arrival in CONUS, patients willgenerally be held for 24 to 36 hours in the ASF atthe aerial port of debarkation. Then they willnormally be loaded aboard C-9 aircraft for furthermovement to destination airfields, where they willbe met by medical personnel (of their respectiveServices, if possible) and moved by an appropriatemeans to their destination hospitals.

4-18. Joint Medical Regulating Office

a. The JMRC is a joint agency, consistingof elements of two or more Services, established toregulate the movements of patients, within a TOto MTFs having the capabilities to provide thenecessary care. It also coordinates the movementof patients to CONUS with the ASMRO. TheDefense Medical Regulating Information System(DMRIS) is used within the Pacific and EuropeanCommands to communicate patient regulatinginformation to ASMRO. Many of the fixed MTFsin both theaters are connected to DMRIS tocommunicate with JMRO and ASMRO.

b. The JMRO functions as part of theunified command surgeon’s section. It consists ofa Medical Service Corps officer and enlistedadministrative specialists from all Services.Composition varies from unified command tounified command. Personnel include both perma-nently assigned staff and Reserve augmentationand personnel provided by components. The com-

mand surgeon may establish subunified commandJMROs and AJMROs to provide regional reg-ulating.

c. Specified duties of the JMRO are asfollows:

(1) To develop and recommend tothe unified command surgeon overall policies,procedures, and guidance for reporting medicalevacuation requirements.

(2) To maintain direct liaison withthe ASMRO, MEDREG offices of component Ser-vices, transportation agencies which furnish evac-uation transportation, and the component surgeons.

(3) To coordinate with the unifiedcommand surgeon in determining bed availability.

(4) To obtain reports of availablebeds from the surgeons of component Servicesaccessible to the JMRO.

(5) To accept requests for beds fromthe Service regulating officers.

(6) To identify facilities to receivepatients requiring medical care at another MTF.

(7) To coordinate with ASMRO forbeds at CONUS MTFs for patients requiringmovement out of the TO because estimatedhospitalization will exceed the theater’s establishedevacuation policy.

(8) To obtain, consolidate, anddisseminate current and projected estimates ofevacuation requirements within the joint forceand to CONUS. In the COMMZ and CZ, theAJMRO needs the evacuation requirements. ForCONUS-bound evacuees, the ASMRO and theCommander, JTF for CONUS Medical Mobil-ization, as a minimum, also need this information

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to provide beds and transportation from the theaterto CONUS medical facilities.

4-19. Armed Services Medical RegulatingOffice

The ASMRO is a joint agency operatedby the Chief of Staff, USAF, as executive agent forthe JCS, and subject to the direction, control, andauthority of the JCS. The ASMRO performs asupporting role to the combatant commands.

NOTE

The ASMRO is pending reorganizationunder US Transportation Command(USTRANSCOM). When the reorgan-ization is effected, it will be a direct

reporting unit of the USTRANSCOM.It will continue to perform a supportingrole to the combatant commands.

b. The ASMRO regulates patients fromTO based on requests from a JMRO or otherdesignated reporting activity to CONUS MTFscapable of providing the required level of care.In making the regulating decisions, the ASMROcoordinates with the USTRANSCOM to makeoptimum use of transportation assets. TheASMRO is also responsible for MEDREG withinCONUS. To accomplish the MEDREG mis-sion, ASMRO maintains continuous liaison withthe joint force JMRO. The ASMRO regulatespatients using the DMRIS (in peacetime andwartime) and the automatic digital network(AUTODIN). When authorized by ASMRO, othermeans of communications such as facsimile andtelephone may be used.

Section V. MEDICAL EVACUATION UNITS

4-20. Medical Battalion (Evacuation), TOE08-446L000

a. Mission. This unit provides commandand control of air and ground medical evacuationunits within the TO.

b. Assignment. The medical battalion(evacuation) is assigned to the TA MEDCOM orcorps medical brigade. It is normally furtherattached to the medical brigade in the COMMZ ormedical group in the corps.

c. Capabilities. This unit provides—

• Command and control and su-pervision of operations, training, and admin-istration of a combination of three to seven assignedor attached medical companies (air ambulances,

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TOEs 08-447L100 [UH-1] and 08-447L200 [UH-60], and ground ambulance, TOE 08-449L000).

• Staff and technical supervisionof aviation operations, safety, and aviation unitmaintenance (AVUM) within attached air am-bulance companies.

• Coordination of medical evacu-ation operations and communications functions ona 24-hour, two-shift basis.

Žtached units.

Žmedicine.

Medical supply support to at-

Echelon I HSS and aviation

d. Basis of Allocation. One medicalbattalion (evacuation) is allocated per combination

FM 8-55

of the following units: three to seven medicalcompanies, air ambulance and/or ground am-bulance.

4-21. Medical Company (Air Ambulance)(UH-1V or UH-60A Aircraft), TOE08-447L100 and TOE 08-447L200

a. Mission. The mission of the medicalcompany (air ambulance) is to provide AE andsupport within the TO.

b. Assignment. The medical company(air ambulance) is normally assigned to the medicalbrigade and is normally further attached to theheadquarters and headquarters detachment(HHD), medical battalion (evacuation).

c. Capabilities. This unit provides—

• Fifteen helicopter ambulancesto evacuate patients consistent with evacuationpriorities and operational considerations, frompoints as far forward as possible to Echelon II andIII MTFs.

• Air crash rescue support, lessfire suppression in combat search and rescueoperations.

• Expeditious delivery of wholeblood, biologicals, and medical supplies to meetcritical requirements.

Ž Rapid movement of medicalpersonnel and accompanying equipment andsupplies to meet the requirements of MASCALsituations, reinforcement, and/or reconstitution,or emergency situations.

Ž Movement of patients betweenhospitals, ASFs, MASFs, seaports, or railheads inboth the corps and COMMZ.

d. Basis of Allocation. This unit isallocated on the basis of—

• 1.0 per division supported.

Ž 0.333 per supported separatebrigade or ACR.

• 1.0 per two divisions supported(general support).

• 1.0 per theater in support ofhospital ships.

NOTE

Communications zone rules for allo-cation of units are derived from theCINC or theater commander based onthe unit’s mission requirements andgeographical dispersion.

4-22. Medical Company (Ground Ambu-lance), TOE 08-449L000

a. Mission. The mission of the medicalcompany (ground ambulance) is to provide groundevacuation of patients within the TO.

b. Assignment. The medical company(ground ambulance) is assigned to the medicalbrigade and further attached to an HHD, medicalbattalion (evacuation) for command and control.

c. Capabilities. This unit provides—

• Truck ambulances with a single-lift capability for evacuation of 160 litter patientsor 320 ambulatory patients.

• Evacuation of patients fromdivision medical companies to CZ hospitals.

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• Evacuation of patients from areasupport medical companies to supporting hospitals.

Ž Reinforcement of division med-ical company evacuation assets when required.

Ž Reinforcement covering force anddeep battle operations.

• Movement of patients betweenhospitals and ASFs, MASFs, seaports, or railroadsin both the corps and COMMZ.

Ž Area evacuation support beyondthe capability of the area support medical battalion.

• Emergency movement of med-ical supplies.

d. Basis of Allocation. This unit isallocated on the basis of–

Ž 0.333 per separate brigade orACR.

Ž 1.0 per division supported.

Ž 1.0 per corps supported in theCOMMZ.

4-23. United States Transportation Com-mand

The USTRANSCOM, through its Service com-ponent commands, provides resources for medicalevacuation of patients in support of the worldwiderequirements of supported CINC.

a. Air Mobility Command. The AMCprovides intratheater, strategic (or intertheater),and domestic AE support. The AMC is tasked toprovide operational policies, doctrine, standardsand evaluation, and training for the AE system.The AE system consists of three subsystems which

correspond to casualty flow patterns from initialpoint of injury to CONUS. Assets described in thisparagraph can be established to support any ofthese subsystems, as needed.

(1) Strategic (or intertheater) sub-system. Strategic AE support normally providespatient evacuation between the TO and anothertheater or CONUS. Strategic AE may be ac-complished using the retrograde portion ofUSTRANSCOM’s assigned airlift missions bydedicated airlift if authorized by the supportedCINC. Strategic AE may also be accomplished ondedicated CRAF B-767 aircraft activated as part ofthe AE segment of CRAF. The strategic AEsubsystem will normally operate from primaryC-141 support airfields.

(2) Theater subsystem. The theaterAE subsystem provides evacuation of patients be-tween MTFs within a theater. Theater AE movespatients to rearward MTFs, and/or to MTFs witha higher level of care. The AMC provides resourcesto establish theater capabilities or augment existingones. The theater subsystem operates under theOPCON of the Air Force component commander.The theater AE subsystem normally operates fromforward C-130 resupply airfields and can use eitherretrograde or dedicated airlift.

(3) Domestic subsystem. The do-mestic AE subsystem supports patient movementfrom strategic aerial ports of debarkation (APOD)to airfields nearest CONUS destination hospitalsor from one MTF to another within CONUS.

b. Military Sealift Command. The MSCassists, as required, in arranging or providingpatient movement by sea, or from and/or betweenships at sea using organic assets of the ships.Embarked medical personnel are US Navy assetsassigned to various naval medical units, none ofwhich are part of MSC. Similarly, the US Navyhospital ships are operated by the Navy and arenot MSC controlled.

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c. Military Traffic Management Com- providing patient movement from a reception airfieldmand. The Military Traffic Management Command to a CONUS MTF, if the movement is not provided(MTMC) assists, as required, in arranging or by the AMC domestic AE system.

Section VI. COMPONENTS OF THE AEROMEDICALEVACUATION SYSTEM

4-24. Aeromedical Evacuation Elements

Aeromedical evacuation operations are conductedusing the following six basic AE elements: anAECC, AECEs, MASFs, ASFs, AELTs, and AEcrews. The AE system does not own any aircraft.Aeromedical evacuation movements are requestedthrough the AECC and are entered into the theaterairlift request system just like any other airmovement requests. With the exception of ASFs,AE elements are capable of operations on any bareor unimproved air base or airhead if adequate baseoperating support can be furnished by the hostService. Elements of the AE system (with thepossible exception of the ASF) are linked througha high frequency radio net.

a. Aeromedical Evacuation Coordi-nation Center. The AECC is the operations centerwhere overall planning, coordinating, and directingof AE operations are accomplished. The AECCcollocates with the deployed tanker airlift controlcenter (D-TACC), which is the senior airliftrepresentative’s command and control function forall airlift operations. The AECC coordinates andmanages the AE system while the D-TACC ortactical air control center (TACC) (for intertheater)controls aircraft. The AECC merges patientmovement requirements once a destination hospitalis determined to identify AE aircraft missionsneeded. The AECC then coordinates with theD-TACC or TACC for airlift and communicatesairlift schedules with supporting AE elementsand MTFs. The theater AECC is initially staffedwith personnel from the nearest AD AE squadron.Long-term manning of theater AECCs could include

a combination of AD and Air Reserve Component(ARC) (Air National Guard and Air Force Reserve)personnel. The personnel complement providesfor continuous 24-hour operations. Specificresponsibilities of the AECC include:

(1) Advising the senior airlift rep-resentative on aeromedical issues.

(2) Coordinating the selection andscheduling of theater airlift aircraft allocated forAE missions.

(3) Monitoring AE crews.

(4) Coordinating special medicalequipment and supplies.

(5) Maintaining statistical data andproviding reports.

(6) Monitoring resupply for sub-ordinate AE elements.

(7) Monitoring field maintenancesupport for assigned vehicles, aerospace groundequipment, and communications equipment.

(8) Serving as the high frequencyradio net control station.

b. Aeromedical Evacuation ControlElement. The AECE is the functional managerfor AE operations at a specific airfield. Aeromedi-cal evacuation control elements come under the

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OPCON of the AECC and are responsible for thefollowing operations on a 24-hour basis:

(1) Exercising OPCON and crewmanagement functions over all AE crews assigned,attached, or transiting its location.

(2) Supervising ground handlingand on/off loading of casualties.

(3) Managing special medical equip-ment, supplies, and medical and AE kits, includingtracking and resupply.

(4) Arranging for casualty in-flightfood service.

(5) Coordinating mission prepara-tion, including aircraft configuration and servicingfor AE requirements.

(6) Maintaining communicationswith the AECC, supported ASF and/or MTF, andhost base activities regarding mission tasking,casualty flow, and support. Various forms ofcommunications are used, to include the integratedhigh frequency net, land lines, and couriers.

c. Aeromedical Evacuation LiaisonTeam. The AELT provides a direct high frequencyradio communications link and immediate coordi-nation between the user Service originatingrequirements for AE and the AECC. Aeromedicalevacuation liaison teams are under the OPCON ofthe AECC or the AECE if a regional commandstructure is set up. They are normally located atthe echelon of the user Service where patientmovements are authorized. Depending on thetactical operation being supported, AELTs can becollocated directly with an MTF, or at any otherlevel of command to ensure a smooth and coordi-nated patient flow into the AE system. In addition,the AELT can be used at any AE element as acommunications team as operations dictate. Thefunctions and responsibilities of the AELT include—

(1) Coordinating casualty move-ment requests and subsequent movement activitiesbetween the AECC and the user Service.

(2) Determining time factors in-volved for the user Service to transport patients tothe designated staging facility.

(3) Determining requirements forspecial equipment and/or medical attendants toaccompany casualties during flight.

d. Mobile Aeromedical Staging Facility.The MASF is a mobile, tented, temporary stagingfacility deployed to provide supportive patient careand administration. Each MASF is capable ofroutinely holding and processing 25 patients atany given time. It is not intended to hold patientsovernight or for an extended period. Patients cangenerally be held from 2 to 6 hours. Normally, aMASF will be capable of cycling its patient loadfour times within a 24-hour period. It can, however,surge to six cycles in 24 hours for a limited time.Mobile aeromedical staging facilities are locatednear runways or taxiways of airfields or forwardoperating bases that are used by tactical airliftaircraft to resupply combat forces.

(1) Each MASF deploys with suffi-cient supplies and equipment to sustain its patientstaging operation for 5 days. If it is to be deployed fora longer period or is expected to receive more patientsthan normal, it must be resupplied. The MASF isdependent upon the host base for food, potablewater, billeting, POL, and other general support.

(2) Manning of the MASF typicallyincludes flight nurses, AE technicians, and radiooperators. The senior flight nurse serves as the of-ficer in charge and functions under OPCON of theAECC or an AECE. There are no physicians as-signed to a MASF. If a physician is needed, thatrequirement must be coordinated through one ofthe nearby MTFs. A MASF performs the followingfunctions:

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(a) Receives patients desig-nated for AE from user Service forward medicalelements. The MASF has no organic patienttransportation capability; the user Service isresponsible for patient transportation to and fromthe MASF.

(b) Provides supportive nur-sing care to casualties awaiting airlift.

(c) Prepares patient manifests(if not yet accomplished by the user Service),patient aircraft load plans, and other administrativesupport on a limited basis.

(d Assists AE crews in con-figuring the aircraft to receive Iitter and ambulatorypatients.

(e) Notifies AECC when an AEaircraft has departed.

(f) Functions as an AECEwhen an AECE is not collocated.

(g) Provides status/capabilityreports to the AECC.

(3) Mobile aeromedical stagingfacilities are neither staffed nor equipped toaccomplish certain patient support activities. Theoriginating MTF must provide the followingminimum support:

(a) Transportation for pa-tients to and from the airfield.

(b) Special supplies and equip-ment required for patients in flight.

NOTE

USAF elements do not accomplishblanket and litter exchange.

(c) Any required guards orattendants (medical or nonmedical).

e. Aeromedical Staging Facility. AnASF is a fixed medical facility (50 to 250 beds)located on or near an enplaning or deplaning airbase or airstrip to provide patient reception,administrative processing, ground transportation,feeding, and limited medical care for patiententering, en route in, or leaving the AE system.Aeromedical staging facilities perform all of thefunctions of a MASF, except that they are notreadily mobile. In addition, ASFs have physiciansassigned.

f. Aeromedical Evacuation Crews. Aero-medical evacuation crews provide in-flightsupportive nursing care aboard the evacuationaircraft. The crews are also responsible for ensuringthe aircraft is properly configured and loaded.United States Air Force physicians are not part ofa standard AE crew.

(1) While on a mission, each AEcrew is a self-contained unit under the supervisionof a flight nurse designated the medical crewdirector (MCD). While on a mission, the MCD isunder OPCON of the AECC and is responsible forpatient care and mission management incoordination with the aircraft commander. TheMCD, in coordination with the AECC/AECE, isalso responsible for scheduling the return of theAE crew to its originating location, as well as forsecuring and returning all associated medicalsupplies and equipment. When AE crew personnelare not on an operational mission, they are normallyassigned to an AECE or MASF for OPCON andother crew management support functions.

(2) An individual AE crew normallyconsists of five personnel: two flight nurses andthree aeromedical technicians. However, the crewmay be tailored as the mission dictates, withadditional crew members often assigned to missionswith over 50 patients.

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Section VIl. THE INFORMATION MANAGEMENT SYSTEM

4-25. Theater Army Medical ManagementInformation System

The Theater Army Medical Management Infor-mation System (TAMMIS) is the wartime baselinesystem for the Department of the Army.Adjustments may be made to meet Army, Navy,and USAF wartime requirements while ensuringcompatibility between Services throughout theTO. The TAMMIS automates specific tasks tomanage medical resources and medical materiel.Although the primary focus is to automate wartimeoperations, it also includes peacetime functions.The purpose is to support readiness missions whilein garrison and during training exercises, thusensuring a rapid transition from peace to war.

4-26. Medical Regulating Subsystem

The TAMMIS MEDREG subsystem assists theMRO in managing the evacuation of patientsso that patient medical needs and movementrequirements are most efficiently matched againstavailable beds/resources. The MEDREG operateswithin the corps and at echelons above corps(EAC). Medical regulators at medical groupsand brigades, MEDCOM, and the JMRO will useMEDREG to designate beds for patients and tocoordinate patient movement within the theater.The JMRO (or the senior MEDREG activity inthe theater) will also coordinate with the ASMROto regulate patients to facilities outside thetheater.

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